In July 2020, we highlighted Sierra Leone’s experience confronting COVID-19 from the vantage point of a fragile state—one that lived through civil war and, more recently, another acute public health crisis with Ebola in 2014, as well as a damaging mudslide in Freetown in 2017. Drawing on lessons learned from Ebola, Sierra Leone moved to close schools at the end of March, instituted a series of lockdowns in April and May, closed land borders for several months, and instituted a national mask mandate beginning in June. The government also prioritized more community-focused, tailored messaging and partnered with local leaders and civil society organizations to disseminate information and deliver protective and public health materials, such as “Veronica buckets” to encourage compliance with handwashing directives.

As of early February 2021, there have been 3,699 cases and 79 deaths reported in Sierra Leone.¹ As the last nine months have made all too clear around the world, the pandemic has also precipitated acute parallel economic crises, particularly in low and middle-income countries. Tellingly, the World Bank revised initial estimates in October 2020 and now projects that COVID-19 will add as many as 150 million extreme poor globally by 2021. For countries such as Sierra Leone, the virus threatens decades of work in trying to reduce poverty. 

Building on findings and policy engagement with in-country partners at the Ministry of Health, the Ministry of Gender and Children Affairs, as well as the Ministry of Public Affairs, UNICEF, UNCDF, the International Growth Centre, the World Bank Group, as well as the Bank of Sierra Leone, from the first round of the RECOVR survey (May 27-June 19), IPA implemented the second round of the survey October 1-16, 2020. As the RECOVR survey was explicitly designed as a panel survey to track respondents’ experiences over time, we surveyed the same set of respondents from Round 1.^{2, 3} This blog post summarizes the key findings from a range of health, economic, social protection, and education outcomes, including trends across rounds, and their policy implications. More information about RECOVR is available here.

Mental health concerns are on the rise

The uncertainty, open-endedness, and disruptions to daily life that have resulted from the pandemic, to name but a few factors, amount to individual and societal stress tests borne out in emotional and socioeconomic tolls and economic fallout. The United Nations warned in May 2020 that, worldwide, “a long-term upsurge in the number and severity of mental health problems is likely.” Accordingly, IPA worked with our partners to ensure that the RECOVR survey included questions related to mental health. One in four respondents reported that they or someone in their household developed mental health symptoms (defined as sleep difficulties, anxiety, aggressive behavior, or sadness) since early April. Critically, this share is more than double the proportion of respondents that affirmed this question (11 percent) in Round 1.
 

 

Lessons learned from other crises, such as the Ebola epidemic, could help inform long-term strategies and further contextualize responses to COVID-19. For example, a 2015 national survey jointly implemented by the Centers for Disease Control (USA) and the Ministry of Health and Sanitation (Sierra Leone) found that nearly half of respondents reported symptoms of anxiety-depression, and three-fourths indicated symptoms of post-traumatic stress disorder one year after the peak of the Ebola crisis. As the national health system explores responses and potential interventions to support Sierra Leoneans in addressing mental health, ongoing studies on the impacts of particular strategies, such as Cognitive Behavioral Therapy, can assist with crafting targeted policies. 

Informal workers and women are more likely to report adverse economic conditions

Survey data on employment and economic activity paints a more varied picture. Between rounds, there was an increase in the proportion of respondents that worked the same or more hours in the last week compared to a typical week in February 2020 (29 percent in Round 1 vs. 46 percent in Round 2). The proportion of respondents that worked fewer hours by this same measure decreased by 17 percentage points from 71 percent in Round 1 to 54 percent in Round 2. Respondents or household heads working in informal employment were almost twice as likely to work fewer hours than their formally employed counterparts (75 percent vs. 41 percent). Additionally, 46 percent of respondents or heads of household with formal employment earned more or the same compared to February while working in the last week.
 

 

When considering gender parity, there are also significant differences across the sample. Nearly six in ten female respondents reported not working in the past seven days, and almost half of female respondents indicated that they are self-employed. Additionally, among respondents whose labor supply fell (i.e. those who were working in February and report working fewer or no hours in the past week), more than one in five women have taken on additional domestic duties and childcare.

In terms of financial security, there are also observable declines. Forty-eight percent of respondents indicated that it would be “impossible or very difficult” to come up with 200,000 Leones (about US$20 ) within the next 30 days if the need arose. This question was constructed based on the Global Findex Survey, which uses 1/20th of Gross National Income Per Capita as an international benchmark for financial access. Those who are unemployed are twice as likely as those with informal employment to sell their assets to obtain such emergency funds, and 77 percent of these unemployed reported that they or someone in their household had to deplete savings to pay for food, healthcare, and other expenses.

 

Food insecurity persists and has worsened

Food insecurity has persisted and, in fact, worsened. When asked about the last week, a large majority of respondents (86 percent) indicated being unable to buy the usual amount of food. Their answers reveal an increase in the prevalence of market shortages and household income drops since Round 1. Poor respondents are more likely to report being unable to buy the usual amount of food because of reduced incomes (81 percent vs. 75 percent of non-poor respondents), further exacerbating existing gaps. 
 

We also note that the majority of our sample live in urban areas. As such, this gap could be driven by households that typically rely on paid work and cannot count on agricultural production and additional subsistence production more typical of rural households. On the same note, we find that compared to informal sector workers, formally employed workers are 10 percentage points more likely to say there is “nothing they can do” to adjust when they stop working or lose income. Policymakers will need to consider that while urban and formal sector households may be starting from a stronger economic position compared to their rural counterparts, they may also have fewer available alternatives when a negative shock arises.

 

Accordingly, 63 percent of respondents have had to limit their household’s meal portions in the last week, and forty-nine percent have had to reduce the number of meals. These measures saw an increase of 20 percentage points and seven percentage points, respectively, across rounds. Poor respondents are more likely than non-poor respondents (67 percent vs. 57 percent) to report that adults in the household have reduced portions.

 

As previously discussed, one possible reason for the high prevalence of food insecurity in this survey may be that a majority of respondents live in urban areas: most urban Sierra Leoneans rely on cash income for food, while rural residents are more likely to be smallholder farmers who grow their own and can compensate (even if temporarily) through these means. For example, a study of rural smallholder farmers in neighboring Liberia and Malawi by Aggarwal et al. found that, while rural markets were disrupted by the pandemic, food security for these groups was largely unaffected in the short-run, at the time of the survey in April.

Parents' concerns have evolved over time

Finally, with regards to education, trends across both rounds shed light on the various aspects that parents must balance to monitor their children's’ well-being. 
 

The survey suggests that radio programs, such as the National Life Skills Program, are an important stop-gap, with more than half of respondents reporting listening to the program every day or several times a week. Even still, nearly all primary and secondary students have still relied on their own school books to keep up with education. Furthermore, there is still insufficient information regarding the impact of the NLSP and the longer-term impact of COVID-19 restrictions on the population, driving home the need for continued monitoring and evidence generation. 

During the first survey round, parents’ main concern (61 percent) was around their children falling behind in their education, but in Round 2 parents’ concerns increased around childrens’ safety, security, and activities. As the pandemic and initial short-term adjustments drag on, it is not surprising that familial worries also evolve.

 

Parents were overall eager for students to return to in-person schooling. Schools in Sierra Leone reopened on October 5th, ahead of the second round of the survey, and 91 percent of parent respondents indicated that they would send their children back to in-person schooling. There were also no significant differences between poor and non-poor respondents’ likelihood of sending their children back to school. As the country continues in-person learning, it will be critical to monitor educational attainment and address any learning losses that may have occurred over the last year.

Balancing health demands with economic recovery

As the global fight against COVID-19 approaches its second year, countries must continue to balance public/physical health demands and economic recovery.
 

With vaccination campaigns already underway in several countries around the world, preparing the country for immunization against the virus is now a pressing policy priority. While it is unclear when Sierra Leone will approve and secure enough vaccines for its population, 80 percent of survey respondents indicated that they would get the vaccine to protect against the disease. Of the 20 percent who say they would not get the vaccine, more than half (54 percent) cite potential side effects as their main worry. Though vaccine acceptance could change over time, behaviorally-informed interventions from previous immunization efforts in Sierra Leone could be considered to encourage social norms around inoculation (though any public health messaging and information campaigns should be designed to reflect realities specific to COVID-19). 

On the economic front, Sierra Leone has instituted several programs to assist its people during the pandemic, such as the Special Fund for Emergency and Rehabilitation Activities (a partnership between the Ministry of Agriculture and FAO) and the National Commission for Social Action’s cash and in-kind transfers for vulnerable populations. Between rounds, respondents reported a 12 percentage point increase in their community receiving cash assistance from the government in response to COVID-19, and it is important for the government to continue to track the reach and impact of this assistance. Additionally, it will be necessary to further target government programs to address growing inequities across more vulnerable groups, including women and those in the informal economy.

Though the pandemic is fast-moving and policymakers are challenged to both think ahead and remain nimble, it is critical to inform approaches and programs with timely and actionable data. We invite readers to explore ongoing studies and evaluations of many such interventions on the RECOVR Research Hub.

1. https://coronavirus.jhu.edu/region/sierra-leone
2. Round 1: we surveyed 1,304 respondents about a range of health, economic, and education outcomes using random digit dialing, making them statistically representative of the set of active mobile phone numbers held by adults in Sierra Leone. A large percentage of these respondents are urban residents of the capital district, with the majority (60%) having completed secondary school. Women make up 35% of the sample and informal sector workers make up 55% of employed respondents (or their household head).
3. For Round 2, there were 1,070 respondents out of 1,272 respondents attempted. The Round 2 analysis is weighted by gender and region to adjust for attrition in the panel.