Coping with Covid by using Informal Institutions

Coping Through the Use of Informal Institutions during COVID-19 in South Africa, Nigeria, and Swaziland

Chapter 1: Introduction

The global outbreak of COVID-19 raises many concerns regarding how individuals and communities who live in African countries, with fragile health systems, cope with the pandemic. During past pandemics, individuals and communities in Africa have relied on customary practices and traditions, also commonly referred to as informal institutions (Moore, 2020). Informal institutions have continued to function in rural and poverty-stricken areas of Africa in response to a lack of adequate support from formal governing bodies and are primarily used at the community level (Azevedo, 2017). Thus, there is a plethora of literature on community participation in informal institutions within African communities; however, no known research has explored the experiences of individuals who use informal institutions to cope during a pandemic. This chapter begins with background information relevant to the topic, followed by a description of the problem and the significance of the study. Next, the conceptual framework, purpose statement, research questions, and rationale for the methodology are presented.

Background of the Study

From 1964 - 2000, nineteen armed conflicts took place in Africa (Sollenberg, 2001). Post-conflict Africa has been characterized by a breakdown in central governance and an increase in Western and international aid in an attempt to implement a democratic society, economic reform, and establish formal governance structures (Ogbaharya, 2008). Formal governance structures, also referred to as formal institutions, are most successful when they are complemented by informal support systems, such as social and customary practices (Ogbaharya, 2008). These practices have become known as informal institutions. Informal institutions are customary practices such as socially shared rules, usually unwritten that are created, communicated, and enforced outside of officially sanctioned channels (North, 1997). In Africa, the marginalized and socially isolated rely heavily on informal institutions to navigate daily life and cope during crises.

During health crises and environmental shocks, local communities in Africa and elsewhere in the developing work turn to their social networks and customary for sustenance and support. For example, due to the longstanding fight against communicable diseases such lung disease and tuberculosis, local communities in African countries have become quite familiar with social distancing and infection control (DW, 2020). They used these experiences to inform how they coped during pandemics. Notwithstanding the establishment of formal government structures in the colonial and post-colonial era, customary practices remain central to multifaceted aspects of rural livelihood in many parts of Africa. Customary authorities continue to command a level of local legitimacy and can elicit significant community participation in times of crisis (Azevedo, 2017). This is evident in the widely recognized term Ubuntu, the word used for humanity and communal life in sub-Saharan Africa.

Ubuntu is an ethical ideology that emphasizes the value of people\\\'s relations with, and allegiances towards each other. The Ubuntu principle is excellently manifested in the dictum \\\'I am because we are, and since we are, therefore, I am\\\' (Fagunwa, 2019). This ideology draws its origins from the southern African Xhosa and Zulu languages, and was accepted as a guiding ideal for the transition to majority rule in South Africa and Zimbabwe (then Southern Rhodesia). The interim Constitution of South Africa emphasizes the need for Ubuntu as opposed to victimization, and reparation as opposed to retaliation as the guiding principles for all South Africans in the transition from apartheid to majority rule.

Ubuntu ties to Africanism in several ways. The first is through local African languages. Etymologically, Ubuntu is an abstract word formed from the combination of the words\\\' ntu\\\' and \\\'Ubu\\\', the former of which is a common word used to refer to a human being in many Sub-Saharan African countries (Fagunwa, 2019). For instance, the word shares a strong relation with \\\'Muntu\\\', the word used to refer to a human being among the East African Bantu speaking people; \\\'bumutu\\\', in Botswana, \\\'vumuntu\\\' in Mozambique, \\\'umunthu\\\' in Malawi, and \\\'gimuntu\\\' in Angola (Fagunwa, 2019). Based on its link to humanism, the Ubuntu concept is largely associated with the art of being human, and using one\\\'s existence to contribute to the general welfare of others and the greater community (Fagunwa, 2019).

Besides language, the ethos of Ubuntu is also apparent in the cultures and traditions of most African societies (Fagunwa, 2019). The Oromo society of the modern-day Ethiopia aptly demonstrates this. The community operates a socio-political system of governance referred to as the Gada system, which operates like a democracy (Asmarom, 2001). Leaders are selected based on their popularity and generational grade/group – elders, and inclined to pursue sustainable development, intimacy, peace, and security (Fagunwa, 2019). Under this political system, leaders are chosen by the people and nurtured in the value system of unity, humanity, and togetherness such that they always protect the well-being of the people. This makes it impossible for a tyrannical leader to exist in an ideal Ubuntu framework (Fagunwa, 2019).

Tied to the very core of the African society, Ubuntu is a platform that connects Africans together in a value system that emphasizes people\\\'s interconnectedness and the need to act morally at all times for the protection of a common humanity. The Ubuntu logo is crafted to represent three individuals holding each other\\\'s hands to symbolize togetherness; its concept draws its basis from the African language, traditions, and beliefs, and is thus an expression of the very essence of being African (Fagunwa, 2019). The concept of Ubuntu aids in understanding how community participation empowers and increases the competence of citizens (Brager et al., 1987). By participating in governing of their societies, citizens can exert influence by voicing their opinions on issues and act for the good of the general public (Poovan et al., 2006).

Informal institutions attracted attention from scholars in the 1990s when the concept of social change gained popularity. While the Western world tested many social and community development initiatives, most failed because Western ideologies did not align with traditional informal institutions (Ostrom and Gibson et al., 2009). Nevertheless, since the late 1990s, many global development organizations, including the World Bank, have insisted on local participation to ensure that community and social development initiatives have a higher likelihood of success (Dongier et al. 2003). As a result, stakeholder participation is highly valued to ensure project sustainability; engaging the community not only ensures sustainability, but it can also help with or involve community empowerment and capacity building (Brett, 2003; Brager et al., 1987).

While research highlights the importance of community participation among the African people, little is known about individual-level experiences with informal institutions when coping during a pandemic. Further, much of the literature on this topic relevant to health crises has focused on how informal institutions have worsened health crises, mainly because of the lack of science-based information and the many myths used to explain \\\"western\\\" health issues the initial stages. For example, during the HIV/AIDS epidemic in Africa, many believed that the disease could be transmitted by touch, and many villages were burned in an attempt to eradicate the disease (Chirikure, 2020). Similarly, during the Ebola outbreak in West Africa, the reliance on informal institutions were found to lead to several adverse effects and further spread of the disease; the WHO reported that approximately 60% of Ebola cases in Guinea were attributed to traditional burial practices (WHO, 2014). Reasons for these adverse effects have been attributed to a complex social phenomenon characterized by various religious and cultural beliefs held by the African people (Manguvo & Mafuvadze, 2015). While this research had advanced our knowledge on the negative consequences of primarily relying on informal institutions in Africa, few researchers have studied the benefits of informal institutions to the African people during a health pandemic. This literature gap justifies the need for additional research on individual-level experiences with informal institutions during a pandemic in select African countries (Marsland, 2006; White, 2015; Worden 2012).

Problem Statement and Significance of the Study

In Africa, a high number of deaths due to COVID-19 were expected due to the fragile health system, lack of access to preventive measures, barriers to testing, and potentially vulnerable populations (Schwikowski, 2020). However, sub-Saharan Africa is the least affected region in the world, with 1.5% of the world\\\'s reported COVID-19 cases and 0.1% of the world\\\'s deaths (WHO, 2020). These statistics are expected to change drastically, given the predicted economic collapse as a result of COVID-19 (Hameed, 2020). The World Bank (2020) estimates that up to 60 million people living in Africa will be pushed into extreme poverty by the end of the year, which presents a multitude of crises across the African continent.

In the past, people living in African countries relied heavily on informal institutions to cope with pandemics (Moore, 2020) despite the availability of support offered by official governing bodies (i.e., formal institutions). While helpful for many, there are often gaps in care provided by formal institutions, particularly with underprivileged populations that are socially isolated and low-income (World Economic Forum, 2020). As a result, many Africans rely on informal institutions such as community groups and faith-based groups to navigate crises. Informal institutions are primarily used as a collective, meaning that communities and groups fill the gaps formal institutions do not. However, collectivism poses challenges due to the need for social distancing to slow or prevent the spread of disease, such as what is required during pandemics. Given that much of the research on informal institutions has focused on group-level participation (collectivism), it would be beneficial to understand the lived experience of coping through the use of informal institutions on an individual-level during the COVID-19 pandemic. Knowledge generated might contribute to the future role of informal institutions during pandemic and inform future health policy in Africa.

This topic is significant to individuals living in rural South Africa, Nigeria, and Swaziland because the COVID-19 pandemic is expected to result in high death rates and economic collapse in Africa, primarily rural Africa. Approximately 60% of the African continent\\\'s population resides in rural Africa and depend on informal institutions to cope and survive during crises (Starkey, M., 2015). Because informal institutions remain mostly unchanged in the African social landscape, it is essential to draw attention to those informal institutions that have a positive impact on the African people. While informal institutions should not replace formal government efforts, they are used widely among communities and cultural groups in Africa, primarily in the form of community participation. Given the need to socially distance during the COVID-19 pandemic, it is suspected that these informal institutions will need to be adapted to be used at the individual level. Understanding the individual-level experience of coping through the use of informal institutions during COVID-19 might uncover successful coping mechanisms that can be shared with individuals living in rural Africa, and inform collaborative partnerships between formal governing structures and community leaders. Conceptual Framework

According to Imenda (2014), \\\"the conceptual or theoretical framework is the soul of every research project\\\" (p. 185); it determines how researchers formulate their study problem, purpose, and questions, how they investigate the problem, and what meaning they ascribe to the collected data. Studies that use inductive logic (typically qualitative) construct conceptual frameworks and may use multiple theories to guide inquiry (Imenda, 2014). Regardless of the qualitative approach taken, the conceptual/theoretical framework represents \\\"the system of concepts, assumptions, expectations, beliefs, and theories that supports and informs your research\\\" (Maxwell, 2004, p. 33). It is a visual and or written product that describes how the researcher understands the phenomenon under study.

A conceptual framework was developed to inform this study based on W. Richard Scott\\\'s (2004) institutional theory and Robert Wunrthrow\\\'s (1975) interpretive theory. Scottt\\\'s (2004) institutional theory was chosen because it tends to seek a deeper understanding of social norms, it has an authoritative status, and can be used to determine whether these norms are merely imitation, or used only when necessary. Interpretive theory was chosen to build on the work of Robert Wuthow and his sociological study of culture, exploring the intricate interrelation of alternative approaches to cultural analyses and how it overlaps. Components of each theory were integrated into a conceptual framework to inform the proposed study (Figure 1). This section will describe each theory, primarily focusing on the components of the theory that were used to develop a conceptual framework for this study.

Figure 1.

Conceptual Framework: The Relationship between Components of Scott\\\'s (2004) Institutional Theory, Wunthrow\\\'s (1987) Interpretive Theory, and an Individual\\\'s Response to Crisis

Institutional Theory and Path Dependency

Institutional theory encompasses the processes by which structures, norms, daily life routines, communal and state rules, and individual habits and expectations become enshrined and institutionalized within a populace and serve to act, ultimately, as authoritative guidelines for social behavior (Scott, 2004). Institutional theory provides a suitable sociological lens for interpreting the findings of this study and exploring the experiences of individuals who live in parts of rural Africa and rely on customary authorities, a type of informal institution enforced as norms and networks rather than codified into formal, positive law (Scott, 2004). How individuals restructure and adapt existing informal institutions in times of crisis can also be explained through path dependency, an area of institutional theory (Rose, 1990; Mahoney, 2000; Pierson, 2000).

Institutional theory (Scott, 2004) is rooted in the social sciences, and early research on institutional theory began in the early nineteenth century. It was embedded within the positivism (sociology) and behaviorism (political science) movements (Scott, 2001). Since that time, institutional theory has become widely recognized and researched by social science scholars and organizational management scholars (Scott, 2004). For example, institutional theory has been applied in the study of authority systems (Dornbusch & Scott, 1975) and the effects of technology on classroom and school structure (Cohen et al., 1979). Path dependency and institutional theory have also been applied in the study of how individuals within international health agencies shape an institution\\\'s response to changes within and outside the organization (Gomez, 2013). Together, two theories complement each other in that they explain how individuals, as agents within an institution, can shape an institution\\\'s acceptance and resistance of change.

Early versions of institutional theory emphasized cultural-cognitive elements (Douglas, 1986; Zucker 1977), regulative elements (North, 1990), and normative elements (Parsons, 1990). The normative element represents the values and norms of a culture or institution and allows for the establishment of individual roles (Scott, 2008). The regulative element represents rule-setting, sanctioning, and monitoring activities of a culture or institution as part of an attempt to influence the future behavior of individuals (Scott, 2008). The cultural-cognitive element represents the \\\"shared conceptions that constitute the nature of social reality and creates the frames through which meaning is made\\\" (Scott, 2008, p. 67).

Scott (2004) focused primarily on the regulative and normative elements of the theory because he did not believe the three elements - cultural-cognitive, normative, and regulative - were always aligned and concluded that certain aspects undermined others. Scott (2004) also believed that during times of conflict or change, individual actors within institutions might experience competing rules or schemas, leading to a restructuring of the rules, norms, and beliefs that guide their actions. This belief is echoed in the earlier work of Barley (1986) who studied the response of individuals working in hospitals during the introduction of technology in the healthcare field. Two years later, DiMaggio (1988) purported that an individual\\\'s agency, or ability to adapt based on their situation, supported a \\\"bottom-up\\\" view of institutional models. With this view, social scientists began considering how individuals responded in varying ways to outside forces and did not always behave according to institutional beliefs and standards.

Path dependency explains how an individual\\\'s cognitive beliefs and prior experiences shape institutions\\\' response to change. An individual\\\'s cognitive beliefs can constrain the legitimacy and learning of an institution. Legitimacy of the institution is constrained because people often consider existing approaches to be the most legitimate and therefore favor these approaches over new approaches. In addition, when individuals spend time learning a new approach through experience, and as they acquire more knowledge and experience about an approach, they become resistant to learning new approaches. Furthermore, as time passes, individuals within an institution pass on knowledge to others and new members, which makes it all the more challenging for the institution and the individual\\\'s within it to adopt and learn new approaches (Gomez, 2013).

Interpretive Theory

Robert Wunthrow\\\'s (1987) interpretive theory will complement institutional theory. Interpretive theory can be traced back to the seminal works of Max Weber (1864-1920). The interpretive approach is a general category of philosophy, including symbolic interactionism, labeling, ethnomethodology, phenomenological sociology, and the social construction of reality. The interpretive method is more accepting of free will and sees human behavior as the outcome of the subjective interpretation of the environment. Wunthrow (1975) expanded on Weber\\\'s work in his seminal text Meaning and Moral Order: Explorations in Cultural Analysis. Wunthrow argued that the study of culture had been ill-served by a subjective orientation that reduces cultural objects to individual beliefs and meanings. He also discussed the issues surrounding cultural analysis, including the problem of meaning, the nature of moral order, the character and role of ritual, the role of ideology, and the function of the state in producing ideology (Wunthrow, 1975).

Seeking an alternative approach, Wuthrow (1987) identified four theoretical schools that inform the work of social scientists—subjectivity, the structural, the dramaturgic, and the institutional—and examined the methodological implications of employing each of them. The subjective school encompasses an individual\\\'s beliefs, attitudes, opinions, values, ideas, moods, goals, outlook, anxieties, interpreting reality, and commitment. The structural school encompasses orderly relations, rules, coherence, identity, distinction, and symbolic boundaries. The dramaturgical approach includes the expressive dimension, which includes an individual\\\'s communicative properties and interactions with others—the institutional school encompasses organizations as actors.

This study will primarily focus on the subjective component of Wunthrow\\\'s (1987) framework, as this study seeks to explore the experience of coping through the use of informal institutions at the individual level. Because beliefs and customary practices to combat illness are rooted in culture, which necessitates the involvement and commitment of the individual, and are not necessarily solely controlled or optimized by groups or institutions. Therefore, Wunthrow\\\'s (1975) framework is useful because it has both cultural and material consequences. On the one hand, there are apparent social, economic, and financial consequences that result from individual health issues when many people in the community are ill or are at risk of becoming ill. Formal and informal institutions must react accordingly and appropriately; however, the individual underpins both. Through the application of interpretive theory, the researcher will focus on the subjective perspective to highlight the importance of the individual in relationship to the community, as well as the individual\\\'s reliance on informal institutions.

Relationship between Theoretical Constructs

As shown earlier in Figure 1, each of these components influences an individual\\\'s action and coping behaviors during a crisis. With the application of these two frameworks, it can be inferred that an individual\\\'s decision-making process during a pandemic is influenced by four perspectives (i.e., the normative, culture-cognitive, regulatory, and subjective perspectives) and how the individuals\\\' cognitive beliefs and prior experiences may prevent appropriate responses to change. The normative perspective influences the extent to which one perceives their government as capable or just. From the perspective of an individual living in rural Africa who is often a victim of continued unpunished corruption by governing bodies, there is often a perception of less responsive leadership (Bratton, 2010). Consequently, individuals expect little, if any, assistance from the government during a time of crises, such as a pandemic.

The culture-cognitive perspective influences the social networks and identities within which an individual aligns and how these influence their decision-making (Linden, 2015). Based on the culture-cognition perspective, an individual\\\'s decision-making is influenced by their worldview. With the perceptions of government underperformance, the African individual derives most of their support from their social networks. As such, they make decisions based on the position(s) held by those with whom they share essential ties (Linden, 2015).

The regulatory perspective captures the effectiveness of sanctions available to cushion individuals against institutional failure. The court system, which is meant to regulate the functioning of formal institutions, often lacks independence (Amoako, 2018). Consequently, individuals have little confidence in the effectiveness of the formal regulatory system and its ability to ensure accountability in formal institutions. Sanctions governing informal institutions include shaming, boycotting, ostracism, shunning, gossip, internalized norms adherence (standard operating procedures), self-enforcement obligation mechanisms, and use of violence. These sanctions have little support in law and are, consequently, highly ineffective (Amoako, 2018). Thus, those who live in rural African often have low confidence in their ability to regulate and ensure ethical compliance by informal institutions. Finally, the subjective perspective involves an individual\\\'s needs, feelings, and attitudes, and how these influence their decision-making during crises. Finally, path dependency explains how these perspectives intersect with an individual\\\'s cognitive beliefs and prior experiences with an institution to inform their future actions and coping behaviors.

Action and Related Outcomes

In the absence of government service delivery and being disconnected from communal programs, individuals who live in rural African during a crisis, such as a pandemic, utilize informal institutions at the individual level as a coping strategy. For instance, due to a lack of access to government-provided healthcare and a lack of funds to seek private healthcare, an individual might choose to use herbs and customary medicine practices. Further, with the loss of employment and lack of supportive support programs, the city dweller, unable to raise house rent, disposes of their property and returns to rural areas.

One of the resultant outcomes of this action is an increased level of coping; the challenges the individual faces during the crisis and the fact that they have to cope without participating within a community helps them build resilience to deal with future pandemics. The individual also develops an increased level of adapting as they are forced to create innovative ways to survive based on age-old customs. For instance, they learn to plant food and prepare medicinal herbs as opposed to relying on prescribed drugs, hence increasing self-sufficiency and self-development. Finally, the individual restructures the norms and rules they previously held to align with the reality posed by the crisis.

Definition of Key Theoretical Concepts

Concept

Meaning/Definition

Subjective school

Encompasses an individual\\\'s beliefs, attitudes, opinions, values, ideas, moods, goals, outlook, anxieties, interpreting reality, and commitment.

Structural school

Encompasses orderly relations, rules, coherence, identity, distinction, and symbolic boundaries

Dramaturgical approach

Includes the expressive dimension, which consists of an individual\\\'s communicative properties and interactions with others

Institutional school

Encompasses organizations as actors

Normative element

Represents the values and norms of a culture or institution and allows for the establishment of individual roles (Scott, 2008)

Regulative element

Represents the values and norms of a culture or institution and allows for establishing individual roles (Scott, 2008).

Cultural-cognitive element

Represents the \\\"shared conceptions that constitute the nature of social reality and creates the frames through which meaning is made\\\" (Scott, 2008, p. 67)

Purpose of the Study and Research Questions

The purpose of this interpretative phenomenological analysis is to understand the coping behaviors of individuals living in rural South Africa, Nigeria, and Swaziland and who engage with informal institutions to cope during the COVID-19 pandemic. Informal institutions include but are not limited to religious organizations, community groups, community functions, social practices, etc. In Africa, customary practices in institutions are often preferred over scientific methods for fighting the spread of disease during pandemics (Manguvo & Mafuvdaze, 2015). Informal institutions are adopted at the community level, which is particularly challenging during the COVID-19 pandemic due to the need for social distancing. It would be beneficial to understand this phenomenon at the individual level, as it might provide additional insights to inform the development of awareness campaigns and other relevant measures to help individuals who might not be able to rely on traditional community practices during a pandemic. Therefore, the following research questions will guide this interpretative phenomenological analysis:

RQ1: How do individuals living in rural Africa use informal institutions to cope with the COVID-19 pandemic?

Rationale for Methodology

This study will employ a qualitative approach using an interpretative phenomenological analysis (IPA hereafter) research design to explore the lived experience of coping through the use of informal institutions at the individual-level during the COVID-19 pandemic. A qualitative approach is appropriate when a researcher aims to explore and understand, as opposed to confirm and explain, a problem (Creswell & Poth, 2018). There are several common characteristics of qualitative research: multiple data collection methods, natural setting, the researcher as a key data collection instrument, inductive and deductive logic which aids in complex reasoning, various perspectives and meanings held by participants, an emergent design, a holistic approach (Creswell & Poth, 2018). These characteristics, coupled with the fact that qualitative research methodology focuses on how people understand experiences, make this methodology appropriate for the phenomenon under study.

An interpretative phenomenological analysis design was chosen because it will allow the researcher to explore how individuals living in rural Africa make sense of their experiences using informal institutions to cope with the COVID-19 pandemic. An interpretative phenomenological analysis is appropriate for researchers who seek to explore and interpret the human experience with a phenomenon (Smith, 1996). Phenomenological researchers ascribe to the belief that reality is subjective and based on the subjective realities of individuals (Smith, 1996). An interpretative approach, as opposed to a descriptive approach, was chosen because it aligns with the researcher\\\'s premise that the human experience cannot be understood without interpretation, whereas descriptive phenomenologists believe that the human experience can be understood by bracketing biases and judgment (Smith et al., 2009). The process of interpreting the human experience is achieved through the hermeneutic process, or the process of exploring and making sense of the individual\\\'s experiences through the researcher\\\'s perceptions (Smith & Osborn, 2007). As a result, the researcher can understand the first-person (participant) perspective from their third-person position (Larkin et al., 2011). Given the researcher\\\'s personal experiences with informal institutions, while living in Africa, this approach is appropriate because it will allow the researcher to interpret individual experiences through their own experientially formed lens (Smith et al., 2009).

Overview of Data Collection Procedures

A total of nine to twelve participants will be purposefully recruited, among these three to four will be recruited from each of the three counties under study: South Africa, Nigeria, and Swaziland. According to Smith et al. (2009), this is an ideal sample size because IPA research requires a small sample with similar experiences in order for the researcher to capture in-depth details about each individual\\\'s lived experience. The researcher will use a key informant in each country based on their personal network to gain access and recruit participants. Prior to participating in the study, individuals will be asked to complete a brief screening questionnaire via Qualtrics to confirm eligibility. To be included in the study, participants must be at least 18 years of age, native to the country under study, and a current resident. An interpreter will not be needed, as the researcher is fluent in the languages spoken in the countries under study.

Each individual will participate in two semi-structured interviews, with the option of a third interview. Seidman\\\'s (2006) three-interview series will be modified to guide the interview process. The purpose of the first interview will be to develop rapport with the participants and capture in-depth, context-specific information to aid in the development of participant profiles. The purpose of the second interview will be to collect data specific to the study\\\'s research questions. The purpose of the optional third interview is to allow for the opportunity for the researcher to ask follow-up questions if the depth of information needed is not collected during the first and second interviews.

An interview protocol will be developed prior to conducting the first and second interviews; however, the protocol will be modified, if needed, based on participant responses. This is in alignment with the emergent feature of qualitative research. Interviews will last approximately 60-90 minutes and will take place via Zoom at a time of the participant\\\'s choosing. The recording feature on the Zoom platform will be used to record interviews. The number of interview questions will vary, but will generally consist of six to ten open-ended questions including appropriate prompts (Smith et al., 2009).

Audio recordings will be professionally transcribed via Rev.com. Data analysis will follow Smith et al. \\\'s (2009) six-step data analysis process: (1) Reading and re-reading; (2) Initial noting; (3) Developing emergent themes; (4) Searching for connections across emergent themes; (5) Moving to the next case; and (6) Looking for patterns across cases. Steps 1–4 will be repeated for each participants interview.

Definition of the Terms

Term

Definition

Coping

Defined by VandenBos (2007, p.232) as the utilization of behavioral and cognitive strategies for managing the demands of a specific situation when these are assessed as taxing or surpassing one\\\'s resources or to diminish the conflict and negative emotions induced by stress (as cited in Barnett, C.L. Miller-Perrin, and R.D. Perrin, 2010, p.373).

Community participation

A notion in international development discourse refers to residents\\\' engagement in decision-making processes and the assessment of development projects. It is also associated with empowerment and the use of and respect for local knowledge. Still, the concept appears broader as it is believed to involve such a social practice as cost-sharing (Marsland, 2006, pp.67-68).

Cost-sharing

According to Smith and Rawal (1992), it was a practice employed in different African states like Tanzania and aimed at reducing government spending and stimulate self-reliance

Customary practices

Long-established practices inherited from the past are accepted, respected, and even considered the unwritten law by the members of a community. There are many different customs in Africa, some being positive and others negative ones (Handler, 2016 and Himonga, 2016). Customary practices can also be understood to fall under the category of social practices.

Social practices

Ghose et al. (2015, pp.37-38) defined as routine practices habitually or typically performed in (much of) a society; the reason is that a variety of society members implements long-established practices

Social capital

The factors of effectively functioning social groups, such as reciprocity, cooperation, trust, shared values, shared norms, a shared understanding, a shared sense of identity, and interpersonal relations (Yama & Salvano-Pardieu, 2019, p.170)

Chapter 2: Literature Review

The COVID-19 pandemic poses a significant threat to indigenous people and rural livelihoods with limited access to public health provision in Africa and elsewhere. Indigenous people are especially vulnerable to COVID-19, as they are at higher risk for communicable diseases and experience higher rates of mortality (Lane, 2020). Contributing factors to this increased vulnerability include limited access to clean water, sanitation, malnutrition, and medical care (Lane, 2020). For example, early reports out of Kenya indicate in the village of Maasai, which is home to more than a million indigenous people, livestock markets have closed leading to food shortages and loss of income for many (Wight, 2020). Further, many communities rely on elders for cultural knowledge and practices; because COVID-19 is deadly for older adults, elders are at high risk for death (Lane, 2020). There are numerous other examples of informal traditions that cannot be relied on during the COVID-19 pandemic, forcing individuals to adapt their coping behaviors.

This literature review begins with an overview of Africa\\\'s post-conflict history in order to set the stage for how formal institutions were established during health crises in Africa. Next, a description of the formal institutions established in South Africa, Nigeria, and Swaziland in response to the Ebola, Tuberculosis, and HIV/AIDS epidemics will be presented. Following is an in-depth description and analysis of informal institutions in each of the three countries under study. The chapter ends with an analysis of institutional theory and how it has been applied in the study of health pandemics in rural Africa.

Overview of Africa\\\'s Post-Conflict History

Centuries before missionaries and colonialists arrived in Africa and before the slave trade commenced, Africans relied heavily on cultural and social practices, and mechanisms, to alleviate the loss of lives and prevent the spread of diseases (Iganus & Haruna, 2017). Most customary practices were initiated after elders or senior members of African societies met and discussed crises and suggested ways to cope based on historical knowledge and experience (Iganus & Haruna, 2017). In Ghana, for instance, the lack of recognizing and integrating informal institutions into formal government structures resulted in the \\\"silent conflict\\\" among the wealthier demographic, who favor government funded support systems (formal institutions), over the lower-income and socially isolated demographic, who heavily rely on customary practices to navigate crises (Lozare, 1994). More importantly, conflicts between tribes have continued to negatively affect long after the actual conflict, as tensions and suspicions continue to linger. This suspicion and tension have a major effect on how these tribes respond to health crises, requiring a harmonious and universal response protocol. This section contains a brief overview of Africa\\\'s post-conflict history with a specific focus on formal and informal institutions that arose following conflict in South Africa, Nigeria, as these are the proposed research sites for the study. Swaziland will also be included as a research site, however, there is little to no literature on their post conflict history.

South Africa\\\'s Anti-Apartheid Struggle

The Anti-Apartheid struggle between 1912 and 1992 was led by the African National Congress to oppose the Apartheid system and its oppression of the majority non-white South Africans (Kurtz, 2009). The minority white South Africans (Afrikaners) used the Apartheid system to monopolize control of the economy and state, and excluded the majority non-whites from political and economic power. The immediate effect of the conflict was an attempt by the Afrikaners to intimidate the non-whites by forcibly ejecting them from their homes and relocating them to segregated neighborhoods, banning leaders of the revolt from public life, and imposing martial law. Informal and formal organizations of governance emerged as a result of the conflict. Informal organizations that arose include political parties such as the ANC and United Democratic Front; trade unions such as the Congress of South African Trade Unions (COSATU); and religious organizations such as the South African Council of Churches[footnoteRef:1]. These informal institutions were used primarily to drive the agenda of non-white South Africans. Formal institutions to aid in governance were also established, including alternative community-based institutions such as legal resource centers, community clinics, and cooperatives that eventually replaced the traditional government institutions at the community level (Kurtz, 2009). [1: During the Struggle for independence, churches, and in particular the Black South African Church was largely informal, and only operational in the informal settlements occupied by Black South African people.]

Biafran War in Nigeria

The Nigerian Civil War began in July 1967 and ended in January 1970 after diplomatic efforts failed to bring peace between the Christian Igbos and Muslim Hausas in northern Nigeria. Biafra, comprising mainly of Igbo Christians, seceded from Nigeria under Colonel Odumegwu Ojukwu (Heerten, 2017). However, Nigeria capitalized on its military strength to reduce Biafra\\\'s territory. Consequently, the state lost its oil fields, which were its primary revenue source, to Nigeria leading to a lack of funds to import food supplies (Heerten, 2017). As a result, millions of Biafra citizens starved to death. The war was characterized by the development of several formal and informal institutions. Formal institutions that arose sought to strengthen the Biafran army and included an advisory committee to advise the head of state on military and political matters, a Food Directorate for coordinating the importation and supply of food items, a transport directorate to coordinate logistics, and a petroleum management board to coordinate the management of fuels and petroleum, oil, and lubricant laboratories (Heerten, 2017). Informal organizations that arose included a voluntary women service to educate women on the crisis and train them on the rehabilitation of casualties of war, as well as civil defense corporations, orphanages, and nurseries (Heerten, 2017).

The Use of Formal Institutions during Health Crises

The onset and spread of TB, Ebola, and HIV/AIDS in South Africa, Nigeria, and Swaziland has resulted in the establishment of numerous formal institutions. While these formal institutions have benefited many African communities, there are also significant limitations. Commonly cited limitations include inadequate supportive supervision and leadership, competing political ideologies, lack of funding, and poor support infrastructure. These limitations impede the effectiveness of formal institutions for rural African communities, particularly during health crises. It is imperative to review and understand the formal institutions that were established during health crises and their limitations to fully comprehend the need for informal institutions in rural African communities.

South Africa\\\'s Response to Tuberculosis (Mhlongo-Sigwebela, 2010)

Governing bodies in South Africa established five key formal institutions to aid in the management of tuberculosis (TB), which affected 649 South Africans per 100,000 people by 2007. The first, the National Department of Health, was established to improve healthcare delivery through improved access, equity, efficiency, and sustainability. In response to TB, in 1995, the Directly Observed Treatment Short Course (DOTS) strategy was implemented by the National Department of Health to provide free TB diagnosis and treatment in a bid to increase access to care. Five years later, Parliament established the National Health Laboratory Service to coordinate the provision of public sector laboratory services by conducting research on new testing methods and developing new technologies for diagnoses. The fourth formal institution established in response to the TB epidemic is the South African National TB Control Program, which works collaboratively with other stakeholders to integrate TB treatment with HIV, and coordinate community-based strategies for influencing patients to seek and adhere to TB treatment. Finally, the USAID Technical Assistance and Support Project (TASC II TB) was established, which partners with academic research institutions to support local health authorities in improving the management of TB support systems as well as increasing the quality, availability, and demand for TB services.

Limitations of Response in South Africa

Despite the establishment of formal institutions in the fight against TB and their benefits to African communities, there are also a number of limitations associated with South Africa\\\'s response to TB that hindered their effectiveness and reach. A notable limitation of formal institutions in South Africa is poor stewardship at the policy level and inadequate supportive supervision at the implementation level (Coovadia et al., 2013). This primarily affects the National Department of Health, which is known for developing promising policies but lacks proper leadership to ensure policies are adequately implemented throughout the system (Coovadia et al., 2013). As such, most of these policies rarely reach people who need them. For instance, the failure of the national tuberculosis control program in ensuring treatment completion by TB patients has been attributed to a lack of accountability for performance and managerial oversight (Coovadia et al., 2013).

Human resource limitations, particularly in the rural areas, have also hindered the ability of the National TB Control Program to use local healthcare facilities and personnel to help patients at the community-level seek and adhere to treatment (Coovadia et al., 2013). Consequently, TB cure rates have been significantly low in rural areas. Data released in 2007, indicates that cure rates were 80 percent in Western Cape Province as compared to the rural Kwa-Zulu Natal, where most districts reported cure rates of between 40 and 50 percent (Coovadia et al., 2013).

Inadequate funding is another fundamental major limitation, as the availability of funding depends, to a significant extent, on political ideology. For instance, the TB control program\\\'s funding between 1998 and 2005 was significantly low, as then-president Thabo Mbeki and his health ministers held a bizarre belief that HIV did not cause AIDS and, thus, there was no need to commit resources toward the prevention and treatment of HIV/AIDS (Coovadia et al., 2013). This led to a stagnation of national responses towards HIV and TB, causing a considerable burden of ill health (Coovadia et al., 2013).

Nigeria\\\'s Response to Ebola and Tuberculosis

Nigeria, the most populous African state, has benefited from investment and development, as well experienced changes in formal health care approaches to reflect modern universal trends (Shuaib et al., 2014). As a result, Nigeria was able stop the spread of Ebola. Ebola first appeared in Nigeria following the 2014 outbreak that began in West Africa and spread throughout the neighboring state of Guinea. From Guinea, Ebola spread to Liberia and when a traveler from Liberia traveled through the Lagos Airport, the pandemic reached the state of Nigeria. Through contact tracing, Nigerian health authorities were able to identify 72 individuals who were potentially exposed (Shuaib et al., 2014, p. 867). This action on behalf of the Federal Ministry of Health, which was overseen by the Nigeria Centre for Disease Control, led to the swift containment of Ebola. This formal institution has been modeled after the CDC in the United States. Because Nigeria had prior experience with disease outbreaks in the past, its national public institution was ready to respond to the Ebola outbreak (Shuaib et al., 2014). This is but one example of how a formal health institution in Africa has emerged to battle health problems. However, many informal health institutions in Africa have developed as a result of economic disparities that prevent more destitute and impoverished populations from seeking care at formal institutions like this one in Nigeria (Nelissen et al., 2020).

Nigeria also faces a significant TB health burden and is among the 30 high TB burden countries in the world (Ogbuabor & Onwujekwe, 2019). To minimize the risk posed by TB, Nigerian agencies have developed several formal institutions. In 1993, the Federal Ministry of Health adopted the DOTS strategy to enhance case detection by sputum microscopy, improve short-course treatment, and increase TB notification (Ogbuabor & Onwujekwe, 2019). To complement DOTS, the ministry also adopted the Stop TB Partnership, which focuses on addressing the needs of the population concerning multidrug resistant TB and the TB-HIV (Ogbuabor & Onwujekwe, 2019). These strategies have been geared at implementing universal health coverage and providing support to enhance access, treatment, and control of TB. Another crucial formal institution is the National TB Control Program under the federal ministry. The Program\\\'s primary duty is to provide TB and TB-HIV services and conduct operational research to inform government policy concerning TB and HIV (Ogbuabor & Onwujekwe, 2019). The third crucial formal institution for TB management is the national strategic plan for TB Control, which provides policy directions and serves as a basis upon which TB-related legislation is enacted and budgets developed to enhance treatment and access (Ogbuabor & Onwujekwe, 2019).

Limitations of Response

Lack of government commitment and goodwill has emerged as a fundamental limitation of formal institutions in Nigeria. For instance, despite having a strategic TB plan, the country lacks TB-specific legislation, making the integration of TB control into the community a challenge (Ogbuabor & Onwujekwe, 2019). The National TB Control Program is tasked with conducting operational research to inform government policy regarding TB and HIV. However, reports indicate that the program\\\'s effectiveness is hindered by human resource limitations and old delivery systems that make policy-implementation at the community level difficult (Ogbuabor & Onwujekwe, 2019).

Poor leadership within the National TB Control Program has also emerged as a severe limitation to the program\\\'s effectiveness. The program has a clear reporting structure, an electronic data management system, and proper surveillance strategies. However, the lack of stewardship has resulted in ineffective monitoring and supervision, ultimately leading to poor implementation of policies at the primary level (Ogbuabor & Onwujekwe, 2019).

Funding limitations are evident in Nigeria as in other African countries – the National TB Control Program, for instance, relies primarily on the Global Fund and, is at times, forced to scale down its operations due to funding limitations. In 2019, for example, the program was forced to scale down health product buffer levels for its drug-resistant TB (DR-TB) program due to funding limitations (Garmaise, 2018). Such adjustments present a risk for treatment disruptions, which may have severe consequences for the health of the population.

Swaziland\\\'s Response to HIV/AIDS

In response to its HIV/AIDS epidemic, Swaziland established several formal institutions. One of the most fundamental institutions is the National Strategic Plan for HIV/AIDS, which primarily serves to inform policy, identify objectives and milestones with HIV/AIDS, and provide the basis for budgeting and HIV-related legislation. The HIV Crisis Management and Technical Committee is the highest body with the authority to coordinate the national HIV response (HIV Crisis Management and Technical Committee, 2000). Comprised of experts drawn from government, donor agencies, traditional healers, media, churches, the private sector, and NGOs, the Committee is tasked with the implementation of the HIV strategic plan, mobilization of resources and social services, monitoring community-based management programs, raising awareness on HIV/AIDS, and reviewing the prevalence of HIV annual statistics in a bid to assess progress (HIV Crisis Management and Technical Committee, 2000). The Ministry of Health and social welfare also plays a vital role in the development of policy and initiatives relating to care for the infected and those affected, including raising awareness on the causes and risk factors for HIV, as well as the consequences at the individual level (HIV Crisis Management and Technical Committee, 2000). Of crucial importance is also the U.S. government\\\'s President\\\'s Emergency Plan for AIDS Relief Program, whose primary role is to ease the disease burden in Swaziland and South Africa through the provision of ARVs.

Limitations of Response

A report by the U.S. President\\\'s Emergency Plan for AIDS Relief Program (PEPFAR) indicates that one limitation it faces in Swaziland is inadequate road systems and poor internet connectivity, which affect the ability of partners in different geographical locations to network and collaborate (PEPFAR, 2019). The program also reported a lack of skilled personnel in the field and unreliable baseline data, which limits the ability to adequately track program implementation and assess outcomes (PEPFAR, 2019). In addition, funding challenges pose a considerable challenge to the HIV Crisis Management and Technical Committee, as the Committee depends on the Global Fund. The overdependence on the Global Fund implies that the Committee has to adjust its purchase and planned programs in situations where the Global Fund\\\'s donation streams are affected by uncontrollable events.

Informal Institutions in South Africa, Nigeria, and Swaziland

Various informal institutions exist within African communities. These informal institutions are primarily used at the community level through community participation. Community participation is an essential element of African communities and is characterized by various social methods and involves various social capital factors (Marsland, 2006). In times of crises, community participation is expected in African communities, but not all community care provisions have been successful (Shuaib et al., 2014). Non-governmental organizations (NGOs), community health workers, traditional healers, chiefs and local community elders, and faith-based organizations are all examples of informal institutions that are engaged at the community level in responses to health crises.

The United Nations recently released a report with recommendations for how formal institutions engage and collaborate with indigenous people during the COVID-19 pandemic. They recommended that governments: include community leaders and traditional authorities to oversee official response to the COVID-19 pandemic; involve indigenous women when making decisions related to social distancing and lockdowns; provide technology and assistance for remote learning and support indigenous communities\\\' educational initiatives; respect their right to remain in voluntary isolation; provide post-COVID funds to help rebuild resources. A number of other recommendations were made for NGOs and private sector organizations to ensure indigenous people are protected and supported (\\\"Indigenous Peoples & the COVID-19 Pandemic: Considerations\\\", 2020). Despite these recommendations, cases of COVID-19 are growing in Africa. Thus, it is critical to gain a better understanding of how remote and rural communities have responded to prior health crises to cope. This literature strand includes an in-depth examination of informal institutions that exist across African including an analysis of literature regarding the informal institutions that were developed as South Africa, Nigeria, and Swaziland responded to the TB, Ebola, and HIV/AIDS epidemics, respectively.

South Africa

Multiple distinct informal institutions were engaged at the community level to help South African communities cope during past pandemics. For instance, in response to the TB pandemic, a local TB community-based Non-Profit Organization (NPO) was formed (Mosamaria[footnoteRef:2]). Mosamaria provides a range of support services, including help to reduce stigma, encouraging TB patients to seek testing and treatment, conducting social mobilization and local advocacy around TB, consolidating services for people co-infected with HIV, and providing home-based individualized treatment support for TB patients (USAID, 2019). A USAID report indicates that between 2016 and 2019, a total of 485 individuals in South Africa were diagnosed with TB and linked to care through these NGOs (USAID, 2019). [2: Operational in the South African informal sector, this NPO operates mainly through personal relations for persons suffering from TB or AIDS within the South African informal settlements.]

Community health workers including community volunteers and supervisors, also play a key role in TB management at the community level, particularly in low-income urban settlements. Community health workers are involved in the provision of health activities in their community, though they are not formal government employees and are not incentivized (WHO, 2013). Community health workers are involved in direct observed therapy, a program geared at ensuring that patients take their medication at the right time and in the right quantities (WHO, 2006). A 2003 study conducted by the WHO in the Guguletu District of South Africa found that using community health workers in direct observed therapy contributed to increased TB control compared to approaches based purely on health facilities (WHO, 2003). This section includes a more in-depth look at other types of informal institutions in South Africa and their role in supporting individuals who live in rural communities.

Traditional Healers and Medicine

Traditional medicines are substances used in traditional health practice for the diagnosis, prevention, and treatment of illness, as well as the promotion of well-being in most rural African societies (Majomoodally, 2013). Traditional medicines include a diverse range of plant and animal products that are either self-administered by the patient or administered by traditional healers and believed to treat a wide range of conditions including mental disorders, tuberculosis, and diabetes. For instance, the leaf of the Aloe Ferox plant has been shown to have anti-diabetic properties, the Ubulawu, a traditional medicine drawn from the stem of Helinus integrifolius and root of the Sillene bellidioides is used to cleanse the body and soul, while the Cryptocarya bark mixed with crocodile fat is used in the treatment of chest pains (Mmamosheledi & Sibanda, 2018).

Traditional healers are responsible for the administration of traditional medicine in South Africa and include birth attendants, traditional surgeons, herbalists (iNyanga) and diviners (iSangoma) (Mmamosheledi & Sibanda, 2018). Traditional healing is interwoven with religious beliefs and cultural practices and is, therefore, believed to be holistic, involving both the mind and soul (Mmamosheledi & Sibanda, 2018). South Africans link traditional healing practices with spirituality and believe that traditional healers are capable of communicating with ancestors and an individual\\\'s departed blood-relatives who are believed to mediate between the living and God, and who serve as the custodians of the destinies of living generations (Mmamosheledi & Sibanda, 2018). For instance, diviners in the South African belief system are considered spirituality experts capable of defining and diagnosing the origin and reason of illness with the help of the patient\\\'s ancestors (Mmamosheledi & Sibanda, 2018).

Traditional healers have also played an important role in the management of TB in South Africa (WHO, 2013). Traditional healers are primarily involved as supervisors of TB treatment in their local communities, and research demonstrates they may be a useful contribution to the performance of TB programs (WHO, 2013). Finally, there are chiefs and local community elders who command significant respect in the villages and local jurisdictions. Chiefs and local community elders are supported by the Southern Africa Tuberculosis and Health Systems Support (SATBHSSP), and play a crucial role in transmitting TB information to the masses including raising awareness on screening and the health benefits of early diagnosis (SATBHSSP, 2018).

The strong beliefs that traditional healers employ some form of spiritual connection with ancestors and God that could intervene in illness makes traditional healers the first treatment option for most patients, although patients also prefer them because they are more affordable. In the wake of the COVID-19 pandemic, traditional healers could help reduce the strain on the formal healthcare system by administering or guiding patients to self-medicate using traditional medicines such as Umckaloabo used in the treatment of chest pains and bronchitis symptoms (Mmamosheledi & Sibanda, 2013). Also, because traditional healers are more popular within the communities they operate in, they provide a perfect opportunity to sensitize people to abide by the COVID-19 mitigation strategies, washing hands, and social distancing. Traditional healers and medicinal options are more affordable and readily available to rural populations than formal options (e.g., aspirin and non-steroidal anti-inflammatory drugs) and would effectively help patients with mild symptoms manage the disease at home.

Subsistence Farming and Food Security

Farming is one of the primary economic activities in South Africa. Traditionally, farmers practiced subsistence and organic farming with households in rural areas, primarily producing their own food while those in urban areas rely largely on market purchases. In recent years, however, there has been a shift toward market food purchases in both rural and urban households (Baiphethi & Jacobs, 2009). The disruption of food chains as a result of lockdowns and other measures geared at curbing the spread of COVID affects the availability of food substances in the market, increasing the risk of food insecurity, particularly among the urban dwellers who mostly rely on market food purchases. Moreover, it is estimated that food expenditures account for between 60 and 80 percent of total household income in an average Sub-Saharan African household (Baiphethi & Jacobs, 2009).

The decline of food produce in the market as a result of disrupted food chains raises food prices, imposing a further strain on the urban poor who are already experiencing falling incomes as a direct effect of a pandemic. In this regard, a return to the traditional subsistence farming would help increase food security for households, minimizing reliance on market food purchases (Baiphethi & Jacobs, 2009). Several actions have been taken to encourage local communities to shift back to subsistence farming. One such initiative is the partnership between organizations such as the Spire Wine Farm and Sustainability Institute, which seeks to train locals in the Lynedoch area on how to use eco-friendly techniques to grow their own nutritious and fresh produce for consumption (Pretorious, 2020). Such moves toward increased subsistence farming helps to increase the subsistence production of food items that have been shown to boost immunity and hence, minimize the risk of COVID-19.

Informal Trade and Savings Cooperatives

Formal trade and financial services in South Africa are underdeveloped in rural areas where education levels are low and infrastructure is poorly developed (Finmark Trust, 2013). Informal institutions that allow indigenous rural farmers without regular income to save and invest include informal saving groups, rotating savings and credit associations, and accumulating savings and credit associations (Finmark Trust, 2013). These groups provide effective avenues for alternative investment when incomes are falling during crises, helping them to better cope in times of crises (Finmark Trust, 2013).

Marital Traditions

The traditional wedding ceremony varies across African communities. However, in the basic traditional setting, weddings only take place between members of different clans – which can either from the same ethnic group or a different ethnic group; this implies that the individuals had to have different clan names, although men were allowed to marry women from the same clan as their maternal grandmother (Siyabona Africa, 2020). For the two weeks preceding the wedding, the bride is secluded in a specially-constructed structure in her parents\\\' compound in a move designed to shield her from the eyes of men (Siyabona Africa, 2020). She stays in solitary seclusion for the entire period, with only a maiden designated to attend to her needs having direct access to her (Siyabona Africa, 2020). On the day of the wedding, she emerges from seclusion covered by an umbrella and completely wrapped in a blanket, which she adorns in addition to her marriage blanket (Siyabona Africa, 2020). At the end of the ceremony, the couple moves away from the bride\\\'s village to settle in an area belonging to the husband\\\'s clan (Siyabona Africa, 2020).

The seclusion experience helps in the management of disease, such as COVID-19, in that it is a familiar exercise that minimizes social interactions between the woman and other people, helping her keep a safe physical distance. Further, the fact that the bride appears from seclusion completely covered in a blanket also helps with the experience of having to wear a face covering which reduces the risk of COVID-19. The practice of movement away from the bride\\\'s home area into an unfamiliar locality helps to minimize visits from family members, which reduces the couple\\\'s risk of exposure to Covid-19.

Caring Models

South African culture is founded on the Ubuntu framework, which emphasizes teamwork and collectiveness through the social values of survival, solidarity spirit, compassion, respect, and dignity (Poovan et al., 2006). Like in most African societies, the family is the smallest unit of South African society (Ghebregiorgis & Karsten, 2006). The extended family is an outgrowth of the individual family and is the social glue binding various interrelated families together (Ghebregiorgis & Karsten, 2006). The extended family forms the foundation of brotherliness under Ubuntu (Ghebregiorgis & Karsten, 2006).

Members of the extended family are bound by the five values of Ubuntu, which implies that they need to work together as a team to address problems facing the family including illness, as well as caring for the vulnerable such as children and the elderly. Assuming that one gets infected with COVID, for instance, Ubuntu requires members of their extended family to come together in an integrated model of care. The value of survival requires the family and community members to pool their limited resources together to ensure that the patient receives the care and medication that they need to get better (Ghebregiorgis & Karsten, 2006). Employed members of the group have a duty to provide the financial support needed by the sick member of the extended family (Ghebregiorgis & Karsten, 2006). Similarly, healthcare professionals in the family and community have a moral duty to assist the patient through administering medication, monitoring progress, and offering medical advice.

The value of solidarity empowers them to share responsibilities and work cohesively in the making of effective decisions regarding the patient\\\'s treatment (Ghebregiorgis & Karsten, 2006). Compassion requires them to place themselves in the patient\\\'s position and to demonstrate empathy towards the patient (Ghebregiorgis & Karsten, 2006). The values of respect and dignity impose upon family and community members the duty to respect each other and treat each other with dignity regardless of their social status and contribution to the group\\\'s shared vision (Ghebregiorgis & Karsten, 2006).

Community Grocery Stores

A community grocery store, also called a spaza shop, is a type of informal trade in South Africa, which helps with community food supply (Gastrow & Amit, 2013). The term spaza is used mainly throughout South Africa and is operated from houses in townships. These stores sell essential household items such as bread, milk, and toiletries to the local community. Traders operate their shops from converted garages, shipping containers placed in front yards, corrugated iron structures attached to houses, and a room inside their dwellings. What makes these shops unique is that they sell to communities that are far from formal shopping malls and stores. Besides location, they invest great efforts in sourcing low prices for their goods, place low markups on them, and offer products on credit, longer operating hours, and flexible quantities such as a cup of sugar, half a loaf of bread or a single egg (Gastrow & Amit, 2013). Owners of spaza shops also share transport costs and jointly buy in bulk (Charman et al. 2012). These practices help communities cope during crises because it addresses the issue of social distancing as people don\\\'t shop at big stores with many other shoppers. Instead, the shopper is served through a window and there is no physical contact. Secondly, with people losing their jobs and income compromised, the person can buy essentials in smaller quantities. These stores are more \\\'survivalist\\\' than opportunity-driven (Charman et al. 2012).

Nigeria

In Nigeria, community health worker programs have emerged as the most prominent informal institution engaged at the community level in response to TB and will likely play a role in the COVID-19 pandemic. In Nigeria, community health workers include community volunteers, community pharmacists, and patent medicine vendors (Falae & Obeagu, 2016). These individuals are community members with formal health training who have been sensitized on community TB care through either repeated contact with experienced healthcare professionals or short-term training. Though they are not entitled to financial compensation from the national government, these workers often receive financial incentives. Their primary role is to implement DOTs by promoting TB messages through their clientele, identifying possible TB cases by carrying out active case-finding, offering home-based treatment support, and undertaking TB contact screening at the household level (Falae & Obeagu, 2016). Studies have shown community health workers to have a significant effect in educating the masses and increasing diagnosis rates in rural Nigeria (Falae & Obeagu, 2016).

Community-based NGOs such as the Association for Reproduction and Family Health Nigeria and HFG Nigeria are also established informal institutions as part of Nigeria\\\'s TB response program. These local NGOs conduct door-to-door community awareness campaigns and connect patients to available treatment programs (Arshad et al., 2014). Finally, there are community groups such as the Ajegunle Community Partners for Health, which have contributed to TB treatment adherence and improving awareness about TB among locals (Arshad et al., 2014). In most cases, these community groups organize community mobilization events, where they engage successfully treated patients and community leaders to reduce discrimination and stigma (Arshad et al., 2014). This section presents an in-depth look at other types of informal institutions in Nigeria that will likely be helpful for rural Nigerian communities during the COVID-19 pandemic.

Traditional Healers and Traditional Medication

Most Nigerians lack health insurance and are forced to pay for their health expenditures out-of-pocket, which limits access to care (Nelissen et al., 2020). In 2016, for instance, 75 percent of healthcare costs among citizens were settled out-of-pocket due to lacking insurance coverage (Nelissen et al., 2020). Most Nigerian citizens prefer to consult informal healthcare providers including traditional healers and proprietary medicine vendors whenever they fall ill and require treatment (Nelissen et al., 2020). Studies have shown that patients\\\' visits to informal providers are independent of insurance status, leading to the conclusion that the decision to visit a traditional healer for treatment is most likely dictated by cultural beliefs that favor traditional medication over contemporary ones, and traditional healing over formal treatment (Nelissen et al., 2020). In this regard, traditional healers and informal medicine vendors selling traditional medicinal formulations that could aid in the treatment of COVID-19 symptoms could help uninsured patients with mild symptoms effectively manage the disease. Patients would be required to only seek formal healthcare when symptoms are severe enough to require hospitalization, reducing the strain on formal healthcare facilities. Further, self-medication is a common practice among citizens in rural Nigeria, particularly among older women with knowhow on herbal medications (Gbagbo & Nkrumah, 2020). Increasing access to extracts from the Acacia Nilotica tree, which are commonly used in the treatment of pneumonia and respiratory illnesses could be of great relevance (Okoro et al., 2014).

Subsistence Farming and Food Security

Subsistence agriculture is a fundamental component of rural Nigeria, with most households practicing small-scale farming to feed their families, while the urban dwellers mainly rely on market production. Subsistence farmers play a crucial role in food security with an average farm size ranging between 0.7 and 2.2 hectares (Apata et al., 2011). The Nigerian government has taken action to grow the country\\\'s subsistence agriculture through price incentives, more effective and efficient infrastructure support from the smaller farm holder, shorter policy lags, and fighting corruption in the development and execution of agricultural policies (Kwanashie, Ajilima & Garba, 1998). The interventions are tailored to enhance small-scale subsistence farmers\\\' capacity in a bid to ensure the country\\\'s food security (Apata et al., 2011). With the pandemic, however, affecting food chains and limiting the availability of food in the market for urban dwellers, there is still a need to ensure food security.

A cultural element that has been significant in promoting food security during the pandemic is commensality, which involves eating together with the less vulnerable in society as a sign of sharing and unity (Brager et al., 1987). Nigerian culture emphasizes unity – traditionally, people rarely eat alone as there always is someone with whom to share a meal in the compound (Brager et al., 1987). People eat together in groups subdivided along lines of gender, generation or age, with the common meal serving as a medium for emphasizing kinship and building relationships. The Nigerian culture forbids the idea of a man having to break off a discussion with friends to go home for a meal with his family. The common meal tradition is meant to ensure that men eat together in unity and share all the information they need to share with each other (Brager et al., 1987). The common meal culture instills an aspect of sharing among Nigerians, which helps to ensure food security for all households during pandemics

Informal Trade and Savings Cooperatives

The saving culture in Nigeria is poor, particularly in rural areas (Nwachukwu & Odigie, 2011). Formal banks in Nigeria have been shown to neglect the rural areas because of insecurity, poor educational levels, and poor infrastructure (Oluyombo, 2013). This leaves those in the rural areas underserved, particularly because the available institutions are largely microfinance institutions that emphasize lending and are irrelevant to customers who want to save (Oluyombo, 2013). The poor saving culture in the rural areas limits investment when people lose their jobs in times of crisis (Nwachukwu & Odigie, 2011). Cultivating a culture of saving and investment is one way by which citizens could be encouraged to save and later on, use their savings to begin investment opportunities that they could use to generate alternative incomes in times of crises. Informal trade and savings institutions have been shown to harbor significant prospects in stimulating savings and investments to help people cope better amidst falling revenue streams.

Marital Traditions

As in most African traditional societies, Nigerian weddings involve exclusion of the bride to hide her from the eyes of preying men, and an appearance on the day of the wedding covered in a Hijab (Abdulwahid, 2006). The cover and seclusion both mitigate against the risk of disease through protective clothing and social distancing. However, a unique practice in Nigerian weddings that increases the risk of exposure to the disease is the ‘money spray’, where guests toss cash at the couple as they engage in their first dance. The fund is meant to help the couple obtain a fund with which to start off their married life, however, it enhances contact and poses a high risk of infection.

Caring Models

Community care provision is expected in Nigeria, as was demonstrated in the Ebola crisis in 2014. Community care is provided via an integrated model involving the national government, the respective state government, non-governmental organizations, and international partners (Shuaib et al., 2014). Members of the public were empowered with information through the media on the symptoms of the disease and where to place reports on potential cases (Shuaib et al., 2014). Reports from members of the public were received by the case management team responsible for maintaining and linking reported patients with isolation wards. Once at the isolation ward, patients received coordinated care from trained physicians, attendants, and nurses (Shuaib et al., 2014). Contact-tracing was done through coordinated efforts involving patients, healthcare professionals and government officials under the government’s Social Mobilization Strategy (Shuaib et al., 2014). Staff under the Social Mobilization Strategy conducted door-to-door visits in neighborhoods with Ebola contacts to educate the public on ways of protecting themselves and how to care for the affected (Shuaib et al., 2014). This coordinated model of care involving various agencies at the community level would go a long way toward helping local communities manage the spread of COVID-19. Further, parenting in the traditional Nigerian society is a shared responsibility extending beyond the extended family into the general community. The role of bringing up a child is carried out by the community as is that of taking care of the sick and the vulnerable in the population.

Swaziland

In Swaziland, community-based linkage programs are among the primary informal institutions developed at the community level in response to HIV/AIDS. One such program is the CDC-sponsored CommLink, which engages HIV-positive peer case managers to encourage locals to get tested and connect newly diagnosed cases to relevant psychosocial and antiretroviral therapy (CDC, 2019). Through its outreach teams, the program offers mobile HIV counseling and testing, and connects those who test positive to needed HIV care (CDC, 2019).

Traditional health practitioners are another type of informal institution engaged at the community level in Swaziland. Many people, particularly in rural Swaziland, visit traditional health practitioners for medical care. However, reports have shown that traditional health practitioners may hamper access to HIV services. In response, policymakers have recommended that these providers are recognized as primary care providers to ensure that they are more closely involved in HIV-service delivery, as they play a crucial role in motivating their clientele to get tested, but also linking them to needed care (Avert, 2020).

Faith-based organizations also play a crucial role in the management of HIV/AIDS in Swaziland; their primary function is to promote preventive outcomes by shaping beliefs, attitudes, and realities concerning sexual self-understanding (Ochillo et al., 2017). Studies conducted in Swaziland have shown faith-based organizations and religious leaders to be effective in delivering health promotion information to the masses and influencing their attitudes and beliefs in regard to HIV/AIDS (Ochillo et al., 2017).

Traditional Healers and Traditional Medicine

Swaziland’s cultural practices are quite similar to those of South Africa. Citizens largely prefer traditional healers to formal medical practitioners as they are more affordable and available, particularly in rural Swaziland (Mahomoodally, 2013). Herbalists are responsible for prescribing traditional medicine that are primarily drawn from plants and animals (Mahomoodally, 2013). The popularity of traditional healers is linked in part to cultural beliefs that associate such healers with African spirituality (Mahomoodally, 2013). Traditional medicines are commonly used in patients with HIV/AIDS, although their effectiveness is unsupported (Mahomoodally, 2013). However, common traditional medicinal components such as the gum of the A. Senegal have been shown to be effective in the treatment of bronchitis, respiratory tract infections, typhoid, leprosy, gonorrhea, and bronchitis (Mahomoodally, 2013). These traditional medicines and healers provide avenues for alternative treatment, particularly because most of the older people in the rural areas are known to self-medicate and can self-treat in the case of pain or mild symptoms (Gbagbo & Nkrumah, 2020; Okoro et al., 2014; Gurib-Fakim et al., 2010).

Subsistence Farming and Food Security

Subsistence farming is a key economic activity in rural Swaziland, and a key contributor to food security. Urban households largely depend on market food purchases, with demand fluctuating whenever food chains are affected by crises (Asiseh et al., 2017). However, the tradition in Swaziland, as in most African countries, emphasizes community parenting as a way of bringing up healthy communities. Children and adolescents learn by observing their elders act – strategies that influence households to engage in small-scale subsistence agricultural production thus provide crucial avenues for promoting subsistence farming across generations and ensure food security in times of crises (Asiseh et al., 2017).

Informal Trade and Saving Cooperatives

Formal trade and savings cooperatives in Swaziland are underdeveloped, particularly in rural areas where education levels are low and infrastructure is poorly developed (Simelane & Odhiambo, 2018). Formal institutions such as banks may not effectively serve the needs of indigenous populations in rural Swaziland (Simelane & Odhiambo, 2018). Informal institutions, which are generally referred to as microfinance institutions that allow indigenous Swazi farmers without regular income streams to save and invest - including informal saving groups, rotating savings and credit associations, and accumulating savings and credit associations - provide effective avenues for alternative investment when incomes are falling during crises, helping them to better cope when disrupted food chains make it impossible for them to effectively transport their food produce to the urban areas (Simelane & Odhiambo, 2018).

Marital Traditions

Seclusion of the bride for several days as she is educated on how to maintain a successful marriage is a common feature of traditional weddings in Swaziland, locally referred to as Umtsimba. Further, as is the case in South Africa, the bride is covered in a blanket at the time of their presentation on the wedding day, and goes on to live with her husband away from her clan as men are not allowed to marry from their paternal clans. Both of these elements help to minimize contact, and hence the risk of exposure to the virus (Siyabona Africa, 2020) .

Caring Models

Swaziland is based on the Ubuntu humanist thought, which advocates for brotherliness and communal living (Martin et al., 2011). In the sense of brotherliness, members are expected to be each other’s keeper such that taking care of the aged, the sick, and the vulnerable is a shared responsibility for the extended family and the community by extension. Communities are taught to demonstrate the values of Ubuntu, which call for compassionate care and solidarity with the less privileged. In the event of sickness, members of the extended family are expected to come together and pool resources to ensure that the patient has access to the care they need (Martin et al., 2011).

Institutional Theory

Institutional theory is concerned with the regulations, standards, and procedures that are formulated within institutions as commanding instructions for social behavior (Scott, 2004). Researchers use institutional theory to study how organizations are shaped, as well as how society informs the behavior of individuals within an organization. According to institutional theory, communication is the sole indicator of how organizations are formulated, with the help of formal rules and regulations, which reflects how formal rules and regulations are observed across all levels of an organization. How this occurs ultimately builds an organizational culture for coping with social and political issues. With this in mind, informal institutions are socially shared instructions, typically unwritten, that are formed, transferred and imposed outside the official boundaries (Torniainen & Sasstamoinen, 2007). As such, the normative, structural, regulative, and cognitive elements of institutional theory can be observed in the study of informal institutions.

Through the lens of institutional theory, Maclean (2010) observed political administration, social service delivery, and economic policy in four villages in rural Africa. Maclean believed that in societies where literacy level is low and strong oral traditions are held, defining unwritten rules as information would be challenging. The primary consideration is not whether the rules are written or not, or if they are considered formal; the main concern is the amount to which the familiarity of practices is exposed, noticeable, and clear. McLean observed that public knowledge was essential for formal institutions to be effective. Furthermore, there are more opportunities for discussion and negotiation if informal rules seem uncertain and are non-transparent. The author also mentioned that informal institutional change can be political and regulatory but can vary from country to country; the same was the case in Ghana. In such cultures, if a village resident had an issue with another village resident, they might reach a village committee for the resolution of the problem. This was considered a high-level formal institution, although their rules were not written they were expected to be transferred strictly from generation to generation. It was also distinctively mentioned by McLean (2010) that the government’s provision of infrastructure for day-to-day medical services is embedded in diverse relations of reciprocity. The state’s role in risk elimination is critical, and these systems should be studied more closely and deeply for highlighting informal risk-sharing networks (McLean, 2010).

Gobat et al. (2018) used institutional theory to interpret the understanding of participants in pandemic clinical research in four European countries. The authors sought to better understand how public views shape primary and critical healthcare times of crisis. In the light of interpretive theory, public engagement in clinical research about the pandemic would be fundamental for improving medical health care since the need for healthcare would be high at such times. Better treatments and their access would be ensured along with transparency in science and fair clinical practice.

Since the start of the COVID-19 outbreak, two researchers have applied institutional theory in the study of the food supply chain (Craighead et al., 2020) and the institutional effects on digital platform progress (Renner-Micah et al., 2020). Craighead and colleagues (2020) used institutional theory to explore the food supply chain during the pandemic and found that individuals revert to informal institutions to cope.

Renner-Micah and colleagues (2020) applied institutional theory in the study of institutional effects on digital platform progress and use for national health insurance in emerging countries such as Ghana. The authors discussed that there were regulative, normative, and cultural-cognitive institutional enablers with regard to Ghana culture, which allowed for the access and expansion of health service. The increased use of health services under health insurance was the core reason for this enabler. Another normative enabler was the use of technology and mobile apps for the need of a digital platform for health services. The regulatory institution enables the surety of whether the legal establishment of the organization is working following rules and policies. However, there were certain constraints, as well. Normative constraints included the difficulty in handling and implementation of the interface of the technological software, and the health insurance people could not maximize its service experience. The cultural-cognitive constraint, which was no knowledge to the head of the family about any family member receiving health services and not responding to the messages generated to the head NHIS provider, made it hard for the system to keep track of the members and the delivery of medical care. It also increases the costs of the institutions like the government, including its sustainability drive. With the use of institutional theory, the authors deduced that in an emerging country like Ghana, digital platform development and the use of health insurance were based on many enablers and hindrances. It was also known that digital technology could not be ignored since it is the best in modern times to help health insurance organizations to attain national coverage.

Conclusion (place holder)

Chapter 3: Methodology

The research question guiding this study is: How do individuals living in rural Africa use informal institutions to cope with the COVID-19 pandemic? A qualitative research approach using an interpretative phenomenological analysis (IPA) research design will by employed. Using IPA, the researcher will explore the lived experience of coping with the COVID-19 pandemic through the use of informal institutions among individual living in rural Africa. This chapter begins with a description of the research paradigm, approach, and tradition. Next, the participant recruitment procedures and data collection methods will be described, followed by the data analysis plan and strategies to enhance trustworthiness.

Research Paradigm

Creswell and Creswell (2018) define a paradigm as a basic set of interrelated assumptions that guide a researcher’s inquiries. A paradigm is also a representation and reflection of the beliefs and values of the researcher regarding the world (Kamal, 2019). This implies that a paradigm is a philosophical way of thinking that shapes how researchers conduct their inquiries (Kivunja & Kuyini, 2017). Therefore, the research paradigm influences the way researchers think about issues and how they frame their research topics. The research paradigm is an essential part of the determination of a research issue and its exploration as it shapes the researcher’s world.

The proposed study will follow the constructivist-interpretivist research paradigm based on the idea that reality is developed and subjective to each person (Ponterotto, 2005). The researcher believes that every individual creates their own reality instead of the existence of a single objective reality. The creation and subjectivity of reality based on each individual is critical as it shapes the lived experience of people concerning a particular phenomenon. Because this study seeks to explore individuals\\\' lived experiences coping with COVID-19, the researcher needs to understand reality as it is constructed by the participants. A constructivist-interpretivist paradigm provides a suitable framework for the researcher to examine and understand the individual realities of the study participants. Additionally the constructivist-interpretivist paradigm is appropriate for the proposed research because individuals create adaptable and multiple subjective meanings of their lived experiences (Ponterotto, 2005).

The adoption of a constructivist-interpretivist paradigm implies that the research embraces a hermeneutical approach, which involves reappraisal and reinterpretation concerning cultural contexts (McCaffrey et al., 2012). This approach incorporates various factors such as intuition, subjectivity, creativity, and corporeality in theoretical reflection. The use of a hermeneutical approach as part of the research paradigm provides a framework for the interpretative and reciprocal procedure of understanding the experiences of each individual. Based on this approach, the researcher will engage with the participants to explore, interpret, and understand their lived experiences through dialogue using semi-structured interviews. Semi-structured interviews will be used as the means to elicit in-depth descriptions regarding personal experiences on the issue and highlight emerging patterns across these individual cases. The researcher will then reflect upon insights obtained from the participants as part of his interpretive role in understanding their lived experiences.

Research Approach

A qualitative research approach will be used in the proposed study as the researcher seeks to explore and understand the lived experience of coping with the COVID-19 pandemic using informal institutions at the individual level. This approach is deemed suitable for the study as it will enable the researcher to make sense of and ascribe meaning to the lived experiences of individuals living in rural Africa in their fight against the COVID-19 pandemic. According to Creswell and Creswell (2018), qualitative research approaches are appropriate for studies that are exploratory, descriptive, or explanatory. Using a qualitative research approach, the researcher explores the phenomenon in a manner that enhances the understanding of relationships, individual experiences, and variations in observations (Creswell & Creswell, 2018). As a flexible, emergent research design, the qualitative approach will enable the researcher to develop a detailed description of the phenomenon under investigation.

Research Tradition

IPA is an approach to qualitative inquiry that was recently developed from the field of psychology (Smith et al., 2009). It focuses on evaluating how individuals “make sense of their major life experiences” (Smith et al., 2009, p.1). The development of this approach to qualitative inquiry was influenced by the need to bridge discourse analysis and social cognition, which are two conflicting perspectives of social psychology’s core methods of inquiry (Smith, 1996). IPA emerged as an approach that unifies these conflicting perspectives and provides a more in-depth way for researchers to explore and interpret human experiences (Smith, 1996).

Larkin and colleagues (2011) contend that IPA seeks to understand how people ascribe meanings to relationships, processes, and events according to their specific life worlds. Regardless of the phenomenon under investigation, the objective of embracing IPA is a study is to explore and understand what the individual experiences in his/her context. Therefore, lived experience is one of the components of IPA and is designed to encapsulate the interpreted and meaningfully lived aspect of life in our respective contexts. Since the focus of IPA is the lived experience, the researcher approaches the phenomenon under investigation from the participant’s perspective. Consequently, the researcher collects detailed and rich data from a small sample to adequately situate, describe, and interpret it. IPA’s stated interest is cognition through which it has positioned itself as a distinctive and experiential approach to qualitative inquiry, especially in the field of psychology (Smith et al., 2017). For the proposed study, exploring the lived experiences of individuals living in rural Africa will provide insights into their beliefs, feelings, and responses to the COVID-19 pandemic through the use of informal institutions.

Theoretical Underpinnings

IPA has theoretical roots in idiography, phenomenology, and hermeneutics (Smith, 2011). The IPA approach is significantly shaped by the intersection of these influences and provides a more in-depth framework for studying the human experience. This section includes an overview of the theoretical underpinnings of IPA: phenomenology, hermeneutics, and idiography.

Phenomenology

Phenomenology is one of the theoretical underpinnings of IPA that has become the dominant means in the pursuit of knowledge development in various fields of research, including health-related disciplines (Dowling, 2007). Smith (2011) defines phenomenology as the philosophical movement that focuses on lived experience. Therefore, it is concerned with carrying out an in-depth evaluation of specific human experiences depending on the phenomenon under investigation. Phenomenology is based on the assumption that reality is individual and subjective as opposed to being objective and rational. Accordingly, phenomenology aligns with the constructivist-interpretivist research paradigm as it supports the idea that people create flexible and different subjective meanings of their lived experiences, as stated by Ponterotto (2005). Phenomenology has evolved to enhance exploration and understanding of the individual human experience through the contributions of various philosophers (i.e., Edmund Husserl, Martin Heidegger, Maurice Merleau-Ponty, and Jean Paul Satre).

Husserl initiated the concept of phenomenology as a philosophy and research technique in his quest to understand the human experience and consciousness. Husserl was inspired by Frank Brentano, who utilized the phrase “descriptive psychology or descriptive phenomenology” (Dowling, 2007). Husserl borrowed from Brentano to study the specifics in attempt to understand the core of the human experience. Consequently, he developed a phenomenological reduction, which seeks to explore or understand something without interpretation or imposing judgment. Heidegger influenced the evolution of phenomenology by proposing an alternative view that emphasizes the critical role of interpretation in understanding the human experience (Smith et al., 2009). Merleau-Ponty expanded upon the ideas of Husserl and Heidegger by emphasizing the crucial role of the physical self in communicating with the world and its impact on perceptions (Dowling, 2007). Satre expanded Heidegger’s approach but deviated from Husserl by introducing the presence or lack of relationships with others.

Hermeneutics

Hermeneutics is a theory of interpretation and was initiated by Heidegger as an alternative view of phenomenology to Husserl’s philosophy (Dowling, 2007). IPA engages in a double hermeneutic because the researcher tries to make sense of the individual trying to make sense of his/her life experiences (Smith, 2011). Heidegger introduced the concept of the hermeneutic circle based on the idea that understanding is a reciprocal activity. In essence, based on this concept, an individual is between preunderstanding and understanding. When examining a phenomenon, the researcher suspends his/her experience to explore and understand how participants ascribe meaning to life events and processes. Hermeneutics plays an essential role in IPA as it forms the basis in which the researcher engages with and interprets participants’ descriptions while reflecting on their meanings. Smith (2009) contends that hermeneutics is essential in IPA as it promotes the ability of the researcher to evaluate parts and the entire of the phenomenon being studied.

Idiography

Smith (2011) states that IPA is idiographic in its commitment to assessing each case in a corpus in a comprehensive manner. The commitment is sometimes manifested through the writing up of single case-studies that represent or reflect in-depth assessments of an individual’s lived experience. Idiography is a concept that signifies an approach to knowledge that focuses on particular processes that are unique to individuals (Smith et al., 2009). IPA entails a comprehensive analytic treatment of every case followed by evaluation and identification of patterns across the cases. Given the significance of each case, a purposeful approach to participant sampling is employed since participants must be known to have experience with the phenomenon being investigated. As the researcher carries out a comprehensive analysis of each case, he/she becomes immersed in the lived experiences of participants before establishing general statements that reflect all cases included in the study.

Participants

According to Smith et al. (2009), IPA is an approach to qualitative inquiry that requires rich data. This implies that study participants should tell their stories, develop their ideas, express their concerns, and speak freely and reflectively in detail. Therefore, the researcher should recruit participants who are best suited to provide a rich, comprehensive, first-person account of their experiences. In alignment with IPA, participants will be selected based on their experience of the phenomenon being studied (Smith et al., 2009). Thus, only participants affected by the COVID-19 pandemic will be recruited.

A total sample of 9-12 individuals will be purposefully recruited from Swaziland, Nigeria, and South Africa (3-4 individuals from each country). Smith and colleagues (2009) contend that IPA studies require the researcher to select a homogeneous sample representing the target population and for whom the research question is meaningful. Because homogeneity is important for IPA research, the researcher use purposeful sampling. Creswell (2014) states that using a suitable sampling technique helps to achieve homogeneity by ensuring the sample is representative of the target population. Given the nature of the issue under investigation, the proposed study will employ purposeful sampling instead of random sampling. Smith et al. (2009) contend that purposeful sampling is the most appropriate for studies utilizing the IPA approach because of the need to enroll people with experience on the specific phenomenon under investigation. Snowball sampling will also be used if enough participants cannot be purposefully recruited. Snowball sampling involves recruiting new participants depending on referral by enrolled participants (Creswell & Creswell, 2018). The following inclusion and exclusion criteria will be used to identify participants:

· Individuals currently living in rural Swaziland, Nigeria, or South Africa and who are affected by COVID-19 pandemic;

· Must be 18 years of age;

· Native to the country under study;

· Experience in using informal institutions to cope with the pandemic;

· Willing to participate in a minimum of two, with the possibility of a third, virtual interview;

· Agree to the use of an audio recording of the interview(s); and

· Agree to the publication of data obtained and analyzed from this research.

Recruitment and Access

Once IRB approval is obtained, the researcher will contact a key informant in each country based on their personal and professional network to access and recruit participants. The key informant will be asked to share a recruitment email (Appendix A) with prospective participants. The recruitment email will include a brief explanation of the study’s purpose, eligibility criteria, participants’ responsibilities, and researcher contact information. A link to a brief eligibility questionnaire will be included at the bottom of the email and prospective participants will be instructed to click on the link to determine their eligibility.

The brief screening questionnaire (Appendix B) will be administered via Qualtrics to confirm eligibility based on the established participant selection criteria. The questionnaire will include questions based on the stated inclusion and exclusion criteria. Once the questionnaire is completed, individuals will be informed whether they qualify to participate in the study based on their responses. Eligible participants will be asked to submit their name, phone number, and email address to be contacted by the researcher regarding next steps. The researcher will then email all eligible participants who indicated their interest in volunteering to participate in the study to schedule an interview. Each participant will be required to review and sign an informed consent form before participating in the first interview to address any ethical concerns relating to the study. Participants will also be requested to share the recruitment email with any additional individuals who will undergo the selection process to determine their eligibility and participation in the proposed research.

Data Collection

According to Smith, Flowers & Larkin (2009), many established measures to qualitative research have specific requirements, limitations, and data collection preferences. The most suitable data collection method for an IPA approach to qualitative inquiry is one that entails inviting participants to provide rich, detailed, first-person accounts of their experiences with the phenomenon under investigation. Such data collection methods are utilized in IPA since they provide a more in-depth way for researchers to explore and interpret human experiences (Smith, 1996).

Smith et al. (2009) suggested that in-depth interviews and diaries are the most suitable methods of data collection for IPA studies. This is primarily because IPA requires rich data, which implies that participants should be given opportunities to share their stories. In-depth interviews and diaries promote the elicitation of stories, feelings, and thoughts by participants regarding the targeted phenomenon. However, researchers conducting studies using an IPA approach could also consider using participant observation or focus groups. Participant observation could be used in IPA studies where the activity under observation entails discussion of individual experiences. Creswell (2014) also stated that researchers can conduct structured, unstructured, or semi-structured interviews when conducting qualitative studies.

The proposed study will employ in-depth interviews for data collection since they will generate rich, detailed, first-hand accounts of participants’ experience with the targeted phenomenon. In-depth interviews are recommended as the primary data collection method for studies using an IPA approach since they enable participants to provide rich data regarding their experience with the phenomenon being studied (Smith et al., 2009). As stated by Creswell (2014), an in-depth interview entails dialogue between the researcher and participant. During this process, the participant speaks freely regarding his/her experience of the targeted phenomenon while the researcher mostly listens.

The researcher will use a semi-structured interview format. A semi-structured interview format is recommended for IPA studies as it enables participants to freely express themselves rather than having their responses limited like in a structured interview (Smith et al., 2009). Semi-structured interviews consist of a pre-determined set of open-ended questions designed to elicit participants’ stories and descriptions of experiences relating to the research issue (Smith & Osborn, 2007). However, during the interview, the research should not rely only on the interview questions. The researcher (interviewer) should be led by the participants’ descriptions and ask follow-up questions when necessary (Smith et al., 2009). This enables the researcher to elicit rich, detailed data from the participants.

The other component of in-depth interviews in IPA studies is the use of open-ended interview questions rather than closed-ended questions. Smith et al. (2009) contend that interview questions in IPA studies should be open-ended in order to generate detailed accounts of the phenomenon being studied. According to Creswell (2014), qualitative studies tend to employ open-ended data without pre-determined responses unlike quantitative studies that usually incorporate closed-ended responses. The use of open-ended interview questions ensures that IPA studies generate data from participants without pre-determined responses. The first question in IPA studies employing in-depth interviews should be designed to make the participant comfortable. The other interview questions should be more analytical and probing as the interview progresses. Smith et al. (2009) state that the number of interview questions vary but should generally be around 10 open-ended questions with suitable prompts.

For IPA studies, a one-on-one interview is preferred over a group interview (Smith et al., 2009). A one-on-one interview is ideal because it promotes personal rapport between the researcher and participant, which in turn allows participants to provide more information on their experiences with the research issue. On the other hand, personal rapport enables the researcher to modify the questions and ask follow-up questions through which participants provide more information.

For the proposed study, a total of 8-12 individuals will be interviewed. As previously indicated, 3-4 individuals will be purposefully recruited from South Africa, Swaziland, and Nigeria using a key informant. Each individual will participate in two semi-structured interviews, with the option of a third interview. Seidman’s (2006) three-interview series will be modified to guide the interview process. The purpose of the first interview will be to develop rapport with the participants and capture in-depth, context-specific information to aid in the development of participant profiles. The purpose of the second interview will be to collect data specific to the study’s research questions. The purpose of the optional third interview is to allow for the opportunity for the researcher to ask follow-up questions if the depth of information needed is not collected during the first and second interviews.

The researcher will develop an interview protocol prior to conducting the first and second interviews; however, the protocol will be modified, if needed, based on participant responses. This is in alignment with the emergent feature of qualitative research. Interviews will last approximately 60-90 minutes and will take place via Zoom at a time of the participant’s choosing. The recording feature on the Zoom platform will be used to record interviews. The number of interview questions will vary, but will generally consist of six to ten open-ended questions including appropriate prompts (Smith et al., 2009). Audio recordings will be professionally transcribed via Rev.com.

Data Storage

As previously indicated, each interview will be recorded using the recording feature on the Zoom platform. An audio copy of each interview recording will be saved on the researcher’s local computer hard drive and then uploaded to a cloud storage account and professionally transcribed via Rev.com. Data encryption and password protection will be employed to ensure confidentiality and security of the audio recordings data. In addition, audio recordings will be de-identified and pseudonyms will be used to replace participants’ names in order to safeguard their privacy. Rev.com will be used for transcription since it is a professional transcription company. While these interview recordings will be transcribed verbatim, nonverbal aspects of the interviews such as the exact length of pauses are not required. Smith et al. (2009) states that transcriptions in qualitative studies do not require all nonverbal aspects since only participants’ responses should be noted and analyzed.

The researcher will save and de-identify interview transcripts in the same manner as recordings to prevent third-party access. Digital copies of participants’ informed consent and the brief screening questionnaires will be stored in a password and encrypted cloud storage account only accessible to the researcher. After completing this doctoral thesis project, the researcher will transfer all the data to an external hard drive that will be stored in a locked file cabinet for five years. All data and associated documents will then be deleted the hard drive five years after completion of this study.

Data Analysis

Data analysis will commence after all interviews are completed with each participant. According to Creswell (2014), qualitative data analysis generates themes, codes or quotes that are used to answer the research question(s). Data analysis in IPA studies is conducted systematically (Smith et al., 2009). Because the IPA approach has idiographic commitment, the analysis process is carried out in different stages that culminate in answering the research question. In this regard, the first case is analyzed in detail followed by the second case, and this process is repeated until all cases are analyzed. As such, each interview transcript is treated and analyzed as a single case. A researcher should consider beginning with the interview found to be the most detailed, engaging, and complex (Smith et al., 2009).

For the proposed study, the six-step data analysis process proposed by Smith et al. (2009) will be utilized. To prepare for data analysis, the researcher will convert raw field notes taken during the interview into expanded reports and review them for accuracy. The reports will be frequently referenced during the coding process to facilitate the interpretation of data. The six-step process developed by Smith et al. (2009) includes: (1) Reading and re-reading; (2) Initial noting; (3) Developing emergent themes; (4) Searching for connections across emergent themes; (5) Moving to the next case; and (6) Looking for patterns across cases. The first four steps will be repeated for each participant’s interview as part of analyzing every single case at a time. The six-step process emphasizes an inductive and iterative cycle as the researcher moves from the specific to the shared while remaining committed to understanding each participant’s perspective regarding the phenomenon under investigation.

Step 1: Reading and Re-reading

Pietkiewicz & Smith (2012) state that analyzing qualitative data using an IPA framework can be a time-consuming and complex process, though an exciting activity. As a result, it is recommended for researchers using the IPA framework to completely immerse themselves in the data. To achieve this, data analysis of qualitative data obtained using the IPA framework follows a series of systematic steps beginning with reading and re-reading. The first step of an IPA analysis is reading and re-reading, which entails immersing oneself in some of the initial data (Smith et al., 2009). This process is carried out to ensure that the participant is the focus of the analysis as the researcher tries to put him/herself in the participant’s shoes. For instance, when reading and re-reading interview data, the researcher should listen to the audio recording. He/she should reimagine the participant’s voice during subsequent readings of the transcript. Reading and re-reading help the researcher to obtain clarity (Alase, 2017).

For the proposed study, the data analysis process will commence with the researcher’s immersion in the original recordings and transcript as recommended by Smith et al. (2009). The researcher will listen to the audio-recordings first before reading and re-reading the transcripts. After listening to the audio-recordings, the researcher will read each interview transcript slowly and purposefully to ensure active engagement with the data. During this process, the researcher will identify a rhythm to the interview and determine richer sections of data for further analysis. The identified richer sections of the data will be utilized in the subsequent sections of the data analysis process.

Step 2: Initial Noting

The second step in IPA analysis is initial noting, which is essentially the initial level of data analysis. This phase is most time-consuming and detailed as it involves examining language use and semantic content on a very exploratory level (Smith et al., 2009). However, the researcher maintains an open mind while noting anything of interest from the data. As the researcher carried out initial noting, he/she becomes more familiar with the transcript. The researcher also starts to identify specific ways in which the participant expresses, understands, and thinks about the phenomenon being studied. Initial noting is close to being a free textual analysis since the researcher starts writing notes on the transcript.

Initial noting is carried out prior to establishing emerging themes and incorporates a series of descriptive, linguistic, and conceptual commenting. Descriptive commenting entails reading the transcript and generating notes regarding the context of the participants’ views while linguistic commenting entail noting specific words used by the participant to understand his/her use of language to describe the experience. On the other hand, conceptual commenting involves linking abstract concepts to help identify emerging patterns and meaning. For the proposed study, the researcher will carry out a line-by-line analysis of the interview transcript while making descriptive, linguistic, and conceptual comments. During this process, the researcher will underline text that appears important while making marginal notes.

Step 3: Developing Emerging Themes

After initial noting, IPA analysis involves developing emerging themes given that a large data set is likely to emerge from the completion of the first two steps. The substantial growth in the data set is attributable to the additional level of potentially important, but provisional notes. The larger data set is the focus of the next stage of data analysis in which the researcher looks for emerging patterns or themes. When looking for emerging themes, the researcher’s task shifts from managing the data as he/she simultaneously attempts to lessen the volume of detail while maintaining complexities. During this process, the researcher attempts to map connections, interrelationships, and patterns between exploratory notes. In essence, the researcher primarily works with initial notes instead of the transcript itself. However, the initial notes are closely linked to the initial transcript through comprehensive exploratory commenting. As stated by Smith et al. (2009), the process of the hermeneutic circle commences in this stage because the initial whole of the interview becomes different parts. These different parts then come together to create another new whole at the end of the data analysis process. Notes are converted into themes by identifying the essence of each comment to create a theme that reflects the interview and text as a whole.

The proposed study will entail the development of emerging themes through converting notes. The researcher will generate the themes through interpreting the text and exploratory comments to represent the participants’ thoughts and words and the researcher’s interpretation of these thoughts and words. The end result of this process is chronological labeling of ideas that represent exploration and understanding of the participant’s experience relating to the phenomenon under investigation (Smith et al., 2009).

Step 4: Searching for Connections across Emergent Themes

Once emerging themes are developed, the next step in the data analysis process is searching for connections across emergent themes. In this regard, the researcher attempts to connect the emergent themes with a map or chart. There are various ways through which the researcher can accomplish this including organizing themes in order, abstraction, or polarization. As the researcher searches for connections across emergent themes, he/she demonstrates thinking on how they fit together. The connections across emergent themes can be identified through organizing them in order of when they appear in the original transcript. This is followed by visually assessing ways in which the emergent themes can be reorganized into groups of related themes. On the contrary, abstraction involves developing a new superordinate theme that includes patterns identified in the emergent themes. Polarization organizes themes according to the differences among them (Smith et al., 2009).

For the proposed study, the researcher will search for connections across emergent themes by organizing them in the order they appear in the original transcript. After organizing these emergent themes in that order, the researcher will then examine ways in which they can be rearranged into groups of related themes. In this case, the researcher will also utilize abstraction as the premise for identifying the reorganization of the emergent themes in different groupings based on patterns in data.

Step 5: Moving to the Next Case

Smith and colleagues (2009) emphasize the significance of analyzing every single case before searching for patterns across cases. The analysis of each case individually is carried out by bracketing ideas and thoughts prior to analyzing subsequent cases. The next step of an IPA analysis involves moving to the next participant’s transcript and repeating the first four steps in this analysis. This is a critical step as it enables the researcher to treat each case on its own terms and to do justice to each individual case. While the researcher could be influenced by the themes identified in the analysis of the first case, it is important to allow new themes to emerge with each case. This can be achieved by ensuring that each of the first four steps is carried out systematically and in a comprehensive manner.

For the proposed study, each of the first four steps will be repeated to each participant’s transcript. The researcher will follow each step systematically and comprehensively to allow new themes or patterns to emerge. This will help the researcher to ensure each case is treated individually and take into account the experience of each participant regarding the phenomenon under investigation.

Step 6: Looking for Patterns across Cases

The final step in IPA analysis is searching for patterns across cases (Smith et al., 2009). It entails laying each table/figure out on a large surface and looking across them to determine any connections across the cases. During this process, the researcher also identifies the most potent themes and how each of them helps to illuminate a different case. In some cases, the researcher could reconfigure or relabel the themes based on the identified connections or patterns. Similar to Step 4, this final phase of IPA analysis can be facilitated by creating maps or charts that demonstrate the connections between cases. The researcher could also benefit from creating a table of themes or a master list to demonstrate how the emergent themes are within superordinate themes. Additionally, the researcher can count the themes to determine prevalence and differences among cases (Smith et al., 2009).

The researcher will employ each of these steps to analyze participants’ interviews and identify themes focusing on how individuals living in rural Africa use informal institutions to cope with COVID-19 pandemic. In this regard, an in-depth step-by-step analysis of each case will be carried out and used to identify themes that represent the whole. By analyzing each participants’ account, the researcher will ensure that each case is treated individually before moving to the next one. As previously indicated, the researcher will allow the emergence of new themes when examining each case individually. The findings of each case will then be utilized to identify themes that help answer the research question based on the connections across cases.

Strategies to Enhance Trustworthiness

According to Lincoln & Guba (1985), reliability in qualitative research entails establishing credibility, transferability, dependability, and confirmability. Reliability in a research refers to the extent of confidence in data, interpretation of data, and measures employed to ensure quality. As such, Lincoln and Guba (1985) developed a framework for evaluating trustworthiness in qualitative research.

Trustworthiness is a relatively obscure concept because qualitative researchers do not utilize known metrics regarding validity and reliability, unlike quantitative researchers (Lincoln & Guba, 1985). Consequently, qualitative researchers face the need to ensure their research is trustworthy. Thus, qualitative researchers must establish protocols and processes to ensure the trustworthiness of their research. For the proposed study, the researcher will utilize Lincoln & Guba’s (1985) framework to guide the selection of strategies to enhance trustworthiness of the findings.

Credibility

Credibility is defined as confidence in the truth of the study’s findings (Lincoln & Guba, 2985). By employing strategies to ensure credibility, a qualitative researcher seeks to demonstrate that the findings of their research are true and accurate. To establish credibility, qualitative researchers employ measures such as triangulation, member checking, peer debriefing, prolonged engagement, and persistent observation (Houghton et al., 2012).

For the proposed study, the researcher will enhance credibility by member checking. Member checking is a strategy for enhancing credibility that entails sharing transcript data and/or initial themes with research participants to evaluate accuracy (Creswell, 2014). The goal of member checking is for participants to identify and correct any inaccurate interpretations or accounts of their experiences with the phenomenon under investigation. Through this process, the participants ensure that the researcher has accurate reports or interpretations of their experience concerning the issue being studied.

For the proposed study, each participant will be asked to review the raw transcripts of their interview following the transcription of the audio recordings. As they review their transcripts, participants will be requested to provide feedback and request revisions where necessary to help ensure the data is accurate (Creswell, 2014). The process will also involve asking each participant to examine the themes that emerge from their interviews, which would happen after Step 4 of data analysis. The review of emerging themes by study participants will help ensure that the findings of the study are true and accurate, which is essential in establishing the trustworthiness of a study (Lincoln & Guba, 1985).

Dependability

Dependability refers to whether the study findings are consistent and reliable and the degree to which the research procedures are documented to allow for easy following, auditing, and critique of the research process (Lincoln & Guba, 1985; Streubert, 2007). By enhancing dependability, qualitative researchers ensure that enough information is provided in the report that if the study were to be repeated, the findings would be consistent. Lincoln and Guba (1985) contend that dependability is closely tied to credibility, and many qualitative researchers use overlapping techniques such as individual interviews and focus groups on improving credibility and dependability. To enhance dependability, qualitative researchers should ensure that processes within the study are reported in detail, which would enable a future researcher to repeat the study even if the motivation is not to obtain similar results/findings. An in-depth description of processes within the study demonstrates the extent to which proper research practices and procedures have been followed (Shenton, 2004).

The researcher will enhance dependability in the proposed study by using reflexivity as a strategy. Lincoln and Guba (1985) define reflexivity as an attitude of attending methodically to the context of knowledge development. This process is carried out to the effect of the researcher at each step of the research process. Reflexivity is based on the idea that the researcher’s perspective or position influences all research regardless of whether it is qualitative or quantitative. For the proposed study, the researcher will create a reflexive journal in which regular entries of the research process will be made during the study. These regular entries will include information on different aspects of the research process, such as methodological decisions and reasons for them, and the logistics of the research. Also, the researcher will make entries that demonstrate reflection upon what is occurring based on personal values and interests. A reflexive journal will help enhance dependability by providing details regarding the research process and how the researcher’s perspective or position influenced it.

Confirmability

Confirmability refers to the degree of neutrality or the extent to which participants shape study findings instead of researcher motivation, interest, or bias (Lincoln & Guba, 1985). This implies that the results of the research are based on responses from participants and not personal motivations or potential bias of the researcher. The process of enhancing the confirmability of a study implies that the researcher ensures his/her bias, interest, or motivations do not skew the interpretation of the participants’ responses. In other words, the researcher ensures that the participants’ responses are not skewed to fit a particular narrative or position.

The concept of confirmability is the qualitative researcher’s focus on objectivity (Shenton, 2004). In essence, the process of enhancing confirmability focuses on ensuring objectivity throughout the research process. Therefore, the researcher should adopt measures to ensure the findings reflect the ideas or experiences of participants instead of his/her characteristics or preferences. Some of the techniques proposed by Lincoln & Guba (1985) to enhance confirmability include audit trail, triangulation, confirmability audit, and reflexivity.

For the proposed study, the researcher seeks to enhance confirmability by keeping an audit trail. Lincoln & Guba (1985) define an audit trail as a transparent description of the steps taken in the research from the beginning of the project to the development and reporting of findings. The researcher intends to document raw data or field notes from the start of the project. During this process, the researcher will record observations during the data collection process to highlight any assumptions regarding the interview data. This will enable the researcher to ensure that assumptions and preconceptions regarding the use of informal institutions to help cope with the COVID-19 pandemic did not inappropriately influence study findings.

Transferability

Transferability refers to demonstrating that study findings are applicable in other contexts (Lincoln & Guba, 1985). In this regard, different contexts imply similar phenomena, similar populations, and similar situations. Transferability primarily concerns external validity, which is the extent to which study findings can be applied to other contexts/situations (Shenton, 2004; Creswell, 2014)). Qualitative researchers need to enhance transferability because such studies use a small sample in comparison to quantitative or mixed-methods researches. Lincoln and Guba (1985) suggest that adequate contextual information regarding the fieldwork sites is needed to enhance transferability.

Transferability can be enhanced using thick description, which entails describing a phenomenon in enough detail so that a reader can start to assess the extent to which its conclusions are transferable to other settings, people, situations, and time (Lincoln & Guba, 1985). Using this strategy, the researcher intends to provide detailed descriptions of the study participants, setting, and context. During this process, the researcher will make explicit patterns of social and cultural relationships in the research process and its findings. When developing the research report for the proposed study, the researcher intends to provide rich, detailed descriptions of the emergent themes so that readers can transfer study findings to other contexts (Creswell, 2014). The proposed study will incorporate thick descriptions to report themes and their associated results to enhance findings\\\' transferability. Through this, the researcher will avoid providing thin, superficial accounts of participants’ experiences.

Impact of the research findings

The successful completion of this research will be beneficial to African Countries, particularly in managing crises, especially health crises, e.g., the current COVID-19 pandemic. As shown through the discussion above, the typical pre-colonial traditional African society had systems used to deal with a health crisis, including epidemics. The systems in place provide a framework for mitigation of the health threat, the economic downturn resulting from the crisis, and processes to address food shortage and ensure that each member of the community got food. This knowledge would be highly useful in the modern African community, given the poorly equipped healthcare systems in the majority of African countries; the findings of this research will have an impactful effect in helping African government deal with health crises by bringing onboard traditional health mitigation strategies that have been proven to work. In addition to mitigating the health crisis, this research\\\'s findings will be useful for government and communities in the management of the other social hardships that are attached to a health crisis, e.g., economic slowdown and the unavailability of enough to eat.

The findings of this research will be a resourceful addition to the available literature on traditional health management strategies. In the traditional African context, information was passed mainly through word of mouth, with minimal record-keeping. Consequently, there is very little original material on historical and traditional strategies to manage crises. The results of this study will be useful material for future research.

Limitations

One of the limitations of this research is the limited literature material available. Because of the limited record-keeping in the traditional pre-colonial history of Africa, there is very limited original literature material on traditional processes. This will be a major limitation for the current study as it will be difficult to find original and authentic materials for use in this research. The second limitation for this research is expected to be the inability to determine the authenticity and correctness of the responses made by the study participants. The IPA methodology is proposed for this research, which will involve collecting information from the target population. The IPA relies on getting truthful and in-depth information through, among other, interviews with the study participants. However, this limitation will be countered by using various data collection methods, including observation, diaries, focus groups, and a significantly large sample.

References

Abdulwahid, S. (2006). Gender differences in mobilization for collective action: Case studies of villages in Northern Nigeria. http://www.capri.cgiar.org/pdf/capriwp58.pdf CAPRI Working Paper No. 58. Washington, DC, CAPRI.