The coronavirus has struck the world’s most powerful economies first, leading countries in Europe, North America and East Asia to carry out an array of strategies to help control its spread. But as the virus picks up speed across the global south, those policies may not be applicable there. Low- and middle-income countries like Bangladesh, Pakistan, Indonesia and Nigeria should not blindly follow strategies that are sensible for richer nations.
Europe, the United States and Canada can offset the economic losses caused by social-distancing policies with stimulus payments to businesses and individuals. China can mobilize the power of its state apparatus to enforce compliance with lockdown orders. South Korea and Taiwan can deploy technologically sophisticated tracking methods to test and isolate cases.
But the developing world simply can’t replicate these measures. In addition, universal social distancing and work closures may do more harm than good in places where a disproportionate number of people depend on a day’s or week’s labor to feed their families. In many countries in the global south it is also not unusual to have 15 people or more living in a small structure, making social distancing virtually impossible.
Fortunately, there are simple measures that poorer countries can take that will slow the spread of the virus. It is urgent that such countries begin to take them.
Sierra Leone, drawing on its experience fighting an Ebola outbreak in 2014, offers a possible model for how to combat the coronavirus in a developing economy. The country is extremely poor, but it is deploying low-cost strategies to fight the pandemic that other low- and middle-income countries can adopt at large scale. (One of us, Mr. Meriggi, has advised the country’s Ministry of Health and Sanitation during the post-Ebola recovery.)
As of June 15, Sierra Leone had 1,176 confirmed cases of Covid-19 and 51 deaths related to Covid-19. On April 11, the country started imposing a “soft” lockdown that limited inter-district travel and constrained working hours in an effort to protect the livelihood of most laborers. Sierra Leone was early to establish airport screening measures and traveler quarantines.
The government and its development partners have been distributing and encouraging the use of face masks and Veronica buckets, a Ghanaian invention popularized during the Ebola crisis. The buckets are simple wash stations with (sometimes bleached) water, along with soap and a plastic basin for washing hands. Since they do not require running water, they can be placed at police checkpoints on the way to and inside remote villages, as well as in upscale and urban areas.
Such frugal innovations make it easier to impose a policy of compulsory hand-washing or mask-wearing before entering villages or buildings. Low labor costs in Sierra Leone — as in other poor countries — also allow it to deploy people to monitor and encourage healthy behaviors, and to take people’s temperature with infrared thermometers as a condition of entry.
During the Ebola outbreak in Sierra Leone, government officials in military vehicles blasted public health messages at people, who typically ran away instead of listening — a reasonable response, given the country’s history of civil war. Now the country is adopting a community-centered focus in tailoring those messages to specific populations and collaborating with local leaders to spread information. While the urban population is easier to reach with print, web and social media, people living in rural areas have less access to the internet and mobile technology. Village elders and chiefs, key female leaders, religious figures and local councils are being asked to provide Covid-19 information. Local “town criers” with boomboxes broadcast health messages on foot.
Sierra Leone also established high standards during the Ebola crisis for local care in field units known as community care centers — temporary facilities in repurposed buildings or in makeshift structures with water pumps, electric generators and toilets. These centers were used mostly to isolate, test and treat Ebola patients. They were staffed with locals, which helped build trust among patients. Sierra Leone has adopted a similar model for isolating Covid-19 patients.
This is not to say that Sierra Leone is certain to win the fight against the coronavirus. The government has acknowledged serious challenges, including limited testing capacity, difficulties enforcing quarantine regimens and obstacles to supplying care centers. The health system remains comparatively weak, and if the virus spreads more widely, as with Ebola, millions could be left unable to get care.
But this harsh reality only underscores the importance of simple, inexpensive policies and solutions that can prevent widespread infection and enable poor people to work and feed their families. Though each country will have to find out what works best in its own context, governments and emergency medical workers across the global south deserve more information about coronavirus strategies that are viable for them.
Niccoló F. Meriggi is an economist at the International Growth Center in Sierra Leone. Ahmed Mushfiq Mobarak (@mushfiq_econ) is a professor of economics at Yale University and the founder of the Yale Research Initiative on Innovation and Scale.
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