EA Cameroon—COVID-19 Awareness and Prevention in the Santa Division of Cameroon Project Proposal

September 1, 2021 update:

DMI does not have data on the effects of mask wearing in reduction COVID-19 incidence or DALY burden, however, it refers to the $7-27 per DALY cost of a COVID-unrelated radio-based behavior change campaign. Thus, this program could have been more or less cost-effective than that of DMI.

However, it could have been done much better (targeting healthcare providers or community leaders with generous mask cash advance (to be used per discretion and masks made e. g. of local material) and role model expectations/​accountability and perhaps the poster).

Also, the war may be a much more significant contributor to DALY burden (both in terms of health-related quality of life (HRQoL) and deaths), so, spending the $3,600 to pay e. g. 5 local university graduates to each work full-time for 9 weeks ($2/​hour or $8/​day) on developing and advancing solutions and managing them/​asking questions and brainstorming solutions with the skilled volunteer work could have been a better philanthropic investment.

So, potentially, a cost-effective solution is that skilled decisionmakers obtain information on fundamental local problems and work with underemployed locals (to allow for lower wages and perhaps gain more sincere/​locally understanding thoughts) to resolve these issues. Outcomes can be measured by a single metric, such as improvements in HRQoL.

August 30, 2021 update

Please correct any mistakes.

Effects on mask wearing

The before and after data has been analyzed. As per the analyst, “Preliminary findings: The mean effect on mask-wearing is an increase of about 1.6 in the log-odds ratio (very roughly equivalent to a 300% increase in mask-wearing) -- 94% credible interval is (1.1, 2.1). … The absolute increase in mask wearing was somewhere around 5 percentage points.”

Using a very simple [after-before(program) - after-before(control)] analysis in Sheets, the increase in mask wearing is 8 percentage points. This may be reasonable, since the analyst used weak priors.

Using a linear regression (R code for Bayesian and linear regressions here),

maskCount = a1campaign*followup + a2log_pop + a3log_pop*followup + a4date,

the increase attributable to the program is about 8.82 percentage points (a1=48.5, which is the number of masks out of 550 that the fact that the community is campaign and is observed after the program, at followup. (48.5/​550)*100=8.82).

Thus, we deduce that

[after-before(program) - after-before(control)]

calculations in Sheets can estimate effects attributable to the program (assuming program and control comparability and study units comparability to the general population) with an error of a factor of about 2.

Costs

The total cost of this program was $3,650. This comprised of:

Cost-effectiveness

The total population of the campaign communities is approximately: 25,100.

That is $3,650/​25,100 = $0.145 to quadruple one’s chance to wear a mask or to increase it by 5 percentage points (conservative estimate).

We are not sure about the cost-effectiveness of this project compared to that of DMI’s COVID programming, however, we are asking DMI. We will also appreciate assistance in estimating cost-effectiveness in terms of $/​QALY or $/​case averted, in case you can share with us any epidemiological insights.

Cost-effectiveness of the program approach compared to targeting healthcare providers

Potentially, the program’s cost-effectiveness could have been increased. Low percentage of healthcare providers (about 5%) wore masks. Providing them with a stipend to purchase masks (alongside with local networks’ expectations and accountability) and a poster to inform patients about the preventive standards and their importance could have increased the normalization of preventive measures more effectively. However, it is unclear whether some remote communities would have gathered this information (according to this program, as of November 2020, no primary healthcare facilities operate in many villages).

Cost-effectiveness of the program approach in the local context

In addition, other programs could have been prioritized in order to benefit the community optimally. Further data is needed to estimate the wellbeing effects of reduced COVID risk given the ongoing war. For example, an increasing mortality due to COVID (with limited assistance due to government clinic closures and low NGO presence) could have made a barely-worth-living situation negative. Or, coronavirus could have not affected the health situation substantially (patients die commonly due to missing funds) and skilled work could have been better utilized to improve local institutions’ decisions (mitigate the conflict), which could be the necessary and sufficient determinant of persons’ increased wellbeing. Or, skilled work could have been used to improve the global governance system that leads some groups to be resolving perceived issues through armed conflict. (This program has not developed connections with local rebel leaders. Relatedly, the Reach Out Cameroon project has but ended in November 2020.)

Learnings

Learnings from this project include:

  • Expecting an organizer to keep funds while waiting for evidence in low resource settings may constitute an unnecessary issue. The volunteers and locals were given about $1,040 as need-targeted cash transfers. This could have been still allocated cost-effectively, since the organizer presented an authority and local networks accountability in one approaching the decisionmaker only in great need and somewhat as a last resort (high counterfactual impact).

    • In this case, distance (as well as community standards (no personal gain) or a locally vetted life-threatening personal needs fund when considering EAs from low resource settings – to what extent their networks?) can be used as a sufficient shield from local immediate needs that could bias resource allocation (if every day, only 10 close neighbors asked for only $10 to cover a medical expense, or to feed a hungry child, in a month, the COVID prevention budget would have been used). For instance, allocation decisions can be made internationally (or across moral circles or just rationally), through understanding local priorities and aiming to uncover reasoning biases. Subsequently, budgets can be provided only for the highest priorities.

  • Relatedly, contractors paid a limited amount (e. g. > $1/​hour) may benefit from an ‘emergency’ fund for immediate needs (in lieu of a higher hourly stipend). For example, volunteers can be paid the minimum wage (or assist in their communities unpaid) but for every number of hours be eligible for a need-based one-time assistance. Then, volunteers can feel cared for in need (which a sample of 30 respondents in a slum would give up 78% of their remaining life for (q13)), prevent any perception of burden (rejection of many/​all close ones before finding a sponsor when in dire need may lead to low wellbeing of entire networks), and encourage skill development for the purpose of sharing (persons being transparently preferred in assistance due to their own help).

  • Persons in low resource settings may confuse Effective Altruism with ‘we understand, care, and can help specifically you with your hardships.’ Either, it can be explained that their issues are not as cost-effective to address, or if they are, there is just an extensive room for skills and funding and it does not matter who is helped, so why not someone else or that if cost-effective measures are locally identified, then also sustainable local sourcing should be developed or if that is not possible then the problem should be addressed otherwise (such as by increasing personal capacity to think of and test innovative solutions, e. g. through participating in EA) – or just preventing the confusion by working with an NGO that is clear in only having funds for this program (then, persons will not participate in EA or develop innovative solutions). Thus, possibly, emphasizing the standard of no personal gain but an opportunity to develop and share skills/​cost-effective solutions for free (while potentially gaining perks such as support in helping more) can prevent suboptimal appeals (e. g. to buy more nutritious meals which can be extremely cost-ineffective) and discourage/​exclude persons who may seek dependency on a resourceful network.

  • Persons with high relevant capital (e. g. ability to influence local networks to change their behaviors based on understanding a topic) can be hired for low wage (e. g. here, $0.85/​hour including all emergency community bonuses).

  • Locals may be strong generalists: can be hired for any task that relates to local negotiation or operations and does not require significant computer literacy or summarizing skills (here, local community members conducted networking, ran info sessions, collected data, and trekked to all communities).

  • Similarly, NGOs can be provided funding to implement a specific project or recommended specific means to achieve an objective (here, for example, COVID awareness and prevention was a request from the local leadership but the media information part was suggested). NGOs can differ in the cost of implementation by an order of magnitude. For example, 5 hours of data gathering in 8 communities may cost a total of $40 (volunteer stipends plus coordination costs) when conducted by the contracted NGO. Reach Out Cameroon (a larger NGO, $1.8m income in 2019) could charge $400 for the same task (based on preliminary negotiation). Small local NGOs may have limited online presence (for example only have a Facebook page but not a website). Accountability can be increased by transparency requirements (e. g. requiring past financial statements) and detailed inquiry regarding spending needs (understanding that at-the-cost quotes may include small surcharges that different persons may benefit from to a limited extent). Double the minimum wage for skilled field staff otherwise working informally can be greatly welcome. Normal local prices should be known (e. g. $2/​return trip for local transport, $35/​1,000km for distance bus, $1/​1GB of internet data, $0.1/​A4 B&W page). Or, different NGOs can be invited to provide a quote and operations particulars and the best fit one contracted.

  • Relatedly, local NGOs may be constrained by skills and scale-up initiative in effecting cost-effective impact more so than by funding. For example, the newspaper article could have been ‘sold’ to the paper as a general contribution as opposed to purchased as an ad. Further, this article could have been shared with papers in similarly uninformed localities across Cameroon to increase awareness levels. Analogous measures could have been taken with the radio show (anecdotally, the local station offered a free-of-charge extension (double the time it runs) to the show). Thus, developing liked and beneficial media resources and sharing them with local networks through personal conversations may be particularly cost-effective.

  • Also relatedly, conducting a robust statistical evaluation can be affordable even to small NGOs.

  • When statistically evaluating a project, focus on one (or a few) representative measurable outcome (here, mask wearing as a proxy to all preventive measures). Gain other information to optimize the project/​clarify fundamental issues in addition (here, we used only one variable from the 64 and we learned what we needed to know (e. g. general beliefs regarding COVID, sources that inform behaviors) from the organizer who works in the area. This approach can be also preferred by local employees (why would they spend a significant amount of time asking locals about what all parties know that the enumerators already know).

  • Conduct programs and impact evaluation in a way that discerns what has worked (we do not know what combination of program aspects (radio, newspaper, posters, in-person) worked to what extent. Ideally, we would thus estimate additional cost-effectiveness conditional on other measures and optimize for total cost-effectiveness (for example, we could find that when locals hear a show in a radio, it only takes a poster at the community center by the community leader to change behavior; that when volunteers operate in person, radio and newspaper has no significant additional impact; or that when radio, newspaper, and poster campaign is run, volunteers are received poorly due to the perception of ‘persistent advertisement’ of a ‘foreign’ measure).

Image credits

Soldiers in masks, Moki Edwin Kindzeka, VOA, March 07, 2021

CFA Francs exchange, Thierry Gouegnon PW/​SM /​Reuters, Al Jazeera, 12 Jul 2019

Persons outside, Vatican News, 25 September 2019

Dream team gears, Creativedge Training, 6 September 2014

Specialist generalist, Fizzle Co., Corbett Barr

2×10,000 XAF, Joël Té-Léssia Assoko, The Africa Report, 2 December 2020

10×10,000 XAF, René Nkowa, from douala with love, 12 March 2020

January 28, 2021, update:

The project has been run and follow-up survey data in most communities collected. We should update this post with impact evaluation.

September 21 update:

The Santa Division has been under lockdown for two weeks, since September 7. No cars or motorcycles are permitted to operate. The project will continue when the restrictions are lifted.

September 6 update:

EA Cameroon collected baseline data and is looking to start campaigning this week. If you are interested in working with us on baseline data analysis (Excel), please comment on this post or let Bara know via the EA Forum.

August 23 update:

The radio show in the seven (added one) locally-spoken languages...

… has been recorded.

We are waiting for the conclusion of baseline surveys to start broadcasting the show. Further project updates will follow.

August 14 update:

The funds were processed. We will update with baseline data and other project particulars once these are available.

August 7 update:

We are waiting for funds processing at the Cameroonian bank headquarters. We will update when the funds can be collected and the project can start.

July 25 update:

We (at least temporarily) stopped fundraising. Based on the raised amount USD 3,650 (after the GoFundMe 2.9% + $0.3/​transaction processing fee, including a USD 640 bank-transfer donation), we updated the tentative budget:

After one month, we will estimate the cost-effectiveness of the campaign and compare it to that of the DMI’s COVID-19 program. If the cost-effectiveness may be comparable, we will see if we can meet any remaining project needs with the remaining funds (USD 1,040, or 28% of the currently available amount), if we require further funding, or if campaign should be extended to other areas. If DMI’s program is more cost-effective, we will inquire funders of the remaining amount about further steps.

Currently, newspaper poster & flyer graphics are finalized, radio show transcript is almost finalized, detailed information about COVID-19 preventive measures for community leaders can be shared in its current form, and M&E baseline and midline questionnaires are drafted.

Feel free to comment on any of this material.

We are waiting for bank transfer processing. Ideally, we would like to start the program at the end of next week.

July 9 update:

The Development Media International’s COVID-19 prevention campaign (28:52) uses, marginally, about USD 0.017/​person informed. The cost per life saved is between $50 and $1,000 (31:55–32:20). In comparison, EA Cameroon’s cost is USD 0.0283/​person. However, EACAM adds personal delivery of informational flyers to local community leaders, workshops on making own masks, and newspaper articles. Also, if only some of the activities to inform the Santa community are selected, the cost/​person will decrease. Thus, donating to EA Cameroon for the COVID-19 prevention campaign may be the most cost-effective way to provide a quality life that is currently available.

Counterarguments: However, newspaper articles may already exist (as per EACAM, none on prevention), flyers may be too few (if shared in-person while talking with local community leaders, the flyers may be well regarded), and workshops may be better run via radio (it may be difficult to explain what piece of fabric to put where, videocalls are not possible because of very low smartphone/​computer use).

So,

deliberate carefully, potentially donate now

Use the GoFundMe link above or message brb243 if you wish to donate via a US or EU bank transfer or an international transfer to Cameroon.

--> Also, please, do let us know why you choose to support any parts of this project or to refrain from doing so. Also, please tell us if we can help even more cost-effectively. We can possibly make it happen.

Summary

EA Cameroon aims to inform 180,000 individuals in the Santa Division of Cameroon about COVID-19 and its prevention measures. Since virtually no prevention information has been shared so far, we aim to reduce new coronavirus cases 35×. For 4 months, we plan to run 3 talk shows in local languages per week, post one infographic article in local newspaper per week, distribute 1,000 flyers to local community leaders, and run 2 workshops on making own masks.

We have radio talk show experience, infographic writing skills, community connections, organizational expertise, and relevant linguistic knowledge. The only thing that is missing is funding.

We require USD 5,090 (USD 0.0283/​person) to manage all of these prevention measures. This includes all costs and overhead.

Please donate now via GoFundMe, or message brb243 for US and EU banking details. Let us know regarding any possible support (for particular activities or otherwise) or feedback in the comments below, at ea.cam@yahoo.com or call Alex at +237652263908. We will appreciate any prompt responses since in Cameroon, coronavirus cases are increasing at the second highest rate in Africa (after South Africa).

Project details

EA Cameroon plans to inform 180,000 individuals in the Santa Division of Cameroon about COVID-19 and its prevention measures. We aim to reduce new coronavirus cases 35× (https://​www.washingtonpost.com/​nation/​2020/​05/​15/​social-distancing-study-coronavirus-spread/​).

We (core EA Cameroon and trusted community volunteers) plan to manage these 4 activities for 4 months:

· Run 3 30-min radio talk shows per week in local dialects, Pidgin English, and English.

· Write weekly COVID-19 situation update and prevention reminders in local newspapers.

· In-person distribute 1,000 flyers to trusted village leaders while raising their awareness of COVID-19 and talking to them about effective prevention measures that they can share with their communities. We will trek to several communities because of poor conditions or the absence of roads.

· Run 2 workshops on making own masks while maximizing social distancing.

At the time of submission of this proposal, none of these four measures took place in the Santa Division. Social distancing has not increased: people are crowded in the markets, at local njangi (associations), shops, funerals, etc. Only one in five wears a mask. Further, citizens hesitate to trust government statistics on the disease.

Concurrently, COVID-19 cases in Cameroon are increasing at the second highest rate in Africa (after South Africa), with regards to daily surge. On July 6, 2020, Cameroon has confirmed 13,711 cases. The death toll from the virus rose to 328 after 22 more patients died in the last 24 hours. 11,114 patients are currently recovering. The Santa Division has confirmed 720 cases, 350 recoveries, and 28 deaths.

We propose to leverage existing human and information infrastructure resources to reverse the trends in the spread of COVID-19 in the Santa Division of Cameroon (villages Akum, Meforbe, Santa, Pinyin, Njong, Bamock, and Mbei).

Our Track Record

EA Cameroon comprises experts from various fields who are caring, loving, and aimed at doing good to humanity and the environment. Since 2017, we have been assisting the poorest members of the Santa Division’s rural communities to meet their various needs. With little available resources and extensive local knowledge, we maximize our operational cost-effectiveness, responding to the greatest and most neglected needs.

Relevantly to the proposed project, last month, we distributed 180 masks to people in 4 communities. Recipients are wearing them. Unfortunately, most persons had to be turned down because of the mask shortage. Thus, running workshops on making own masks from available materials may be more suitable in Santa.

In the past, we run radio talk shows on climate change, children’s rights, and gender equality. Our members speak many of the local dialects and can organize translation into languages that we do not speak. We will be delighted to share WHO Africa’s COVID-19 prevention recommendations with our friends who shall be happy to hear from us again.

Additionally, we can make COVID-19 prevention infographics for local newspapers, publishing them as ads. We can adjust these as flyers that we plan to bring to and talk about with village leaders that we meet through our connections.

Traditionally, we have relied on local sources and volunteer commitments to run our activities, building on existing community assets to improve the community life. However, the COVID-19 Awareness and Prevention project requires external support. Since other actors are not likely to step in at this point of the local coronavirus spread, or at all in remote villages, we offer a great opportunity for making cost-effective impact in COVID-19 prevention.

Other Team Members

[July 21, 2020 edit] In addition, Bara Hanzalova (brb243), an EA volunteer with 8 years of international development work and study experience, is supporting this project online.

[July 26, 2020 edit] Pim, an instructional designer, is working on the graphic design.

[August 7, 2020 edit] Malvya Chintakindi and Sayak Khatua of 3ie are consulting on impact evaluation.

Proposed budget

Contact details

E-mail: ea.cam@yahoo.com

Phone: +237652263908 (Alex Gwanvalla, EA Cameroon organizer)

Please contact us anytime (or comment below) with any collaboration offers or/​and feedback on our activities. We welcome any support, for particular measures or otherwise.