Coping with Covid by Using Informal Institutions Conclusion Chapter

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Coping Through the Use of Informal Institutions during COVID-19 in South Africa, Nigeria, and SwazilandChapter 1: IntroductionThe 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 StudyFrom 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…

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…CopingThroughtheUseofInformalInstitutionsduringCOVID-19inSouthAfrica,Nigeria,andSwazilandChapter1:IntroductionTheglobaloutbreakofCOVID-19raisesmanyconcernsregardinghowindividualsandcommunitieswholiveinAfricancountries,withfragilehealthsystems,copewiththepandemic.Duringpastpandemics,individualsandcommunitiesinAfricahavereliedoncustomarypracticesandtraditions,alsocommonlyreferredtoasinformalinstitutions(Moore,2020).Informalinstitutionshavecontinuedtofunctioninruralandpoverty-strickenareasofAfricainresponsetoalackofadequatesupportfromformalgoverningbodiesandareprimarilyusedatthecommunitylevel(Azevedo,2017).Thus,thereisaplethoraofliteratureoncommunityparticipationininformalinstitutionswithinAfricancommunities;however,noknownresearchhasexploredtheexperiencesofindividualswhouseinformalinstitutionstocopeduringapandemic.Thischapterbeginswithbackgroundinformationrelevanttothetopic,followedbyadescriptionoftheproblemandthesignificanceofthestudy.Next,theconceptualframework,purposestatement,researchquestions,andrationaleforthemethodologyarepresented.BackgroundoftheStudyFrom1964-2000,nineteenarmedconflictstookplaceinAfrica(Sollenberg,2001).Post-conflictAfricahasbeencharacterizedbyabreakdownincentralgovernanceandanincreaseinWesternandinternationalaidinanattempttoimplementademocraticsociety,economicreform,andestablishformalgovernancestructures(Ogbaharya,2008).Formalgovernancestructures,alsoreferredtoasformalinstitutions,aremostsuccessfulwhentheyarecomplementedbyinformalsupportsystems,suchassocialandcustomarypractices(Ogbaharya,2008).Thesepracticeshavebecomeknownasinformalinstitutions.Informalinstitutionsarecustomarypracticessuchassociallysharedrules,usuallyunwrittenthatarecreated,communicated,andenforcedoutsideofofficiallysanctionedchannels(North,1997).InAfrica,themarginalizedandsociallyisolatedrelyheavilyoninformalinstitutionstonavigatedailylifeandcopeduringcrises.Duringhealthcrisesandenvironmentalshocks,localcommunitiesinAfricaandelsewhereinthedevelopingworkturntotheirsocialnetworksandcustomaryforsustenanceandsupport.Forexample,duetothelongstandingfightagainstcommunicablediseasessuchlungdiseaseandtuberculosis,localcommunitiesinAfricancountrieshavebecomequitefamiliarwithsocialdistancingandinfectioncontrol(DW,2020).Theyusedtheseexperiencestoinformhowtheycopedduringpandemics.Notwithstandingtheestablishmentofformalgovernmentstructuresinthecolonialandpost-colonialera,customarypracticesremaincentraltomultifacetedaspectsofrurallivelihoodinmanypartsofAfrica.Customaryauthoritiescontinuetocommandaleveloflocallegitimacyandcanelicitsignificantcommunityparticipationintimesofcrisis(Azevedo,2017).ThisisevidentinthewidelyrecognizedtermUbuntu,thewordusedforhumanityandcommunallifeinsub-SaharanAfrica.Ubuntuisanethicalideologythatemphasizesthevalueofpeople\'srelationswith,andallegiancestowardseachother.TheUbuntuprincipleisexcellentlymanifestedinthedictum\'Iambecauseweare,andsinceweare,therefore,Iam\'(Fagunwa,2019).ThisideologydrawsitsoriginsfromthesouthernAfricanXhosaandZululanguages,andwasacceptedasaguidingidealforthetransitiontomajorityruleinSouthAfricaandZimbabwe(thenSouthernRhodesia).TheinterimConstitutionofSouthAfricaemphasizestheneedforUbuntuasopposedtovictimization,andreparationasopposedtoretaliationastheguidingprinciplesforallSouthAfricansinthetransitionfromapartheidtomajorityrule.UbuntutiestoAfricanisminseveralways.ThefirstisthroughlocalAfricanlanguages.Etymologically,Ubuntuisanabstractwordformedfromthecombinationofthewords\'ntu\'and\'Ubu\',theformerofwhichisacommonwordusedtorefertoahumanbeinginmanySub-SaharanAfricancountries(Fagunwa,2019).Forinstance,thewordsharesastrongrelationwith\'Muntu\',thewordusedtorefertoahumanbeingamongtheEastAfricanBantuspeakingpeople;\'bumutu\',inBotswana,\'vumuntu\'inMozambique,\'umunthu\'inMalawi,and\'gimuntu\'inAngola(Fagunwa,2019).Basedonitslinktohumanism,theUbuntuconceptislargelyassociatedwiththeartofbeinghuman,andusingone\'sexistencetocontributetothegeneralwelfareofothersandthegreatercommunity(Fagunwa,2019).Besideslanguage,theethosofUbuntuisalsoapparentintheculturesandtraditionsofmostAfricansocieties(Fagunwa,2019).TheOromosocietyofthemodern-dayEthiopiaaptlydemonstratesthis.Thecommunityoperatesasocio-politicalsystemofgovernancereferredtoastheGadasystem,whichoperateslikeademocracy(Asmarom,2001).Leadersareselectedbasedontheirpopularityandgenerationalgrade/group–elders,andinclinedtopursuesustainabledevelopment,intimacy,peace,andsecurity(Fagunwa,2019).Underthispoliticalsystem,leadersarechosenbythepeopleandnurturedinthevaluesystemofunity,humanity,andtogethernesssuchthattheyalwaysprotectthewell-beingofthepeople.ThismakesitimpossibleforatyrannicalleadertoexistinanidealUbuntuframework(Fagunwa,2019).TiedtotheverycoreoftheAfricansociety,UbuntuisaplatformthatconnectsAfricanstogetherinavaluesystemthatemphasizespeople\'sinterconnectednessandtheneedtoactmorallyatalltimesfortheprotectionofacommonhumanity.TheUbuntulogoiscraftedtorepresentthreeindividualsholdingeachother\'shandstosymbolizetogetherness;itsconceptdrawsitsbasisfromtheAfricanlanguage,traditions,andbeliefs,andisthusanexpressionoftheveryessenceofbeingAfrican(Fagunwa,2019).TheconceptofUbuntuaidsinunderstandinghowcommunityparticipationempowersandincreasesthecompetenceofcitizens(Brageretal.,1987).Byparticipatingingoverningoftheirsocieties,citizenscanexertinfluencebyvoicingtheiropinionsonissuesandactforthegoodofthegeneralpublic(Poovanetal.,2006).Informalinstitutionsattractedattentionfromscholarsinthe1990swhentheconceptofsocialchangegainedpopularity.WhiletheWesternworldtestedmanysocialandcommunitydevelopmentinitiatives,mostfailedbecauseWesternideologiesdidnotalignwithtraditionalinformalinstitutions(OstromandGibsonetal.,2009).Nevertheless,sincethelate1990s,manyglobaldevelopmentorganizations,includingtheWorldBank,haveinsistedonlocalparticipationtoensurethatcommunityandsocialdevelopmentinitiativeshaveahigherlikelihoodofsuccess(Dongieretal.2003).Asaresult,stakeholderparticipationishighlyvaluedtoensureprojectsustainability;engagingthecommunitynotonlyensuressustainability,butitcanalsohelpwithorinvolvecommunityempowermentandcapacitybuilding(Brett,2003;Brageretal.,1987).WhileresearchhighlightstheimportanceofcommunityparticipationamongtheAfricanpeople,littleisknownaboutindividual-levelexperienceswithinformalinstitutionswhencopingduringapandemic.Further,muchoftheliteratureonthistopicrelevanttohealthcriseshasfocusedonhowinformalinstitutionshaveworsenedhealthcrises,mainlybecauseofthelackofscience-basedinformationandthemanymythsusedtoexplain\"western\"healthissuestheinitialstages.Forexample,duringtheHIV/AIDSepidemicinAfrica,manybelievedthatthediseasecouldbetransmittedbytouch,andmanyvillageswereburnedinanattempttoeradicatethedisease(Chirikure,2020).Similarly,duringtheEbolaoutbreakinWestAfrica,therelianceoninformalinstitutionswerefoundtoleadtoseveraladverseeffectsandfurtherspreadofthedisease;theWHOreportedthatapproximately60%ofEbolacasesinGuineawereattributedtotraditionalburialpractices(WHO,2014).ReasonsfortheseadverseeffectshavebeenattributedtoacomplexsocialphenomenoncharacterizedbyvariousreligiousandculturalbeliefsheldbytheAfricanpeople(Manguvo&Mafuvadze,2015).WhilethisresearchhadadvancedourknowledgeonthenegativeconsequencesofprimarilyrelyingoninformalinstitutionsinAfrica,fewresearchershavestudiedthebenefitsofinformalinstitutionstotheAfricanpeopleduringahealthpandemic.Thisliteraturegapjustifiestheneedforadditionalresearchonindividual-levelexperienceswithinformalinstitutionsduringapandemicinselectAfricancountries(Marsland,2006;White,2015;Worden2012).ProblemStatementandSignificanceoftheStudyInAfrica,ahighnumberofdeathsduetoCOVID-19wereexpectedduetothefragilehealthsystem,lackofaccesstopreventivemeasures,barrierstotesting,andpotentiallyvulnerablepopulations(Schwikowski,2020).However,sub-SaharanAfricaistheleastaffectedregionintheworld,with1.5%oftheworld\'sreportedCOVID-19casesand0.1%oftheworld\'sdeaths(WHO,2020).Thesestatisticsareexpectedtochangedrastically,giventhepredictedeconomiccollapseasaresultofCOVID-19(Hameed,2020).TheWorldBank(2020)estimatesthatupto60millionpeoplelivinginAfricawillbepushedintoextremepovertybytheendoftheyear,whichpresentsamultitudeofcrisesacrosstheAfricancontinent.Inthepast,peoplelivinginAfricancountriesreliedheavilyoninformalinstitutionstocopewithpandemics(Moore,2020)despitetheavailabilityofsupportofferedbyofficialgoverningbodies(i.e.,formalinstitutions).Whilehelpfulformany,thereareoftengapsincareprovidedbyformalinstitutions,particularlywithunderprivilegedpopulationsthataresociallyisolatedandlow-income(WorldEconomicForum,2020).Asaresult,manyAfricansrelyoninformalinstitutionssuchascommunitygroupsandfaith-basedgroupstonavigatecrises.Informalinstitutionsareprimarilyusedasacollective,meaningthatcommunitiesandgroupsfillthegapsformalinstitutionsdonot.However,collectivismposeschallengesduetotheneedforsocialdistancingtosloworpreventthespreadofdisease,suchaswhatisrequiredduringpandemics.Giventhatmuchoftheresearchoninformalinstitutionshasfocusedongroup-levelparticipation(collectivism),itwouldbebeneficialtounderstandthelivedexperienceofcopingthroughtheuseofinformalinstitutionsonanindividual-levelduringtheCOVID-19pandemic.KnowledgegeneratedmightcontributetothefutureroleofinformalinstitutionsduringpandemicandinformfuturehealthpolicyinAfrica.ThistopicissignificanttoindividualslivinginruralSouthAfrica,Nigeria,andSwazilandbecausetheCOVID-19pandemicisexpectedtoresultinhighdeathratesandeconomiccollapseinAfrica,primarilyruralAfrica.Approximately60%oftheAfricancontinent\'spopulationresidesinruralAfricaanddependoninformalinstitutionstocopeandsurviveduringcrises(Starkey,M.,2015).BecauseinformalinstitutionsremainmostlyunchangedintheAfricansociallandscape,itisessentialtodrawattentiontothoseinformalinstitutionsthathaveapositiveimpactontheAfricanpeople.Whileinformalinstitutionsshouldnotreplaceformalgovernmentefforts,theyareusedwidelyamongcommunitiesandculturalgroupsinAfrica,primarilyintheformofcommunityparticipation.GiventheneedtosociallydistanceduringtheCOVID-19pandemic,itissuspectedthattheseinformalinstitutionswillneedtobeadaptedtobeusedattheindividuallevel.Understandingtheindividual-levelexperienceofcopingthroughtheuseofinformalinstitutionsduringCOVID-19mightuncoversuccessfulcopingmechanismsthatcanbesharedwithindividualslivinginruralAfrica,andinformcollaborativepartnershipsbetweenformalgoverningstructuresandcommunityleaders.ConceptualFrameworkAccordingtoImenda(2014),\"theconceptualortheoreticalframeworkisthesoulofeveryresearchproject\"(p.185);itdetermineshowresearchersformulatetheirstudyproblem,purpose,andquestions,howtheyinvestigatetheproblem,andwhatmeaningtheyascribetothecollecteddata.Studiesthatuseinductivelogic(typicallyqualitative)constructconceptualframeworksandmayusemultipletheoriestoguideinquiry(Imenda,2014).Regardlessofthequalitativeapproachtaken,theconceptual/theoreticalframeworkrepresents\"thesystemofconcepts,assumptions,expectations,beliefs,andtheoriesthatsupportsandinformsyourresearch\"(Maxwell,2004,p.33).Itisavisualandorwrittenproductthatdescribeshowtheresearcherunderstandsthephenomenonunderstudy.AconceptualframeworkwasdevelopedtoinformthisstudybasedonW.RichardScott\'s(2004)institutionaltheoryandRobertWunrthrow\'s(1975)interpretivetheory.Scottt\'s(2004)institutionaltheorywaschosenbecauseittendstoseekadeeperunderstandingofsocialnorms,ithasanauthoritativestatus,andcanbeusedtodeterminewhetherthesenormsaremerelyimitation,orusedonlywhennecessary.InterpretivetheorywaschosentobuildontheworkofRobertWuthowandhissociologicalstudyofculture,exploringtheintricateinterrelationofalternativeapproachestoculturalanalysesandhowitoverlaps.Componentsofeachtheorywereintegratedintoaconceptualframeworktoinformtheproposedstudy(Figure1).Thissectionwilldescribeeachtheory,primarilyfocusingonthecomponentsofthetheorythatwereusedtodevelopaconceptualframeworkforthisstudy.Figure1.ConceptualFramework:TheRelationshipbetweenComponentsofScott\'s(2004)InstitutionalTheory,Wunthrow\'s(1987)InterpretiveTheory,andanIndividual\'sResponsetoCrisisInstitutionalTheoryandPathDependencyInstitutionaltheoryencompassestheprocessesbywhichstructures,norms,dailyliferoutines,communalandstaterules,andindividualhabitsandexpectationsbecomeenshrinedandinstitutionalizedwithinapopulaceandservetoact,ultimately,asauthoritativeguidelinesforsocialbehavior(Scott,2004).InstitutionaltheoryprovidesasuitablesociologicallensforinterpretingthefindingsofthisstudyandexploringtheexperiencesofindividualswholiveinpartsofruralAfricaandrelyoncustomaryauthorities,atypeofinformalinstitutionenforcedasnormsandnetworksratherthancodifiedintoformal,positivelaw(Scott,2004). Howindividualsrestructureandadaptexistinginformalinstitutionsintimesofcrisiscanalsobeexplainedthroughpathdependency,anareaofinstitutionaltheory(Rose,1990;Mahoney,2000;Pierson,2000).Institutionaltheory(Scott,2004)isrootedinthesocialsciences,andearlyresearchoninstitutionaltheorybeganintheearlynineteenthcentury.Itwasembeddedwithinthepositivism(sociology)andbehaviorism(politicalscience)movements(Scott,2001).Sincethattime,institutionaltheoryhasbecomewidelyrecognizedandresearchedbysocialsciencescholarsandorganizationalmanagementscholars(Scott,2004).Forexample,institutionaltheoryhasbeenappliedinthestudyofauthoritysystems(Dornbusch&Scott,1975)andtheeffectsoftechnologyonclassroomandschoolstructure(Cohenetal.,1979).Pathdependencyandinstitutionaltheoryhavealsobeenappliedinthestudyofhowindividualswithininternationalhealthagenciesshapeaninstitution\'sresponsetochangeswithinandoutsidetheorganization(Gomez,2013).Together,twotheoriescomplementeachotherinthattheyexplainhowindividuals,asagentswithinaninstitution,canshapeaninstitution\'sacceptanceandresistanceofchange.Earlyversionsofinstitutionaltheoryemphasizedcultural-cognitiveelements(Douglas,1986;Zucker1977),regulativeelements(North,1990),andnormativeelements(Parsons,1990).Thenormativeelementrepresentsthevaluesandnormsofacultureorinstitutionandallowsfortheestablishmentofindividualroles(Scott,2008).Theregulativeelementrepresentsrule-setting,sanctioning,andmonitoringactivitiesofacultureorinstitutionaspartofanattempttoinfluencethefuturebehaviorofindividuals(Scott,2008).Thecultural-cognitiveelementrepresentsthe\"sharedconceptionsthatconstitutethenatureofsocialrealityandcreatestheframesthroughwhichmeaningismade\"(Scott,2008,p.67).Scott(2004)focusedprimarilyontheregulativeandnormativeelementsofthetheorybecausehedidnotbelievethethreeelements-cultural-cognitive,normative,andregulative-werealwaysalignedandconcludedthatcertainaspectsunderminedothers.Scott(2004)alsobelievedthatduringtimesofconflictorchange,individualactorswithininstitutionsmightexperiencecompetingrulesorschemas,leadingtoarestructuringoftherules,norms,andbeliefsthatguidetheiractions.ThisbeliefisechoedintheearlierworkofBarley(1986)whostudiedtheresponseofindividualsworkinginhospitalsduringtheintroductionoftechnologyinthehealthcarefield.Twoyearslater,DiMaggio(1988)purportedthatanindividual\'sagency,orabilitytoadaptbasedontheirsituation,supporteda\"bottom-up\"viewofinstitutionalmodels.Withthisview,socialscientistsbeganconsideringhowindividualsrespondedinvaryingwaystooutsideforcesanddidnotalwaysbehaveaccordingtoinstitutionalbeliefsandstandards.Pathdependencyexplainshowanindividual\'scognitivebeliefsandpriorexperiencesshapeinstitutions\'responsetochange.Anindividual\'scognitivebeliefscanconstrainthelegitimacyandlearningofaninstitution.Legitimacyoftheinstitutionisconstrainedbecausepeopleoftenconsiderexistingapproachestobethemostlegitimateandthereforefavortheseapproachesovernewapproaches.Inaddition,whenindividualsspendtimelearninganewapproachthroughexperience,andastheyacquiremoreknowledgeandexperienceaboutanapproach,theybecomeresistanttolearningnewapproaches.Furthermore,astimepasses,individualswithinaninstitutionpassonknowledgetoothersandnewmembers,whichmakesitallthemorechallengingfortheinstitutionandtheindividual\'swithinittoadoptandlearnnewapproaches(Gomez,2013).InterpretiveTheoryRobertWunthrow\'s(1987)interpretivetheorywillcomplementinstitutionaltheory.InterpretivetheorycanbetracedbacktotheseminalworksofMaxWeber(1864-1920).Theinterpretiveapproachisageneralcategoryofphilosophy,includingsymbolicinteractionism,labeling,ethnomethodology,phenomenologicalsociology,andthesocialconstructionofreality.Theinterpretivemethodismoreacceptingoffreewillandseeshumanbehaviorastheoutcomeofthesubjectiveinterpretationoftheenvironment.Wunthrow(1975)expandedonWeber\'sworkinhisseminaltextMeaningandMoralOrder:ExplorationsinCulturalAnalysis.Wunthrowarguedthatthestudyofculturehadbeenill-servedbyasubjectiveorientationthatreducesculturalobjectstoindividualbeliefsandmeanings.Healsodiscussedtheissuessurroundingculturalanalysis,includingtheproblemofmeaning,thenatureofmoralorder,thecharacterandroleofritual,theroleofideology,andthefunctionofthestateinproducingideology(Wunthrow,1975).Seekinganalternativeapproach,Wuthrow(1987)identifiedfourtheoreticalschoolsthatinformtheworkofsocialscientists—subjectivity,thestructural,thedramaturgic,andtheinstitutional—andexaminedthemethodologicalimplicationsofemployingeachofthem.Thesubjectiveschoolencompassesanindividual\'sbeliefs,attitudes,opinions,values,ideas,moods,goals,outlook,anxieties,interpretingreality,andcommitment.Thestructuralschoolencompassesorderlyrelations,rules,coherence,identity,distinction,andsymbolicboundaries.Thedramaturgicalapproachincludestheexpressivedimension,whichincludesanindividual\'scommunicativepropertiesandinteractionswithothers—theinstitutionalschoolencompassesorganizationsasactors.ThisstudywillprimarilyfocusonthesubjectivecomponentofWunthrow\'s(1987)framework,asthisstudyseekstoexploretheexperienceofcopingthroughtheuseofinformalinstitutionsattheindividuallevel.Becausebeliefsandcustomarypracticestocombatillnessarerootedinculture,whichnecessitatestheinvolvementandcommitmentoftheindividual,andarenotnecessarilysolelycontrolledoroptimizedbygroupsorinstitutions.Therefore,Wunthrow\'s(1975)frameworkisusefulbecauseithasbothculturalandmaterialconsequences.Ontheonehand,thereareapparentsocial,economic,andfinancialconsequencesthatresultfromindividualhealthissueswhenmanypeopleinthecommunityareillorareatriskofbecomingill.Formalandinformalinstitutionsmustreactaccordinglyandappropriately;however,theindividualunderpinsboth.Throughtheapplicationofinterpretivetheory,theresearcherwillfocusonthesubjectiveperspectivetohighlighttheimportanceoftheindividualinrelationshiptothecommunity,aswellastheindividual\'srelianceoninformalinstitutions.RelationshipbetweenTheoreticalConstructsAsshownearlierinFigure1,eachofthesecomponentsinfluencesanindividual\'sactionandcopingbehaviorsduringacrisis.Withtheapplicationofthesetwoframeworks,itcanbeinferredthatanindividual\'sdecision-makingprocessduringapandemicisinfluencedbyfourperspectives(i.e.,thenormative,culture-cognitive,regulatory,andsubjectiveperspectives)andhowtheindividuals\'cognitivebeliefsandpriorexperiencesmaypreventappropriateresponsestochange.Thenormativeperspectiveinfluencestheextenttowhichoneperceivestheirgovernmentascapableorjust.FromtheperspectiveofanindividuallivinginruralAfricawhoisoftenavictimofcontinuedunpunishedcorruptionbygoverningbodies,thereisoftenaperceptionoflessresponsiveleadership(Bratton,2010).Consequently,individualsexpectlittle,ifany,assistancefromthegovernmentduringatimeofcrises,suchasapandemic.Theculture-cognitiveperspectiveinfluencesthesocialnetworksandidentitieswithinwhichanindividualalignsandhowtheseinfluencetheirdecision-making(Linden,2015).Basedontheculture-cognitionperspective,anindividual\'sdecision-makingisinfluencedbytheirworldview.Withtheperceptionsofgovernmentunderperformance,theAfricanindividualderivesmostoftheirsupportfromtheirsocialnetworks.Assuch,theymakedecisionsbasedontheposition(s)heldbythosewithwhomtheyshareessentialties(Linden,2015).Theregulatoryperspectivecapturestheeffectivenessofsanctionsavailabletocushionindividualsagainstinstitutionalfailure.Thecourtsystem,whichismeanttoregulatethefunctioningofformalinstitutions,oftenlacksindependence(Amoako,2018).Consequently,individualshavelittleconfidenceintheeffectivenessoftheformalregulatorysystemanditsabilitytoensureaccountabilityinformalinstitutions.Sanctionsgoverninginformalinstitutionsincludeshaming,boycotting,ostracism,shunning,gossip,internalizednormsadherence(standardoperatingprocedures),self-enforcementobligationmechanisms,anduseofviolence.Thesesanctionshavelittlesupportinlawandare,consequently,highlyineffective(Amoako,2018).Thus,thosewholiveinruralAfricanoftenhavelowconfidenceintheirabilitytoregulateandensureethicalcompliancebyinformalinstitutions.Finally,thesubjectiveperspectiveinvolvesanindividual\'sneeds,feelings,andattitudes,andhowtheseinfluencetheirdecision-makingduringcrises.Finally,pathdependencyexplainshowtheseperspectivesintersectwithanindividual\'scognitivebeliefsandpriorexperienceswithaninstitutiontoinformtheirfutureactionsandcopingbehaviors.ActionandRelatedOutcomesIntheabsenceofgovernmentservicedeliveryandbeingdisconnectedfromcommunalprograms,individualswholiveinruralAfricanduringacrisis,suchasapandemic,utilizeinformalinstitutionsattheindividuallevelasacopingstrategy.Forinstance,duetoalackofaccesstogovernment-providedhealthcareandalackoffundstoseekprivatehealthcare,anindividualmightchoosetouseherbsandcustomarymedicinepractices.Further,withthelossofemploymentandlackofsupportivesupportprograms,thecitydweller,unabletoraisehouserent,disposesoftheirpropertyandreturnstoruralareas.Oneoftheresultantoutcomesofthisactionisanincreasedlevelofcoping;thechallengestheindividualfacesduringthecrisisandthefactthattheyhavetocopewithoutparticipatingwithinacommunityhelpsthembuildresiliencetodealwithfuturepandemics.Theindividualalsodevelopsanincreasedlevelofadaptingastheyareforcedtocreateinnovativewaystosurvivebasedonage-oldcustoms.Forinstance,theylearntoplantfoodandpreparemedicinalherbsasopposedtorelyingonprescribeddrugs,henceincreasingself-sufficiencyandself-development.Finally,theindividualrestructuresthenormsandrulestheypreviouslyheldtoalignwiththerealityposedbythecrisis.DefinitionofKeyTheoreticalConceptsConceptMeaning/DefinitionSubjectiveschoolEncompassesanindividual\'sbeliefs,attitudes,opinions,values,ideas,moods,goals,outlook,anxieties,interpretingreality,andcommitment.StructuralschoolEncompassesorderlyrelations,rules,coherence,identity,distinction,andsymbolicboundariesDramaturgicalapproachIncludestheexpressivedimension,whichconsistsofanindividual\'scommunicativepropertiesandinteractionswithothersInstitutionalschoolEncompassesorganizationsasactorsNormativeelementRepresentsthevaluesandnormsofacultureorinstitutionandallowsfortheestablishmentofindividualroles(Scott,2008)RegulativeelementRepresentsthevaluesandnormsofacultureorinstitutionandallowsforestablishingindividualroles(Scott,2008).Cultural-cognitiveelementRepresentsthe\"sharedconceptionsthatconstitutethenatureofsocialrealityandcreatestheframesthroughwhichmeaningismade\"(Scott,2008,p.67)PurposeoftheStudyandResearchQuestionsThepurposeofthisinterpretativephenomenologicalanalysisistounderstandthecopingbehaviorsofindividualslivinginruralSouthAfrica,Nigeria,andSwazilandandwhoengagewithinformalinstitutionstocopeduringtheCOVID-19pandemic.Informalinstitutionsincludebutarenotlimitedtoreligiousorganizations,communitygroups,communityfunctions,socialpractices,etc.InAfrica,customarypracticesininstitutionsareoftenpreferredoverscientificmethodsforfightingthespreadofdiseaseduringpandemics(Manguvo&Mafuvdaze,2015).Informalinstitutionsareadoptedatthecommunitylevel,whichisparticularlychallengingduringtheCOVID-19pandemicduetotheneedforsocialdistancing.Itwouldbebeneficialtounderstandthisphenomenonattheindividuallevel,asitmightprovideadditionalinsightstoinformthedevelopmentofawarenesscampaignsandotherrelevantmeasurestohelpindividualswhomightnotbeabletorelyontraditionalcommunitypracticesduringapandemic.Therefore,thefollowingresearchquestionswillguidethisinterpretativephenomenologicalanalysis:RQ1:HowdoindividualslivinginruralAfricauseinformalinstitutionstocopewiththeCOVID-19pandemic?RationaleforMethodologyThisstudywillemployaqualitativeapproachusinganinterpretativephenomenologicalanalysis(IPAhereafter)researchdesigntoexplorethelivedexperienceofcopingthroughtheuseofinformalinstitutionsattheindividual-levelduringtheCOVID-19pandemic.Aqualitativeapproachisappropriatewhenaresearcheraimstoexploreandunderstand,asopposedtoconfirmandexplain,aproblem(Creswell&Poth,2018).Thereareseveralcommoncharacteristicsofqualitativeresearch:multipledatacollectionmethods,naturalsetting,theresearcherasakeydatacollectioninstrument,inductiveanddeductivelogicwhichaidsincomplexreasoning,variousperspectivesandmeaningsheldbyparticipants,anemergentdesign,aholisticapproach(Creswell&Poth,2018).Thesecharacteristics,coupledwiththefactthatqualitativeresearchmethodologyfocusesonhowpeopleunderstandexperiences,makethismethodologyappropriateforthephenomenonunderstudy.AninterpretativephenomenologicalanalysisdesignwaschosenbecauseitwillallowtheresearchertoexplorehowindividualslivinginruralAfricamakesenseoftheirexperiencesusinginformalinstitutionstocopewiththeCOVID-19pandemic.Aninterpretativephenomenologicalanalysisisappropriateforresearcherswhoseektoexploreandinterpretthehumanexperiencewithaphenomenon(Smith,1996).Phenomenologicalresearchersascribetothebeliefthatrealityissubjectiveandbasedonthesubjectiverealitiesofindividuals(Smith,1996).Aninterpretativeapproach,asopposedtoadescriptiveapproach,waschosenbecauseitalignswiththeresearcher\'spremisethatthehumanexperiencecannotbeunderstoodwithoutinterpretation,whereasdescriptivephenomenologistsbelievethatthehumanexperiencecanbeunderstoodbybracketingbiasesandjudgment(Smithetal.,2009).Theprocessofinterpretingthehumanexperienceisachievedthroughthehermeneuticprocess,ortheprocessofexploringandmakingsenseoftheindividual\'sexperiencesthroughtheresearcher\'sperceptions(Smith&Osborn,2007).Asaresult,theresearchercanunderstandthefirst-person(participant)perspectivefromtheirthird-personposition(Larkinetal.,2011).Giventheresearcher\'spersonalexperienceswithinformalinstitutions,whilelivinginAfrica,thisapproachisappropriatebecauseitwillallowtheresearchertointerpretindividualexperiencesthroughtheirownexperientiallyformedlens(Smithetal.,2009).OverviewofDataCollectionProceduresAtotalofninetotwelveparticipantswillbepurposefullyrecruited,amongthesethreetofourwillberecruitedfromeachofthethreecountiesunderstudy:SouthAfrica,Nigeria,andSwaziland.AccordingtoSmithetal.(2009),thisisanidealsamplesizebecauseIPAresearchrequiresasmallsamplewithsimilarexperiencesinorderfortheresearchertocapturein-depthdetailsabouteachindividual\'slivedexperience.Theresearcherwilluseakeyinformantineachcountrybasedontheirpersonalnetworktogainaccessandrecruitparticipants.Priortoparticipatinginthestudy,individualswillbeaskedtocompleteabriefscreeningquestionnaireviaQualtricstoconfirmeligibility.Tobeincludedinthestudy,participantsmustbeatleast18yearsofage,nativetothecountryunderstudy,andacurrentresident.Aninterpreterwillnotbeneeded,astheresearcherisfluentinthelanguagesspokeninthecountriesunderstudy.Eachindividualwillparticipateintwosemi-structuredinterviews,withtheoptionofathirdinterview.Seidman\'s(2006)three-interviewserieswillbemodifiedtoguidetheinterviewprocess.Thepurposeofthefirstinterviewwillbetodeveloprapportwiththeparticipantsandcapturein-depth,context-specificinformationtoaidinthedevelopmentofparticipantprofiles.Thepurposeofthesecondinterviewwillbetocollectdataspecifictothestudy\'sresearchquestions.Thepurposeoftheoptionalthirdinterviewistoallowfortheopportunityfortheresearchertoaskfollow-upquestionsifthedepthofinformationneededisnotcollectedduringthefirstandsecondinterviews.Aninterviewprotocolwillbedevelopedpriortoconductingthefirstandsecondinterviews;however,theprotocolwillbemodified,ifneeded,basedonparticipantresponses.Thisisinalignmentwiththeemergentfeatureofqualitativeresearch.Interviewswilllastapproximately60-90minutesandwilltakeplaceviaZoomatatimeoftheparticipant\'schoosing.TherecordingfeatureontheZoomplatformwillbeusedtorecordinterviews.Thenumberofinterviewquestionswillvary,butwillgenerallyconsistofsixtotenopen-endedquestionsincludingappropriateprompts(Smithetal.,2009).AudiorecordingswillbeprofessionallytranscribedviaRev.com.DataanalysiswillfollowSmithetal.\'s(2009)six-stepdataanalysisprocess:(1)Readingandre-reading;(2)Initialnoting;(3)Developingemergentthemes;(4)Searchingforconnectionsacrossemergentthemes;(5)Movingtothenextcase;and(6)Lookingforpatternsacrosscases.Steps1–4willberepeatedforeachparticipantsinterview.DefinitionoftheTermsTermDefinitionCopingDefinedbyVandenBos(2007,p.232)astheutilizationofbehavioralandcognitivestrategiesformanagingthedemandsofaspecificsituationwhentheseareassessedastaxingorsurpassingone\'sresourcesortodiminishtheconflictandnegativeemotionsinducedbystress(ascitedinBarnett,C.L.Miller-Perrin,andR.D.Perrin,2010,p.373).CommunityparticipationAnotionininternationaldevelopmentdiscoursereferstoresidents\'engagementindecision-makingprocessesandtheassessmentofdevelopmentprojects.Itisalsoassociatedwithempowermentandtheuseofandrespectforlocalknowledge.Still,theconceptappearsbroaderasitisbelievedtoinvolvesuchasocialpracticeascost-sharing(Marsland,2006,pp.67-68).Cost-sharingAccordingtoSmithandRawal(1992),itwasapracticeemployedindifferentAfricanstateslikeTanzaniaandaimedatreducinggovernmentspendingandstimulateself-relianceCustomarypracticesLong-establishedpracticesinheritedfromthepastareaccepted,respected,andevenconsideredtheunwrittenlawbythemembersofacommunity.TherearemanydifferentcustomsinAfrica,somebeingpositiveandothersnegativeones(Handler,2016andHimonga,2016).Customarypracticescanalsobeunderstoodtofallunderthecategoryofsocialpractices.SocialpracticesGhoseetal.(2015,pp.37-38)definedasroutinepracticeshabituallyortypicallyperformedin(muchof)asociety;thereasonisthatavarietyofsocietymembersimplementslong-establishedpracticesSocialcapitalThefactorsofeffectivelyfunctioningsocialgroups,suchasreciprocity,cooperation,trust,sharedvalues,sharednorms,asharedunderstanding,asharedsenseofidentity,andinterpersonalrelations(Yama&Salvano-Pardieu,2019,p.170)Chapter2:LiteratureReviewTheCOVID-19pandemicposesasignificantthreattoindigenouspeopleandrurallivelihoodswithlimitedaccesstopublichealthprovisioninAfricaandelsewhere.IndigenouspeopleareespeciallyvulnerabletoCOVID-19,astheyareathigherriskforcommunicablediseasesandexperiencehigherratesofmortality(Lane,2020).Contributingfactorstothisincreasedvulnerabilityincludelimitedaccesstocleanwater,sanitation,malnutrition,andmedicalcare(Lane,2020).Forexample,earlyreportsoutofKenyaindicateinthevillageofMaasai,whichishometomorethanamillionindigenouspeople,livestockmarketshaveclosedleadingtofoodshortagesandlossofincomeformany(Wight,2020).Further,manycommunitiesrelyoneldersforculturalknowledgeandpractices;becauseCOVID-19isdeadlyforolderadults,eldersareathighriskfordeath(Lane,2020).TherearenumerousotherexamplesofinformaltraditionsthatcannotbereliedonduringtheCOVID-19pandemic,forcingindividualstoadapttheircopingbehaviors.ThisliteraturereviewbeginswithanoverviewofAfrica\'spost-conflicthistoryinordertosetthestageforhowformalinstitutionswereestablishedduringhealthcrisesinAfrica.Next,adescriptionoftheformalinstitutionsestablishedinSouthAfrica,Nigeria,andSwazilandinresponsetotheEbola,Tuberculosis,andHIV/AIDSepidemicswillbepresented.Followingisanin-depthdescriptionandanalysisofinformalinstitutionsineachofthethreecountriesunderstudy.ThechapterendswithananalysisofinstitutionaltheoryandhowithasbeenappliedinthestudyofhealthpandemicsinruralAfrica.OverviewofAfrica\'sPost-ConflictHistoryCenturiesbeforemissionariesandcolonialistsarrivedinAfricaandbeforetheslavetradecommenced,Africansreliedheavilyonculturalandsocialpractices,andmechanisms,toalleviatethelossoflivesandpreventthespreadofdiseases(Iganus&Haruna,2017).MostcustomarypracticeswereinitiatedaftereldersorseniormembersofAfricansocietiesmetanddiscussedcrisesandsuggestedwaystocopebasedonhistoricalknowledgeandexperience(Iganus&Haruna,2017).InGhana,forinstance,thelackofrecognizingandintegratinginformalinstitutionsintoformalgovernmentstructuresresultedinthe\"silentconflict\"amongthewealthierdemographic,whofavorgovernmentfundedsupportsystems(formalinstitutions),overthelower-incomeandsociallyisolateddemographic,whoheavilyrelyoncustomarypracticestonavigatecrises(Lozare,1994).Moreimportantly,conflictsbetweentribeshavecontinuedtonegativelyaffectlongaftertheactualconflict,astensionsandsuspicionscontinuetolinger.Thissuspicionandtensionhaveamajoreffectonhowthesetribesrespondtohealthcrises,requiringaharmoniousanduniversalresponseprotocol.ThissectioncontainsabriefoverviewofAfrica\'spost-conflicthistorywithaspecificfocusonformalandinformalinstitutionsthatarosefollowingconflictinSouthAfrica,Nigeria,asthesearetheproposedresearchsitesforthestudy.Swazilandwillalsobeincludedasaresearchsite,however,thereislittletonoliteratureontheirpostconflicthistory.SouthAfrica\'sAnti-ApartheidStruggleTheAnti-Apartheidstrugglebetween1912and1992wasledbytheAfricanNationalCongresstoopposetheApartheidsystemanditsoppressionofthemajoritynon-whiteSouthAfricans(Kurtz,2009).TheminoritywhiteSouthAfricans(Afrikaners)usedtheApartheidsystemtomonopolizecontroloftheeconomyandstate,andexcludedthemajoritynon-whitesfrompoliticalandeconomicpower.TheimmediateeffectoftheconflictwasanattemptbytheAfrikanerstointimidatethenon-whitesbyforciblyejectingthemfromtheirhomesandrelocatingthemtosegregatedneighborhoods,banningleadersoftherevoltfrompubliclife,andimposingmartiallaw.Informalandformalorganizationsofgovernanceemergedasaresultoftheconflict.InformalorganizationsthataroseincludepoliticalpartiessuchastheANCandUnitedDemocraticFront;tradeunionssuchastheCongressofSouthAfricanTradeUnions(COSATU);andreligiousorganizationssuchastheSouthAfricanCouncilofChurches[footnoteRef:1].Theseinformalinstitutionswereusedprimarilytodrivetheagendaofnon-whiteSouthAfricans.Formalinstitutionstoaidingovernancewerealsoestablished,includingalternativecommunity-basedinstitutionssuchaslegalresourcecenters,communityclinics,andcooperativesthateventuallyreplacedthetraditionalgovernmentinstitutionsatthecommunitylevel(Kurtz,2009).[1:DuringtheStruggleforindependence,churches,andinparticulartheBlackSouthAfricanChurchwaslargelyinformal,andonlyoperationalintheinformalsettlementsoccupiedbyBlackSouthAfricanpeople.]BiafranWarinNigeriaTheNigerianCivilWarbeganinJuly1967andendedinJanuary1970afterdiplomaticeffortsfailedtobringpeacebetweentheChristianIgbosandMuslimHausasinnorthernNigeria.Biafra,comprisingmainlyofIgboChristians,secededfromNigeriaunderColonelOdumegwuOjukwu(Heerten,2017).However,NigeriacapitalizedonitsmilitarystrengthtoreduceBiafra\'sterritory.Consequently,thestatelostitsoilfields,whichwereitsprimaryrevenuesource,toNigerialeadingtoalackoffundstoimportfoodsupplies(Heerten,2017).Asaresult,millionsofBiafracitizensstarvedtodeath.Thewarwascharacterizedbythedevelopmentofseveralformalandinformalinstitutions.FormalinstitutionsthatarosesoughttostrengthentheBiafranarmyandincludedanadvisorycommitteetoadvisetheheadofstateonmilitaryandpoliticalmatters,aFoodDirectorateforcoordinatingtheimportationandsupplyoffooditems,atransportdirectoratetocoordinatelogistics,andapetroleummanagementboardtocoordinatethemanagementoffuelsandpetroleum,oil,andlubricantlaboratories(Heerten,2017).Informalorganizationsthataroseincludedavoluntarywomenservicetoeducatewomenonthecrisisandtrainthemontherehabilitationofcasualtiesofwar,aswellascivildefensecorporations,orphanages,andnurseries(Heerten,2017).TheUseofFormalInstitutionsduringHealthCrisesTheonsetandspreadofTB,Ebola,andHIV/AIDSinSouthAfrica,Nigeria,andSwazilandhasresultedintheestablishmentofnumerousformalinstitutions.WhiletheseformalinstitutionshavebenefitedmanyAfricancommunities,therearealsosignificantlimitations.Commonlycitedlimitationsincludeinadequatesupportivesupervisionandleadership,competingpoliticalideologies,lackoffunding,andpoorsupportinfrastructure.TheselimitationsimpedetheeffectivenessofformalinstitutionsforruralAfricancommunities,particularlyduringhealthcrises.ItisimperativetoreviewandunderstandtheformalinstitutionsthatwereestablishedduringhealthcrisesandtheirlimitationstofullycomprehendtheneedforinformalinstitutionsinruralAfricancommunities.SouthAfrica\'sResponsetoTuberculosis(Mhlongo-Sigwebela,2010)GoverningbodiesinSouthAfricaestablishedfivekeyformalinstitutionstoaidinthemanagementoftuberculosis(TB),whichaffected649SouthAfricansper100,000peopleby2007.Thefirst,theNationalDepartmentofHealth,wasestablishedtoimprovehealthcaredeliverythroughimprovedaccess,equity,efficiency,andsustainability.InresponsetoTB,in1995,theDirectlyObservedTreatmentShortCourse(DOTS)strategywasimplementedbytheNationalDepartmentofHealthtoprovidefreeTBdiagnosisandtreatmentinabidtoincreaseaccesstocare.Fiveyearslater,ParliamentestablishedtheNationalHealthLaboratoryServicetocoordinatetheprovisionofpublicsectorlaboratoryservicesbyconductingresearchonnewtestingmethodsanddevelopingnewtechnologiesfordiagnoses.ThefourthformalinstitutionestablishedinresponsetotheTBepidemicistheSouthAfricanNationalTBControlProgram,whichworkscollaborativelywithotherstakeholderstointegrateTBtreatmentwithHIV,andcoordinatecommunity-basedstrategiesforinfluencingpatientstoseekandadheretoTBtreatment.Finally,theUSAIDTechnicalAssistanceandSupportProject(TASCIITB)wasestablished,whichpartnerswithacademicresearchinstitutionstosupportlocalhealthauthoritiesinimprovingthemanagementofTBsupportsystemsaswellasincreasingthequality,availability,anddemandforTBservices.LimitationsofResponseinSouthAfricaDespitetheestablishmentofformalinstitutionsinthefightagainstTBandtheirbenefitstoAfricancommunities,therearealsoanumberoflimitationsassociatedwithSouthAfrica\'sresponsetoTBthathinderedtheireffectivenessandreach.AnotablelimitationofformalinstitutionsinSouthAfricaispoorstewardshipatthepolicylevelandinadequatesupportivesupervisionattheimplementationlevel(Coovadiaetal.,2013).ThisprimarilyaffectstheNationalDepartmentofHealth,whichisknownfordevelopingpromisingpoliciesbutlacksproperleadershiptoensurepoliciesareadequatelyimplementedthroughoutthesystem(Coovadiaetal.,2013).Assuch,mostofthesepoliciesrarelyreachpeoplewhoneedthem.Forinstance,thefailureofthenationaltuberculosiscontrolprograminensuringtreatmentcompletionbyTBpatientshasbeenattributedtoalackofaccountabilityforperformanceandmanagerialoversight(Coovadiaetal.,2013).Humanresourcelimitations,particularlyintheruralareas,havealsohinderedtheabilityoftheNationalTBControlProgramtouselocalhealthcarefacilitiesandpersonneltohelppatientsatthecommunity-levelseekandadheretotreatment(Coovadiaetal.,2013).Consequently,TBcurerateshavebeensignificantlylowinruralareas.Datareleasedin2007,indicatesthatcurerateswere80percentinWesternCapeProvinceascomparedtotheruralKwa-ZuluNatal,wheremostdistrictsreportedcureratesofbetween40and50percent(Coovadiaetal.,2013).Inadequatefundingisanotherfundamentalmajorlimitation,astheavailabilityoffundingdepends,toasignificantextent,onpoliticalideology.Forinstance,theTBcontrolprogram\'sfundingbetween1998and2005wassignificantlylow,asthen-presidentThaboMbekiandhishealthministersheldabizarrebeliefthatHIVdidnotcauseAIDSand,thus,therewasnoneedtocommitresourcestowardthepreventionandtreatmentofHIV/AIDS(Coovadiaetal.,2013).ThisledtoastagnationofnationalresponsestowardsHIVandTB,causingaconsiderableburdenofillhealth(Coovadiaetal.,2013).Nigeria\'sResponsetoEbolaandTuberculosisNigeria,themostpopulousAfricanstate,hasbenefitedfrominvestmentanddevelopment,aswellexperiencedchangesinformalhealthcareapproachestoreflectmodernuniversaltrends(Shuaibetal.,2014).Asaresult,NigeriawasablestopthespreadofEbola.EbolafirstappearedinNigeriafollowingthe2014outbreakthatbeganinWestAfricaandspreadthroughouttheneighboringstateofGuinea.FromGuinea,EbolaspreadtoLiberiaandwhenatravelerfromLiberiatraveledthroughtheLagosAirport,thepandemicreachedthestateofNigeria.Throughcontacttracing,Nigerianhealthauthoritieswereabletoidentify72individualswhowerepotentiallyexposed(Shuaibetal.,2014,p.867).ThisactiononbehalfoftheFederalMinistryofHealth,whichwasoverseenbytheNigeriaCentreforDiseaseControl,ledtotheswiftcontainmentofEbola.ThisformalinstitutionhasbeenmodeledaftertheCDCintheUnitedStates.BecauseNigeriahadpriorexperiencewithdiseaseoutbreaksinthepast,itsnationalpublicinstitutionwasreadytorespondtotheEbolaoutbreak(Shuaibetal.,2014).ThisisbutoneexampleofhowaformalhealthinstitutioninAfricahasemergedtobattlehealthproblems.However,manyinformalhealthinstitutionsinAfricahavedevelopedasaresultofeconomicdisparitiesthatpreventmoredestituteandimpoverishedpopulationsfromseekingcareatformalinstitutionslikethisoneinNigeria(Nelissenetal.,2020).NigeriaalsofacesasignificantTBhealthburdenandisamongthe30highTBburdencountriesintheworld(Ogbuabor&Onwujekwe,2019).TominimizetheriskposedbyTB,Nigerianagencieshavedevelopedseveralformalinstitutions.In1993,theFederalMinistryofHealthadoptedtheDOTSstrategytoenhancecasedetectionbysputummicroscopy,improveshort-coursetreatment,andincreaseTBnotification(Ogbuabor&Onwujekwe,2019).TocomplementDOTS,theministryalsoadoptedtheStopTBPartnership,whichfocusesonaddressingtheneedsofthepopulationconcerningmultidrugresistantTBandtheTB-HIV(Ogbuabor&Onwujekwe,2019).Thesestrategieshavebeengearedatimplementinguniversalhealthcoverageandprovidingsupporttoenhanceaccess,treatment,andcontrolofTB.AnothercrucialformalinstitutionistheNationalTBControlProgramunderthefederalministry.TheProgram\'sprimarydutyistoprovideTBandTB-HIVservicesandconductoperationalresearchtoinformgovernmentpolicyconcerningTBandHIV(Ogbuabor&Onwujekwe,2019).ThethirdcrucialformalinstitutionforTBmanagementisthenationalstrategicplanforTBControl,whichprovidespolicydirectionsandservesasabasisuponwhichTB-relatedlegislationisenactedandbudgetsdevelopedtoenhancetreatmentandaccess(Ogbuabor&Onwujekwe,2019).LimitationsofResponseLackofgovernmentcommitmentandgoodwillhasemergedasafundamentallimitationofformalinstitutionsinNigeria.Forinstance,despitehavingastrategicTBplan,thecountrylacksTB-specificlegislation,makingtheintegrationofTBcontrolintothecommunityachallenge(Ogbuabor&Onwujekwe,2019).TheNationalTBControlProgramistaskedwithconductingoperationalresearchtoinformgovernmentpolicyregardingTBandHIV.However,reportsindicatethattheprogram\'seffectivenessishinderedbyhumanresourcelimitationsandolddeliverysystemsthatmakepolicy-implementationatthecommunityleveldifficult(Ogbuabor&Onwujekwe,2019).PoorleadershipwithintheNationalTBControlProgramhasalsoemergedasaseverelimitationtotheprogram\'seffectiveness.Theprogramhasaclearreportingstructure,anelectronicdatamanagementsystem,andpropersurveillancestrategies.However,thelackofstewardshiphasresultedinineffectivemonitoringandsupervision,ultimatelyleadingtopoorimplementationofpoliciesattheprimarylevel(Ogbuabor&Onwujekwe,2019).FundinglimitationsareevidentinNigeriaasinotherAfricancountries–theNationalTBControlProgram,forinstance,reliesprimarilyontheGlobalFundand,isattimes,forcedtoscaledownitsoperationsduetofundinglimitations.In2019,forexample,theprogramwasforcedtoscaledownhealthproductbufferlevelsforitsdrug-resistantTB(DR-TB)programduetofundinglimitations(Garmaise,2018).Suchadjustmentspresentariskfortreatmentdisruptions,whichmayhavesevereconsequencesforthehealthofthepopulation.Swaziland\'sResponsetoHIV/AIDSInresponsetoitsHIV/AIDSepidemic,Swazilandestablishedseveralformalinstitutions.OneofthemostfundamentalinstitutionsistheNationalStrategicPlanforHIV/AIDS,whichprimarilyservestoinformpolicy,identifyobjectivesandmilestoneswithHIV/AIDS,andprovidethebasisforbudgetingandHIV-relatedlegislation.TheHIVCrisisManagementandTechnicalCommitteeisthehighestbodywiththeauthoritytocoordinatethenationalHIVresponse(HIVCrisisManagementandTechnicalCommittee,2000).Comprisedofexpertsdrawnfromgovernment,donoragencies,traditionalhealers,media,churches,theprivatesector,andNGOs,theCommitteeistaskedwiththeimplementationoftheHIVstrategicplan,mobilizationofresourcesandsocialservices,monitoringcommunity-basedmanagementprograms,raisingawarenessonHIV/AIDS,andreviewingtheprevalenceofHIVannualstatisticsinabidtoassessprogress(HIVCrisisManagementandTechnicalCommittee,2000).TheMinistryofHealthandsocialwelfarealsoplaysavitalroleinthedevelopmentofpolicyandinitiativesrelatingtocarefortheinfectedandthoseaffected,includingraisingawarenessonthecausesandriskfactorsforHIV,aswellastheconsequencesattheindividuallevel(HIVCrisisManagementandTechnicalCommittee,2000).OfcrucialimportanceisalsotheU.S.government\'sPresident\'sEmergencyPlanforAIDSReliefProgram,whoseprimaryroleistoeasethediseaseburdeninSwazilandandSouthAfricathroughtheprovisionofARVs.LimitationsofResponseAreportbytheU.S.President\'sEmergencyPlanforAIDSReliefProgram(PEPFAR)indicatesthatonelimitationitfacesinSwazilandisinadequateroadsystemsandpoorinternetconnectivity,whichaffecttheabilityofpartnersindifferentgeographicallocationstonetworkandcollaborate(PEPFAR,2019).Theprogramalsoreportedalackofskilledpersonnelinthefieldandunreliablebaselinedata,whichlimitstheabilitytoadequatelytrackprogramimplementationandassessoutcomes(PEPFAR,2019).Inaddition,fundingchallengesposeaconsiderablechallengetotheHIVCrisisManagementandTechnicalCommittee,astheCommitteedependsontheGlobalFund.TheoverdependenceontheGlobalFundimpliesthattheCommitteehastoadjustitspurchaseandplannedprogramsinsituationswheretheGlobalFund\'sdonationstreamsareaffectedbyuncontrollableevents.InformalInstitutionsinSouthAfrica,Nigeria,andSwazilandVariousinformalinstitutionsexistwithinAfricancommunities.Theseinformalinstitutionsareprimarilyusedatthecommunitylevelthroughcommunityparticipation.CommunityparticipationisanessentialelementofAfricancommunitiesandischaracterizedbyvarioussocialmethodsandinvolvesvarioussocialcapitalfactors(Marsland,2006).Intimesofcrises,communityparticipationisexpectedinAfricancommunities,butnotallcommunitycareprovisionshavebeensuccessful(Shuaibetal.,2014).Non-governmentalorganizations(NGOs),communityhealthworkers,traditionalhealers,chiefsandlocalcommunityelders,andfaith-basedorganizationsareallexamplesofinformalinstitutionsthatareengagedatthecommunitylevelinresponsestohealthcrises.TheUnitedNationsrecentlyreleasedareportwithrecommendationsforhowformalinstitutionsengageandcollaboratewithindigenouspeopleduringtheCOVID-19pandemic.Theyrecommendedthatgovernments:includecommunityleadersandtraditionalauthoritiestooverseeofficialresponsetotheCOVID-19pandemic;involveindigenouswomenwhenmakingdecisionsrelatedtosocialdistancingandlockdowns;providetechnologyandassistanceforremotelearningandsupportindigenouscommunities\'educationalinitiatives;respecttheirrighttoremaininvoluntaryisolation;providepost-COVIDfundstohelprebuildresources.AnumberofotherrecommendationsweremadeforNGOsandprivatesectororganizationstoensureindigenouspeopleareprotectedandsupported(\"IndigenousPeoples&theCOVID-19Pandemic:Considerations\",2020).Despitetheserecommendations,casesofCOVID-19aregrowinginAfrica.Thus,itiscriticaltogainabetterunderstandingofhowremoteandruralcommunitieshaverespondedtopriorhealthcrisestocope.Thisliteraturestrandincludesanin-depthexaminationofinformalinstitutionsthatexistacrossAfricanincludingananalysisofliteratureregardingtheinformalinstitutionsthatweredevelopedasSouthAfrica,Nigeria,andSwazilandrespondedtotheTB,Ebola,andHIV/AIDSepidemics,respectively.SouthAfricaMultipledistinctinformalinstitutionswereengagedatthecommunityleveltohelpSouthAfricancommunitiescopeduringpastpandemics.Forinstance,inresponsetotheTBpandemic,alocalTBcommunity-basedNon-ProfitOrganization(NPO)wasformed(Mosamaria[footnoteRef:2]).Mosamariaprovidesarangeofsupportservices,includinghelptoreducestigma,encouragingTBpatientstoseektestingandtreatment,conductingsocialmobilizationandlocaladvocacyaroundTB,consolidatingservicesforpeopleco-infectedwithHIV,andprovidinghome-basedindividualizedtreatmentsupportforTBpatients(USAID,2019).AUSAIDreportindicatesthatbetween2016and2019,atotalof485individualsinSouthAfricawerediagnosedwithTBandlinkedtocarethroughtheseNGOs(USAID,2019).[2:OperationalintheSouthAfricaninformalsector,thisNPOoperatesmainlythroughpersonalrelationsforpersonssufferingfromTBorAIDSwithintheSouthAfricaninformalsettlements.]Communityhealthworkersincludingcommunityvolunteersandsupervisors,alsoplayakeyroleinTBmanagementatthecommunitylevel,particularlyinlow-incomeurbansettlements.Communityhealthworkersareinvolvedintheprovisionofhealthactivitiesintheircommunity,thoughtheyarenotformalgovernmentemployeesandarenotincentivized(WHO,2013).Communityhealthworkersareinvolvedindirectobservedtherapy,aprogramgearedatensuringthatpatientstaketheirmedicationattherighttimeandintherightquantities(WHO,2006).A2003studyconductedbytheWHOintheGuguletuDistrictofSouthAfricafoundthatusingcommunityhealthworkersindirectobservedtherapycontributedtoincreasedTBcontrolcomparedtoapproachesbasedpurelyonhealthfacilities(WHO,2003).Thissectionincludesamorein-depthlookatothertypesofinformalinstitutionsinSouthAfricaandtheirroleinsupportingindividualswholiveinruralcommunities.TraditionalHealersandMedicineTraditionalmedicinesaresubstancesusedintraditionalhealthpracticeforthediagnosis,prevention,andtreatmentofillness,aswellasthepromotionofwell-beinginmostruralAfricansocieties(Majomoodally,2013).Traditionalmedicinesincludeadiverserangeofplantandanimalproductsthatareeitherself-administeredbythepatientoradministeredbytraditionalhealersandbelievedtotreatawiderangeofconditionsincludingmentaldisorders,tuberculosis,anddiabetes.Forinstance,theleafoftheAloeFeroxplanthasbeenshowntohaveanti-diabeticproperties,theUbulawu,atraditionalmedicinedrawnfromthestemofHelinusintegrifoliusandrootoftheSillenebellidioidesisusedtocleansethebodyandsoul,whiletheCryptocaryabarkmixedwithcrocodilefatisusedinthetreatmentofchestpains(Mmamosheledi&Sibanda,2018).TraditionalhealersareresponsiblefortheadministrationoftraditionalmedicineinSouthAfricaandincludebirthattendants,traditionalsurgeons,herbalists(iNyanga)anddiviners(iSangoma)(Mmamosheledi&Sibanda,2018).Traditionalhealingisinterwovenwithreligiousbeliefsandculturalpracticesandis,therefore,believedtobeholistic,involvingboththemindandsoul(Mmamosheledi&Sibanda,2018).SouthAfricanslinktraditionalhealingpracticeswithspiritualityandbelievethattraditionalhealersarecapableofcommunicatingwithancestorsandanindividual\'sdepartedblood-relativeswhoarebelievedtomediatebetweenthelivingandGod,andwhoserveasthecustodiansofthedestiniesoflivinggenerations(Mmamosheledi&Sibanda,2018).Forinstance,divinersintheSouthAfricanbeliefsystemareconsideredspiritualityexpertscapableofdefininganddiagnosingtheoriginandreasonofillnesswiththehelpofthepatient\'sancestors(Mmamosheledi&Sibanda,2018).TraditionalhealershavealsoplayedanimportantroleinthemanagementofTBinSouthAfrica(WHO,2013).TraditionalhealersareprimarilyinvolvedassupervisorsofTBtreatmentintheirlocalcommunities,andresearchdemonstratestheymaybeausefulcontributiontotheperformanceofTBprograms(WHO,2013).Finally,therearechiefsandlocalcommunityelderswhocommandsignificantrespectinthevillagesandlocaljurisdictions.ChiefsandlocalcommunityeldersaresupportedbytheSouthernAfricaTuberculosisandHealthSystemsSupport(SATBHSSP),andplayacrucialroleintransmittingTBinformationtothemassesincludingraisingawarenessonscreeningandthehealthbenefitsofearlydiagnosis(SATBHSSP,2018).ThestrongbeliefsthattraditionalhealersemploysomeformofspiritualconnectionwithancestorsandGodthatcouldinterveneinillnessmakestraditionalhealersthefirsttreatmentoptionformostpatients,althoughpatientsalsopreferthembecausetheyaremoreaffordable.InthewakeoftheCOVID-19pandemic,traditionalhealerscouldhelpreducethestrainontheformalhealthcaresystembyadministeringorguidingpatientstoself-medicateusingtraditionalmedicinessuchasUmckaloabousedinthetreatmentofchestpainsandbronchitissymptoms(Mmamosheledi&Sibanda,2013).Also,becausetraditionalhealersaremorepopularwithinthecommunitiestheyoperatein,theyprovideaperfectopportunitytosensitizepeopletoabidebytheCOVID-19mitigationstrategies,washinghands,andsocialdistancing.Traditionalhealersandmedicinaloptionsaremoreaffordableandreadilyavailabletoruralpopulationsthanformaloptions(e.g.,aspirinandnon-steroidalanti-inflammatorydrugs)andwouldeffectivelyhelppatientswithmildsymptomsmanagethediseaseathome.SubsistenceFarmingandFoodSecurityFarmingisoneoftheprimaryeconomicactivitiesinSouthAfrica.Traditionally,farmerspracticedsubsistenceandorganicfarmingwithhouseholdsinruralareas,primarilyproducingtheirownfoodwhilethoseinurbanareasrelylargelyonmarketpurchases.Inrecentyears,however,therehasbeenashifttowardmarketfoodpurchasesinbothruralandurbanhouseholds(Baiphethi&Jacobs,2009).ThedisruptionoffoodchainsasaresultoflockdownsandothermeasuresgearedatcurbingthespreadofCOVIDaffectstheavailabilityoffoodsubstancesinthemarket,increasingtheriskoffoodinsecurity,particularlyamongtheurbandwellerswhomostlyrelyonmarketfoodpurchases.Moreover,itisestimatedthatfoodexpendituresaccountforbetween60and80percentoftotalhouseholdincomeinanaverageSub-SaharanAfricanhousehold(Baiphethi&Jacobs,2009).Thedeclineoffoodproduceinthemarketasaresultofdisruptedfoodchainsraisesfoodprices,imposingafurtherstrainontheurbanpoorwhoarealreadyexperiencingfallingincomesasadirecteffectofapandemic.Inthisregard,areturntothetraditionalsubsistencefarmingwouldhelpincreasefoodsecurityforhouseholds,minimizingrelianceonmarketfoodpurchases(Baiphethi&Jacobs,2009).Severalactionshavebeentakentoencouragelocalcommunitiestoshiftbacktosubsistencefarming.OnesuchinitiativeisthepartnershipbetweenorganizationssuchastheSpireWineFarmandSustainabilityInstitute,whichseekstotrainlocalsintheLynedochareaonhowtouseeco-friendlytechniquestogrowtheirownnutritiousandfreshproduceforconsumption(Pretorious,2020).Suchmovestowardincreasedsubsistencefarminghelpstoincreasethesubsistenceproductionoffooditemsthathavebeenshowntoboostimmunityandhence,minimizetheriskofCOVID-19.InformalTradeandSavingsCooperativesFormaltradeandfinancialservicesinSouthAfricaareunderdevelopedinruralareaswhereeducationlevelsarelowandinfrastructureispoorlydeveloped(FinmarkTrust,2013).Informalinstitutionsthatallowindigenousruralfarmerswithoutregularincometosaveandinvestincludeinformalsavinggroups,rotatingsavingsandcreditassociations,andaccumulatingsavingsandcreditassociations(FinmarkTrust,2013).Thesegroupsprovideeffectiveavenuesforalternativeinvestmentwhenincomesarefallingduringcrises,helpingthemtobettercopeintimesofcrises(FinmarkTrust,2013).MaritalTraditionsThetraditionalweddingceremonyvariesacrossAfricancommunities.However,inthebasictraditionalsetting,weddingsonlytakeplacebetweenmembersofdifferentclans–whichcaneitherfromthesameethnicgrouporadifferentethnicgroup;thisimpliesthattheindividualshadtohavedifferentclannames,althoughmenwereallowedtomarrywomenfromthesameclanastheirmaternalgrandmother(SiyabonaAfrica,2020).Forthetwoweeksprecedingthewedding,thebrideissecludedinaspecially-constructedstructureinherparents\'compoundinamovedesignedtoshieldherfromtheeyesofmen(SiyabonaAfrica,2020).Shestaysinsolitaryseclusionfortheentireperiod,withonlyamaidendesignatedtoattendtoherneedshavingdirectaccesstoher(SiyabonaAfrica,2020).Onthedayofthewedding,sheemergesfromseclusioncoveredbyanumbrellaandcompletelywrappedinablanket,whichsheadornsinadditiontohermarriageblanket(SiyabonaAfrica,2020).Attheendoftheceremony,thecouplemovesawayfromthebride\'svillagetosettleinanareabelongingtothehusband\'sclan(SiyabonaAfrica,2020).Theseclusionexperiencehelpsinthemanagementofdisease,suchasCOVID-19,inthatitisafamiliarexercisethatminimizessocialinteractionsbetweenthewomanandotherpeople,helpingherkeepasafephysicaldistance.Further,thefactthatthebrideappearsfromseclusioncompletelycoveredinablanketalsohelpswiththeexperienceofhavingtowearafacecoveringwhichreducestheriskofCOVID-19.Thepracticeofmovementawayfromthebride\'shomeareaintoanunfamiliarlocalityhelpstominimizevisitsfromfamilymembers,whichreducesthecouple\'sriskofexposuretoCovid-19.CaringModelsSouthAfricancultureisfoundedontheUbuntuframework,whichemphasizesteamworkandcollectivenessthroughthesocialvaluesofsurvival,solidarityspirit,compassion,respect,anddignity(Poovanetal.,2006).LikeinmostAfricansocieties,thefamilyisthesmallestunitofSouthAfricansociety(Ghebregiorgis&Karsten,2006).Theextendedfamilyisanoutgrowthoftheindividualfamilyandisthesocialgluebindingvariousinterrelatedfamiliestogether(Ghebregiorgis&Karsten,2006).TheextendedfamilyformsthefoundationofbrotherlinessunderUbuntu(Ghebregiorgis&Karsten,2006).MembersoftheextendedfamilyareboundbythefivevaluesofUbuntu,whichimpliesthattheyneedtoworktogetherasateamtoaddressproblemsfacingthefamilyincludingillness,aswellascaringforthevulnerablesuchaschildrenandtheelderly.AssumingthatonegetsinfectedwithCOVID,forinstance,Ubunturequiresmembersoftheirextendedfamilytocometogetherinanintegratedmodelofcare.Thevalueofsurvivalrequiresthefamilyandcommunitymemberstopooltheirlimitedresourcestogethertoensurethatthepatientreceivesthecareandmedicationthattheyneedtogetbetter(Ghebregiorgis&Karsten,2006).Employedmembersofthegrouphaveadutytoprovidethefinancialsupportneededbythesickmemberoftheextendedfamily(Ghebregiorgis&Karsten,2006).Similarly,healthcareprofessionalsinthefamilyandcommunityhaveamoraldutytoassistthepatientthroughadministeringmedication,monitoringprogress,andofferingmedicaladvice.Thevalueofsolidarityempowersthemtoshareresponsibilitiesandworkcohesivelyinthemakingofeffectivedecisionsregardingthepatient\'streatment(Ghebregiorgis&Karsten,2006).Compassionrequiresthemtoplacethemselvesinthepatient\'spositionandtodemonstrateempathytowardsthepatient(Ghebregiorgis&Karsten,2006).Thevaluesofrespectanddignityimposeuponfamilyandcommunitymembersthedutytorespecteachotherandtreateachotherwithdignityregardlessoftheirsocialstatusandcontributiontothegroup\'ssharedvision(Ghebregiorgis&Karsten,2006).CommunityGroceryStoresAcommunitygrocerystore,alsocalledaspazashop,isatypeofinformaltradeinSouthAfrica,whichhelpswithcommunityfoodsupply(Gastrow&Amit,2013).ThetermspazaisusedmainlythroughoutSouthAfricaandisoperatedfromhousesintownships.Thesestoressellessentialhouseholditemssuchasbread,milk,andtoiletriestothelocalcommunity.Tradersoperatetheirshopsfromconvertedgarages,shippingcontainersplacedinfrontyards,corrugatedironstructuresattachedtohouses,andaroominsidetheirdwellings.Whatmakestheseshopsuniqueisthattheyselltocommunitiesthatarefarfromformalshoppingmallsandstores.Besideslocation,theyinvestgreateffortsinsourcinglowpricesfortheirgoods,placelowmarkupsonthem,andofferproductsoncredit,longeroperatinghours,andflexiblequantitiessuchasacupofsugar,halfaloafofbreadorasingleegg(Gastrow&Amit,2013).Ownersofspazashopsalsosharetransportcostsandjointlybuyinbulk(Charmanetal.2012).Thesepracticeshelpcommunitiescopeduringcrisesbecauseitaddressestheissueofsocialdistancingaspeopledon\'tshopatbigstoreswithmanyothershoppers.Instead,theshopperisservedthroughawindowandthereisnophysicalcontact.Secondly,withpeoplelosingtheirjobsandincomecompromised,thepersoncanbuyessentialsinsmallerquantities.Thesestoresaremore\'survivalist\'thanopportunity-driven(Charmanetal.2012).NigeriaInNigeria,communityhealthworkerprogramshaveemergedasthemostprominentinformalinstitutionengagedatthecommunitylevelinresponsetoTBandwilllikelyplayaroleintheCOVID-19pandemic.InNigeria,communityhealthworkersincludecommunityvolunteers,communitypharmacists,andpatentmedicinevendors(Falae&Obeagu,2016).TheseindividualsarecommunitymemberswithformalhealthtrainingwhohavebeensensitizedoncommunityTBcarethrougheitherrepeatedcontactwithexperiencedhealthcareprofessionalsorshort-termtraining.Thoughtheyarenotentitledtofinancialcompensationfromthenationalgovernment,theseworkersoftenreceivefinancialincentives.TheirprimaryroleistoimplementDOTsbypromotingTBmessagesthroughtheirclientele,identifyingpossibleTBcasesbycarryingoutactivecase-finding,offeringhome-basedtreatmentsupport,andundertakingTBcontactscreeningatthehouseholdlevel(Falae&Obeagu,2016).StudieshaveshowncommunityhealthworkerstohaveasignificanteffectineducatingthemassesandincreasingdiagnosisratesinruralNigeria(Falae&Obeagu,2016).Community-basedNGOssuchastheAssociationforReproductionandFamilyHealthNigeriaandHFGNigeriaarealsoestablishedinformalinstitutionsaspartofNigeria\'sTBresponseprogram.TheselocalNGOsconductdoor-to-doorcommunityawarenesscampaignsandconnectpatientstoavailabletreatmentprograms(Arshadetal.,2014).Finally,therearecommunitygroupssuchastheAjegunleCommunityPartnersforHealth,whichhavecontributedtoTBtreatmentadherenceandimprovingawarenessaboutTBamonglocals(Arshadetal.,2014).Inmostcases,thesecommunitygroupsorganizecommunitymobilizationevents,wheretheyengagesuccessfullytreatedpatientsandcommunityleaderstoreducediscriminationandstigma(Arshadetal.,2014).Thissectionpresentsanin-depthlookatothertypesofinformalinstitutionsinNigeriathatwilllikelybehelpfulforruralNigeriancommunitiesduringtheCOVID-19pandemic.TraditionalHealersandTraditionalMedicationMostNigerianslackhealthinsuranceandareforcedtopayfortheirhealthexpendituresout-of-pocket,whichlimitsaccesstocare(Nelissenetal.,2020).In2016,forinstance,75percentofhealthcarecostsamongcitizensweresettledout-of-pocketduetolackinginsurancecoverage(Nelissenetal.,2020).MostNigeriancitizensprefertoconsultinformalhealthcareprovidersincludingtraditionalhealersandproprietarymedicinevendorswhenevertheyfallillandrequiretreatment(Nelissenetal.,2020).Studieshaveshownthatpatients\'visitstoinformalprovidersareindependentofinsurancestatus,leadingtotheconclusionthatthedecisiontovisitatraditionalhealerfortreatmentismostlikelydictatedbyculturalbeliefsthatfavortraditionalmedicationovercontemporaryones,andtraditionalhealingoverformaltreatment(Nelissenetal.,2020).Inthisregard,traditionalhealersandinformalmedicinevendorssellingtraditionalmedicinalformulationsthatcouldaidinthetreatmentofCOVID-19symptomscouldhelpuninsuredpatientswithmildsymptomseffectivelymanagethedisease.Patientswouldberequiredtoonlyseekformalhealthcarewhensymptomsaresevereenoughtorequirehospitalization,reducingthestrainonformalhealthcarefacilities.Further,self-medicationisacommonpracticeamongcitizensinruralNigeria,particularlyamongolderwomenwithknowhowonherbalmedications(Gbagbo&Nkrumah,2020).IncreasingaccesstoextractsfromtheAcaciaNiloticatree,whicharecommonlyusedinthetreatmentofpneumoniaandrespiratoryillnessescouldbeofgreatrelevance(Okoroetal.,2014).SubsistenceFarmingandFoodSecuritySubsistenceagricultureisafundamentalcomponentofruralNigeria,withmosthouseholdspracticingsmall-scalefarmingtofeedtheirfamilies,whiletheurbandwellersmainlyrelyonmarketproduction.Subsistencefarmersplayacrucialroleinfoodsecuritywithanaveragefarmsizerangingbetween0.7and2.2hectares(Apataetal.,2011).TheNigeriangovernmenthastakenactiontogrowthecountry\'ssubsistenceagriculturethroughpriceincentives,moreeffectiveandefficientinfrastructuresupportfromthesmallerfarmholder,shorterpolicylags,andfightingcorruptioninthedevelopmentandexecutionofagriculturalpolicies(Kwanashie,Ajilima&Garba,1998).Theinterventionsaretailoredtoenhancesmall-scalesubsistencefarmers\'capacityinabidtoensurethecountry\'sfoodsecurity(Apataetal.,2011).Withthepandemic,however,affectingfoodchainsandlimitingtheavailabilityoffoodinthemarketforurbandwellers,thereisstillaneedtoensurefoodsecurity.Aculturalelementthathasbeensignificantinpromotingfoodsecurityduringthepandemiciscommensality,whichinvolveseatingtogetherwiththelessvulnerableinsocietyasasignofsharingandunity(Brageretal.,1987).Nigeriancultureemphasizesunity–traditionally,peoplerarelyeataloneastherealwaysissomeonewithwhomtoshareamealinthecompound(Brageretal.,1987).Peopleeattogetheringroupssubdividedalonglinesofgender,generationorage,withthecommonmealservingasamediumforemphasizingkinshipandbuildingrelationships.TheNigeriancultureforbidstheideaofamanhavingtobreakoffadiscussionwithfriendstogohomeforamealwithhisfamily.Thecommonmealtraditionismeanttoensurethatmeneattogetherinunityandsharealltheinformationtheyneedtosharewitheachother(Brageretal.,1987).ThecommonmealcultureinstillsanaspectofsharingamongNigerians,whichhelpstoensurefoodsecurityforallhouseholdsduringpandemicsInformalTradeandSavingsCooperativesThesavingcultureinNigeriaispoor,particularlyinruralareas(Nwachukwu&Odigie,2011).FormalbanksinNigeriahavebeenshowntoneglecttheruralareasbecauseofinsecurity,pooreducationallevels,andpoorinfrastructure(Oluyombo,2013).Thisleavesthoseintheruralareasunderserved,particularlybecausetheavailableinstitutionsarelargelymicrofinanceinstitutionsthatemphasizelendingandareirrelevanttocustomerswhowanttosave(Oluyombo,2013).Thepoorsavingcultureintheruralareaslimitsinvestmentwhenpeoplelosetheirjobsintimesofcrisis(Nwachukwu&Odigie,2011).Cultivatingacultureofsavingandinvestmentisonewaybywhichcitizenscouldbeencouragedtosaveandlateron,usetheirsavingstobegininvestmentopportunitiesthattheycouldusetogeneratealternativeincomesintimesofcrises.Informaltradeandsavingsinstitutionshavebeenshowntoharborsignificantprospectsinstimulatingsavingsandinvestmentstohelppeoplecopebetteramidstfallingrevenuestreams.MaritalTraditionsAsinmostAfricantraditionalsocieties,Nigerianweddingsinvolveexclusionofthebridetohideherfromtheeyesofpreyingmen,andanappearanceonthedayoftheweddingcoveredinaHijab(Abdulwahid,2006).Thecoverandseclusionbothmitigateagainsttheriskofdiseasethroughprotectiveclothingandsocialdistancing.However,auniquepracticeinNigerianweddingsthatincreasestheriskofexposuretothediseaseisthe‘moneyspray’,wheregueststosscashatthecoupleastheyengageintheirfirstdance.Thefundismeanttohelpthecoupleobtainafundwithwhichtostartofftheirmarriedlife,however,itenhancescontactandposesahighriskofinfection.CaringModelsCommunitycareprovisionisexpectedinNigeria,aswasdemonstratedintheEbolacrisisin2014.Communitycareisprovidedviaanintegratedmodelinvolvingthenationalgovernment,therespectivestategovernment,non-governmentalorganizations,andinternationalpartners(Shuaibetal.,2014).Membersofthepublicwereempoweredwithinformationthroughthemediaonthesymptomsofthediseaseandwheretoplacereportsonpotentialcases(Shuaibetal.,2014).Reportsfrommembersofthepublicwerereceivedbythecasemanagementteamresponsibleformaintainingandlinkingreportedpatientswithisolationwards.Onceattheisolationward,patientsreceivedcoordinatedcarefromtrainedphysicians,attendants,andnurses(Shuaibetal.,2014).Contact-tracingwasdonethroughcoordinatedeffortsinvolvingpatients,healthcareprofessionalsandgovernmentofficialsunderthegovernment’sSocialMobilizationStrategy(Shuaibetal.,2014).StaffundertheSocialMobilizationStrategyconducteddoor-to-doorvisitsinneighborhoodswithEbolacontactstoeducatethepubliconwaysofprotectingthemselvesandhowtocarefortheaffected(Shuaibetal.,2014).ThiscoordinatedmodelofcareinvolvingvariousagenciesatthecommunitylevelwouldgoalongwaytowardhelpinglocalcommunitiesmanagethespreadofCOVID-19.Further,parentinginthetraditionalNigeriansocietyisasharedresponsibilityextendingbeyondtheextendedfamilyintothegeneralcommunity.Theroleofbringingupachildiscarriedoutbythecommunityasisthatoftakingcareofthesickandthevulnerableinthepopulation.SwazilandInSwaziland,community-basedlinkageprogramsareamongtheprimaryinformalinstitutionsdevelopedatthecommunitylevelinresponsetoHIV/AIDS.OnesuchprogramistheCDC-sponsoredCommLink,whichengagesHIV-positivepeercasemanagerstoencouragelocalstogettestedandconnectnewlydiagnosedcasestorelevantpsychosocialandantiretroviraltherapy(CDC,2019).Throughitsoutreachteams,theprogramoffersmobileHIVcounselingandtesting,andconnectsthosewhotestpositivetoneededHIVcare(CDC,2019).TraditionalhealthpractitionersareanothertypeofinformalinstitutionengagedatthecommunitylevelinSwaziland.Manypeople,particularlyinruralSwaziland,visittraditionalhealthpractitionersformedicalcare.However,reportshaveshownthattraditionalhealthpractitionersmayhamperaccesstoHIVservices.Inresponse,policymakershaverecommendedthattheseprovidersarerecognizedasprimarycareproviderstoensurethattheyaremorecloselyinvolvedinHIV-servicedelivery,astheyplayacrucialroleinmotivatingtheirclienteletogettested,butalsolinkingthemtoneededcare(Avert,2020).Faith-basedorganizationsalsoplayacrucialroleinthemanagementofHIV/AIDSinSwaziland;theirprimaryfunctionistopromotepreventiveoutcomesbyshapingbeliefs,attitudes,andrealitiesconcerningsexualself-understanding(Ochilloetal.,2017).StudiesconductedinSwazilandhaveshownfaith-basedorganizationsandreligiousleaderstobeeffectiveindeliveringhealthpromotioninformationtothemassesandinfluencingtheirattitudesandbeliefsinregardtoHIV/AIDS(Ochilloetal.,2017).TraditionalHealersandTraditionalMedicineSwaziland’sculturalpracticesarequitesimilartothoseofSouthAfrica.Citizenslargelyprefertraditionalhealerstoformalmedicalpractitionersastheyaremoreaffordableandavailable,particularlyinruralSwaziland(Mahomoodally,2013).Herbalistsareresponsibleforprescribingtraditionalmedicinethatareprimarilydrawnfromplantsandanimals(Mahomoodally,2013).ThepopularityoftraditionalhealersislinkedinparttoculturalbeliefsthatassociatesuchhealerswithAfricanspirituality(Mahomoodally,2013).TraditionalmedicinesarecommonlyusedinpatientswithHIV/AIDS,althoughtheireffectivenessisunsupported(Mahomoodally,2013).However,commontraditionalmedicinalcomponentssuchasthegumoftheA.Senegalhavebeenshowntobeeffectiveinthetreatmentofbronchitis,respiratorytractinfections,typhoid,leprosy,gonorrhea,andbronchitis(Mahomoodally,2013).Thesetraditionalmedicinesandhealersprovideavenuesforalternativetreatment,particularlybecausemostoftheolderpeopleintheruralareasareknowntoself-medicateandcanself-treatinthecaseofpainormildsymptoms(Gbagbo&Nkrumah,2020;Okoroetal.,2014;Gurib-Fakimetal.,2010).SubsistenceFarmingandFoodSecuritySubsistencefarmingisakeyeconomicactivityinruralSwaziland,andakeycontributortofoodsecurity.Urbanhouseholdslargelydependonmarketfoodpurchases,withdemandfluctuatingwheneverfoodchainsareaffectedbycrises(Asisehetal.,2017).However,thetraditioninSwaziland,asinmostAfricancountries,emphasizescommunityparentingasawayofbringinguphealthycommunities.Childrenandadolescentslearnbyobservingtheireldersact–strategiesthatinfluencehouseholdstoengageinsmall-scalesubsistenceagriculturalproductionthusprovidecrucialavenuesforpromotingsubsistencefarmingacrossgenerationsandensurefoodsecurityintimesofcrises(Asisehetal.,2017).InformalTradeandSavingCooperativesFormaltradeandsavingscooperativesinSwazilandareunderdeveloped,particularlyinruralareaswhereeducationlevelsarelowandinfrastructureispoorlydeveloped(Simelane&Odhiambo,2018).FormalinstitutionssuchasbanksmaynoteffectivelyservetheneedsofindigenouspopulationsinruralSwaziland(Simelane&Odhiambo,2018).Informalinstitutions,whicharegenerallyreferredtoasmicrofinanceinstitutionsthatallowindigenousSwazifarmerswithoutregularincomestreamstosaveandinvest-includinginformalsavinggroups,rotatingsavingsandcreditassociations,andaccumulatingsavingsandcreditassociations-provideeffectiveavenuesforalternativeinvestmentwhenincomesarefallingduringcrises,helpingthemtobettercopewhendisruptedfoodchainsmakeitimpossibleforthemtoeffectivelytransporttheirfoodproducetotheurbanareas(Simelane&Odhiambo,2018).MaritalTraditionsSeclusionofthebrideforseveraldaysassheiseducatedonhowtomaintainasuccessfulmarriageisacommonfeatureoftraditionalweddingsinSwaziland,locallyreferredtoasUmtsimba.Further,asisthecaseinSouthAfrica,thebrideiscoveredinablanketatthetimeoftheirpresentationontheweddingday,andgoesontolivewithherhusbandawayfromherclanasmenarenotallowedtomarryfromtheirpaternalclans.Bothoftheseelementshelptominimizecontact,andhencetheriskofexposuretothevirus(SiyabonaAfrica,2020).CaringModelsSwazilandisbasedontheUbuntuhumanistthought,whichadvocatesforbrotherlinessandcommunalliving(Martinetal.,2011).Inthesenseofbrotherliness,membersareexpectedtobeeachother’skeepersuchthattakingcareoftheaged,thesick,andthevulnerableisasharedresponsibilityfortheextendedfamilyandthecommunitybyextension.CommunitiesaretaughttodemonstratethevaluesofUbuntu,whichcallforcompassionatecareandsolidaritywiththelessprivileged.Intheeventofsickness,membersoftheextendedfamilyareexpectedtocometogetherandpoolresourcestoensurethatthepatienthasaccesstothecaretheyneed(Martinetal.,2011).InstitutionalTheoryInstitutionaltheoryisconcernedwiththeregulations,standards,andproceduresthatareformulatedwithininstitutionsascommandinginstructionsforsocialbehavior(Scott,2004).Researchersuseinstitutionaltheorytostudyhoworganizationsareshaped,aswellashowsocietyinformsthebehaviorofindividualswithinanorganization.Accordingtoinstitutionaltheory,communicationisthesoleindicatorofhoworganizationsareformulated,withthehelpofformalrulesandregulations,whichreflectshowformalrulesandregulationsareobservedacrossalllevelsofanorganization.Howthisoccursultimatelybuildsanorganizationalcultureforcopingwithsocialandpoliticalissues.Withthisinmind,informalinstitutionsaresociallysharedinstructions,typicallyunwritten,thatareformed,transferredandimposedoutsidetheofficialboundaries(Torniainen&Sasstamoinen,2007).Assuch,thenormative,structural,regulative,andcognitiveelementsofinstitutionaltheorycanbeobservedinthestudyofinformalinstitutions.Throughthelensofinstitutionaltheory,Maclean(2010)observedpoliticaladministration,socialservicedelivery,andeconomicpolicyinfourvillagesinruralAfrica.Macleanbelievedthatinsocietieswhereliteracylevelislowandstrongoraltraditionsareheld,definingunwrittenrulesasinformationwouldbechallenging.Theprimaryconsiderationisnotwhethertherulesarewrittenornot,oriftheyareconsideredformal;themainconcernistheamounttowhichthefamiliarityofpracticesisexposed,noticeable,andclear.McLeanobservedthatpublicknowledgewasessentialforformalinstitutionstobeeffective.Furthermore,therearemoreopportunitiesfordiscussionandnegotiationifinformalrulesseemuncertainandarenon-transparent.Theauthoralsomentionedthatinformalinstitutionalchangecanbepoliticalandregulatorybutcanvaryfromcountrytocountry;thesamewasthecaseinGhana.Insuchcultures,ifavillageresidenthadanissuewithanothervillageresident,theymightreachavillagecommitteefortheresolutionoftheproblem.Thiswasconsideredahigh-levelformalinstitution,althoughtheirruleswerenotwrittentheywereexpectedtobetransferredstrictlyfromgenerationtogeneration.ItwasalsodistinctivelymentionedbyMcLean(2010)thatthegovernment’sprovisionofinfrastructureforday-to-daymedicalservicesisembeddedindiverserelationsofreciprocity.Thestate’sroleinriskeliminationiscritical,andthesesystemsshouldbestudiedmorecloselyanddeeplyforhighlightinginformalrisk-sharingnetworks(McLean,2010).Gobatetal.(2018)usedinstitutionaltheorytointerprettheunderstandingofparticipantsinpandemicclinicalresearchinfourEuropeancountries.Theauthorssoughttobetterunderstandhowpublicviewsshapeprimaryandcriticalhealthcaretimesofcrisis.Inthelightofinterpretivetheory,publicengagementinclinicalresearchaboutthepandemicwouldbefundamentalforimprovingmedicalhealthcaresincetheneedforhealthcarewouldbehighatsuchtimes.Bettertreatmentsandtheiraccesswouldbeensuredalongwithtransparencyinscienceandfairclinicalpractice.SincethestartoftheCOVID-19outbreak,tworesearchershaveappliedinstitutionaltheoryinthestudyofthefoodsupplychain(Craigheadetal.,2020)andtheinstitutionaleffectsondigitalplatformprogress(Renner-Micahetal.,2020).Craigheadandcolleagues(2020)usedinstitutionaltheorytoexplorethefoodsupplychainduringthepandemicandfoundthatindividualsreverttoinformalinstitutionstocope.Renner-Micahandcolleagues(2020)appliedinstitutionaltheoryinthestudyofinstitutionaleffectsondigitalplatformprogressandusefornationalhealthinsuranceinemergingcountriessuchasGhana.Theauthorsdiscussedthattherewereregulative,normative,andcultural-cognitiveinstitutionalenablerswithregardtoGhanaculture,whichallowedfortheaccessandexpansionofhealthservice.Theincreaseduseofhealthservicesunderhealthinsurancewasthecorereasonforthisenabler.Anothernormativeenablerwastheuseoftechnologyandmobileappsfortheneedofadigitalplatformforhealthservices.Theregulatoryinstitutionenablesthesuretyofwhetherthelegalestablishmentoftheorganizationisworkingfollowingrulesandpolicies.However,therewerecertainconstraints,aswell.Normativeconstraintsincludedthedifficultyinhandlingandimplementationoftheinterfaceofthetechnologicalsoftware,andthehealthinsurancepeoplecouldnotmaximizeitsserviceexperience.Thecultural-cognitiveconstraint,whichwasnoknowledgetotheheadofthefamilyaboutanyfamilymemberreceivinghealthservicesandnotrespondingtothemessagesgeneratedtotheheadNHISprovider,madeithardforthesystemtokeeptrackofthemembersandthedeliveryofmedicalcare.Italsoincreasesthecostsoftheinstitutionslikethegovernment,includingitssustainabilitydrive.Withtheuseofinstitutionaltheory,theauthorsdeducedthatinanemergingcountrylikeGhana,digitalplatformdevelopmentandtheuseofhealthinsurancewerebasedonmanyenablersandhindrances.Itwasalsoknownthatdigitaltechnologycouldnotbeignoredsinceitisthebestinmoderntimestohelphealthinsuranceorganizationstoattainnationalcoverage.Conclusion(placeholder)Chapter3:MethodologyTheresearchquestionguidingthisstudyis:HowdoindividualslivinginruralAfricauseinformalinstitutionstocopewiththeCOVID-19pandemic?Aqualitativeresearchapproachusinganinterpretativephenomenologicalanalysis(IPA)researchdesignwillbyemployed.UsingIPA,theresearcherwillexplorethelivedexperienceofcopingwiththeCOVID-19pandemicthroughtheuseofinformalinstitutionsamongindividuallivinginruralAfrica.Thischapterbeginswithadescriptionoftheresearchparadigm,approach,andtradition.Next,theparticipantrecruitmentproceduresanddatacollectionmethodswillbedescribed,followedbythedataanalysisplanandstrategiestoenhancetrustworthiness.ResearchParadigmCreswellandCreswell(2018)defineaparadigmasabasicsetofinterrelatedassumptionsthatguidearesearcher’sinquiries.Aparadigmisalsoarepresentationandreflectionofthebeliefsandvaluesoftheresearcherregardingtheworld(Kamal,2019).Thisimpliesthataparadigmisaphilosophicalwayofthinkingthatshapeshowresearchersconducttheirinquiries(Kivunja&Kuyini,2017).Therefore,theresearchparadigminfluencesthewayresearchersthinkaboutissuesandhowtheyframetheirresearchtopics.Theresearchparadigmisanessentialpartofthedeterminationofaresearchissueanditsexplorationasitshapestheresearcher’sworld.Theproposedstudywillfollowtheconstructivist-interpretivistresearchparadigmbasedontheideathatrealityisdevelopedandsubjectivetoeachperson(Ponterotto,2005).Theresearcherbelievesthateveryindividualcreatestheirownrealityinsteadoftheexistenceofasingleobjectivereality.Thecreationandsubjectivityofrealitybasedoneachindividualiscriticalasitshapesthelivedexperienceofpeopleconcerningaparticularphenomenon.Becausethisstudyseekstoexploreindividuals\'livedexperiencescopingwithCOVID-19,theresearcherneedstounderstandrealityasitisconstructedbytheparticipants.Aconstructivist-interpretivistparadigmprovidesasuitableframeworkfortheresearchertoexamineandunderstandtheindividualrealitiesofthestudyparticipants.Additionallytheconstructivist-interpretivistparadigmisappropriatefortheproposedresearchbecauseindividualscreateadaptableandmultiplesubjectivemeaningsoftheirlivedexperiences(Ponterotto,2005).Theadoptionofaconstructivist-interpretivistparadigmimpliesthattheresearchembracesahermeneuticalapproach,whichinvolvesreappraisalandreinterpretationconcerningculturalcontexts(McCaffreyetal.,2012).Thisapproachincorporatesvariousfactorssuchasintuition,subjectivity,creativity,andcorporealityintheoreticalreflection.Theuseofahermeneuticalapproachaspartoftheresearchparadigmprovidesaframeworkfortheinterpretativeandreciprocalprocedureofunderstandingtheexperiencesofeachindividual.Basedonthisapproach,theresearcherwillengagewiththeparticipantstoexplore,interpret,andunderstandtheirlivedexperiencesthroughdialogueusingsemi-structuredinterviews.Semi-structuredinterviewswillbeusedasthemeanstoelicitin-depthdescriptionsregardingpersonalexperiencesontheissueandhighlightemergingpatternsacrosstheseindividualcases.Theresearcherwillthenreflectuponinsightsobtainedfromtheparticipantsaspartofhisinterpretiveroleinunderstandingtheirlivedexperiences.ResearchApproachAqualitativeresearchapproachwillbeusedintheproposedstudyastheresearcherseekstoexploreandunderstandthelivedexperienceofcopingwiththeCOVID-19pandemicusinginformalinstitutionsattheindividuallevel.ThisapproachisdeemedsuitableforthestudyasitwillenabletheresearchertomakesenseofandascribemeaningtothelivedexperiencesofindividualslivinginruralAfricaintheirfightagainsttheCOVID-19pandemic.AccordingtoCreswellandCreswell(2018),qualitativeresearchapproachesareappropriateforstudiesthatareexploratory,descriptive,orexplanatory.Usingaqualitativeresearchapproach,theresearcherexploresthephenomenoninamannerthatenhancestheunderstandingofrelationships,individualexperiences,andvariationsinobservations(Creswell&Creswell,2018).Asaflexible,emergentresearchdesign,thequalitativeapproachwillenabletheresearchertodevelopadetaileddescriptionofthephenomenonunderinvestigation.ResearchTraditionIPAisanapproachtoqualitativeinquirythatwasrecentlydevelopedfromthefieldofpsychology(Smithetal.,2009).Itfocusesonevaluatinghowindividuals“makesenseoftheirmajorlifeexperiences”(Smithetal.,2009,p.1).Thedevelopmentofthisapproachtoqualitativeinquirywasinfluencedbytheneedtobridgediscourseanalysisandsocialcognition,whicharetwoconflictingperspectivesofsocialpsychology’scoremethodsofinquiry(Smith,1996).IPAemergedasanapproachthatunifiestheseconflictingperspectivesandprovidesamorein-depthwayforresearcherstoexploreandinterprethumanexperiences(Smith,1996).Larkinandcolleagues(2011)contendthatIPAseekstounderstandhowpeopleascribemeaningstorelationships,processes,andeventsaccordingtotheirspecificlifeworlds.Regardlessofthephenomenonunderinvestigation,theobjectiveofembracingIPAisastudyistoexploreandunderstandwhattheindividualexperiencesinhis/hercontext.Therefore,livedexperienceisoneofthecomponentsofIPAandisdesignedtoencapsulatetheinterpretedandmeaningfullylivedaspectoflifeinourrespectivecontexts.SincethefocusofIPAisthelivedexperience,theresearcherapproachesthephenomenonunderinvestigationfromtheparticipant’sperspective.Consequently,theresearchercollectsdetailedandrichdatafromasmallsampletoadequatelysituate,describe,andinterpretit.IPA’sstatedinterestiscognitionthroughwhichithaspositioneditselfasadistinctiveandexperientialapproachtoqualitativeinquiry,especiallyinthefieldofpsychology(Smithetal.,2017).Fortheproposedstudy,exploringthelivedexperiencesofindividualslivinginruralAfricawillprovideinsightsintotheirbeliefs,feelings,andresponsestotheCOVID-19pandemicthroughtheuseofinformalinstitutions.TheoreticalUnderpinningsIPAhastheoreticalrootsinidiography,phenomenology,andhermeneutics(Smith,2011).TheIPAapproachissignificantlyshapedbytheintersectionoftheseinfluencesandprovidesamorein-depthframeworkforstudyingthehumanexperience.ThissectionincludesanoverviewofthetheoreticalunderpinningsofIPA:phenomenology,hermeneutics,andidiography.PhenomenologyPhenomenologyisoneofthetheoreticalunderpinningsofIPAthathasbecomethedominantmeansinthepursuitofknowledgedevelopmentinvariousfieldsofresearch,includinghealth-relateddisciplines(Dowling,2007).Smith(2011)definesphenomenologyasthephilosophicalmovementthatfocusesonlivedexperience.Therefore,itisconcernedwithcarryingoutanin-depthevaluationofspecifichumanexperiencesdependingonthephenomenonunderinvestigation.Phenomenologyisbasedontheassumptionthatrealityisindividualandsubjectiveasopposedtobeingobjectiveandrational.Accordingly,phenomenologyalignswiththeconstructivist-interpretivistresearchparadigmasitsupportstheideathatpeoplecreateflexibleanddifferentsubjectivemeaningsoftheirlivedexperiences,asstatedbyPonterotto(2005).Phenomenologyhasevolvedtoenhanceexplorationandunderstandingoftheindividualhumanexperiencethroughthecontributionsofvariousphilosophers(i.e.,EdmundHusserl,MartinHeidegger,MauriceMerleau-Ponty,andJeanPaulSatre).Husserlinitiatedtheconceptofphenomenologyasaphilosophyandresearchtechniqueinhisquesttounderstandthehumanexperienceandconsciousness.HusserlwasinspiredbyFrankBrentano,whoutilizedthephrase“descriptivepsychologyordescriptivephenomenology”(Dowling,2007).HusserlborrowedfromBrentanotostudythespecificsinattempttounderstandthecoreofthehumanexperience.Consequently,hedevelopedaphenomenologicalreduction,whichseekstoexploreorunderstandsomethingwithoutinterpretationorimposingjudgment.Heideggerinfluencedtheevolutionofphenomenologybyproposinganalternativeviewthatemphasizesthecriticalroleofinterpretationinunderstandingthehumanexperience(Smithetal.,2009).Merleau-PontyexpandedupontheideasofHusserlandHeideggerbyemphasizingthecrucialroleofthephysicalselfincommunicatingwiththeworldanditsimpactonperceptions(Dowling,2007).SatreexpandedHeidegger’sapproachbutdeviatedfromHusserlbyintroducingthepresenceorlackofrelationshipswithothers.HermeneuticsHermeneuticsisatheoryofinterpretationandwasinitiatedbyHeideggerasanalternativeviewofphenomenologytoHusserl’sphilosophy(Dowling,2007).IPAengagesinadoublehermeneuticbecausetheresearchertriestomakesenseoftheindividualtryingtomakesenseofhis/herlifeexperiences(Smith,2011).Heideggerintroducedtheconceptofthehermeneuticcirclebasedontheideathatunderstandingisareciprocalactivity.Inessence,basedonthisconcept,anindividualisbetweenpreunderstandingandunderstanding.Whenexaminingaphenomenon,theresearchersuspendshis/herexperiencetoexploreandunderstandhowparticipantsascribemeaningtolifeeventsandprocesses.HermeneuticsplaysanessentialroleinIPAasitformsthebasisinwhichtheresearcherengageswithandinterpretsparticipants’descriptionswhilereflectingontheirmeanings.Smith(2009)contendsthathermeneuticsisessentialinIPAasitpromotestheabilityoftheresearchertoevaluatepartsandtheentireofthephenomenonbeingstudied.IdiographySmith(2011)statesthatIPAisidiographicinitscommitmenttoassessingeachcaseinacorpusinacomprehensivemanner.Thecommitmentissometimesmanifestedthroughthewritingupofsinglecase-studiesthatrepresentorreflectin-depthassessmentsofanindividual’slivedexperience.Idiographyisaconceptthatsignifiesanapproachtoknowledgethatfocusesonparticularprocessesthatareuniquetoindividuals(Smithetal.,2009).IPAentailsacomprehensiveanalytictreatmentofeverycasefollowedbyevaluationandidentificationofpatternsacrossthecases.Giventhesignificanceofeachcase,apurposefulapproachtoparticipantsamplingisemployedsinceparticipantsmustbeknowntohaveexperiencewiththephenomenonbeinginvestigated.Astheresearchercarriesoutacomprehensiveanalysisofeachcase,he/shebecomesimmersedinthelivedexperiencesofparticipantsbeforeestablishinggeneralstatementsthatreflectallcasesincludedinthestudy.ParticipantsAccordingtoSmithetal.(2009),IPAisanapproachtoqualitativeinquirythatrequiresrichdata.Thisimpliesthatstudyparticipantsshouldtelltheirstories,developtheirideas,expresstheirconcerns,andspeakfreelyandreflectivelyindetail.Therefore,theresearchershouldrecruitparticipantswhoarebestsuitedtoprovidearich,comprehensive,first-personaccountoftheirexperiences.InalignmentwithIPA,participantswillbeselectedbasedontheirexperienceofthephenomenonbeingstudied(Smithetal.,2009).Thus,onlyparticipantsaffectedbytheCOVID-19pandemicwillberecruited.Atotalsampleof9-12individualswillbepurposefullyrecruitedfromSwaziland,Nigeria,andSouthAfrica(3-4individualsfromeachcountry).Smithandcolleagues(2009)contendthatIPAstudiesrequiretheresearchertoselectahomogeneoussamplerepresentingthetargetpopulationandforwhomtheresearchquestionismeaningful.BecausehomogeneityisimportantforIPAresearch,theresearcherusepurposefulsampling.Creswell(2014)statesthatusingasuitablesamplingtechniquehelpstoachievehomogeneitybyensuringthesampleisrepresentativeofthetargetpopulation.Giventhenatureoftheissueunderinvestigation,theproposedstudywillemploypurposefulsamplinginsteadofrandomsampling.Smithetal.(2009)contendthatpurposefulsamplingisthemostappropriateforstudiesutilizingtheIPAapproachbecauseoftheneedtoenrollpeoplewithexperienceonthespecificphenomenonunderinvestigation.Snowballsamplingwillalsobeusedifenoughparticipantscannotbepurposefullyrecruited.Snowballsamplinginvolvesrecruitingnewparticipantsdependingonreferralbyenrolledparticipants(Creswell&Creswell,2018).Thefollowinginclusionandexclusioncriteriawillbeusedtoidentifyparticipants:·IndividualscurrentlylivinginruralSwaziland,Nigeria,orSouthAfricaandwhoareaffectedbyCOVID-19pandemic;·Mustbe18yearsofage;·Nativetothecountryunderstudy;·Experienceinusinginformalinstitutionstocopewiththepandemic;·Willingtoparticipateinaminimumoftwo,withthepossibilityofathird,virtualinterview;·Agreetotheuseofanaudiorecordingoftheinterview(s);and·Agreetothepublicationofdataobtainedandanalyzedfromthisresearch.RecruitmentandAccessOnceIRBapprovalisobtained,theresearcherwillcontactakeyinformantineachcountrybasedontheirpersonalandprofessionalnetworktoaccessandrecruitparticipants.Thekeyinformantwillbeaskedtosharearecruitmentemail(AppendixA)withprospectiveparticipants.Therecruitmentemailwillincludeabriefexplanationofthestudy’spurpose,eligibilitycriteria,participants’responsibilities,andresearchercontactinformation.Alinktoabriefeligibilityquestionnairewillbeincludedatthebottomoftheemailandprospectiveparticipantswillbeinstructedtoclickonthelinktodeterminetheireligibility.Thebriefscreeningquestionnaire(AppendixB)willbeadministeredviaQualtricstoconfirmeligibilitybasedontheestablishedparticipantselectioncriteria.Thequestionnairewillincludequestionsbasedonthestatedinclusionandexclusioncriteria.Oncethequestionnaireiscompleted,individualswillbeinformedwhethertheyqualifytoparticipateinthestudybasedontheirresponses.Eligibleparticipantswillbeaskedtosubmittheirname,phonenumber,andemailaddresstobecontactedbytheresearcherregardingnextsteps.Theresearcherwillthenemailalleligibleparticipantswhoindicatedtheirinterestinvolunteeringtoparticipateinthestudytoscheduleaninterview.Eachparticipantwillberequiredtoreviewandsignaninformedconsentformbeforeparticipatinginthefirstinterviewtoaddressanyethicalconcernsrelatingtothestudy.Participantswillalsoberequestedtosharetherecruitmentemailwithanyadditionalindividualswhowillundergotheselectionprocesstodeterminetheireligibilityandparticipationintheproposedresearch.DataCollectionAccordingtoSmith,Flowers&Larkin(2009),manyestablishedmeasurestoqualitativeresearchhavespecificrequirements,limitations,anddatacollectionpreferences.ThemostsuitabledatacollectionmethodforanIPAapproachtoqualitativeinquiryisonethatentailsinvitingparticipantstoproviderich,detailed,first-personaccountsoftheirexperienceswiththephenomenonunderinvestigation.SuchdatacollectionmethodsareutilizedinIPAsincetheyprovideamorein-depthwayforresearcherstoexploreandinterprethumanexperiences(Smith,1996).Smithetal.(2009)suggestedthatin-depthinterviewsanddiariesarethemostsuitablemethodsofdatacollectionforIPAstudies.ThisisprimarilybecauseIPArequiresrichdata,whichimpliesthatparticipantsshouldbegivenopportunitiestosharetheirstories.In-depthinterviewsanddiariespromotetheelicitationofstories,feelings,andthoughtsbyparticipantsregardingthetargetedphenomenon.However,researchersconductingstudiesusinganIPAapproachcouldalsoconsiderusingparticipantobservationorfocusgroups.ParticipantobservationcouldbeusedinIPAstudieswheretheactivityunderobservationentailsdiscussionofindividualexperiences.Creswell(2014)alsostatedthatresearcherscanconductstructured,unstructured,orsemi-structuredinterviewswhenconductingqualitativestudies.Theproposedstudywillemployin-depthinterviewsfordatacollectionsincetheywillgeneraterich,detailed,first-handaccountsofparticipants’experiencewiththetargetedphenomenon.In-depthinterviewsarerecommendedastheprimarydatacollectionmethodforstudiesusinganIPAapproachsincetheyenableparticipantstoproviderichdataregardingtheirexperiencewiththephenomenonbeingstudied(Smithetal.,2009).AsstatedbyCreswell(2014),anin-depthinterviewentailsdialoguebetweentheresearcherandparticipant.Duringthisprocess,theparticipantspeaksfreelyregardinghis/herexperienceofthetargetedphenomenonwhiletheresearchermostlylistens.Theresearcherwilluseasemi-structuredinterviewformat.Asemi-structuredinterviewformatisrecommendedforIPAstudiesasitenablesparticipantstofreelyexpressthemselvesratherthanhavingtheirresponseslimitedlikeinastructuredinterview(Smithetal.,2009).Semi-structuredinterviewsconsistofapre-determinedsetofopen-endedquestionsdesignedtoelicitparticipants’storiesanddescriptionsofexperiencesrelatingtotheresearchissue(Smith&Osborn,2007).However,duringtheinterview,theresearchshouldnotrelyonlyontheinterviewquestions.Theresearcher(interviewer)shouldbeledbytheparticipants’descriptionsandaskfollow-upquestionswhennecessary(Smithetal.,2009).Thisenablestheresearchertoelicitrich,detaileddatafromtheparticipants.Theothercomponentofin-depthinterviewsinIPAstudiesistheuseofopen-endedinterviewquestionsratherthanclosed-endedquestions.Smithetal.(2009)contendthatinterviewquestionsinIPAstudiesshouldbeopen-endedinordertogeneratedetailedaccountsofthephenomenonbeingstudied.AccordingtoCreswell(2014),qualitativestudiestendtoemployopen-endeddatawithoutpre-determinedresponsesunlikequantitativestudiesthatusuallyincorporateclosed-endedresponses.Theuseofopen-endedinterviewquestionsensuresthatIPAstudiesgeneratedatafromparticipantswithoutpre-determinedresponses.ThefirstquestioninIPAstudiesemployingin-depthinterviewsshouldbedesignedtomaketheparticipantcomfortable.Theotherinterviewquestionsshouldbemoreanalyticalandprobingastheinterviewprogresses.Smithetal.(2009)statethatthenumberofinterviewquestionsvarybutshouldgenerallybearound10open-endedquestionswithsuitableprompts.ForIPAstudies,aone-on-oneinterviewispreferredoveragroupinterview(Smithetal.,2009).Aone-on-oneinterviewisidealbecauseitpromotespersonalrapportbetweentheresearcherandparticipant,whichinturnallowsparticipantstoprovidemoreinformationontheirexperienceswiththeresearchissue.Ontheotherhand,personalrapportenablestheresearchertomodifythequestionsandaskfollow-upquestionsthroughwhichparticipantsprovidemoreinformation.Fortheproposedstudy,atotalof8-12individualswillbeinterviewed.Aspreviouslyindicated,3-4individualswillbepurposefullyrecruitedfromSouthAfrica,Swaziland,andNigeriausingakeyinformant.Eachindividualwillparticipateintwosemi-structuredinterviews,withtheoptionofathirdinterview.Seidman’s(2006)three-interviewserieswillbemodifiedtoguidetheinterviewprocess.Thepurposeofthefirstinterviewwillbetodeveloprapportwiththeparticipantsandcapturein-depth,context-specificinformationtoaidinthedevelopmentofparticipantprofiles.Thepurposeofthesecondinterviewwillbetocollectdataspecifictothestudy’sresearchquestions.Thepurposeoftheoptionalthirdinterviewistoallowfortheopportunityfortheresearchertoaskfollow-upquestionsifthedepthofinformationneededisnotcollectedduringthefirstandsecondinterviews.Theresearcherwilldevelopaninterviewprotocolpriortoconductingthefirstandsecondinterviews;however,theprotocolwillbemodified,ifneeded,basedonparticipantresponses.Thisisinalignmentwiththeemergentfeatureofqualitativeresearch.Interviewswilllastapproximately60-90minutesandwilltakeplaceviaZoomatatimeoftheparticipant’schoosing.TherecordingfeatureontheZoomplatformwillbeusedtorecordinterviews.Thenumberofinterviewquestionswillvary,butwillgenerallyconsistofsixtotenopen-endedquestionsincludingappropriateprompts(Smithetal.,2009).AudiorecordingswillbeprofessionallytranscribedviaRev.com.DataStorageAspreviouslyindicated,eachinterviewwillberecordedusingtherecordingfeatureontheZoomplatform.Anaudiocopyofeachinterviewrecordingwillbesavedontheresearcher’slocalcomputerharddriveandthenuploadedtoacloudstorageaccountandprofessionallytranscribedviaRev.com.Dataencryptionandpasswordprotectionwillbeemployedtoensureconfidentialityandsecurityoftheaudiorecordingsdata.Inaddition,audiorecordingswillbede-identifiedandpseudonymswillbeusedtoreplaceparticipants’namesinordertosafeguardtheirprivacy.Rev.comwillbeusedfortranscriptionsinceitisaprofessionaltranscriptioncompany.Whiletheseinterviewrecordingswillbetranscribedverbatim,nonverbalaspectsoftheinterviewssuchastheexactlengthofpausesarenotrequired.Smithetal.(2009)statesthattranscriptionsinqualitativestudiesdonotrequireallnonverbalaspectssinceonlyparticipants’responsesshouldbenotedandanalyzed.Theresearcherwillsaveandde-identifyinterviewtranscriptsinthesamemannerasrecordingstopreventthird-partyaccess.Digitalcopiesofparticipants’informedconsentandthebriefscreeningquestionnaireswillbestoredinapasswordandencryptedcloudstorageaccountonlyaccessibletotheresearcher.Aftercompletingthisdoctoralthesisproject,theresearcherwilltransferallthedatatoanexternalharddrivethatwillbestoredinalockedfilecabinetforfiveyears.Alldataandassociateddocumentswillthenbedeletedtheharddrivefiveyearsaftercompletionofthisstudy.DataAnalysisDataanalysiswillcommenceafterallinterviewsarecompletedwitheachparticipant.AccordingtoCreswell(2014),qualitativedataanalysisgeneratesthemes,codesorquotesthatareusedtoanswertheresearchquestion(s).DataanalysisinIPAstudiesisconductedsystematically(Smithetal.,2009).BecausetheIPAapproachhasidiographiccommitment,theanalysisprocessiscarriedoutindifferentstagesthatculminateinansweringtheresearchquestion.Inthisregard,thefirstcaseisanalyzedindetailfollowedbythesecondcase,andthisprocessisrepeateduntilallcasesareanalyzed.Assuch,eachinterviewtranscriptistreatedandanalyzedasasinglecase.Aresearchershouldconsiderbeginningwiththeinterviewfoundtobethemostdetailed,engaging,andcomplex(Smithetal.,2009).Fortheproposedstudy,thesix-stepdataanalysisprocessproposedbySmithetal.(2009)willbeutilized.Topreparefordataanalysis,theresearcherwillconvertrawfieldnotestakenduringtheinterviewintoexpandedreportsandreviewthemforaccuracy.Thereportswillbefrequentlyreferencedduringthecodingprocesstofacilitatetheinterpretationofdata.Thesix-stepprocessdevelopedbySmithetal.(2009)includes:(1)Readingandre-reading;(2)Initialnoting;(3)Developingemergentthemes;(4)Searchingforconnectionsacrossemergentthemes;(5)Movingtothenextcase;and(6)Lookingforpatternsacrosscases.Thefirstfourstepswillberepeatedforeachparticipant’sinterviewaspartofanalyzingeverysinglecaseatatime.Thesix-stepprocessemphasizesaninductiveanditerativecycleastheresearchermovesfromthespecifictothesharedwhileremainingcommittedtounderstandingeachparticipant’sperspectiveregardingthephenomenonunderinvestigation.Step1:ReadingandRe-readingPietkiewicz&Smith(2012)statethatanalyzingqualitativedatausinganIPAframeworkcanbeatime-consumingandcomplexprocess,thoughanexcitingactivity.Asaresult,itisrecommendedforresearchersusingtheIPAframeworktocompletelyimmersethemselvesinthedata.Toachievethis,dataanalysisofqualitativedataobtainedusingtheIPAframeworkfollowsaseriesofsystematicstepsbeginningwithreadingandre-reading.ThefirststepofanIPAanalysisisreadingandre-reading,whichentailsimmersingoneselfinsomeoftheinitialdata(Smithetal.,2009).Thisprocessiscarriedouttoensurethattheparticipantisthefocusoftheanalysisastheresearchertriestoputhim/herselfintheparticipant’sshoes.Forinstance,whenreadingandre-readinginterviewdata,theresearchershouldlistentotheaudiorecording.He/sheshouldreimaginetheparticipant’svoiceduringsubsequentreadingsofthetranscript.Readingandre-readinghelptheresearchertoobtainclarity(Alase,2017).Fortheproposedstudy,thedataanalysisprocesswillcommencewiththeresearcher’simmersionintheoriginalrecordingsandtranscriptasrecommendedbySmithetal.(2009).Theresearcherwilllistentotheaudio-recordingsfirstbeforereadingandre-readingthetranscripts.Afterlisteningtotheaudio-recordings,theresearcherwillreadeachinterviewtranscriptslowlyandpurposefullytoensureactiveengagementwiththedata.Duringthisprocess,theresearcherwillidentifyarhythmtotheinterviewanddeterminerichersectionsofdataforfurtheranalysis.Theidentifiedrichersectionsofthedatawillbeutilizedinthesubsequentsectionsofthedataanalysisprocess.Step2:InitialNotingThesecondstepinIPAanalysisisinitialnoting,whichisessentiallytheinitiallevelofdataanalysis.Thisphaseismosttime-consuminganddetailedasitinvolvesexamininglanguageuseandsemanticcontentonaveryexploratorylevel(Smithetal.,2009).However,theresearchermaintainsanopenmindwhilenotinganythingofinterestfromthedata.Astheresearchercarriedoutinitialnoting,he/shebecomesmorefamiliarwiththetranscript.Theresearcheralsostartstoidentifyspecificwaysinwhichtheparticipantexpresses,understands,andthinksaboutthephenomenonbeingstudied.Initialnotingisclosetobeingafreetextualanalysissincetheresearcherstartswritingnotesonthetranscript.Initialnotingiscarriedoutpriortoestablishingemergingthemesandincorporatesaseriesofdescriptive,linguistic,andconceptualcommenting.Descriptivecommentingentailsreadingthetranscriptandgeneratingnotesregardingthecontextoftheparticipants’viewswhilelinguisticcommentingentailnotingspecificwordsusedbytheparticipanttounderstandhis/heruseoflanguagetodescribetheexperience.Ontheotherhand,conceptualcommentinginvolveslinkingabstractconceptstohelpidentifyemergingpatternsandmeaning.Fortheproposedstudy,theresearcherwillcarryoutaline-by-lineanalysisoftheinterviewtranscriptwhilemakingdescriptive,linguistic,andconceptualcomments.Duringthisprocess,theresearcherwillunderlinetextthatappearsimportantwhilemakingmarginalnotes.Step3:DevelopingEmergingThemesAfterinitialnoting,IPAanalysisinvolvesdevelopingemergingthemesgiventhatalargedatasetislikelytoemergefromthecompletionofthefirsttwosteps.Thesubstantialgrowthinthedatasetisattributabletotheadditionallevelofpotentiallyimportant,butprovisionalnotes.Thelargerdatasetisthefocusofthenextstageofdataanalysisinwhichtheresearcherlooksforemergingpatternsorthemes.Whenlookingforemergingthemes,theresearcher’staskshiftsfrommanagingthedataashe/shesimultaneouslyattemptstolessenthevolumeofdetailwhilemaintainingcomplexities.Duringthisprocess,theresearcherattemptstomapconnections,interrelationships,andpatternsbetweenexploratorynotes.Inessence,theresearcherprimarilyworkswithinitialnotesinsteadofthetranscriptitself.However,theinitialnotesarecloselylinkedtotheinitialtranscriptthroughcomprehensiveexploratorycommenting.AsstatedbySmithetal.(2009),theprocessofthehermeneuticcirclecommencesinthisstagebecausetheinitialwholeoftheinterviewbecomesdifferentparts.Thesedifferentpartsthencometogethertocreateanothernewwholeattheendofthedataanalysisprocess.Notesareconvertedintothemesbyidentifyingtheessenceofeachcommenttocreateathemethatreflectstheinterviewandtextasawhole.Theproposedstudywillentailthedevelopmentofemergingthemesthroughconvertingnotes.Theresearcherwillgeneratethethemesthroughinterpretingthetextandexploratorycommentstorepresenttheparticipants’thoughtsandwordsandtheresearcher’sinterpretationofthesethoughtsandwords.Theendresultofthisprocessischronologicallabelingofideasthatrepresentexplorationandunderstandingoftheparticipant’sexperiencerelatingtothephenomenonunderinvestigation(Smithetal.,2009).Step4:SearchingforConnectionsacrossEmergentThemesOnceemergingthemesaredeveloped,thenextstepinthedataanalysisprocessissearchingforconnectionsacrossemergentthemes.Inthisregard,theresearcherattemptstoconnecttheemergentthemeswithamaporchart.Therearevariouswaysthroughwhichtheresearchercanaccomplishthisincludingorganizingthemesinorder,abstraction,orpolarization.Astheresearchersearchesforconnectionsacrossemergentthemes,he/shedemonstratesthinkingonhowtheyfittogether.Theconnectionsacrossemergentthemescanbeidentifiedthroughorganizingtheminorderofwhentheyappearintheoriginaltranscript.Thisisfollowedbyvisuallyassessingwaysinwhichtheemergentthemescanbereorganizedintogroupsofrelatedthemes.Onthecontrary,abstractioninvolvesdevelopinganewsuperordinatethemethatincludespatternsidentifiedintheemergentthemes.Polarizationorganizesthemesaccordingtothedifferencesamongthem(Smithetal.,2009).Fortheproposedstudy,theresearcherwillsearchforconnectionsacrossemergentthemesbyorganizingthemintheordertheyappearintheoriginaltranscript.Afterorganizingtheseemergentthemesinthatorder,theresearcherwillthenexaminewaysinwhichtheycanberearrangedintogroupsofrelatedthemes.Inthiscase,theresearcherwillalsoutilizeabstractionasthepremiseforidentifyingthereorganizationoftheemergentthemesindifferentgroupingsbasedonpatternsindata.Step5:MovingtotheNextCaseSmithandcolleagues(2009)emphasizethesignificanceofanalyzingeverysinglecasebeforesearchingforpatternsacrosscases.Theanalysisofeachcaseindividuallyiscarriedoutbybracketingideasandthoughtspriortoanalyzingsubsequentcases.ThenextstepofanIPAanalysisinvolvesmovingtothenextparticipant’stranscriptandrepeatingthefirstfourstepsinthisanalysis.Thisisacriticalstepasitenablestheresearchertotreateachcaseonitsowntermsandtodojusticetoeachindividualcase.Whiletheresearchercouldbeinfluencedbythethemesidentifiedintheanalysisofthefirstcase,itisimportanttoallownewthemestoemergewitheachcase.Thiscanbeachievedbyensuringthateachofthefirstfourstepsiscarriedoutsystematicallyandinacomprehensivemanner.Fortheproposedstudy,eachofthefirstfourstepswillberepeatedtoeachparticipant’stranscript.Theresearcherwillfolloweachstepsystematicallyandcomprehensivelytoallownewthemesorpatternstoemerge.Thiswillhelptheresearchertoensureeachcaseistreatedindividuallyandtakeintoaccounttheexperienceofeachparticipantregardingthephenomenonunderinvestigation.Step6:LookingforPatternsacrossCasesThefinalstepinIPAanalysisissearchingforpatternsacrosscases(Smithetal.,2009).Itentailslayingeachtable/figureoutonalargesurfaceandlookingacrossthemtodetermineanyconnectionsacrossthecases.Duringthisprocess,theresearcheralsoidentifiesthemostpotentthemesandhoweachofthemhelpstoilluminateadifferentcase.Insomecases,theresearchercouldreconfigureorrelabelthethemesbasedontheidentifiedconnectionsorpatterns.SimilartoStep4,thisfinalphaseofIPAanalysiscanbefacilitatedbycreatingmapsorchartsthatdemonstratetheconnectionsbetweencases.Theresearchercouldalsobenefitfromcreatingatableofthemesoramasterlisttodemonstratehowtheemergentthemesarewithinsuperordinatethemes.Additionally,theresearchercancountthethemestodetermineprevalenceanddifferencesamongcases(Smithetal.,2009).Theresearcherwillemployeachofthesestepstoanalyzeparticipants’interviewsandidentifythemesfocusingonhowindividualslivinginruralAfricauseinformalinstitutionstocopewithCOVID-19pandemic.Inthisregard,anin-depthstep-by-stepanalysisofeachcasewillbecarriedoutandusedtoidentifythemesthatrepresentthewhole.Byanalyzingeachparticipants’account,theresearcherwillensurethateachcaseistreatedindividuallybeforemovingtothenextone.Aspreviouslyindicated,theresearcherwillallowtheemergenceofnewthemeswhenexaminingeachcaseindividually.Thefindingsofeachcasewillthenbeutilizedtoidentifythemesthathelpanswertheresearchquestionbasedontheconnectionsacrosscases.StrategiestoEnhanceTrustworthinessAccordingtoLincoln&Guba(1985),reliabilityinqualitativeresearchentailsestablishingcredibility,transferability,dependability,andconfirmability.Reliabilityinaresearchreferstotheextentofconfidenceindata,interpretationofdata,andmeasuresemployedtoensurequality.Assuch,LincolnandGuba(1985)developedaframeworkforevaluatingtrustworthinessinqualitativeresearch.Trustworthinessisarelativelyobscureconceptbecausequalitativeresearchersdonotutilizeknownmetricsregardingvalidityandreliability,unlikequantitativeresearchers(Lincoln&Guba,1985).Consequently,qualitativeresearchersfacetheneedtoensuretheirresearchistrustworthy.Thus,qualitativeresearchersmustestablishprotocolsandprocessestoensurethetrustworthinessoftheirresearch.Fortheproposedstudy,theresearcherwillutilizeLincoln&Guba’s(1985)frameworktoguidetheselectionofstrategiestoenhancetrustworthinessofthefindings.CredibilityCredibilityisdefinedasconfidenceinthetruthofthestudy’sfindings(Lincoln&Guba,2985).Byemployingstrategiestoensurecredibility,aqualitativeresearcherseekstodemonstratethatthefindingsoftheirresearcharetrueandaccurate.Toestablishcredibility,qualitativeresearchersemploymeasuressuchastriangulation,memberchecking,peerdebriefing,prolongedengagement,andpersistentobservation(Houghtonetal.,2012).Fortheproposedstudy,theresearcherwillenhancecredibilitybymemberchecking.Membercheckingisastrategyforenhancingcredibilitythatentailssharingtranscriptdataand/orinitialthemeswithresearchparticipantstoevaluateaccuracy(Creswell,2014).Thegoalofmembercheckingisforparticipantstoidentifyandcorrectanyinaccurateinterpretationsoraccountsoftheirexperienceswiththephenomenonunderinvestigation.Throughthisprocess,theparticipantsensurethattheresearcherhasaccuratereportsorinterpretationsoftheirexperienceconcerningtheissuebeingstudied.Fortheproposedstudy,eachparticipantwillbeaskedtoreviewtherawtranscriptsoftheirinterviewfollowingthetranscriptionoftheaudiorecordings.Astheyreviewtheirtranscripts,participantswillberequestedtoprovidefeedbackandrequestrevisionswherenecessarytohelpensurethedataisaccurate(Creswell,2014).Theprocesswillalsoinvolveaskingeachparticipanttoexaminethethemesthatemergefromtheirinterviews,whichwouldhappenafterStep4ofdataanalysis.Thereviewofemergingthemesbystudyparticipantswillhelpensurethatthefindingsofthestudyaretrueandaccurate,whichisessentialinestablishingthetrustworthinessofastudy(Lincoln&Guba,1985).DependabilityDependabilityreferstowhetherthestudyfindingsareconsistentandreliableandthedegreetowhichtheresearchproceduresaredocumentedtoallowforeasyfollowing,auditing,andcritiqueoftheresearchprocess(Lincoln&Guba,1985;Streubert,2007).Byenhancingdependability,qualitativeresearchersensurethatenoughinformationisprovidedinthereportthatifthestudyweretoberepeated,thefindingswouldbeconsistent.LincolnandGuba(1985)contendthatdependabilityiscloselytiedtocredibility,andmanyqualitativeresearchersuseoverlappingtechniquessuchasindividualinterviewsandfocusgroupsonimprovingcredibilityanddependability.Toenhancedependability,qualitativeresearchersshouldensurethatprocesseswithinthestudyarereportedindetail,whichwouldenableafutureresearchertorepeatthestudyevenifthemotivationisnottoobtainsimilarresults/findings.Anin-depthdescriptionofprocesseswithinthestudydemonstratestheextenttowhichproperresearchpracticesandprocedureshavebeenfollowed(Shenton,2004).Theresearcherwillenhancedependabilityintheproposedstudybyusingreflexivityasastrategy.LincolnandGuba(1985)definereflexivityasanattitudeofattendingmethodicallytothecontextofknowledgedevelopment.Thisprocessiscarriedouttotheeffectoftheresearcherateachstepoftheresearchprocess.Reflexivityisbasedontheideathattheresearcher’sperspectiveorpositioninfluencesallresearchregardlessofwhetheritisqualitativeorquantitative.Fortheproposedstudy,theresearcherwillcreateareflexivejournalinwhichregularentriesoftheresearchprocesswillbemadeduringthestudy.Theseregularentrieswillincludeinformationondifferentaspectsoftheresearchprocess,suchasmethodologicaldecisionsandreasonsforthem,andthelogisticsoftheresearch.Also,theresearcherwillmakeentriesthatdemonstratereflectionuponwhatisoccurringbasedonpersonalvaluesandinterests.Areflexivejournalwillhelpenhancedependabilitybyprovidingdetailsregardingtheresearchprocessandhowtheresearcher’sperspectiveorpositioninfluencedit.ConfirmabilityConfirmabilityreferstothedegreeofneutralityortheextenttowhichparticipantsshapestudyfindingsinsteadofresearchermotivation,interest,orbias(Lincoln&Guba,1985).Thisimpliesthattheresultsoftheresearcharebasedonresponsesfromparticipantsandnotpersonalmotivationsorpotentialbiasoftheresearcher.Theprocessofenhancingtheconfirmabilityofastudyimpliesthattheresearcherensureshis/herbias,interest,ormotivationsdonotskewtheinterpretationoftheparticipants’responses.Inotherwords,theresearcherensuresthattheparticipants’responsesarenotskewedtofitaparticularnarrativeorposition.Theconceptofconfirmabilityisthequalitativeresearcher’sfocusonobjectivity(Shenton,2004).Inessence,theprocessofenhancingconfirmabilityfocusesonensuringobjectivitythroughouttheresearchprocess.Therefore,theresearchershouldadoptmeasurestoensurethefindingsreflecttheideasorexperiencesofparticipantsinsteadofhis/hercharacteristicsorpreferences.SomeofthetechniquesproposedbyLincoln&Guba(1985)toenhanceconfirmabilityincludeaudittrail,triangulation,confirmabilityaudit,andreflexivity.Fortheproposedstudy,theresearcherseekstoenhanceconfirmabilitybykeepinganaudittrail.Lincoln&Guba(1985)defineanaudittrailasatransparentdescriptionofthestepstakenintheresearchfromthebeginningoftheprojecttothedevelopmentandreportingoffindings.Theresearcherintendstodocumentrawdataorfieldnotesfromthestartoftheproject.Duringthisprocess,theresearcherwillrecordobservationsduringthedatacollectionprocesstohighlightanyassumptionsregardingtheinterviewdata.ThiswillenabletheresearchertoensurethatassumptionsandpreconceptionsregardingtheuseofinformalinstitutionstohelpcopewiththeCOVID-19pandemicdidnotinappropriatelyinfluencestudyfindings.TransferabilityTransferabilityreferstodemonstratingthatstudyfindingsareapplicableinothercontexts(Lincoln&Guba,1985).Inthisregard,differentcontextsimplysimilarphenomena,similarpopulations,andsimilarsituations.Transferabilityprimarilyconcernsexternalvalidity,whichistheextenttowhichstudyfindingscanbeappliedtoothercontexts/situations(Shenton,2004;Creswell,2014)).Qualitativeresearchersneedtoenhancetransferabilitybecausesuchstudiesuseasmallsampleincomparisontoquantitativeormixed-methodsresearches.LincolnandGuba(1985)suggestthatadequatecontextualinformationregardingthefieldworksitesisneededtoenhancetransferability.Transferabilitycanbeenhancedusingthickdescription,whichentailsdescribingaphenomenoninenoughdetailsothatareadercanstarttoassesstheextenttowhichitsconclusionsaretransferabletoothersettings,people,situations,andtime(Lincoln&Guba,1985).Usingthisstrategy,theresearcherintendstoprovidedetaileddescriptionsofthestudyparticipants,setting,andcontext.Duringthisprocess,theresearcherwillmakeexplicitpatternsofsocialandculturalrelationshipsintheresearchprocessanditsfindings.Whendevelopingtheresearchreportfortheproposedstudy,theresearcherintendstoproviderich,detaileddescriptionsoftheemergentthemessothatreaderscantransferstudyfindingstoothercontexts(Creswell,2014).Theproposedstudywillincorporatethickdescriptionstoreportthemesandtheirassociatedresultstoenhancefindings\'transferability.Throughthis,theresearcherwillavoidprovidingthin,superficialaccountsofparticipants’experiences.ImpactoftheresearchfindingsThesuccessfulcompletionofthisresearchwillbebeneficialtoAfricanCountries,particularlyinmanagingcrises,especiallyhealthcrises,e.g.,thecurrentCOVID-19pandemic.Asshownthroughthediscussionabove,thetypicalpre-colonialtraditionalAfricansocietyhadsystemsusedtodealwithahealthcrisis,includingepidemics.Thesystemsinplaceprovideaframeworkformitigationofthehealththreat,theeconomicdownturnresultingfromthecrisis,andprocessestoaddressfoodshortageandensurethateachmemberofthecommunitygotfood.ThisknowledgewouldbehighlyusefulinthemodernAfricancommunity,giventhepoorlyequippedhealthcaresystemsinthemajorityofAfricancountries;thefindingsofthisresearchwillhaveanimpactfuleffectinhelpingAfricangovernmentdealwithhealthcrisesbybringingonboardtraditionalhealthmitigationstrategiesthathavebeenproventowork.Inadditiontomitigatingthehealthcrisis,thisresearch\'sfindingswillbeusefulforgovernmentandcommunitiesinthemanagementoftheothersocialhardshipsthatareattachedtoahealthcrisis,e.g.,economicslowdownandtheunavailabilityofenoughtoeat.Thefindingsofthisresearchwillbearesourcefuladditiontotheavailableliteratureontraditionalhealthmanagementstrategies.InthetraditionalAfricancontext,informationwaspassedmainlythroughwordofmouth,withminimalrecord-keeping.Consequently,thereisverylittleoriginalmaterialonhistoricalandtraditionalstrategiestomanagecrises.Theresultsofthisstudywillbeusefulmaterialforfutureresearch.LimitationsOneofthelimitationsofthisresearchisthelimitedliteraturematerialavailable.Becauseofthelimitedrecord-keepinginthetraditionalpre-colonialhistoryofAfrica,thereisverylimitedoriginalliteraturematerialontraditionalprocesses.Thiswillbeamajorlimitationforthecurrentstudyasitwillbedifficulttofindoriginalandauthenticmaterialsforuseinthisresearch.Thesecondlimitationforthisresearchisexpectedtobetheinabilitytodeterminetheauthenticityandcorrectnessoftheresponsesmadebythestudyparticipants.TheIPAmethodologyisproposedforthisresearch,whichwillinvolvecollectinginformationfromthetargetpopulation.TheIPAreliesongettingtruthfulandin-depthinformationthrough,amongother,interviewswiththestudyparticipants.However,thislimitationwillbecounteredbyusingvariousdatacollectionmethods,includingobservation,diaries,focusgroups,andasignificantlylargesample.

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