Declining adherence to COVID-19 guidelines in Nigerian universities: What can school-based health centres do?
By Aloysius Odii, University of Nigeria
On 11 March 2020, concerned by the alarming levels of spread and the severity of the illness, the World Health Organization (WHO) declared Covid-19 a global pandemic. This blog post is part of a series to reflect on the past year of the COVID-19 pandemic.
Nearly a year after the emergence of COVID-19, government and non-governmental organisations (NGOs) have accepted life during the pandemic as the new normal. After months of restrictions, Nigerian national health authorities now agree that businesses must go on and learning must continue, but there must be strict protective measures to prevent the spread of the virus. Hence, restrictions in different sectors were lifted with clear guidelines for reopening.
In Nigeria’s education sector, the Nigerian Centre for Disease Control (NCDC) emphasized that for safe reopening, schools must be ready to implement infection prevention and control measures. These measures included ensuring physical distancing, frequent handwashing, and the use of face masks in school environments.
On 23 March 2020, the Academic Staff Union of Universities (ASUU) declared a nationwide strike following a disagreement with the federal government. A week later, the federal government announced the first lockdown in three states, and this was later widened to more states due to the rapid spread of COVID-19. After the restriction of movement was lifted, Universities remained closed until 18 January 2021 when the strike was called off. For safe reopening of schools, NCDC requested that school administrators put up a checklist to ensure compliance and adherence with preventive measures. They warned that learning facilities must make water, sanitation and hygiene (WASH) facilities available, including hand-washing equipment and soaps, and ensure that learners stay two-meters from each other and use face masks. Schools were also required to set up committees to monitor and promote compliance.
Declining adherence to COVID-19 Guidelines in Nigerian universities
In compliance with NCDC guidelines for safe reopening of schools, most schools set up washing equipment in strategic points, and students were required to wear a face mask in class and other public spaces. ‘No face mask, no entry’ signs could be seen in major entrance within the school environment. School administrators also setup COVID-19 committees at the faculty and departmental level to monitor and promote compliance and explore different ways of limiting contacts among students and persons within the university community. However, five weeks into resumption, my observation in three Nigerian universities was that compliance to these measures declined sharply. Most students now attend classes without regard for two-meter distance, face masks and other protective equipment recommended by NCDC. Public spaces formerly out-of-bounds to people without face mask became accessible to everyone. In fact, the university carried on like the ‘old normal’, except for few individuals who adhered.
It is predicted that, over time, compliance to the use of protective measures will decline. This, however, is not because of fatigue but because of optimum bias – the idea that people will predict that others have greater chance of falling into calamity than themselves. A survey in four countries has shown that, indeed, people are optimistic about the risk of being infected with the virus. In fact, about half of the participants judged that COVID-19 is less likely to happen to them than to other people. This feeling of optimism may be the trigger for declining compliance to COVID-19 preventive measures recommended to the university community.
What needs to be done
NCDC prepared the guidelines for safe reopening of schools but did not anticipate that, over time, compliance to the measures would decline due to optimism about the risk of being infected with the virus. As a result, the guidelines did not contain strategies to sustain the measures put in place. Another major weakness in the NCDC guidelines is that they did not mandate health workers in school-based health centres to be included in COVID-19 committees. Considering that most Nigerian universities have their established health centres where students seek first-hand health services, leveraging on resources available in these health centres could be key to addressing decline in adherence to COVID-19 preventive measures. This is because, experiments have shown that people will most likely listen to experts, so including health workers as part of the committee would likely encourage people to adopt the advised health practices. Also, health workers in school-based health centres are part of the university community and so know the proper approach to drive health policies.
University administrators must, therefore, consider the importance of sustaining persuasive health messages that centre around the fact that everyone is at risk. Such messages must focus on maintaining high perceptions of risk to dissuade the idea that the virus will not affect certain people. Health workers in school-based health centres are in strategic position to drive such messages.
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Image: International Monetary Fund/Flickr, CC BY-NC-ND 2.0
