Communities are key in stopping the spread of COVID-19. Only by understanding how people communicate, what they know, their needs and gaps in understanding about COVID-19, can humanitarian organizations achieve a community-driven response that will reduce the spread of the virus.
Perception Survey
As part of the inter-agency Risk Communication and Community Engagement (RCCE) Working Group, the International Federation of Red Cross and Red Crescent Societies (IFRC), Red Cross and Red Crescent National Societies, United Nations Office for the Coordination of Humanitarian Affairs (OCHA), UNICEF and World Health Organization (WHO) undertook a perception survey on COVID-19 in Indonesia, Malaysia, Myanmar and Pakistan from 29 May to 20 July 2020 with a two-week collection time frame in each country.
In total, 4,993 respondents (52.4 percent male, 47.28 percent female, and 0.67 percent not disclosed) participated in the four countries. Of these participants, the majority were aged 18 to 29, followed by 30 to 39 years old.
Education levels of participants differed across the four countries, with Pakistan having the greatest proportion of participants without any formal education (7.9 percent) or with primary education only (24.4 percent). In contrast, only 1.1 percent of respondents in Indonesia stated to have not attended or attended only primary school, and 82.2 percent shared that they held a secondary school degree. This strong discrepancy is likely also due to the much smaller sample size in Indonesia which was only collected online.
Question on COVID-19 Stigma
One survey question dealt with stigma (Question 11): Do you think a specific group is responsible for spreading COVID-19?
Around one in three respondents across the four countries fully believe that a specific group is responsible for spreading COVID-19 (35 percent in Indonesia, 50 percent in Malaysia, 28 percent in Myanmar, and 17 percent Pakistan said Yes to the question whether they thought a specific group was responsible for spreading COVID-19). If we combine the groups that thought that a specific group was responsible with those who thought a specific group was “a little responsible” the number rises to one in two respondents (55 percent in Indonesia, 69 percent in Malaysia, 32 percent in Myanmar, 30 percent in Pakistan). The belief that a specific group is responsible for spreading COVID-19 is most prevalent in Malaysia (one in two respondents), and lowest in Pakistan (one in five respondents).
In Myanmar, the groups most often thought to be responsible are people from China and people coming back from a foreign country. This can likely be attributed to the facts that the virus originated in China, which has a long, porous land border with Myanmar; and that – according to OCHA at the time when this survey was conducted – there was “limited local transmission with [the] majority of cases confirmed among returning migrants.” In Myanmar, respondents who are male, over fifty years old, and without education, were more likely to believe that a specific group is responsible for spreading the virus.
In Malaysia, 69 percent of respondents believe that a specific group is responsible for spreading COVID-19, with people who are fifty years and above agreeing about 9 percent more than under fifty-year-olds. Malaysian respondents with only secondary-level education and below tend to agree more that a specific group is responsible by about 4 percent than respondents with tertiary education. Moreover, respondents from urban areas agree slightly more (3 percent) than from rural Malaysia.
Among the Malaysian respondents who believe a specific group is responsible, foreigners are mentioned frequently with respondents specifically naming Chinese people, returning migrants, foreign tourists, “illegal foreigners,” migrant workers, and foreigners in general. This is followed closely by COVID-19 positive people and people who are not following government regulations. This is consistent with reports of moves made by Malaysia on foreign tourists and migrants during COVID-19 (particularly undocumented migrants), including tightening regulations to restrict entry1 and increasing detention and deportation efforts,2 and also supports evidence of declining positive public opinion on foreigners3 in general since the beginning of the pandemic.
In Indonesia, a large proportion (55 percent) of respondents believes COVID-19 is spread by a specific group. The majority believe the spread occurs because of some people who refuse to follow government regulations such as not wearing masks, going out unnecessarily, and travelling to and from COVID-19 high-risk areas. There is also a small but notable group that believes that COVID-19 spread because the government did not anticipate the level of spread and did not effectively implement lockdown and strict regulations. In Pakistan, most respondents think that insufficient control measures related to travel, isolation, and quarantine facilities established by the government at the Iranian border as the cause for the spread of COVID-19. Secondly, nationals (for instance pilgrims coming back from Iran and Syria and settling in Sindh and Punjab) and foreigners returning to Pakistan, and finally, people from China are held responsible for the spread of COVID-19.
For all four countries, higher education had a small impact on whether respondents thought a specific group was responsible for COVID-19, with those having tertiary education being slightly less likely to hold a specific group responsible.
Information Needs and Community Engagement
There is a common trend of COVID-19 information needs and community engagement preferences across the four countries. Overall, the respondents suggest they primarily stay informed about COVID-19 through the Ministry of Health, Social Media, and Television (Question 14). As a young woman in Myanmar said: “In COVID times, [our TV tuned in on] MRTV [government channel] is constantly on. Our family gathers around it all day.”
“I always check – is the MOHS logo there?” reported a young man in Myanmar, “I only believe the guidance if their logo is there. Others are just advertising products.”
This suggests that in Myanmar communications about COVID-19 should be made via government agency websites and TV, radio stations, and print media alongside popular social networking channels, such as Facebook and WhatsApp, to ensure that information is not restricted to those with internet access.
In Indonesia, the respondents explain they stay informed mostly through online channels including websites or online news pages, social media, and search engines such as Google. However, these findings are most likely a correlation with the fact that data in Indonesia was exclusively collected through online surveys. Therefore respondents were more likely to be digital natives with regular internet access.
While there is some variety in terms of most used information channels, the most trusted information source in reporting about the COVID-19 (Question 15) across all four countries is television with 61.13 percent, followed by radio stations and printed newspapers. This is followed by radio stations and printed newspapers in both Malaysia and Myanmar. Unlike those in these two countries, the respondents in Pakistan say they trust more the search engines and websites or online news pages, after TV. While respondents in Indonesia report that they mostly trust information from WHO, community health workers, UNICEF, Ministry of Health (MoH), and Red Cross volunteers over television.
Interestingly, in Indonesia and Malaysia, while online channels such as social media, websites/ online news, and search engines are used frequently, they are not as well trusted as other less frequently used channels and sources such as WHO, radio, community health workers, UNICEF and Red Cross volunteers. This suggests that to have effective communication, we need to engage people through well-trusted sources and frequently used channels; for example, MoH or WHO representatives communicating through TV or social media.
Respondents across the four countries say they received information about protection measures, symptoms, and transmission of the virus (Question 13). This information is distributed almost equally between male and female groups in the communities.
Recommendations
► Stigma is a key challenge in all four countries. Almost half of all respondents in Pakistan, Indonesia, Malaysia, and Myanmar believed that a specific group is at fault for the spread of COVID-19. Those perceived to be at fault differs by country.
Findings suggest that more work on addressing stigma is essential to foster community cohesion and address discrimination, particularly against vulnerable groups such as migrants. Continuing to listen and analyze whom individuals hold responsible for the spread of COVID-19 is key to making people feel heard, while also clarifying misconceptions about groups perceived to be responsible for spreading the virus.
► Awareness of COVID-19 is universal in Myanmar, Indonesia and Malaysia. • However, in Pakistan, nearly 10 percent of respondents were not aware of COVID-19.
Findings suggest that in Pakistan more information on COVID-19 through multiple channels needs to be provided, with a focus on reaching people relying on traditional media and face- to-face communication.
► Washing hands, wearing masks, and staying at home are the top COVID-19 prevention measures across the four countries.
Overall, participants are clear on COVID-19 preventative measures. Instead of blanket messaging that may contribute to “messaging fatigue,” communicators should find out which questions remain unanswered in local contexts and seek to answer these.
► Information most sought by surveyed communities includes treatment options and what to do if a family member is sick. Additional research and literature emphasize that individuals are more likely to follow instructions to keep others safe rather than themselves.
Findings suggest that people are interested to hear about what is being done to find treatments and vaccines against COVID-19. Moreover, the findings suggest that content should give practical tips on how to keep family members and others vulnerable to the disease safe.
► More than half of all participants shared that they have worries and fears related to COVID-19. The main worries for respondents were around losing a loved one and getting sick (73 percent of respondents frequently worry about). Respondents also reported that they are frequently worried about the health system being overloaded (72 percent). This shows a significant emotional and mental stress that individuals are facing in addition to other challenges (e.g., economic) and highlights the importance of a response that acknowledges and addresses psycho-social needs.
Accessible and localized mental health and psycho-social support are key. Engagement should focus on actionable advice on how to keep family members safe and care for them.
* This is an edited excerpt of the report released by the inter-agency RCCE working group on 17 September 2020, and is available at Reliefweb, COVID-19: Community Insights from the Asia Pacific Region - Indonesia, Malaysia, Myanmar, and Pakistan (September 2020), https://reliefweb.int/report/ indonesia/covid-19-community- insights-asia-pacific-region- indonesia-malaysia-myanmar- and.
For further information, please contact: RCCE working group Co-Chairs:
• Ljubica Latinovic, Risk Communication Advisor, World Health Organization (WHO) – e-mail: latinovicl@who.int;
• Viviane Fluck, Regional Community Engagement and Accountability Coordinator, International Federation of Red Cross and Red Crescent Societies (IFRC) – e-mail: viviane.fluck@ifrc.org;
• Husni Husni, Humanitarian Affairs Officer, (Community Engagement / Accountability to Affected Populations), Office for the Coordination of Humanitarian Affairs (OCHA) – e-mail: husni.husni@un.org.
Endnotes
1 “Covid-19: Immigration releases list of countries whose citizens are barred from entering M'sia,” The Star, 7 September 2020, www.thestar.com.my/news/nation/2020/09/07/covid-19-immigration-releases-list-of-countries-whose-citizens-are-barred-from-entering-m039sia.
2 Emily Ding, “Malaysia’s Coronavirus Scapegoats,” Foreign Policy, 19 June 2020, https://foreignpolicy.com/ 2020/06/19/malaysias- coronavirus-scapegoats/.
3 Charles Hector and Adrian Pereira, “End discrimination against foreigners and migrants in COVID-19 responses,” Malaysiakini, 30 Jun 2020. www.malaysiakini.com/ announcement/532379; A. Ananthalakshmi, Rozanna Latiff, “Rohingya targeted in Malaysia as coronavirus stokes xenophobia,” Reuters, www.reuters.com/article/us-health-coronavirus-ma-laysia-rohingya/rohingya-targeted-in-malaysia-as-coronavi-rus-stokes-xenophobia-idUSKBN22Z00K.