Preliminary report : survey on socio-economic aspects of COVID-19 in the Maldives : (round two June 2020)

Abstract

The first community case of Covid-19 in the Maldives was reported on the 15th April 2020 which triggered the lockdown of Greater Male’ area with travel restrictions between islands, closure of businesses, government offices, schools and other movement of the people was restricted. The lockdown lasted about 45 days before any ease of movement was given. This report presents the preliminary results of the second round of online survey launched on the 12th of June 2020 to explore the extent of exposure to Covid-19, prevention practices, perceptions on easing the restrictions imposed to contain Covid-19, quality of life, access to essential services and the impact on work and income during lockdown. A quantitative online survey methodology was adopted targeting the whole population. To reach the population, the survey team partnered with the two main telecommunication providers in the country and survey link was sent to all registered mobile phones registered with the two providers. The response rate was 94%, with 2368 people completing the study out of 2517 who responded to the study invitation. The study was registered at the Maldives National University (RR/2020/S-02) and ethics approval was obtained from the National Health Research Council (NHRC/2020/006). The response distribution by gender was quite similar with 53.4% females and 46.6% males but the response rate from the atolls was lower than Male’. Testing for Covid-19 was found to be considerable with 14.3% of the sampled population having tested for the disease. Exposure to the disease was low with 0.4% testing positive for the disease. A large proportion complied with HPA’s advice on the prevention measures of Covid-19 such as hand hygiene (72.9%), wearing face masks (71%) and social distancing (60.4%). Many wanted ease of restrictions but felt the need for increased testing, monitoring of compliance, appropriate guidelines and community empowerment to reduce risk of contracting Covid-19. Findings on the exposure to covid-19 and prevention practices reflected the country’s strategy of early detection, high level of testing capacity, peoples’ health seeking behaviours and acceptance of the interventions adopted in the country. The quality of life during the Covid-19 pandemic indicated a high level of health and wellbeing with an average self-reported score of health during the lockdown at 78.2 out of 100. Except for anxiety and depression suffered by 50% of the population, the other four dimensions of quality of life showed that more than 90% had no problem with mobility and self-care, 71% had no problem with usual activities and 66% had no problem of bodily pain or discomfort during the lockdown. The discrepancy observed between the proportion of population suffering from mental health issues (50%) and the demand for mental health services (9.8%) highlights the need to extend mental health education across the country, proactive screening and treatment for the people in need. Access to essential services during the lockdown demonstrated that 29.8% of the sample needed health services, 9.8% required mental health services, 6.8% needed sexual and reproductive services, 1.4% needed child protection services and 34% needed financial support. The small proportion of people who needed essential services were able to access these services, but majority of those who did access the services felt that their needs were not met. Despite the efforts to enable access to essential services during lockdown, it has highlighted that the quality of services was not adequate, which may be partly driven by the narrow focus of the pandemic planning to respond to the disease specific interventions, overlooking the wider social implications. The lockdown measures put in place was found to have disrupted economic activity for many. Amongst the working population it was common to work both at home and outside but majority were working less hours. People earning income from home-based activities were more vulnerable with earning less than MVR 5000 per month (<$10 per day). Majority who earn from home-based activities were women and were not able to continue their income activities during lockdown, mainly due to increased responsibility of domestic work and care of dependents while isolated at home. While only a third of the people were concerned about exposure to COVID-19 on return to work, majority were concerned about getting back their job, reduced pay, and social aspects such as no social support to look after dependents when they return to work. This suggests that economic concerns outweighed the risk of infection for a large segment of the working population which needs to be taken into account when planning risk communication as it poses significant risk of a resurgence of infection in the community. While the government pandemic response is contemplating the ease of restriction, the risk of a second wave is real, and is heavily reliant on the compliance to the guidelines set out by the Health Protection Agency. The lessons from this pandemic needs to be incorporated into the pandemic preparedness plans and national emergency operational plan with innovative modalities to ensure that pandemic response does not leave the vulnerable behind. Stimulus packages will be helpful in the short run, but in the long term, sustainable safety nets, skill development and avenues for alternative income generating activities needs to be introduced, with a special focus on the informal sector and the women in the working population. Risk communications needs to target empowerment of the businesses and community to take actions on their own for successful suppression of the epidemic.