What India’s COVID Response System Can Learn From Behavioural Science

The inherent challenge in India’s response to COVID-19 is that it relies on individual actors to abide by social distancing and safe public health practices. While the national lockdown(s) facilitated such behaviours to some extent, confirmed cases have climbed to nearly 1.8 lakh, according to the Ministry of Health and Family Welfare.The rise in coronavirus infections suggests that the new reality of remote working and restricted social gatherings is likely to remain in the foreseeable future. With the end of total lockdown, and the economy preparing for a slow and inevitable reopening, ensuring that people continue to follow public health guidelines is crucial to managing the spread of the disease and saving more lives.COVID-19: Negligence Observed During ‘Unlock 1’, Says PM Modi Simplifying Public Communication & MessagingGiven the impact of the pandemic, an additional 12 to 18 months of such social and behavioural measures could be required. But even in better times, behavioural science principles have highlighted the difficulties in effecting sustained behavioural change.People don’t always act rationally, and our behaviour is variably influenced by cognitive biases, our social and environmental surroundings.Insights from behavioural science tell us, for example, that the framing of communication affects people’s responses – how choices are posed to them affects their decisions, and removing daily obstacles makes it easier for people to act on set commitments.All You Wanted to Know About COVID-19 Vaccine CandidatesTake the case of saving money – everyone acknowledges its use, particularly during an economic downturn, but following through is difficult for many. Financial products can be hard to comprehend, and many people live without long-term financial goals.Research has shown that simplifying messages around financial health, helping people plan personal financial goals, and even sending basic SMS reminders can increase savings. Like saving money, social distancing and safe health practices also depend upon human behaviour, and leveraging those behavioural insights can be used to improve COVID-19 response strategies.Applying behavioural insights to public policy is not new in India; behavioural nudges have been used within government schemes such as the Swachh Bharat Mission and Beti Bachao, Beti Padhao (BBBP).Behavioural insights can also be leveraged to boost morale and empower essential workers. Healthcare workers are over-burdened, and their firsthand experiences have been under-utilised.Making the COVID-19 response efforts more behaviourally-informed can improve how policies are designed and implemented, to prioritise public health and safety.How Behavioural Intervention Can Impact Public PolicyApplying behavioural insights to public policy is not new in India; behavioural nudges have been used within government schemes such as the Swachh Bharat Mission (SBM) and Beti Bachao, Beti Padhao (BBBP). SBM helped people internalise its messaging around sanitation and toilet-use by leveraging Gandhi’s ideas of cleanliness and connecting them to the Indian identity. BBBP addressed child sex ratio imbalances by launching social media campaigns, that encouraged fathers to publicly post their daughters’ accomplishments, thereby lessening the gender gap and allowing for their (greater) visibility.Hand Washing With Soap: First Line Of Defence Against COVID-19In the wake of the COVID-19 pandemic, policy priorities have shifted to immediate relief measures to quell the spread of the virus, and behavioural interventions are supporting those efforts. The Centre for Social and Behaviour Change (CSBC) is working with the National Health Authority (NHA) to better design communication materials around hand-washing for simplicity and comprehension; the Department of Telecommunications mandated caller tunes to spread information about the virus; and district officials across the country are working with local communities to paint chalk circles in markets and public places as social cues to maintain social distancing.Compliance With COVID Guidelines Should Be Made EasyAs social and economic recovery continues, the learnings from past behavioural interventions hold important lessons for India’s COVID-19 fight:Make it easy to comply: The behaviourally-informed messaging campaigns already produced should be accompanied by ground-level interventions to encourage people to act on the messages they receive. For example, messaging campaigns on hand washing could be coordinated with the activities of frontline health workers, aligning communication strategies and providing supplemental nudges (hand washing demonstrations or ensuring access to soap or hand sanitiser). Even placing bottles of hand sanitiser in public places would encourage people to follow through.The message & the messenger: Research has shown that people respond to messages differently depending on who delivers them. In India’s fight against tuberculosis, patients’ adherence to treatment increased when they heard stories from survivors, rather than generic health messages, about the importance of taking their medication and practising safe health practices. Patients personally resonated with survivors’ experiences and better internalised the health messages. For COVID-19, re-thinking how the disease is perceived has the potential to improve awareness as well as quell misinformation by providing trusted sources of information.From the Frontlines: How the Workers Are Battling Collective FearBehavioural Insights Can Allow For Both Morale-Boosting & Better Decision-MakingHelp people make the best decisions: The stress of managing the crisis often leads people into ‘cognitive scarcity’ — a type of mental overload that obscures decision-making capacity. In the case of cash transfers, such as the Rs 1,500 spread out over three months under Pradhan Mantri Jan Dhan Yojana (PMJDY), this could lead to inefficient spending. Families may be tempted to bulk purchase large quantities of food or supplies, and fail to think about expenses that may later be incurred. Providing suggestions on how that money could be used, or helping people plan and budget those funds, can dramatically increase resilience to the crisis.Empower those on the front lines: Behavioural insights can also be leveraged to boost morale and empower essential workers. Healthcare workers are over-burdened, and their firsthand experiences have been under-utilised. First, re-emphasising the importance of their role in society and in combatting coronavirus, and ensuring their support, as led by the prime minister, can have a widespread impact. Second, that positive framing can also support their daily tasks. Instead of telling them which actions not to take up, tell them what practices they can do to improve community health and save more lives. Third, creating feedback mechanisms with district and state officials can better leverage their firsthand insights of fighting the virus.Creating An Institutionalised Mechanism to Apply Behavioural Insights to Indian PolicymakingMaking the COVID-19 response efforts more behaviourally-informed can improve how policies are designed and implemented, to prioritise public health and safety. These lessons can help social distancing become more intuitive, hand washing more frequent, and long-term health and financial planning become more thoughtful. Externally, a host of resources are already available to provide support.Established behavioural science experts and organisations are collating best practices and response measures that governments can implement. However, the need under the current system, despite a number of successes, is a formal process to build upon these lessons, and integrate behavioural solutions into a larger policy agenda.From the Frontlines: On Surveillance Duty at a Mumbai COVID CampCreating an institutionalised mechanism to apply behavioural insights to Indian policymaking can provide a more human-centred approach to its COVID-19 response strategy. Institutionalising behavioural insights into a nudge unit, as other countries have done, offers a promising solution. This would fashion a formalised entity to incorporate behavioural insights into the policymaking process, from design to last-mile delivery. Such an entity could support behaviourally-informed COVID-19 response strategies at the state and national levels, while enabling innovation, partnership, and testing of behavioural hypotheses on the ground.As changes to public life are projected to continue for the next twelve months or more, taking a long-term and system-wide perspective is needed to adapt and push through the crisis. The benefits of behaviourally-informed policies are clear, and efforts should be made to formalise their inclusion within Indian policymaking. Applied to the COVID-19 response, behavioural interventions can help the government and frontline workers reach more people, improve public health outcomes, and foster resilience.(Anna Roy is a Senior Advisor at NITI Aayog, and Steven Walker is a Project Lead at the International Innovation Corps. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)

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What India’s COVID-19 Response Can Learn From Behavioural Science

Making COVID-19 response efforts more behaviourally-informed can improve how policies are designed and implemented.

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Topics: Health Policy COVID-19 health workers