COVID-19 pandemic presents the globe and specifically Ghana with several health dilemmas for Public Health experts and watchers of the health system to ponder over. The questions that come to mind are the ethics and morality of the measures in this era of liberalism and emphasis on personal autonomy when it comes health, as opposed to the archaic principle of paternalism which placed the health providers as father figure (in-loco parentis) to the patients/clients and therefore relegated the inputs of patients/clients to the background.
Covid-19 pandemic has seen the implementation of draconian measures using judiciary arsenals such as Imposition of Restriction Act of 2020, Public Health Act of 2012 (Act 851), and its accompanying Executive Instruments to basically force the population into compliance. This has seen incarceration of innocent souls, and imposition of hefty fines on others. Should the wearing of facemask tow similar lane as we have seen with the ban on public gathering among others?
Public Health though to the larger extent relies on healthy policies as the enabling tool for the achievement of greater public good, but tacitly frowns on compulsion because they are not sustainable and often achieve minimal or no results; Typhoid Mary case is a classical case. The powerful arsenal at the disposal of Public Health Officials is the use of several behavioral theories in explaining a particular pattern of behavior or involuntarily whipping people in line in adopting a particular healthy behavior. Could we have used Theory of Planned Behavior and Health Belief Model into better influencing the behavior of the populace into adopting the compulsory wearing of facemask rather than the use of law (sections 169 and 170 (1) of Act 851 of 2012, and Executive Instrument 61)?
The Theory of Planned Behavior explains behavior over which people have the ability to exert self-control. Can people exert self-control when it comes to wearing of facemask? If yes then this theory can be effectively applied. If people are made to belief through effective communication that wearing of facemask would provide expected health outcome of not contracting the dreaded pandemic and that the health and economic outcome of wearing facemask is greater, it will certainly invoke the intention of many into using it (Note: consideration of positive outcome of a particular behavior is an overriding factor in adopting a specific behavior). This model believes that achievement of a particular behavior is dependent on motivation (intention) and ability (behavioral control). Does the population genuinely know the motivation behind the wearing of the facemask or they are just told “no facemask, no entry” in line with E.I 61? Without empowering the person to have control over a particular behavior, the intended or expected behavior change would be moot. They would wear it when entering offices and immediately remove it when they step out there by defeating the rationale behind the usage. The six constructs of this theory are: Attitude, Behavioral Intention, Subjective Norm, Social Norm, Perceived power, and Perceived behavioral control.
Health Belief Model: this psychosocial behavior change model suggests that a person’s belief in the threat of illness or disease together with a person’s belief in the effectiveness of the recommended health action will predict the likelihood of the person adopting the behavior. The model hinges on two pillars: 1) The desire to avoid illness or get well if already ill, and 2) The belief that a specific health action will prevent or cure illness. This fantastic model basically states that no one will like to contract a dreaded illness and go through the excruciating effect of the disease, and giving the opportunity will do everything to avoid contracting the illness, this does not exclude wearing of facemask, or in the worse situation any unbearable intervention such as wearing of helmet to prevent Covid-19 if that would help in the avoidance of a particular health situation; it is also true that as suggested by this model that individuals will adopt a particular behavior if they are convinced that it will lead to prevention or curing of a particular disease. Certainly human beings are rational and will do all in their power to avoid danger at all cost. Authorities have to just engage community members (community engagement is certainly different from communication), and communicate effectively to them on the dangers of the COVID-19 viz-a-viz the potency, and effectiveness of the preventive measures as opposed to the political communication of over reassurance which is not the norm in crisis communication. Once the populace understand the dangers of not wearing the facemask, they would serve as the police in ensuring the voluntary adoption of the wearing of mask. The prison certainly cannot contain all of us, and the police cannot also be everywhere, the most potent tool which can reach everybody is Social Behavior Change Communication (SBCC). The six construct of this model (originally four) are: Perceived Susceptibility, Perceived Severity, Perceived Benefits, Perceived barriers, Cue to Action, and Self-efficacy.
The most common workable denominator elements of these theories are the enabling factors. In a country where unemployment is at its peak, and poverty very visible as evident during the three weeks partial lockdown, what is the assurance that people who genuinely want to acquire facemask can really afford it or even access it? Why will we like to create an elitist society where the poor is perpetually disadvantaged and forever wallow in abject misery and despair? Can’t the government see the distribution of affordable facemask as a social intervention with the sole aim of influencing positive healthy behavior change? The diplomacy and adoption of appropriate behavior change model in influencing behavior when it comes to health should be the preoccupation of our officialdom rather than unsustainable militarization of crucial health intervention, it will certainly face resistance. Which course will we like to chart as a nation?
By Ebenezer Owusu-Sekyere
The writer is a tutor at the College of Health and Well-being in Kintampo.