This section provides practical actions to be undertaken in rural areas during the COVID-19 pandemic, while also considering longer-term actions to promote sustainability. These focus on key COVID-19 preventative behaviours and the infrastructure and products that support them.
1) Promoting and supporting hygiene practices
Handwashing infrastructure - Programmes should focus on scaling up handwashing facilities in households and public settings, such as schools, workplaces, religious sites and markets. A barrier in rural settings can be access to the supplies needed to construct a facility and the cost of constructing such facilities. In some rural settings, this has been resolved by promoting handwashing facilities that can be made from locally available materials like the Tippy-Tap design in this video below.
However, experiences of promoting these kinds of innovations in prior outbreaks or as part of short-term hygiene promotion programmes have shown that often facilities made from local, low-cost materials may not be very sustainable solutions and need to be accompanied by ongoing operation and maintenance mechanisms. Therefore in public settings such as in schools and health care settings, it may be cost-effective to build handwashing facilities that are more durable. WaterAid has developed this guide for building public handwashing facilities. This document builds on other research which shows that handwashing facilities should be designed in partnership with local communities, be easy to use and should be attractive so that handwashing becomes desirable to practice.
Soap availability - In rural areas soap is often not kept at the handwashing facility. This is often because soap is a valued item and people do not want it to be wasted or stolen. Handwashing can be enabled in these settings by encouraging people to keep soap in nets or to attach soap on a rope so that it cannot be easily removed from the handwashing facility. Soapy water, made from dissolving laundry powder in water, is another cost-effective and acceptable way of keeping soap at the handwashing facility. If soap supplies are a major challenge in your area it might be worth considering supporting local residents to make soap or alcohol-based hand rub (ABHR). Read this guide for more information on how to do this and whether it is likely to be appropriate in your context. While ABHR has typically been less common in rural areas, increasing its availability may be useful to overcome barriers of being able to clean hands when outside the home or while undertaking farming work. It may also be appropriate to promote alternative handwashing products in some settings.
Creative hygiene promotion - Hygiene promotion should always be done alongside investment in hygiene infrastructure and products. Conducting hygiene promotion in areas where facilities are lacking may be ineffective. In this resource, we suggest some simple handwashing promotion activities which could work across a range of settings. In rural areas, it may be more challenging to reach populations. This requires programme implementers to take time to assess which delivery channels are likely to be most effective, acceptable and safe to conduct. For more on how to do this read this resource. In rural areas, you may be more able to build upon existing communication structures (as communities may be more close-knit than in urban areas) and communication mediums such as radio or physically distanced house-to-house visits could be considered.
2) Ensure water is affordable and accessible
Affordability - Many rural communities will be disproportionately affected by the economic impacts of COVID-19 due to higher unemployment and reduced remittances. Ensuring that water remains affordable is essential so that hygiene can be maintained to prevent the transmission of COVID-19 and to reduce other health impacts. Some countries have waived water bills or provided water subsidies during the pandemic. Other countries have swapped to enable digital water payments so that human interactions can be minimised whilst supporting financial planning and subsidies. However, these approaches usually only benefit those with access to piped water (likely to be a lower proportion of the population in rural areas). In rural areas, the COVID-19 response should prioritise reducing payments for essential water services. Managing affordability also requires consideration of financial sustainability as a reduction in revenue, such as has been seen in some countries, may affect the ability of smaller water service providers to afford ongoing treatment and maintenance.
Access - The distance and time to collect water can affect how much water is used by a household. During the COVID-19 pandemic, some governments have focused on building new water infrastructure to reach underserved or vulnerable regions; scaling up maintenance efforts to fix existing but damaged water facilities, and working with the private sector to fill key gaps in the short-term water supply. Accessibility to parts and materials has been reported as an issue in some rural areas, limiting the ability to repair damaged water points. In rural areas, the COVID-19 response should prioritise the maintenance of existing but damaged water points, and consider the availability of materials. In the longer-term, it should also include building more water points (particularly in areas where people currently travel more than 30 minutes to collect water) and providing increased training on how to construct and maintain these.
3) Reducing risk of transmission in public spaces
Any setting where people congregate creates risks for COVID-19 transmission. However, sometimes it may still be necessary for people to visit certain locations such as markets, distribution centres, and healthcare facilities, in order to have access to food, water, household essentials, healthcare or to maintain an income for their family. In rural areas, this means that people may still need to travel on public transport to support their families and participate in economic activities. Measures to support essential movement while managing transmission risks include:
Promotion of fabric face masks - Many countries are now promoting the use of face masks in public settings where physical distancing can be hard to maintain. For a deeper understanding of the guidelines and evidence around safe mask use, see these resources. In many rural areas initial efforts may need to focus on increasing the availability of affordable face masks. This could include initiatives to encourage local community groups to make and sell fabric face mass.
Local solutions to encourage physical distancing: There are a range of low-cost measures that can be introduced to encourage physical distancing in rural environments. These include physical markers and environmental nudges (simple cues to influence behaviour) at public places. Hand hygiene stations or hand-sanitiser dispensers should also be made available at these locations with clear processes set out for whose responsibility it is to maintain the facility and refill soap and water or sanitiser. Below we provide some examples of physical distancing measures in rural settings:
IOM Ethiopia stuck painted sticks in the ground to mark out physical distancing measures (as shown in the photo below) and constructed handwashing facilities at water points to reduce the risk of transmission at rural water points.
Image: IOM Ethiopia
In Kenya the image below was posted at rural water points to help people understand how far they should stand apart.
In Myanmar several regional municipalities have adapted their local markets to facilitate physical distancing. In some cases this required moving the markets to larger spaces, imposing restrictions that sellers had to be from the local area and adding demarcations on the ground to ensure vendors and consumers could remain at a distance.
To encourage hand hygiene practice among Filipino students, schools adopted environmental nudges such as footprints painted on the ground leading to handwashing stations, arrow stickers pointing towards the soap dish, and “watching eyes” above the sinks.
Image: IDinsight/Nhu Le
Safe distribution of goods - As the economic impact of COVID-19 takes its toll on rural populations many local governments or response organisations may consider distributions of essential items in rural areas. These need to be managed carefully so that distributions do not unintentionally become sites of potential transmission. For ideas on how these can be done safely see this resource.
Working with larger employers in rural areas - 63% of the world’s poorest people work in agriculture and this represents a large portion of rural populations in low-and middle-income countries. Seasonal agricultural workers are likely to be particularly vulnerable at this time. Taking preventative measures to reduce COVID-19 transmission will necessitate collaborations with agricultural employers or other large employers within rural areas. General guidance on measures that workplaces can take to reduce transmission and risk for employees have been produced by the WHO and CDC. For agricultural work specific adaptations may include the provision of face masks, the provision of additional handwashing or sanitising stations, regular disinfection of equipment, and adapting shifts, accommodation and transportation so that they comprise the same group of workers each time to minimize the number of interactions any one staff member has.
4) Encourage community support systems
In rural areas, communities are often closely-knit and it is more likely that people will have strong social groups and established support systems to address local challenges and needs. There are opportunities to build upon and work with these existing systems to enable an effective response to COVID-19 and contribute to longer-term resilience. Work with communities to identify vulnerable individuals or families. This could include individuals who are prone to more serious forms of the disease such as older people or people with pre-existing conditions as well as families who are likely to be particularly vulnerable to the secondary impacts of COVID-19. Discuss with leaders within the community about how the community can best support these families. For example, in many counties older people and people with pre-existing conditions are being asked to ‘shield’ themselves to reduce their chance of getting COVID-19. In such circumstances, we are seeing volunteer networks develop and play a role in delivering water, food and medication so that these vulnerable individuals can maintain physical distancing.
5) Connect your programme with other services
As mentioned above, people in rural areas are likely to experience a range of secondary impacts of COVID-19 and many people in rural settings may already be dealing with a range of other challenges. Prior to and during the implementation of your COVID-19 response program make sure to engage with communities and understand their needs, challenges and local solutions. Where possible try to link your actions with other community services (such as primary health care, nutrition programmes, maternal and child health services) being provided by governments, civil society groups and non-government organisations to ensure that together you are addressing all local needs.