Sharing learning across borders during Covid-19
Brazil, China, Pakistan and the UK are very different countries with quite divergent development histories and trajectories. But Covid-19 has brought them closer together, along with countries around the world, in their need to respond to a common global crisis. In the process, the pandemic has revealed fragilities in governance systems almost everywhere.
Who has been included and excluded in decision-making around public health during the pandemic? How have contradictory messages, delayed responses, and the sense of the economy being prioritized over public health impacted institutional trust across the world? What needs to be prioritized by the state going forwards? On 12 October, IDS convened a distinguished panel of speakers from partners of our International Development Research and Mutual Learning Hubs to discuss these pertinent issues. The following reflections have been drawn from the speakers’ contributions during the event.
Common tensions in public health decision-making
A common theme across the four countries was the impact of balancing multiple levels of decision making on responding to Covid-19. The countries had differing experiences of the concentration of control, but the challenge of coordinating across devolved, federated units was obvious across all four contexts. In Wuhan the fact that centralised policy would not work across very different experiences of the pandemic among different communities became obvious early on, and community-level efforts to support and contextualise government measures to local situations became vital.
In the UK, decision making has been centralised by ministers and their political aides. Many issues in the UK can be attributed to tensions in the relationship between central and devolved responsibilities. But in recent days we have seen local political leaders become more critical of central government and ask for greater say in decisions, especially now that policy has shifted to emphasise more localised action and city- or region-level lockdowns.
The Brazilian federal government refused to play a coordinating role even as states asked for help, whilst maintaining the dependence of local and regional administrations on central government for resources. With the federal government deliberately sowing confusion around responsibilities for action and facts about the virus, Brazil saw the decision-making process become highly politicised, creating conflict over lockdown measures between the central level and the struggling municipalities, and contributing to the spread of the pandemic.
In something of a contrast, Pakistan’s federated system did manage to coordinate mechanisms for procuring and delivering test kits, developing guidelines, structuring communication, and ensuring political participation of all provinces. Alongside other unobserved factors, this may have contributed to the reduction in infection rates which became evident from July.
The need for more localised and contextualised responses is highlighted by two facts – that people across different parts of these countries have had very different experiences of the pandemic, and that lockdowns have now become more local. But this is where state fragility has been more obvious. In almost all of these countries a vacuum has been revealed in terms of institutional structures that can work with regional and federal governments to create the conditions for compliance in urban neighbourhoods and rural communities while also ensuring stable livelihoods and access to social protection. This vacuum is apparent both in the exclusion of grassroots institutions from opportunities to interface with the state, and in the weakness of local governments, at least in Pakistan and the UK.
Disinformation and misinformation
Citizens in all four countries faced challenges in the availability and reliability of information about Covid-19 and government policies, a key element for institutional trust. The residents of Wuhan had very little access to information in the early stages, though eventually the start of daily briefings from the government and the online dissemination of information about the construction of new emergency hospital facilities helped to reassure people that they would not be unable to access emergency care and thereby increased trust in institutions.
Conflicting information and disinformation remain significant problems in Brazil, particularly relating to confusion over who is responsible for delivering health services. For example, in research by the Solidarity Research Network, more than half of the people surveyed thought that state level governors are responsible for Covid policies, while 15 percent attributed responsibility to the federal government and 20 per cent to municipal government. This confusion, along with the high turnover of health ministers (three over the course of the pandemic, with the most recent admitting he had no experience of health issues before the pandemic), have reduced levels of public trust in state decisions.
Similarly, Covid-19 and lack of information have played a role in exposing what many see as dysfunctional aspects of the state in the UK, including the emphasis on privatisation of public health services. With much of the test and trace budget going to management consultancies and outsourced agencies rather than to mobilising local public health resources, poor performance has led to decreasing public approval for the government’s policy implementation.
Priorities going forward
What happens in each of these four countries over the next few months and beyond will look different depending on the outcomes of political and institutional developments, such as municipal elections for Brazil or Brexit negotiations for the UK. However, there are a few common priorities which apply across these very different national contexts, including the need for effective regional and global cooperation.
Governments at different levels will need to work together to make decisions, including by integrating and building capacities of local, community and civil society actors, harnessing the energy of new solidarity initiatives.
The current crisis may also present a critical juncture at which to review more structural issues that affect all countries – such as how public finances are collected and from whom, and what share of national income is used to ensure access to universal public healthcare and social protection systems.
Finally, we need more research to strengthen our understanding of the inequalities and vulnerabilities that the pandemic is creating, and we need better systems to share what is being learned through this research. Central to these efforts is the realisation that there can be valuable learning across very different contexts. We must intensify our efforts to share learning and reflections across borders to identify the elements that can ensure that institutional trust is strengthened rather than weakened during the pandemic and beyond.
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Dr Shandana Mohmand is an IDS Fellow. Rachel Dixon is the IDS Partnerships Officer. Dr Yi Cai Fellow at Wuhan University Global Health institute, China whose policy briefings have been used as part of government efforts for COVID-19 containment practices. Dr Ali Cheema is Director of the Mahbub ul Haq Research Centre (based at the Lahore University of Management Sciences, Pakistan) and an IDS board member. He was part of a team that advised the response of the Punjab provincial government on containing the pandemic. Professor Marcos Nobre is Director of the Brazilian Center for Analysis and Planning (CEBRAP), Brazil, who has recently published on the global uprising of populist conservatism in Brazil and Bolsonaro’s War against democracy. Professor Graham Smith is Director of the Centre for the Study of Democracy at the University of Westminster, UK and has been working with the charity Involve on the project ‘A democratic response to Covid-19’, looking at what role the public should play.
