We implemented a randomised controlled trial study to measure the impact of one-on-one engagement with local religious leadership on the compliance of protocols at their mosque. Our messaging was a combination of religious appeal and public health guidelines that were interactive, involving frequent elicitation of the respondents’ reactions and agreement, as well as asking them to commit to action. Our study is different from previous strategies of COVID-19 containment as it does not rely on mass messaging but rather focuses on one-on-one engagement with focal community leaders. It aims to improve the implementation and communication of the 20-point plan that was agreed between the government and religious clergy to contain the spread of COVID-19. However, it is not novel in its approach as it is similar to previous interventions like the polio vaccination drive that disseminates knowledge and engages at the community level. Thus, the results from our study can provide valuable insights for strategies used by other public health campaigns to engage the public and build trust, such as polio vaccination and eventually the COVID-19 vaccination.
In a collective effort bringing together 15 studies, researchers from over 30 institutions surveyed over 20,000 individuals between June 2020 and January 2021 on questions regarding respondents’ vaccine acceptance and hesitancy and their most trusted sources for vaccination advice. During some surveys, results from COVID-19 vaccine clinical trials had yet to be announced, and during later surveys, governments had started approving vaccines for use. The fast-moving nature of COVID-19 information may change people’s perceptions about vaccines by the time they are widely available in low- and middle-income countries (LMICs). Over the past six months, the body of evidence demonstrating the safety and efficacy of available COVID-19 vaccines, which have been given to millions of people, has become clearer. At the same time, severe, but rare, side effects may have undermined public confidence.
Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.
We use a Randomized Controlled Trial in Pakistan to test whether one-on-one engagement with community religious leaders can encourage them to advise congregants to comply with public health guidelines from state authorities. We test whether religious content in this engagement increases its effectiveness. We find that simple one-on-one engagement significantly improves the advice given by religious leaders to congregants on preventing COVID transmission in the mosque. Engagement was equally effective with or without explicitly religious content. Treatment effects are driven by the subsample who are already convinced of basic information about COVID at baseline, suggesting the treatment does not work by correcting basic knowledge about the disease. Rather, it may work through the effectiveness of one-on-one engagement that reinforces existing knowledge and connects it to actions that respondents can take in their role as community leaders.
We conduct a ﬁeld experiment offering graduated microcredit clients the opportunity to ﬁnance a business asset worth four times their previous borrowing limit. We implement this using a hire-purchase contract; our control group is offered a zero-interest loan. We ﬁnd large, signiﬁcant and persistent effects from asset ﬁnance contracts: treated microenterprise owners run larger businesses and enjoy higher proﬁts; consequently, household consumption increases, particularly on food and children’s education. A dynamic structural model with non-convex capital adjustment costs rationalizes our results; this highlights the potential for welfare improvements through large capital injections that are ﬁnancially sustainable for microﬁnance institutions.
The COVID-19 pandemic threatens lives and livelihoods, and, with that, has created immediate challenges for institutions that serve affected communities. We focus on implications for local microfinance institutions in Pakistan, a country with a mature microfinance sector, serving a large number of households. The institutions serve populations poorly-served by traditional commercial banks, helping customers invest in microenterprises, save, and maintain liquidity. We report results from ‘rapid response’ phone surveys of about 1,000 microenterprise owners, a survey of about 200 microfinance loan officers, and interviews with regulators and senior representatives of microfinance institutions. We ran these surveys starting about a week after the country went into lockdown to prevent the spread of the novel coronavirus. We find that, on average, week-on-week sales and household income both fell by about 90%. Households’ primary immediate concern in early April became how to secure food. As a result, 70% of the sample of current microfinance borrowers reported that they could not repay their loans; loan officers anticipated a repayment rate of just 34% in April 2020. We build from the results to argue that COVID-19 represents a crisis for microfinance in low-income communities. It is also a chance to consider the future of microfinance, and we suggest insights for policy reform.