The purpose of the COVID-19 Emergency Response and Health Systems Preparedness Project in Malawi is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. This project consists of three components. Component one will provide immediate support to Malawi to prevent the spread of COVID-19 through surveillance and containment strategies. There are two subcomponents: (i) Case Detection, Confirmation, Contact Tracing, Recording, Reporting, and; (ii) Health System Strengthening. Component two will support strengthening the capacity of the public health system for preparedness and response to COVID-19 pandemic and to future pandemics and other threats to health security. Component three will lead coordination of Project activities, as well as fiduciary tasks of procurement and financial management (FM), Monitoring and Evaluation (M&E) and environmental and social safeguards.
BIC, Accountability Research Center (ARC), and the Center for Human Rights and Rehabilitation (CHRR) in Malawi, are monitoring stakeholder engagement and inclusion of marginalized groups and to what extent the commitments to involve communities, marginalized groups, and other stakeholders are being implemented in the COVID-19 response project.
CHRR engaged District Civil Protection Committees (DCPC) in Lilongwe and Salima districts to gain insight into the Malawi COVID-19 Emergency Response and Health Systems Preparedness project. The DCPCs are composed of government departments and also civil society groups, including CHRR. The DCPC’s coordinate with community committees that consist of community members and chiefs and include representatives of marginalized groups.
The committee members have utilized small gatherings to disseminate information, often through funerals, church services, market days and community meetings. At the village level, committees use posters that were distributed by various institutions working within the community and have drama groups perform during meetings. All the committees mentioned that apart from targeting the communities at large, they have also managed to reach out to marginalized groups like persons with disabilities, people living with HIV/AIDS in their support groups, and children through their parents and women. CHRR identified the following concerns based on consultations with the community:
1. The project lacks a platform for a feedback mechanism, where concerns can be raised by either the community committees or community members and addressed by the relevant authorities. The community committee members expressed that they lack the necessary expertise to communicate with persons with hearing impairment. They have resorted to disseminating the COVID-19 information through family members of persons with hearing impairment but it is still difficult for the committees to get feedback from these people, particularly on their concerns about the pandemic.
2. The community committee members mentioned that they have to travel long distances to disseminate information, but they lack the necessary means of transportation, such as bicycles. This hinders their ability to engage with all stakeholders to prevent COVID-19 spread.
3. Many of the concerns focused on the unique challenges facing marginalized groups. Some community members with a physical disability use their hands to move from one place to another, making it difficult to practice hygiene and intensifying the need for access to wheelchairs. For those who are deaf, most messages are not provided in sign language or visual aids. The messages also lack accessibility for people who are blind, since messages are not available in Braille.
4. The elderly had concerns that they cannot afford to procure personal protective equipment, since they do not have any source of income. Persons living with HIV/AIDS also expressed worry about their higher risk from preexisting conditions. They reiterated the need for more support through food access and personal protective equipment.
COVID-19 patients also reported cases of stigma and discrimination for contracting the virus.
The entire project cost of $7 million is being financed by the International Development Association arm of the World Bank.
1. The Bank should facilitate inclusive stakeholder engagement that enhances the community’s capacity and ability to be involved in the project implementation. Due to high illiteracy levels in the communities, most community members are not aware of consultations. The Bank should also inform the community of the project objectives, so they can monitor and contribute during the entire project implementation.
2. The Bank needs to develop a platform for community members to raise their concerns and make suggestions to improve project implementation. An accessible feedback mechanism, which community members are aware of and able to participate in, is essential to the participation of marginalized groups.
3. The Bank should intensify efforts to develop accessible messaging for persons with disabilities, by utilizing specialists in sign language and producing more content using visual aids and Braille. By reaching persons with disabilities, the Bank can also help understand and address their specific concerns.
4. The Bank should strengthen project components that work to mitigate discrimination towards COVID-19 patients and provide counselling for COVID-19 patients to not feel neglected.
