Article Text
Statistics from Altmetric.com
Summary box
The medicalised response to COVID-19 in low- and middle-income countries has had unintended and far-reaching consequences.
Communities, non-governmental organisations and civil society organised themselves from the ‘ground-up’ to alleviate the economic, social and health impacts of COVID-19.
Urgent intersectoral mitigation strategies required for COVID-19 recovery will not be fulfilled through state services alone.
Investing in community cadres and organisations has the potential to build social solidarity, mitigate the impact of COVID-19 and strengthen intersectoral collaboration and safety nets for future crises.
Introduction
Globally the COVID-19 pandemic has destabilised health systems and communities. Governments in low- and middle-income countries (LMICs) followed the approaches adopted by the Global North and advocated by international bodies such as the WHO, and instituted varying degrees of nationwide stay at home orders (lockdowns) from strict restrictions (such as in South Africa, India and Zimbabwe) to weakly enforced lockdown as in Brazil.1 Many have questioned the appropriateness of these measures in LMIC contexts2 where key preventive behaviours such as social distancing and frequent hand washing are impossible to implement in densely populated informal housing settlements. People rely on crowded public transport to get to work, households are cramped and lack easy access to water and sanitation; loss of income leads to food insecurity and hunger as well as high levels of stress and violence. In such conditions viral spread is impossible to control and economic devastation is inevitable. In this commentary we examine (1) some of the unintended impacts of this approach for LMICs and (2) the steps that need to be taken in the short-term and longer-term to mitigate these impacts and the vital role of civil society and communities in this recovery process.
COVID-19 unintended impacts
The response from LMIC governments to contain the COVID-19 pandemic aimed primarily to limit virus spread. The unintended consequences of the …