The onset of the Corona Virus Disease of 2019 (COVID-19) pandemic ignited a plethora of responses around the world. Most notably, countries around the world introduced the concept of lockdown as an intervention to help curb the pandemic. A lockdown simply means a government sanctioned decree limiting movement of people unless for essential reasons (Choudhary 2020). Lockdowns have received mixed reactions within research. Some scholars point out the importance of lockdowns in reducing the spread of the virus, protecting the health system from collapse and saving the lives of many vulnerable people (Dorigatti, et al. 2020, Ferguson, et al. 2020, Alvarez, Argente and Lippi 2020). Other scholars have been critical of lockdowns branding them disproportionate, and further suggesting that they have resulted in various negative externalities (Armitagea and Nellumsa 2020, Hellewell, et al. 2020, Keaveny 2020). While the debate of the usefulness of the lockdown goes on, it has also been highlighted that this debate is pointless unless it is made clear to what extent people are actually abiding by the lockdown (Coroiu, et al. 2020). Some researchers have argued that the reasons why the lockdown has been successful in some areas and not in others lies in the public’s propensity to adhere to the measures (Coroiu, et al. 2020, Anderson, et al. 2020)
Public health literature has already established that the success of non-pharmaceutical interventions such as lockdowns relies heavily on the public’s behavioral change (Muzyamba, Groot and Tomini, et al. 2018, Anderson, et al. 2020). This is anchored on the principle of local-buy-in on the part of the people it is meant to serve. The extent to which local people identify with, and adhere to the intervention is key in the success of that intervention (Muzyamba, Groot and Pavlova, et al. 2017). Studies from western countries have demonstrated relative success in handling the scourge due to relatively higher adherence from the public (Coroiu, et al. 2020). Reasons as to why people adhere or not to COVID-19 regulations have generally been explored in the global north. Similar studies are still missing from the global south. This is despite the fact that most health care systems in the global south face severe threat from any increase in COVID-19 cases. While countries, particularly those in the global south have imposed lockdowns, it is not known in most Sub-Saharan African countries what factors lead to adherence. Uganda is one such country that implemented one of the toughest lockdowns in Africa. For example, the lockdown in Uganda in 2020 included closure of all educational institutions, imposition of travel restrictions and banning of public gatherings including places of worship, bars, music shows and cultural events (Republic of Uganda 2020, Development Initiatives 2020). Further, people arriving in Uganda from abroad were put under 14 days of mandatory quarantine in designated venues hotels. These measures were enacted from 18 March 2020. This was before Uganda had registered its first COVID-19 case. This action was lauded by both the World Health Organization (WHO) and the Africa Centre for Disease Control (Africa CDC) and branded as “decisive reaction against the pandemic” (Lirri 2020, 1).
On the same day that Uganda recorded its first COVID-19 case, Uganda closed its boarders except for cargo and goods. Later, public transport was suspended and restrictions were placed on private vehicle movements. By the end of March 2020, there was a 14-days national curfew from 7pm to 6.30am which was extended in April for another 21 days. Wearing masks in public was also made mandatory as early as May before the country had 100 Covid-19 cases (Republic of Uganda 2020).
The strict lockdown measures in the country were credited for the relatively low cases recorded. As of December 2020, the cumulative number of cases in Uganda stood at 20, 459 with 205 deaths (WHO 2020). This made Uganda the ninth country with most Covid-19 cases in the Africa region representing about 1.4% of total confirmed cases in the region (WHO 2020). Other scholars also point to the fact that Uganda avoided a calamity in the healthcare system due to its strict lockdown. Despite all this, it is still not known what factors in the context of Uganda were associated with adherence to lockdown measures. Hence the aim of this study is to fill this gap by investigating factors associated with adherence to lockdown in Uganda.
There are several reasons that make Uganda an interesting case study when investigating the factors associated with adherence to lockdown measures. Uganda is ranked as a low-income country with an estimated population of 44.27 million, 75.64% of whom live in rural areas (World Bank 2020). Access to health care, especially for those in rural areas is generally low as most people do live almost five kilometers from a health facility (Odokonyero, et al. 2017). Health care delivery is further limited by the low number of health care workers in the country. Some health care facilities at the lower level of care, which provide health care to most people in rural areas, operate with staffing capacity that is as low as 50%. Consequently, the health worker density (number of health workers per 1, 000 people) is only 0.71 (Odokonyero, et al. 2017). Such a state of affairs coupled with a growing population has led to high burden of disease levels as reflected by mortality rates. The five leading causes of death in Uganda are infectious diseases including HIV/AIDS, Malaria and lower respiratory infections (World Health Organisation 2017). Therefore, the advent of COVID19, a respiratory disease, poses a threat on the health care system which can lead to a total collapse of the system.
However, it cannot be definitely concluded that COVID-19’s threat on the health care system is the only factor that that made people adhere to the lockdown regulations in Uganda. As a low-income country, the informal sector makes up to 50% of the population while employing as much as 98% of the labor force (Development Initiatives 2020). This sector was the hardest hit since restrictions imposed by the lockdown limited movement of people essentially halting trade in this sector. With a health care system that is inadequate to provide good health care services to the entire population even before the COVID-19 pandemic and a large proportion of the population relying on the informal sector, it is unclear what factors led the citizens of Uganda to adhere to the lockdown measures. This study fills this gap in literature.