Mask Up! Testing strategies to increase mask use in Uganda and Kenya

Policy Context

Mask mandates are a key non-pharmaceutical intervention to combat the ongoing COVID-19 crisis, particularly in low- and middle-income countries where widespread vaccination still lies in a distant future. However, questions remain on how to effectively promote mask adoption. Despite masks being mandatory, recent evidence shows few wear them in Western Kenya and Uganda.

Study Design

Together with the Ministry of Health in Siaya county, we evaluate a pilot program that distributes a free mask to each citizen, combined with educational interventions informed by insights from behavioral economics. We identify the most cost-effective way to boost adoption, directly informing the design and implementation of an intended scale up in Siaya county (population of 1mio). Four interventions–mask distribution; education; additional information on COVID (mask effectiveness, severity, and inattention); and a role model treatment–are cross-randomized to test a) which is most cost-effective, and b) which channel drives low adoption of publicly observable health goods such as masks. Data are also collected in 90 villages in Eastern Region of Uganda, including 1,530 phone interviews (17 randomly selected households from each village) and 540 field observations of mask wearing (6 observations from each village).

Results and Policy Lessons

The results – particularly of free mask distribution coupled with education, and of role model encouragements separately – were promising. These interventions were able to increase observed mask use by roughly 70%. Results and policy briefs were shared on an ongoing basis (as early as 2 weeks after midline data collection) with Siaya County health officials.  Additionally, the findings were shared with the international research and policy group NORM, presented at various policy and academic meetings, and will hopefully be published in an academic journal to inform future policy.