ROUND 7 COVID-19 IMPACT MONITORING OCT/NOV 2021 Publication Date BACKGROUND In June 2020, the Uganda Bureau of Statistics (UBOS), with the support from the World Bank, officially launched the High Frequency Phone Survey (HFPS) to track the impacts of the COVID-19 pandemic monthly for a period of 12 months. The survey aimed to recontact the entire sample of households that had been interviewed during the Uganda National Panel Survey (UNPS) 2019/20 round and that had phone numbers for at least one household member or a reference individual. UGANDA The first round (baseline) of the survey was conducted in June 2020 and interviewed 2,227 households. Subsequent six rounds attempted to reach the same households. Table 1 contains the number of households interviewed and the time of each round. This brief presents findings from the seventh round of the HFPS. Table 1. Number of completed interviews by round Round 1 Round 2 Round 3 Round 4 Round 5 Round 6 Round 7 (June 20) (Jul/Aug 20) (Sep/Oct 20) (Oct/Nov 20) (February 21) (Mar/Apr 21) (Oct/Nov 21) Number of competed interviews 2227 2199 2147 2136 2122 2100 1950 The timeline of the COVID-19 pandemic in Uganda includes the following key dates. On March 18-20, 2020 all mass gath- erings were suspended in Uganda and schools were closed. A National curfew was announced on March 30, 2020. Re- strictions were eased on May 26th, 2020 allowing private cars with only three people and general merchandise shops with strict social distancing. Vaccination campaigns began in March 2021. Uganda re -entered a partial lockdown starting on June 7th, 2021. The second lockdown was slightly longer than the first one, but less strict. A presidential directive banned travel between districts, restricted gatherings, and suspended schools. Figure 1 shows COVID -19 government response stringency index and the cumulative number of COVID -19 cases in the country since the beginning of 2020. The first and seventh rounds of the HFPS were conducted after the first and second lockdowns. 1 Figure 1. Stringency index and cumulative number of COVID -19 cases in Uganda from January 2020 to December 2021 Source: WHO, Oxford COVID-19 Government Response Tracker, Blavatnik School of Government, University of Oxford. Note: Stringency index varies from zero to 100 with higher values meaning more stringent government policies. KEY FINDINGS  The share of working respondents declined from 92 percent in March/April 2021 to 81 percent in October/November 2021. More than half of stoppages happened in the agriculture sector.  Closures of non-farm family businesses were small, but almost two -thirds of businesses reported less revenue com- pared to the previous round.  Severe and moderate food insecurity indices (FIES) sharply increased in October/November 2021, bouncing to rates higher than those tracked in June 2020 with almost half of household members being moderately insecure and 12 percent being severely food insecure.  Inability to access medicine among those who needed it increased from 14 percent in March/April 2021 to 55 per- cent in October/November 2021.  Access to any type of social assistance increased from four percent in March/April 2021 to 13 percent in October/ November 2021.  Overall participation in education/learning activities and school attendance decreased between April -November 2021 and remained very unequal. 1 Besides COVID-19 related restrictions, Uganda experienced droughts in most parts of the country in the first agricultural season of 2021 (March -May) negatively affecting germination, growth, and harvest of crops in particular cereals and legumes. © 2021 International Bank for Reconstruction and Development/The World Bank COVID-19 IMPACT MONITORING KNOWLEDGE AND BEHAVIORS RELATED TO COVID -19 More respondents started to follow preventive COVID-19 measures after the second lockdown introduced in the sum- mer of 2021. As shown in Figure 2, there was a gradual decline in several safe behaviors among respondents of the HFPS between June 2020 and February 2021. The declining trend slowed down after February 2021 and reversed, with more people practicing safe behaviors after March/April 2021. These behaviors coincided with the increasing number of COVID-19 cases and the second national lockdown introduced in June 2021. In particular, the share of respondents who reported more frequent handwashing with soap increased by 30 percentage points from 54 percent in March/April 2021 to 84 percent in October/November 2021. Similarly, more respondents avoided handshakes and groups of more than 10 people in October/November 2021 compared to March/April of the same year. Regarding regional differences, respond- ents in the Western region were more likely to follow preventive behavior and social distancing compared to residents of other regions (Figure 3). Figure 2. Prevalence of safe practices in the last week across rounds, Figure 3. Prevalence of safe practices in the last week in round 7 across (% of respondents) regions, (% of respondents) There was an increase in the share of respondents with false beliefs about COVID -19 in time. Respondents were asked to share their opinion about different myths and beliefs related to COVID -19 in the first and the seventh rounds of the HFPS (Figure 4). Figure 4. Share of respondents who thought that statements regarding COVID-19 were true Despite public awareness campaigns about COVID-19, compared to June 2020, even more respondents in Oc- tober/November 2021 believed in such false state- ments that Africans were immune to COVID -19 (19 per- cent), that COVID-19 did not affect children (21 per- cent) and that taking alcohol could make one immune to contracting the virus (18 percent). There was a four-time increase in the share of respond- ents who believed that local herbs can be used to treat patients with COVID-19 from 14 percent in April/May 2021 to 64 percent in October/November 2021. This was probably related to Uganda's approval of a locally made herbal treatment (COVIDEX and Covilyce -1) to be used as a supportive treatment. Despite false beliefs, the majority of respondents still agreed that vaccination was likely to reduce severity or casual- ties of COVID-19. About 77 percent of respondents agreed or strongly agreed with this statement. Lower agreement was observed among respondents living in the Eastern region (55 percent), among those without formal education (67 percent) and those below 25 years of age (72 percent). The highest agreement was observed among respondents from the Western region – 91 percent. 2 COVID-19 IMPACT MONITORING VACCINES AND COVID-19 TREATMENT About 24 percent of respondents indicated that they might have had COVID -19 (with or without a test) between Octo- ber 2020 and November 2021. Respondents in rounds five, six and seven were asked if since the last interview they believed to have or had had COVID-19 regardless of whether or not they had done a COVID -19 test. This gave an esti- mate of the share of respondents who potentially had COVID -19 by the end of the seventh round being infected be- tween October 2020 and November 2021. Overall, 24 percent of respondents potentially had COVID -19 during this peri- od. Residents from urban areas were more likely to report getting COVID -19 than those from rural areas (28 versus 22 percent). Substantial regional differences were observed as well. Thus, potential incidence of COVID -19 was about 18 percent in the Western region compared to 31 percent in the Eastern region. It is important to note that this indicator can be very different from administrative data since it covers only respondents to the survey and does not require re- sults from the test. In the seventh round, modern medicine was reported as the most trusted treatment method for COVID -19 among all respondents, while herbal medicine was more frequently used as actual treatment among those who thought they had COVID-19 in the seventh round. All respondents were asked about the most trusted treatment method for COVID -19 (Figure 5). About 73 percent of respondents viewed modern medicine as the most trusted, 20 percent selected herb- al medicine and the remaining 7 percent either did not know or did not trust anything. Figure 5. Most trusted treatment method for COVID-19, % of all respondents Respondents without education, from the poorest first and second pre -COVID consumption quintiles and above 65 years of age were less likely to view modern medicine as most trusted treatment. Inter- estingly, the actual treatment among those who believed to have COVID-19 was skewed toward herbal medicine. Thus, 63 percent of them reported using herbal medicine for actual treatment com- pared to 42 percent using modern medicine Figure 7. Respondents’ lack of knowledge about priority groups for Figure 6. Vaccination status, % of all respondents the vaccine established by the government, % of respondents who knew about vaccine availability in Uganda More than 30 percent of respondents received at least one shot of a COVID -19 vaccine, but there was still a large share of respondents who did not even know if priority groups for the vaccine were established. The share of respondents with at least one shot by November 2021 was higher than the proportion of adults (15+) reported officially by the Govern- ment of Uganda because respondents are typically the most informed and active members of households. Respondents from the Central and Western regions, from the wealthiest pre -COVID-10 consumption quintile, respondents with com- plete secondary education and from the age group 65 years and older were more likely to have had at least one shot by November 2021 (Figure 6). Despite this relatively high vaccination rate, about 15 percent of respondents did not know if priority groups were established for vaccine distribution (Figure 7). This lack of knowledge was the highest among re- spondents without education (26 percent) living in the Northern region (21 percent) and younger than 25 years old (13 percent). COVID-19 IMPACT MONITORING Radio and television were the main source of information about COVID -19 vaccines availability, with some differences across socio-economic groups and regions. Figure 8. Sources of information about availability of the COVID-19 vaccine Uganda, all respondents The far most popular sources of information about vaccines was the radio (72 percent), followed by tel- evision (32 percent), and then health care workers and local authorities (each at 27 percent of respond- ents) (Figure 8). Some important differences in sources were observed across rural and urban areas and regions. Thus, substantial shares of residents in urban areas (50 percent) and in the Central (47 per- cent) and Western (51 percent) regions obtained information from television. Local authorities and health workers played a very important role for re- spondents living in the Northern region. Neighbors and family were the second most frequently used sources in the Eastern region. Elderly respondents ages 65 years and older relied the most on radio to get information about vaccine availability, but also local authorities, family and neighbors. Note: multiple answers were allowed. ACCESS TO EDUCATION Following the suspension of schooling during the second lockdown, overall participation in education/learning activities and school attendance decreased between April -November 2021 and remained very unequal. Only 35 percent of chil- dren aged 3-18 years were engaged in any learning/education activities in October/Nov 2021 (Figure 9). This was six per- centage points lower than in March/April 2021. Partially, this decline in participation in any type of learning was related to being on holiday, as reported by 16 percent of children at the national level. Participation in education and learning activi- ties remained very unequal, with children in urban areas and from the wealthiest pre -COVID consumption quintiles having much higher chances to study compared to children in rural areas and from the poorest quintiles. Prior to the second lockdown, gradual re-opening of Figure 9. Share of children participating in any learning/education school increased the share of children attending school activities in round 6 and 7, % of children age 3-18 to 50 percent but with geographical disparities. Re- spondents were asked if their children ages 3-18 years old were attending school. The gradual re-opening of schools in early 2021 led to an increase in school attend- ance from 18 percent in March/April 2021 to 50 percent just before the second lockdown in June 2021. Although the share was increasing, it remained far below the pre - pandemic level, which was around 84 percent. School enrollment before the second lockdown was unequal across regions. The Central, Western and Eastern regions reported a share of enrollment above 50 percent when the Northern region reported results below 35 percent. Data also showed disparities across the poorest and the richest pre-COVID consumption quintiles but in a smaller magnitude (46 percent versus 53 percent, respectively). 4 COVID-19 IMPACT MONITORING Majority of respondents would agree to send their children to school if schools re -open. About 89 percent of respond- ents in October/November 2021 reported to agree to send their children to school if schools were open . There were not significant differences across socio -demographic status, but with significantly lower willingness to send children to school in the Northern region (69 percent). BASIC NEEDS The need and inability to access medicine and masks appeared to have increased from the previous round. Needs for medicine increased from 72 percent in March/April 2021 to 96 percent in October/November 2021. Inability to access medicine among those who needed it increased as well from 14 percent in March/April 2021 to 55 percent in October/ November 2021. The recent introduction of media campaigns promoting the use of COVID -19 management drugs and the increasing number of COVID-19 cases could potentially contribute to increased demand for medicine. This increased ina- bility to access medicine could also be partially related to protocols medical practitioners follow and share drugs only to those diagnosed with COVID-19. The second lockdown increased the need for respondents to access masks (Figure 11). It increased by 19 percentage points from 76 percent in March/April 2021 to 95 percent in October/November 2021. In- creased demand for masks was accompanied by a slightly lower access to them as five percent of household members were not able to access masks in October/November 2021 compared to one percent in March/April 2021. Figure 10. Need and access to medicine, (% of household members) Figure 11. Need and access to masks, (% of household members) EMPLOYMENT AND FAMILY BUSINESS Work stoppages in October/November 2021 reduced employment to the level below pre-March 2020, but not all stoppages were directly related to COVID -19 restrictions. The share of respondents working in October/November 2021 declined by 11 percentage points – from 92 percent in March/April 2021 to 81 percent in October/November 2021 (Figure 12). The magnitude of this decline was lower than observed in the first round of the HFPS after the first national lockdown when employment dropped by 16 percentage points. The distribution of work stoppages was different as well. Thus, work stoppages after the first lockdown were more prevalent in urban areas and among those working in services sector, while work stoppages after the second lockdown were universally distributed across areas and economic sectors (Figure 13). Figure 12. Working status of respondents across rounds, % of all respondents COVID-19 IMPACT MONITORING As a result, among all work stoppages in October/November 2021 about 54 occurred in agriculture sector, while in June 2020 more than half of all stoppages were happening in commerce and personal services sectors. The difference was also observed in reasons for work stoppages (Figure 14). About 89 percent of work stoppages reported in June 2020 were directly related to COVID -19 (business closed due to COVID-19 restrictions, being ill/quarantined, movement restrictions, rotation due to COVID-19, furlough and so forth), while about 62 percent were related to these reasons in October/ November 2021. This signals that work stoppages after the second lockdown were to a less extent related to COVID -19 restrictions compared to the first lockdown, were more universally distributed, and could be related to other reasons as well, for example seasonality. Figure 13. Work stoppages by residence and economic sector, % Figure 14. Reasons for work stoppages across rounds 1 and 7, % of respondents worked in previous rounds of respondents who stopped working Note: Only the same respondents across current and previous rounds are included in figure 13, while for figure 14 all respondents are included. Closures of non-farm family businesses were rather small in October/November 2021, but almost two -thirds of busi- nesses reported less revenue compared to the previous round. As shown in Figure 15, the share of households with open non-farm family business declined from 43 percent to 41 percent, reversing the positive trend observed in previous rounds. The magnitude of closures was much smaller than in June 2020 after the first lockdown. However, many operating businesses reported less revenues in October/November 2021 compared to the previous round (Figure 16). Thus, family business revenues were lower for 65 percent of households compared to revenues in March/April 2021. Revenue losses were particularly pronounced in businesses operating in the services sectors. Figure 15. Status of nonfarm family business in different rounds, Figure 16. Family non-farm businesses reporting less revenues % of households compared to previous round, % of households with business 6 COVID-19 IMPACT MONITORING SAFETY NETS & FOOD SECURITY The incidence of food and cash transfers increased in October/November 2021, after reaching its minimum level in round 6 of the HFPS conducted in March/April 2021. Figure 17 shows the share of households receiving social assistance by type of program. Overall, access to any type of social assistance increased from four percent in March/April 2021 to 13 percent in October/November 2021. This happened due to the increased reported incidence of food and cash transfers, which covered five percent and four percent of households in October/November 2021. The highest incidence of social assistance was observed in the Northern and Eastern regions. In -kind non-food aid was more prevalent in the Northern and Eastern regions, while cash transfers were more prevalent in the Western region. Figure 17. Incidence of social assistance programs across rounds, % of households Severe and moderate food insecurity indices (FIES) sharply increased in October/November 2021, bouncing to rates higher than those tracked in June 2020. Figure 18 reports the dynamics of the FIES indices across different rounds of the HFPS. After a sharp decrease in food insecurity between July/August 2020 and September/October 2020, the shares of moderate and food insecure households have been relatively steady until March/April 2021. Food insecurity increased dramatically in October/November 2021, with almost half of household members being moderately insecure and 12 per- cent being severely food insecure. Data from the first round of the HFPS is not directly comparable to other rounds as it inquired about adult household members, while other rounds focused on all household members. Figure 19 contains comparable FIES indicators for the first and seventh rounds of the HFPS across regions. Clearly, food insecurity in October/ November 2021 was higher than in June 2020, with much higher levels of food insecurity in the Western and Eastern re- gions. This worsening of the food security situation can be related to a second lockdown imposed in Uganda in June 2021, but also due to other factors such as poor weather conditions which affected the agriculture sector ’s performance. Figure 18. Evolution of severe and moderate composite FIES Figure 19. Evolution of severe and moderate composite FIES index across all rounds, % of household members index across regions for rounds 1 and 7, (% of adults) COVID-19 IMPACT MONITORING AGRICULTURE & LIVESTOCK COVID-19 related restrictions affected one -fifth of households who worked on land preparation or planning, which was slightly less compared to the impact of the first lockdown. Respondents were asked about planting activities con- ducted in the first agricultural season of 2020 (in round 1) and the first agricultural season of 2021 (in round 2). In both rounds, respondents demonstrated a similar involvement in farming activities (79 percent) and slightly different inci- dence of changes in planting activities due to the COVID -19 pandemic (25 percent versus 21 percent, respectively). Households were more likely to reduce the area planted and planted fewer number of crops in round 1, while in round 7 the most frequent changes included increasing and reducing the area planted (Figure 20). Figure 20. Types of changes due to COVID-19 following the first Figure 21. Places to sell agricultural products across last and second lockdown rounds, % of households who needed to sell Despite restrictions, the second lockdown did not have a negative impact on the respondent ’s ability to sell farm pro- duce. While 40 percent of respondents reported not being able to sell any products from farm in June 2020 (post first lockdown), only three percent of respondents reported the same in October/November 2021 after the second lockdown. COVID-19 related restrictions during the second lockdown seemed to have had less of a negative impact on the ability of respondents to sell agricultural produce than the restrictions implemented during the first lockdown. However, when questioned about their expectations in terms of sales compared to the pre -pandemic normal, respond- ents reported a downward trend across the last three rounds. Good or exceptionally good expectations remained at about 20 percent of respondents who normally sell agricultural products between March/April 2021 and October/ November 2021, while there was a slight increase of not good or very bad expectations over this same time period (Figure 22). It is important to note that, when disentangled by regions, reports showed that bad expectations are more frequent in the Northern and Eastern regions (54 and 44 percent respectively in October/November 2021), which could be related to limited market access or low level of commercialization (high level subsistence farming). Figure 22. Share of respondent’s expectations on agriculture results from sales across last rounds. % of households who normally sell agricultural products 8 COVID-19 IMPACT MONITORING Crops most frequently cultivated during the first agricultural season 2021 included maize, beans, cassava and sweet po- tato. Respondents were asked about the key three crops they cultivated during the first agricultural seasons in 2021. At the national level beans and maize accounted for 24 percent each of all cultivated crops followed by cassava (11 percent) and sweet potatoes (7 percent). Households in the Central and Western regions also planted bananas, while households in the Eastern and the Northern regions were more likely to grow cassava. Respondents were more likely to report selling farm production and livestock at the daily or weekly markets. About 44 percent of respondents reported selling farm production and livestock to daily and 29 percent to weekly markets demon- strating substantial increase compared to March/April 2021 (Figure 21). This could be related to adaptations by communi- ties to create spontaneous markets in villages less affected by the movement restrictions, but this requires more detailed information to be confirmed. Data Notes: the UGANDA COVID-19 High Frequency Phone Survey Seventh Round were im- plemented by the Uganda Bureau of Statistics (UBOS) in October-November 2021. This survey is part of a World Bank global effort to support countries in their data collection efforts to monitor the impact of COVID-19. A World Bank team from the Development Data Group and the Pov- erty and Equity Global Practice provided technical support. This survey is the seventh of a planned 12 waves of the COVID-19 High Frequency Phone Survey of households in Uganda. 2,421 successfully interview households from the 2019/20 Uganda National Panel Survey were contacted and 1,950 households in the Seventh Round were fully interviewed. These same house- holds were and will be contacted in all subsequent waves of the COVID-19 High Frequency Phone Survey. The data are representative at the regional and national level and survey weights were calculated to adjust for non-response and undercoverage. For further details on the data, visit https://www.worldbank.org/lsms-covid19