Abstract

Effective engagement with religious leaders to persuade them to encourage compliance with health measures could be critical in the fight against the COVID-19 pandemic, especially since religious gatherings carry a high risk of infection. In Pakistan — a country with one of the highest levels of religiosity in the world — researchers conducted a randomized evaluation to test whether personalized telephone calls with community religious leaders successfully encouraged them to advise people to comply with COVID-19 health recommendations. The evaluation revealed that the calls increased the proportion of religious leaders who advise wearing a mask by 25 percent.  

Policy Issue

The COVID-19 pandemic has highlighted the difficulties that authorities face in promoting health behaviors that benefit  the greater community, such as social distancing and mask-wearing. Likewise, it has shown the role played by influential institutions and leaders— including politicians^[1], political parties^[2] and the media^[3] — in interpreting, challenging, and reinforcing these messages. In some contexts, religious institutions and their leaders may contribute to the compliance of health measures, as they are trusted sources of information.^[4] However, religious leaders may be skeptical of messages from secular health authorities. Engaging effectively with religious leaders to persuade them to encourage compliance with health measures is believed to be critical in light of the COVID-19 pandemic, especially since religious events carry a high risk of infection.

Context of the Evaluation

Pakistan is a country with one of the highest levels of religiosity in the world; 96 percent of the population is Muslim^[5], and according to a recent study, 94 percent of the population considers religion to be very important in their life.^[6] In March 2020, with COVID-19 cases rising, the government announced a nationwide lockdown including the suspension of congregational prayers. However, there was limited compliance of this rule. Nationally influential clerics announced opposition to the rule, and in some cases there were clashes outside mosques between worshippers and the police, who were attempting to enforce the order .^[7] The government and a group of influential clerics at the national level met for a series of negotiations and then announced a joint plan. Mosques would stay open but would follow twenty key guidelines to reduce the spread of COVID. However, implementation of these rules was limited, with NGOs reporting in May that 80 percent of mosques were not following these rules.^[8] After Eid ul Fitr, the first major religious holiday of the year in May 2020, cases climbed faster.

Details of the Intervention

In Pakistan, researchers conducted a randomized evaluation to test whether telephone calls with community religious leaders, successfully encouraged them to advise people to comply with COVID-19 health recommendations. The evaluation took place over a three-week period in July 2020, leading up to the second major religious holiday of the year: Eid ul Azha. Eight hundred and nineteen religious leaders from 19 districts in urban and rural Punjab were randomly assigned to receive one of the following interventions:

• Secular persuasion telephone call: Religious leaders received an interactive persuasive telephone call which included basic information on COVID asymptomatic spread and how it can occur at the mosque, the health measures they should follow, and their importance as community leaders in protecting vulnerable members of the community.
• Secular plus religious persuasion telephone call:  In addition to the information received in the secular persuasion telephone call, religious leaders were reminded that the top religious leaders have endorsed the COVID-19 protocols for mosques, the sayings of the Prophet about avoiding spread of virus, the international Sunni and Shia authorities’ pronouncements on the importance of complying with official authorities to prevent spread of COVID-19, and other examples of Muslim-majority countries complying with and enforcing strong measures to prevent COVID-19 spread.
• Comparison group. Religious leaders did not receive persuasive calls. In addition, some were not involved in the first survey to avoid suspicion of surveillance. All were part of the final “mystery shopper” calls. 

To measure the impacts of these calls, a different surveyor (“mystery shopper”) called each religious leader in the days before Eid, posing as a member of the community to request confirmation on the timing of  Eid prayer services at the mosque. Next, the caller asks several questions about how to prepare for attending prayer services at the mosque given COVID-19 conditions.

Results and Policy Lessons

The study finds that one-on-one engagement with community leaders, as opposed to mass messaging, can help policymakers increase dissemination of advice on public health guidelines. Additionally, they can use the leaders' influence and sway over their community to increase compliance with those guidelines. This can be a very useful strategy in not only increasing compliance with social distancing guidelines but also in the dissemination of the COVID-19 vaccine. The vaccination drive in Pakistan is currently in its nascent stage, however, the government fears that a significant proportion of the population will opt out of the vaccine. In such a climate, building trust with community leaders can play a pivotal role.

Read the full working paper here and published journal article here.

To learn more, read this news article and listen to this podcast episode.
 

Sources