“The right equipment, sundries … alone gives me a reason to go and work” Health workforce incentives and dis-incentives during the COVID-19 pandemic: Experiences from four African countries (preprint)

Background The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. In some settings incentivizing health workers motivated them and ensured continuity in the provision of health services. We describe the incentive and dis-incentives and how these were experienced across the health workforce in the Republic Democratic of Congo (DRC), Senegal, Nigeria and Uganda during the COVID-19 response. The disincentives experienced by health care workers during the pandemic were documented.Methods A qualitative study of a multi-country research involving four African countries namely: - DRC, Nigeria, Senegal and Uganda to assess their health system response to COVID-19. We conducted key informant interviews (n = 60) with staff at ministries of health, policy makers and health workers. Interviews were face to face and virtual using the telephone or zoom. They were audio recorded, transcribed verbatim and analyzed thematically. Themes were identified and quotes were used to support findings.Results Health worker incentives included (i) Financial rewards in the form of allowances and salary increments. These motivated health workers, sustaining the health system and the health workers’ efforts during the COVID-19 response across the four countries. (ii) Non- financial incentives related to COVID-19 management such as provision of medicines/supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support, and supervision. Improvised determination and distribution of both financial and non-financial incentives was common across the countries. Dis-incentives included the lack of personal protective equipment, lack of transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access to and inadequacy of financial incentives.Conclusion Although important, financial incentives ended up being a dis-incentive because of the perceived unfairness in their implementation. Financial incentives should be preferably pre-determined, equitably and transparently provided during health emergencies because arbitrarily applied financial incentives become dis-incentives. Moreover financial incentives are useful only as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments. The potential for interventions such as service delivery re-organizations and lock downs to negatively impact on health worker motivation needs to be anticipated and due precautions exercised to reduce dis-incentives during emergencies.

PREDICTING COVID-19 SECOND WAVE SIGNAL IN SELECTED STATES OF SOUTHWEST NIGERIA: A COMPARISON OF CUMULATIVE SUM C2 AND CUMULATIVE SUM C1 EPIDEMIC THRESHOLDS

INTRODUCTION: Epidemic thresholds generated using the conventional historical data is not optimal for COVID-19 because of its short historical trajectory. This study therefore, aimed to develop and compare Cumulative sum C2 and C1 epidemic thresholds for COVID-19 in selected states in southwestern Nigeria. METHODS: This was a retrospective longitudinal analysis of the COVID-19 surveillance data (week 10 - 48) retrieved from the Nigerian Centre for Disease Control (NCDC) database of situation reports as at the 6th of December, 2020. Data was managed with Microsoft excel. The weekly time scale was adopted for developing the CUSUM C2 and C1 epidemic thresholds for three selected southwest states and Nigeria. RESULTS: A total of 236 situation reports were reviewed for each state. For Lagos state, the maximum C2 and C1 estimated was 2326 which was during the peak of the epidemic. From the four most recent surveillance points, the thresholds and the observed confirmed cases appeared to diverge from each other. For Ogun state, the maximum C2 and C1 estimated was 318 during the peak of the epidemic. From the four most recent surveillance points, the thresholds and the observed confirmed cases appeared to converge. For Oyo state, the maximum C2 and C1 estimated was 708 during the peak of the epidemic. From the four most recent surveillance points, the thresholds and the observed confirmed cases appeared to converge and then diverge. CONCLUSION: A closer monitor of the surveillance data for the states is recommended for a possible public health intervention.

Point of Contact: Investigating Change in Perception through a Serious Game for COVID-19 Preventive Measures

COVID-19 exposed the need to identify newer tools to understand perception of information, behavioral conformance to instructions and model the effects of individual motivation and decisions on the success of measures being put in place. We approach this challenge through the lens of serious games. Serious games are designed to instruct and inform within the confines of their magic circle. We built a multiplayer serious game, Point of Contact (PoC), to investigate effects of a serious game on perception and behavior. We conducted a study with 23 participants to gauge perceptions of COVID-19 preventive measures and quantify the change after playing PoC. The results show a significant positive change to participants' perceptions towards COVID-19 preventive measures, shifting perceptions towards following guidelines more strictly due to a greater awareness of how the virus spreads. We discuss these implications and the value of a serious game like PoC towards pandemic risk modelling at a microcosm level. © 2021 ACM.