In this section we outline some of the reasons why all COVID-19 programmes need to build in mechanisms to allow adaptation.

Adaptive programming can enable programmes to be more effective and responsive to local needs.

Adaptive programming improves existing programmes by modifying them as necessary in response to changing contexts. By adapting programmes to reflect the local realities, it is more likely that public health and WASH programmes will remain relevant. Adaptive programming is especially important to consider when scaling up programmes to ensure they remain effective in achieving behaviour change for the target population. Therefore, adapting programmes throughout the course of their implementation is considered good practice. Adaptive programming is also important if you are undertaking advocacy or policy work.

The dynamic nature of COVID-19 transmission and the changing state of evidence requires constant adaptation.

Each country is experiencing the pandemic differently, and as such, responses vary in different parts of the world and even within countries. In some settings, cases and deaths are still on a steep rise, while others are seeing a decline. There are also many countries where the number of new cases stabilized or declined initially, but there was then a ‘second wave’ of cases and deaths. The graph below shows how transmission has varied across different continents.

Image: BBC based on ECDC data up until 28th December 2020

The secondary economic and social impacts of COVID-19 will also vary by country and this may have a substantial influence over the policy decisions made by national governments. Organisations have had to regularly adapt their programming because of these changes in transmission, policy and social perceptions.

As our understanding of COVID-19 improves, prevention programmes have had to adapt.

Between January and October 2020, more than 60,000 academic publications were written about COVID-19. The speed of our learning about this novel pathogen has been unprecedented and challenging for practitioners to keep up with.

Image: Lit Covid data showing the number of academic publications about COVID-19 per week.

Recommendations around prevention behaviours have changed over time in light of increased understanding about COVID-19. For example, in the early phase of the response many countries were hesitant to recommend the use of masks among the general population. However, as our understanding of COVID-19 transmission improved and further research emerged, mask use was recommended by the WHO and has since been central to the COVID-19 response in most nations. In contrast, in the early stages of the pandemic many countries were considering large-scale disinfectant spraying, but this has since ceased because it is unlikely to be efficacious and can pose safety risks. Other prevention behaviours like handwashing with soap and use of hand sanitisers were recommended early on, have been adopted globally and are still considered key to interrupting transmission. Accordingly, organisations have sometimes had to adapt their strategy and encourage additional behaviours among their target populations.

Adaptation is needed to move from the acute phase of response to longer-term action.

COVID-19 programming will also need to adapt as we transition from the acute, emergency response phase of programming to a more long-term response mode. As we enter this ‘long-term response mode,’ programming must pivot and consider sustainability and policy change. This will require us to:

  1. Close some of the gaps and inequities that result in some populations being disproportionately vulnerable to COVID-19: people who are clinically vulnerable (such as older people and people with pre-existing conditions), people who live and work in settings which put them at increased risk of exposure to COVID-19 (such as densely populated areas), people who are more likely to experience severe socio-economic secondary impacts (such as people living in poverty or working in the informal sector), people who lack access to water, sanitation and hygiene infrastructure, and people who have reduced access to health care or critical services.
  2. Build resilience against future outbreaks and reduce the burden of chronic public health challenges like diarrhoeal diseases.
  3. Improve and sustain efficient public health response systems at the national, institutional and community levels.

Adaptation is necessary to overcome ‘COVID-19 fatigue’ and keep programmes relevant.

Now that populations know the basics about COVID-19 transmission and prevention, it is important to change our approach to avoid disengagement. Without adaptive programming, there is a risk that the target population will get bored and may no longer consider programmes to be relevant to their lives and concerns. For example, Oxfam’s Community Perception Tracker documents community attitudes and concerns around COVID-19 in nine countries. They have found that many populations are tired of programmes that only give COVID-19 messages because the pandemic is only one of many issues they are facing. Ongoing, iterative adaptation is necessary along with the utilisation of innovative, evidence-based activities. It is important that organisations view behaviour change as a process rather than a one-off event. For inspiration in this regard, look to the private sector. Many big brands re-innovate their marketing approach regularly so as to ensure that there is constant interest and demand for their products. For example, Coca-Cola has maintained core aspects of their brand while releasing a new marketing campaign almost every year.

Adaptation to ensure programmes are inclusive.

Oftentimes rapid response programmes, including COVID-19 response programming during the early phase of the pandemic, may not be inclusive. However, with time, more data, and a better understanding of who is vulnerable, programmes can be adapted to address those earlier gaps. Programmes and national strategies are now more commonly targeting specific sub-groups of the population who are at risk. There are now resources dedicated to mapping vulnerable populations and providing more granular data to aid in response. In Kenya, the need for a more targeted response among at-risk populations has also spurred the creation of new indices to measure multiple dimensions of vulnerability (e.g. social, epidemiological) and inform programming. More diverse types of data are also needed to understand the perspectives of different population sub-groups and how the pandemic may have affected people in different ways. Working with groups that represent vulnerable groups (e.g. Disabled Person’s Organisations) can be key to developing successful and acceptable programme adaptations.

Programming also needs to tackle and confront any discrimination and stigmatisation that is observed during response efforts. The fear created by the pandemic can prompt people to blame minority groups as they search for explanations during these uncertain times. This can mean that people of certain ages, genders, religions, ethnicities, castes, socio-economic backgrounds or those who belong to certain professions, become unfairly stigmatised. Adaptive programming necessitates that response actors closely monitor messaging, images and approaches to ensure they are not inadvertently fuelling discrimination.

Keeping communities informed as you adapt

Communities should be informed about policy changes and changes in your programming in order to allow them to make necessary changes in their lives. Information dissemination should be regular and concise in highlighting key milestones in the progression of the pandemic and the ripple effects in programming. For example at the beginning of the pandemic in Zambia, the guideline was for those with COVID-19 symptoms to call a COVID-19 response hotline and not go to the public health facility. However, with time and after prevention and diagnosis measures have been strengthened at the health facilities, people can now go to their local health facility for testing. These and other changes should be communicated in a timely manner and coordinating institutions should ensure messaging is consistent among themselves to avoid misinformation or unnecessary uncertainties.

Want to learn more about fostering a new generation of effective hygiene initiatives built on the pandemic experience?

Editor's note

Author: Elli Leontsini, Peter Winch and Anika Jain
Reviewers: Tracy Morse, Helen Hamilton, Dan Jones, Sian White, Jenala Chipungu
Last update: 04.01.21

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