This brief focuses on cross-border movement in Eastern and Southern Africa (ESA) and its implications for development of risk communication and community engagement (RCCE) strategies aimed at preventing transmission of COVID-19 in the ESA region. Given the extensive risk of cross-border transmission of the virus and the imminent reopening of borders, such strategies are essential to containment efforts. The brief can be read in conjunction with previous SSHAP briefs on cross-border dynamics in the context of Ebola. 1–3 It was developed for the Social Science in Humanitarian Action Platform (SSHAP) by Anthrologica (led by Leslie Jones) and IDS (Megan Schmidt-Sane), and with reviews from International Federation of Red Cross and Red Crescent Societies (Petronella Mugoni), UNICEF (Charles Kakaire and Ida Marie Ameda) and IOM (Sandrine Martin). The brief is the responsibility of the SSHAP.
Cross-border transmission of COVID-19 is an increasing concern, particularly as countries begin to ease travel restrictions and lift border closures. Cross-border travel is essential to the Eastern and Southern Africa region’s economy and society. People on both sides of borders in this region often share culture, familial ties and economic activity, and movement across the borders is fluid regardless of formal closures.
Knowledge, attitudes, and practices influence COVID-19 control. In some border populations, low levels of knowledge of the disease, low risk perception and negative attitudes toward movement restrictions may compromise COVID-19 control.
Evidence from past epidemics shows that stigma may prevent people from seeking treatment for COVID-19 and other health concerns. Groups at high risk of stigma may include truck drivers, sex workers, migrants, returnees or displaced persons.
Structural factors can be a barrier to cross-border COVID-19 management. Historically, few governments have invested in public health capacity at border crossings. Testing, processing and contact-tracing capability, shortages of personnel, PPE and other necessary materials, and medical and social support for confirmed cases and those in quarantine remain a concern and should be addressed.
Efforts to control cross-border COVID-19 transmission may be impeded by political and economic factors, including regional non-cooperation, community resistance to lockdowns, and the devastating effect of border shutdowns on livelihoods in the region.
RCCE efforts for COVID-19 prevention should aim to reach key populations at a broad variety of locations, including formal and informal entry points and along transport routes. Engagement efforts should include truck and boda boda (motorcycle taxi) drivers, traders, migrant workers, fisherfolk and pastoralists, refugees and other displaced persons and other vulnerable groups, returnees, members of border communities, people seeking health care or other services and the contacts of these groups.
Development and sharing of RCCE information should involve trusted community members, including religious and cultural leaders, trusted authorities, leaders of relevant trade associations, and representatives of vulnerable and marginalised population groups.
Due to the diversity of individuals at the border and along transport routes, a variety of online and offline communication channels should be used in line with key populations’ preferences and with the aim of sharing accurate and timely information about COVID-19 and how to minimise infection risks. Technology-based messaging may be suitable for some populations but are not uniformly accessible or trusted; other communication methods, like radio, public address, print materials and personal/peer-to-peer communication should also be used.
Two-way community engagement should cover public health recommendations in local languages using common terminology. Formats accessible to people with disabilities and those of lower literacy are essential. Communication should allow for information sharing from the community which can then be incorporated into revised RCCE.
Experience with past epidemics, including Ebola, demonstrates the importance of regional cooperation and cross-border coordination. Some local governments in border communities need capacity building, which national governments can organise with support from RCCE partners. RCCE implementers should also collaborate across borders and consider interventions for high-risk audiences. Crossborder population groups should be actively involved in joint risk analysis and developing actions to minimise infection risks.