Abstract:

Background: The government of the Democratic Republic of Congo responded to Covid-19 with policy measures, such as business and school closures and distribution of vaccines, which rely on citizen compliance. In other settings, prior experience with effective government programs has increased compliance with public health measures. We study the effect of a national water, sanitation, and hygiene program on compliance with COVID-19 policies.

Methods: Prior to the COVID-19 pandemic, 332 communities were randomly assigned to the Villages et Ecoles Assainis program or control. After COVID-19 reached DRC, individuals who owned phones (590/1312; 45%) were surveyed by phone three times between May 2020-August 2021. Primary outcomes were COVID symptoms, non- COVID illness symptoms, child health, psychological well-being, and vaccine acceptance. Secondary outcomes included COVID-19 preventive behavior and knowledge, and perceptions of governmental performance, including COVID response. All outcomes were self-reported. Outcomes are compared between treatment and control villages using linear models.

Results: The VEA program did not affect respondents’ COVID symptoms (-0.11, 95% CI -0.55, 0.33), non-COVID illnesses (-0.01, 95% CI -0.05, 0.03), child health (0.07, 95% CI -0.19, 0.33), psychological well-being (-0.05, 95% CI -0.35, 0.24), or vaccine acceptance (-0.04, 95% CI -0.19, 0.10). There was no effect on village-level COVID-19 preventive behavior (0.02, 95% CI -0.17, 0.22), COVID-19 knowledge (0.16, 95% CI - 0.08, 0.39), or trust in institutions.

Conclusions and relevance:
Although the VEA program increased access to improved water and sanitation, it did not increase trust in government. Accordingly, there was no evidence of increased compliance with COVID policies, and no reduction in illness.

Publisher's Version