The COVID-19 pandemic has taken the lives of more than 3.5 million people globally. South Asia has become the epicenter of the pandemic. While face masks can slow the spread of the disease and save lives, getting people to consistently and properly wear masks has been a major public health challenge. However, a new model shown to normalize mask-wearing points to a scalable solution. IPA and a large coalition of partners have quickly mobilized to support government and non-government organizations. As of late May, the model is being scaled up to reach over 85 million people, with the potential to save many thousands of lives, but more support is needed to effectively reach all of those people and further expand the model.
To donate to the scale-up efforts, please go here.
What is the research behind the NORMalize mask-wearing model?
In mid-2020, IPA partnered with Yale Research Initiative on Innovation and Scale (Y-RISE), Stanford University Medical School, and a local Bangladesh-based organization called Green Voice to research various strategies – nearly 20 of them – to find ways to increase mask-wearing and evaluate the impact of masks on transmission rates. This research was funded by a grant directed by GiveWell from the Center for Effective Altruism. This was a very large-scale randomized evaluation that included 341,830 adults in 600 villages in rural Bangladesh. The size of the sample – which had to be very large to be able to measure seropositivity (those results forthcoming) – gave researchers the opportunity to also test a number of encouragement strategies to identify the precise combination needed to increase mask-wearing.
After careful piloting and then testing, we found that a four-part model tripled mask usage. Since the approach worked, they believe, by changing social norms around mask wearing – that is, making it go from odd to wear a mask, to odd to not wear a mask in public – they are calling the combination that worked N-O-R-M: No-cost free masks distribution, Offering information on mask-wearing, Reinforcement in-person and in public, and Modeling and endorsement by trusted leaders.
The impact and how to help
In early April, IPA and the research team, led by Mushfiq Mobarak of Yale, began inviting policymakers, funders, and organizations based in the U.S., Europe, and Asia to small dissemination events to share these findings and explore scaling opportunities. As interest increased, we developed an implementation toolkit, a plan for an urban adaptation, and monitoring plans to help ensure impact at scale and in new contexts.
Thanks to these efforts, BRAC, the largest non-governmental organization in the world, is scaling up the model nationwide to reach 81 million people in Bangladesh, beginning in early June (though they have a funding gap; read more below about how you can help). The city of Dhaka (the Dhaka North City Corporation) has also begun scaling the model.
In India, the Self-Employed Women’s Organization (SEWA) is scaling up the approach to 1-3 million people, and in Pakistan, the city of Lahore is starting a scale-up as well.
To help facilitate the scale-ups and inform potential implementers and funders, IPA has been developing a large number of resources, along with a large and growing team of collaborators from the Centre for Social and Behavioural Change at Ashoka University, the Gates Foundation, Givewell, the Inter-American Development Bank, J-PAL South Asia, faculty at the Lahore University of Management and Sciences, and local governments. These materials include a detailed implementation guide, costing information, and a cost-effectiveness analysis.
As of late May, several other coalitions were building to expand the model, while monitoring implementation, in other locations in Asia and Latin America. However, funding and technical gaps exist, and further support is needed to make these scale-ups a reality. High leverage opportunities to fill gaps in coalitions include the following:
- Procuring high-quality masks: some coalitions already have the staff needed to scale it up, but not enough masks. A small purchase of masks (which cost $0.05-$0.10 each) helps ensure the overall package is delivered.
- Monitoring support: other coalitions have all the pieces for the program but lack a small team to do safe, public observation of mask-wearing to confirm the program is working. In the original program, we found that data to quickly course correct was a critical component in rollout.
- Technical assistance for implementers: the teams at IPA, J-PAL, Yale, the Lahore University of Management Sciences (LUMS), and Stanford are all providing technical staff to support governments and organizations to deploy the model. These staff need to be complemented as we reach more coalitions.
- Urban adaptation of the model: the original study was implemented in rural areas, and while we think the mechanisms are similar, the precise activities will necessarily be different. To ensure the model is successfully adapted to urban areas, data should be gathered as it is scaled to adjust if necessary.
IPA is working to rapidly expand our network and foster connections to support scale-ups. If you have connections/resources to share or can offer support yourself, please complete this Google Form. If you would like to give financial support, you can donate here.