Fears, Vulnerabilities, and Precautions over COVID-19: A report on Citizen's Experiences in Malawi and Zambia

This report provides key findings on the local impact of Covid-19 in Malawi and Zambia. In March 2020, Zambia and Malawi reported their first cases of Covid-19. Both governments responded by restricting non-essential travel, banning large public gatherings, and establishing emergency committees to try to contain the pandemic at a national level. These national-level responses were important, but they did not fully reflect how individuals and the communities they reside in responded to Covid-19. The GLD project, “Developing a Locally Rooted Approach to Covid-19 Response,” sought to explore citizens’ responses at a local level. Initiated in March 2020, it aimed to explore how issues such as fear of infection, income loss, social stigma, trust in authorities, and access to information affect individuals’ daily lives during the pandemic. To do so, GLD drew on contact information from respondents gathered in earlier surveys to conduct telephone interviews.


The Tunisian LGPI: Selected Findings on Health

Tunisia has a very good health-care system compared to most of the Arab world. The healthcare system includes primary-care clinics and health centers, which deal with nearly 60 percent of public-sector medical outpatients, reproductive-health visits, schools, and student-health visits; a secondary-care sector with 209 district and regional hospitals; and a tertiary sector with 24 hospitals and academic institutions. It also has a large and expanding private sector, located predominantly in the coastal urban center. The public sector employs 49 percent of doctors, 73 percent of dentists, and 80 percent of pharmacists, and receives 54 percent of total health-care spending. Most Tunisians’ health-care spending is covered or subsidized by insurance plans: Public and private employees and self-employed workers (about 66 percent of the population) are covered by insurance plans overseen by the Caisse nationale de l’assurance malade (CNAM). Another 22 percent of the population is covered by the Free Medical Assistance to the Poor (FMAP)/Medical Assistance Schemes (MAS), made available via a chahedat fakr, or poverty certificate, allocated by the Ministry of Social Affairs. Together, these plans cover close to 90 percent of Tunisians. The availability of health care and insurance may help explain why, according to the World Health Organization, Tunisia has the best health indicators of all North African countries.

However, Tunisia’s health system does face challenges. These challenges lie mainly in the heavy debts the country’s public health-care system shoulders and the fact that private health care, which is of much higher quality, is unaffordable to most. Moreover, doctors and citizens report that health-care service quality varies greatly across localities, with inequities related to class and education.

This report sheds light on both the successes and the shortcomings of the health-care system in Tunisia. It identifies areas needing improvement and highlights areas where the system is doing a good job. Armed with this information, citizens and stakeholders can channel efforts to areas in need and seek to understand best practices and drivers of success from areas of excellence.

The LGPI in Malawi: Selected Findings on Gender

Malawi’s context raises a number of challenges that the government, traditional leaders, civil society, and the development community are working to address. One area of particular focus is gender equality and women’s empowerment. The LGPI supports this effort by providing evidence-based research to inform the extent to which gender inequalities exist across sectors, cultural contexts, and localities. Drawing on the Malawi LGPI, this report assesses the extent to which women and men across different regions of the country, matrilineal and patrilineal cultural groups, and socioeconomic statuses access health and education services equally, experience more or less secure environments, and participate politically.

The LGPI in Malawi: Selected Findings from 15 Districts

The analysis presented in this report draws from the Local Governance Performance Index (LGPI), implemented in Malawi from March 24 to April 27, 2016. The LGPI provides a new approach to the measurement, analysis, and improvement of local governance. The tool aims to help countries collect, assess, and benchmark detailed information concerning issues of local and public-sector performance and service delivery to citizens and businesses. The goals are to provide information to help pinpoint, diagnose, and foster discussion among citizens, policymakers, and the development community regarding areas of need; help formulate policy recommendations; provide a benchmark for assessing policy implementation; and allow us to examine the factors driving good governance and quality service provision. The survey was fielded in 15 of Malawi’s 28 districts, spanning all three administrative regions. Within each region, traditional authorities (TA) or, in urban areas, local council wards were randomly selected for the study. A total of 18 traditional authorities and four urban wards, from three regional strata, were selected according to the principle of probability proportional to size. This document presents key findings from each of the 15 districts sampled. In particular, findings related to livelihoods, health, land, and education are highlighted.

The LGPI in Malawi: Selected Findings on Health

Malawi is one of the poorest countries in the world. Gross national income per capita is just $747 U.S., and nearly 51 percent of the population resides below the national poverty line.  As such, much of the population suffers from health ailments. This report draws on data from the Local Government Performance Index (LGPI)—a heavily clustered, multidimensional, experience-based survey implemented in Malawi from March 24 to April 27, 2016. The LGPI records the frequency of illnesses and chronic diseases among Malawians, Malawians’ ability to access health-care services, and the quality of those services. The data allows us to analyze the relationship between disease incidence and socio-demographic indices, such as gender, education, geographical location, and wealth. The results of this analysis can easily be compared with extant data from government and non-government sources.