Public Health, Trust, and Livelihoods: The Case of COVID-19 in Uganda

Public Health, Trust, and Livelihoods: The Case of COVID-19 in Uganda

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Researchers

Robert Blair, Travis Curtice, David Dow, Guy Grossman

Abstract

Governments play a key role in combating pandemics, but the success of these efforts crucially depends on the actions taken by individuals. The more citizens trust the government and its law enforcement agencies, the more likely they are to trust the information the government provides during crisis events and comply with government directives. This trust may help reduce the rate of risky health behaviours. In Uganda, researchers explored how support for and trust in state institutions shape individuals’ responses to COVID-19 by building on an existing study evaluating a community policing program to understand how the program influences citizens’ health behaviors and their confidence in the government’s response to the pandemic. The research team also explored how partisan affiliations shape these behaviors, and how COVID-19 is affecting income and livelihoods, with special attention to seasonal migration and remittances.

Researchers used an endorsement experiment embedded in a mobile phone survey to show that messages from government officials generate more support for public health restrictions than messages from religious authorities, traditional leaders, or international NGOs. They further show that compliance with these restrictions is strongly positively correlated with trust in government, but only weakly correlated with trust in local authorities or other citizens. The relationship between trust and compliance is especially strong for the Ministry of Health and the police. Building on this latter result, researchers used a field experiment to show that an intervention designed to improve police-community relations increased trust in the police, but that the effects are small and do not result in greater public health compliance. The team concludes that trust is crucial but difficult to change.

Funding for this project was provided by the UK Department for International Development.

Project Outcomes of Interest

Civilian confidence in government response to COVID-19; health behaviors; partisan differences’ roles in health behaviors; migration; money transfers; economic security

Partners

Center for Effective Global Action (CEGA)

Key Findings

 

  • Compliance with COVID-19 restrictions is strongly positively correlated with trust in government, but only weakly correlated with trust in local authorities or other citizens. The relationship between trust and compliance is especially strong for the Ministry of Health and the police.

  • Researchers use a field experiment to show that an intervention designed to improve police–community relations increases trust in the police, but that the effects are small and do not result in greater public health compliance. They conclude that trust is crucial but difficult to change.

Link to Results

Working Paper Manuscript (May 2021)

Impact Goals

  • Build resilience and protect the financial health of families and individuals
  • Improve women’s health, safety, and economic empowerment
  • Promote peace and safety, and improve humanitarian response
  • Reduce COVID-19 transmission rates

Project Data Collection Mode

  • CATI (Computer-assisted telephone interviewing)

Results Status

Results

Results

 

In this study, researchers examined the role of trust in shaping citizens’ compliance with public health restrictions in an electoral autocracy. The study was motivated by the idea that citizens’ responses to public health emergencies is shaped by their trust in multiple state and non-state institutions, not just the government in general.

The team extended existing research by distinguishing between multiple potential targets of trust, and by assessing whether some of these targets are more important than others in generating support for, and compliance with, costly and disruptive public health policies. They then explored whether it is possible to build trust in the institutions responsible for enforcing these policies, focusing in particular on the central but highly controversial role of the police. They answer these questions in the context of the COVID-19 pandemic in Uganda.


Through a series of interconnected experimental and observational studies, they showed that (1) endorsements by the government are more effective in generating support for public health restrictions than endorsements by traditional leaders, religious authorities, or international NGOs; (2) that trust in government is strongly positively correlated with compliance with these restrictions, while trust in local authorities and other citizens is not; (3) that the correlation between compliance and trust in government is unlikely to be a function of differential knowledge of COVID-19 among more and less trusting individuals, and is also unlikely to be an artifact of social desirability bias; (4) that trust in the Ministry of Health and trust in the police appear to be especially important predictors of compliance; and (5) that a community policing intervention designed to build confidence in the police specifically has only weak and inconsistent effects on trust, and no effect on compliance.


Taken together, these results suggest that the relationship between trust and compliance during public health crises is complex and multifaceted. The results also suggest that trust is sticky, perhaps especially in a setting where the government in general—and the police force in particular— has a reputation for repression. The downstream analysis of Uganda’s community policing program is exploratory, and it is possible that a more intensive intervention might have yielded a larger and more sustained improvement in compliance and police–community relations, though the authors note that other recent studies similarly point to the difficulties of building trust in widely distrusted police forces in the Global South (Blair, Karim and Morse 2019; Blaire et al .2021).

These findings are especially important given the tendency of governments throughout the developing world to rely on their police forces to ensure compliance in times of crisis. Further exploration of the important but under-appreciated link between policing and public health in low-income countries strikes us a fruitful avenue for future research