Coproducing Responses to COVID-19 with Community-Based Organizations: Lessons from Zhejiang Province, China.

Zhejiang Province achieved one of the best records in containing the COVID-19 pandemic in China. What lessons can the world learn from it? What roles do community-based organizations play in this success story? Based on more than 100 interviews during and after the outbreak in Zhejiang, this article provides a road map of how community-based organizations were involved in the three distinct stages of Zhejiang's response to COVID-19. The authors recommend that public sector leaders (1) strategically leverage the strengths of community-based organizations at multiple stages of the COVID-19 response; (2) incentivize volunteers to participate in epidemic prevention and control; (3) provide data infrastructure and digital tracking platforms; and (4) build trust and long-term capacity of community-based organizations.

Since the outbreak of the COVID‐19 pandemic, no country can fight it alone, especially in such a globalized world. China was the first country to report COVID‐19 and put in place strong, wartime‐like command and control mechanisms to control the virus. According to information on the cumulative case totals across the most affected countries (see figure 1), although China had the earliest reported outbreak in the world, the curve in China flattened within two months and has remained stable.

Figure 1

Trend of the Accumulation of Confirmed COVID‐19 Cases among the Most Affected Countries

Source: Kaiser Family Foundation COVID‐19 Coronavirus Tracker as of April 29, 2020, https://www.kff.org/coronavirus‐covid‐19/fact‐sheet/coronavirus‐tracker.

Despite such a huge success in containing COVID‐19, China is getting mixed feelings and comments from the rest of the world, especially developed countries in Europe and North America. On the one hand, the world is marveling at how China, with such a large and dense population, could successfully contain the virus within two to three months. On the other hand, because of their faith in individual liberty and the relatively limited power and capacity of their governments, other countries do not regard the experiences in China as valid examples from which they can learn. People often associate the success of China with the complete lockdown in Wuhan and the extreme power of the state machinery. There are also concerns about China covering up the actual statistics on the COVID‐19 outbreak, especially during the early stages in Wuhan (Barnes 2020). These widely held beliefs and assumptions are in conflict with some of the core values held by advanced democratic countries. Further, they prevent other countries from learning the more comprehensive picture of how COVID‐19 was successfully contained in China through complex networks of community‐based organizations working in collaboration with the state. For example, in response to early criticism regarding information disclosure and the resulting information credibility deficit, Li (2020) illustrated how the Chinese government was able to rely on experts and voluntary groups to increase information credibility and quickly restore public trust after the initial COVID‐19 outbreak in Wuhan.

We argue that solely crediting the central government for the successful effort to contain COVID‐19 in China is not only dangerous on ideological grounds but also misleading in terms of how the world can learn from the experiences in China. Despite strong policy directives and commands from the central government, not every province in China faced the same level of pressure from COVID‐19 because of their varying levels of economic development and different geographic locations. They also presented different patterns in how they contained and responded to COVID‐19. These variations can hardly be attributed to central government actions. We argue that the way community‐based organizations worked with their local governments to coproduce responses to COVID‐19 was a key determinant of whether containment strategies were effective at the local level.

The importance of community‐based organizations in shaping public service outcomes and strengthening disaster response is well articulated in the academic literature. McGuire and Schneck (2010) note that strategic collaboration between public, private, and nonprofit organizations is the first principle that the U.S. Department of Homeland Security lists for emergency management. Elinor Ostrom and her colleagues at Indiana University developed the concept of coproduction to describe the nature of public services: “All public goods and services are potentially produced by the regular producer (government agencies) and by those who are frequently referred to as the client. . . . Coproduction implies that citizens can play an active role in producing public goods and services of consequence to them” (Ostrom, 1996, 1073). Community‐based organizations play important mediating roles in helping citizens involved in public service provision and the work of local governments (Cheng 2019).

The response to COVID‐19 is a perfect example of why coproduction and community‐based solutions are important. For a locality to develop a successful strategy in coping with the virus, both government intervention and voluntary cooperation from citizens are required. From self‐quarantine to practicing physical distancing, from wearing masks to using hand sanitizer, the government cannot control every action taken by its citizens. In fact, decentralizing containment strategies to neighborhoods and communities is regarded as one of the keys to China's success story. According to the latest report on China's Fight against COVID‐19 (China Watch Institute 2020), universal participation with social cohesion is considered one of the four most important tools that China leveraged in the fight against COVID‐19. This report synthesizes opinions and contributions from more than 70 experts within and beyond China. It highlights the importance of the active response of citizens to the government's call for action, their self‐discipline, and community‐based management. We chose Zhejiang Province in China to illustrate how community‐based organizations were involved in different stages of the COVID‐19 response. These practices provide lessons for other localities to adapt and adopt.

Background on Zhejiang and Its Success in Containing COVID‐19

Zhejiang, located on the eastern coast of China, has 11 cities and 89 counties/districts (see figure 2). It is regarded as one of the most densely populated and developed regions in China. The population density of Zhejiang is around 540 people per square kilometer, two times and five times that of Britain and France, respectively. Because of the active development of private businesses in Zhejiang, it is also one of the major destinations for migrant workers. In 2018, the net population inflow into the province reached 800,000.

Figure 2

Map of Zhejiang Province, China

Because of its level of economic development and high population density, Zhejiang was one of the most affected provinces in China outside of Hubei, where cases were first reported. Compared with the national average, Zhejiang experienced a larger COVID‐19 outbreak during the initial stage. The curve quickly flattened in Zhejiang, however, while cases in other provinces continued to grow (see figure 3). As the central government issued similar guidelines to provincial governments outside Hubei, why were the responses in Zhejiang so effective? What roles did community‐based organizations play in these responses? What lessons can other cities, countries, and regions learn from these experiences in Zhejiang?

Figure 3

Net Confirmed Cases: Zhejiang versus National Average.

Source: Chinese Center for Disease Control and Prevention, http://www.chinacdc.cn (accessed April 20, 2020).

To shed light on these questions, the authors and colleagues at Zhejiang University conducted 147 semistructured interviews with top government officials (12), agency directors (30), civil servants (70), and ordinary citizens (35) between February 18 and May 13, 2020. The interviews lasted 30 to 60 minutes. To triangulate the responses from multiple parties, the same questions were asked about the roles of community‐based organizations in fighting COVID‐19. After the interviews were transcribed, the research team first synthesized the key roles played by community‐based organizations as they emerged from the interviews and then mapped these roles to different stages of COVID‐19 responses.

The long‐established collaborative relationship between the university and local governments in Zhejiang helped the research team quickly gain trust and support from top government officials to facilitate the implementation of this research. Five major cities and seven counties/districts within these cities were visited by the research team, with two days on average spent in each city. The field interviews were still ongoing in cities and counties/districts in Zhejiang at the time of writing. These field interviews provide firsthand insights from government officials and communities who are at the forefront of this crisis, especially those cities and counties/districts with the highest risk of COVID‐19 transmission in Zhejiang.

Our interview findings generate a strong convergence toward the recognition of the important role of community‐based organizations in every stage of COVID‐19 responses: comprehensive epidemic prevention and control, balancing epidemic control and social functions, and the normalization of epidemic prevention and control. Table 1 presents the examples and the key roles community‐based organizations played in each stage of Zhejiang's response to COVID‐19.

Table 1

The Critical Roles of Community‐Based Organizations in Zhejiang's Response to COVID‐19

Stage of COVID‐19 Response	Key Roles of Community‐Based Organizations	Examples of Community‐Based Organizations
Stage 1: Comprehensive epidemic prevention and control	Mobilizing volunteers to trace the source and spread of COVID‐19 Collecting donations and supplies for epidemic control Providing community services to help people staying at home receive basic life support	Emergency response organizations: Dolphin Emergency Rescue Team of the Hangzhou Dishui Commonweal Service Center; Yueqing Blue Sky Rescue Service Center Charitable organizations: Zhejiang Provincial Charity Federation; Red Cross Society of China Zhejiang Branch Community service organizations: Yuanqiao Township Community Service Center in Huangyan District
Stage 2: Balancing epidemic prevention and social functioning	Mobilizing volunteers to trace the source and spread of COVID‐19 Providing welfare services Assisting enterprises with production resumption	Community service organizations: Haichuang Community Service Center in Yinzhou District Industrial associations: Wenzhou Shoe Leather Industrial Association Business associations: Wenzhou Clothes Business Association
Stage 3: Normalization of epidemic prevention and control	Mobilizing volunteers to trace the source and spread of COVID‐19 Psychological counseling and social work Building collaboration platforms to promote sustainable economic development	Community service organizations: Deqing Association for Mental Health; Wenling Medical Association Industrial associations: Yuhang Metal Products Industry Association Business associations: Wenzhou Glass Business Association

The Critical Roles Played by Community‐Based Organizations in Zhejiang's Response to COVID‐19

Because of its vibrant private economy, Zhejiang has the most active social sector in the country. Community‐based organizations in Zhejiang have historically been active in response to natural disasters, especially typhoons. Although the outbreak of COVID‐19 presented a unique set of challenges compared with a typical natural disaster, these community‐based organizations were able to organize quickly and work with local governments to respond to the disease. Official statistics show that 34,000 community‐based organizations in Zhejiang responded to the COVID‐19 crisis, and more than 2.8 million volunteers were mobilized to join community service activities (Zhejiang Civil Affairs Bureau 2020). The major roles of community‐based organizations during COVID‐19 included mobilizing volunteers to trace the source and spread of COVID‐19, collecting donations and supplies for epidemic control, providing necessary social and community services, offering welfare services, assisting enterprises with production resumption, offering psychological counseling and social work, and building collaboration platforms to promote sustainable economic development.

Stage 1: Comprehensive Epidemic Prevention and Control

The first stage of the COVID response was characterized by the rapid increase in infections and comprehensive tracing and control of COVID‐19 sources. During the stage of comprehensive epidemic prevention and control, community‐based organizations played three major roles: mobilizing volunteers to trace COVID‐19 patients and those residents who were in close contact with the patients, collecting donations and supplies related to epidemic prevention and control, and providing community services to help people who were staying at home receive basic life support.

Emergency community‐based organizations assisted local governments in searching and testing for COVID‐19 cases and setting up checkpoints at the entrances of the province and communities. Since Zhejiang suffers from typhoons and floods in summer and autumn almost every year, community‐based organizations and local governments have accumulated rich experiences in working together. In this stage of responses to COVID‐19, local governments mainly worked on pooling strengths and providing resources to the most affected areas. Emergency community‐based organizations were responsible for rendering specific services to townships, towns, and villages. According to the Zhejiang Civil Affairs Bureau (2020), 70 emergency rescue teams, including the Dolphin Emergency Rescue Team of the Hangzhou Dishui Commonweal Service Center, the Yueqing Blue Sky Rescue Service Center, the Wenzhou Black Horse Rescue Service Center, and the Ouhai Sea Hawk Rescue Center, organized 12,800 volunteers to aid transportation and public security. They established temporary tents to screen people for COVID‐19 through temperature checks at expressway entrances, railway stations, road entrances to villages, and supermarkets. These efforts effectively prevented the virus from spreading.

Community‐based organizations created a cross‐department collaboration network with local governments and private enterprises, building a quick response mechanism for material demands related to epidemic prevention and control. By February 12, 2020, organizations such as the Zhejiang Provincial Charity Federation and the Red Cross Society of China Zhejiang Branch raised 1.557 billion renminbi (RMB) and collected 15,356,300 surgical masks, 704,000 protective suits (disposable surgical gowns), 139,700 pairs of protective goggles, 33,700 pairs of shoe covers, and other materials worth RMB 239 million. The Zhejiang Provincial Charity Federation launched an online fundraising campaign called “Work Together to Fight against COVID‐19,” which, after being launched by the Tencent Foundation on January 25, collected RMB 10 million within 24 hours (Zhejiang Civil Affairs Bureau 2020).

Community‐based organizations also cooperated with local government to carry out community investigations into COVID‐19, and they provided personalized services. The head of Fuyang District said that the cooperation between community‐based organizations and government played a significant role in tracing people who had been in close contact with patients. According to the interview, community‐based organizations in Fuyang visited 179 residential areas in 50 communities. They teamed up with more than 1,400 officers of towns and nearly 1,600 officers of villages under the 24 townships of the district to search for possible close contacts with patients. After three rounds of thorough investigations and quick isolation, Fuyang finally gained control over the risk of epidemic transmission and population mobility.

The head of Huangyan District regarded community‐based organizations’ daily services as a significant contribution that allowed the public to willingly stay at home in quarantine. After Huangyan entered complete lockdown, community‐based organizations delivered food to people living in the town of Yuanqiao, the hardest‐hit area in Huangyan. Their deliveries included a total of 38,151.5 kilograms of pork, 76,850 kilograms of vegetables, 11,347.5 kilograms of eggs, 27,950 kilograms of rice, and 1,734 bottles of cooking oil, worth RMB 2,861,329. Due to these efforts, residents had few complaints about the 18‐day lockdown. Community‐based organizations played a key role in helping local residents access to basic necessities to get through the quarantine period. In our interviews, residents also shared their efforts in preparing free meals and desserts to serve local government officials and volunteers to show their appreciation.

Community‐based organizations also began involving volunteers in community services during epidemic prevention and control. They created a platform called the “Voluntary Bank” to record the place and time of voluntary services. Community‐based organizations converted volunteers’ time into benefits, loans, and financial services at local banks, which encouraged volunteers to contribute their time in fighting COVID‐19. This key role of mobilizing volunteers continued in the subsequent stages of the COVID‐19 response.

Stage 2: Balancing Epidemic Control and Social Functioning

Starting on February 10, 2020, people began to resume work and production, signaling that epidemic prevention and control in China had entered a new stage. The Chinese central government asked local governments to restart economic and social development while ensuring epidemic prevention and control. During the stage of balancing epidemic control and social functioning, community‐based organizations in Zhejiang adopted information technology (IT) and digital tools to closely monitor the status of COVID‐19 patients or people in close contact with these patients, helping enterprises gradually resume production.

The implementation of the Zhejiang health QR codes was a game changer for how community‐based organizations were involved during this stage of COVID‐19 responses. The Zhejiang health QR codes were a digital innovation that Zhejiang adopted to use three colors (green, yellow, and red) to manage and monitor the health conditions of their residents and anyone wanting to enter communities in Zhejiang (see figure 4). This IT‐based health surveillance system provides an efficient and flexible mechanism to generate individual solutions in the prevention and control of COVID‐19 (Wu, Xu, and Wang 2020). While community‐based organizations in Zhejiang continued to maintain checkpoints in residential areas during this stage, the implementation of the health QR codes greatly improved the efficiency and scale of their work. For example, more than 230 community‐based organizations in Yinzhou District came to communities for 24‐hour health codes checking and temperature measurement. The head of Yinzhou District treated this close partnership between community‐based organizations and local governments as the core force in fighting COVID‐19.

Figure 4

Zhejiang's Health QR Codes for Tracking COVID‐19

Notes: Zhejiang implemented a color‐based health code system through cellphone app. People with a green code could travel within Zhejiang and visit or leave Zhejiang by showing their codes. Red and yellow code holders had to go into government quarantine or self‐quarantine for 14 or 7 days, respectively, and their codes would switch to green after consecutive health reports within this period.

Economic organizations also teamed up with industrial and business associations to collect resources and provide services for responding to enterprise needs, so that small and micro enterprises could resume production in an orderly way. The great number of small and micro enterprises in diverse industries is the economic foundation of Zhejiang, accounting for 80 percent of the province's gross domestic product. These small and micro enterprises are vulnerable, however, to market risks and had difficulty quickly resuming production. Industrial and business associations played an instrumental role in organizing these enterprises to support each other during the economic downturn.

The head of Wenzhou City said that during epidemic prevention and control, industrial and business associations grouped member enterprises to alleviate their burdens. For example, the Wenzhou Glass Industry Association and the Wenzhou Clothes Business Association inventoried enterprises’ needs for temperature measurement equipment, masks, and other protective materials, after which they conducted collective procurement, which greatly reduced the cost. In addition, they updated information on production resumption to fix the raw material supply chain and product distribution chain. Industry associations established financial service platforms and channels for legal aid, benefiting member enterprises with high‐quality and convenient counseling services. Business associations initiated fee reductions to lighten rent burdens on member enterprises. Collectively, the efforts of industrial and business associations in Zhejiang accelerated the resumption of small and micro enterprises. On February 26, 2020, 99.3 percent of the 777 small and micro business industrial parks reopened, and the production resumption rate of the businesses located in these parks reached 67.3 percent (Zhejiang Daily 2020).

Stage 3: Normalization of Epidemic Prevention and Control

Starting on March 1, economic and social life in China gradually returned to normal, as 28 provinces celebrated zero increases in confirmed COVID‐19 cases. Zhejiang had not detected any new COVID‐19 patients since February 21, while those discharged from hospitals accounted for 78.3 percent of the total confirmed cases by then. The response to COVID‐19 thus entered a stage of epidemic prevention and control normalization.

In this ongoing stage of the COVID‐19 response, community‐based organizations in Zhejiang shifted their focus to psychological counseling, social work, and economic development. Mental health service providers actively provided psychological support to people affected by COVID‐19 in a bid to prevent, mitigate, and control the social impact of the epidemic. The Zhejiang Association for Mental Health organized psychological experts to join voluntary psychological counseling platforms, providing timely and professional psychological crisis intervention for COVID‐2019 patients, their family members, and health workers. The Xiaoci Social Innovation and Development Center of Jiaxing cooperated with social work institutions to build a team composed of 21 certified psychological counselors and social workers for online services, including psychological counseling, as well as support and crisis intervention for family members of patients and people living in quarantine areas. The Deqing Association for Mental Health, along with many other community‐based organizations, set up a volunteer team and psychological crisis intervention hotline to provide psychological assistance for people under quarantine and for health workers on the front lines.

Community‐based organizations in Zhejiang also participated in medical aid with care services. The Wenling Federation of Internet Practitioners, the Wenling Medical Association, and other organizations joined together to launch a mini program, called “Voluntary Clinic,” which invited local experts to offer free public medical services. The Zhejiang Social Work Development Service Center collaborated with local hospitals to organize medical social workers to support patients, their family members, and health workers.

Community‐based organizations such as the Yuhang Metal Products Industry Association and the Wenzhou Shoe Leather Business Association actively promoted sustainable economic development by building collaboration platforms for work resumption, fueling the sharing of employees and materials. The head of Yuhang District commented that community‐based organizations acquired human resources, established employee‐sharing platforms, and connected industries across the production chain during the normalization of epidemic prevention and control. Industrial and business associations provided enterprises with digital human resource services and released nationwide employment maps and labor force distribution maps, helping enterprises acquire human resources through diverse channels and varied methods. Local industrial associations and leading enterprises utilized their market influence to jointly drive work resumption, create innovative employment methods and work resumption models, and share employees and materials.

What Can Public Sector Leaders Do to Better Engage Community‐Based Organizations in Their Response to COVID‐19?

In 2010, Rosemary O'Leary and David Van Slyke organized a special Public Administration Review issue on the future of public administration in 2020. In this special issue, McGuire and Schneck (2010) proposed a provocative question: what if Hurricane Katrina had hit in 2020? Coincidentally but unfortunately, in 2020, the world is facing a challenge on a much larger scale than Hurricane Katrina. Worldwide confirmed COVID‐19 cases had reached 3.19 million as of April 29, 2020, and this number continues to rise. Making things worse, two superpowers in the world—China and the United States—are still playing the blame game on ideological grounds instead of cooperating to combat this global challenge together. Because of these political and ideological barriers, China's success in fighting against COVID‐19 is framed as a concentration of power in the central government and a deprivation of individual liberty. While the central government and its relationship with provincial and local governments in China differ from Western democratic nations, it is clear that the experiences in Zhejiang teach us the lesson that citizen coproduction and the involvement of community‐based organizations have played crucial roles in every stage of COVID‐19 responses.

How can public sector leaders in other localities and countries learn from Zhejiang's experience? We propose the following recommendations for public sector leaders to better engage their citizens and community‐based organizations in their responses to COVID‐19.

Strategically Leveraging the Strengths of Community‐Based Organizations in Multiple Stages of the COVID‐19 Response

Community‐based organizations played varied yet coordinated roles in Zhejiang's response to COVID‐19. For example, emergency response organizations (e.g., Dolphin Emergency Rescue Team of the Hangzhou Dishui Commonweal Service Center) played major roles in mobilizing resources and providing supplies, while industrial and business associations (e.g., the Wenzhou Glass Industrial Association) played important roles in economic recovery. It is crucial for public sector leaders to think strategically and to create space to leverage the strengths of community‐based organizations in the different stages of the overall COVID‐19 response. Local government leaders should design a public governance mechanism which is inclusive to organizations and stakeholders outside the bureaucratic system and provide rules to facilitate their coproduction of quality public services, in this case, the response to COVID‐19 (Gao and Yu 2020).

Incentivizing Volunteers to Participate in the Prevention and Control of COVID‐19

During the first stage of the COVID‐19 response, there was considerable uncertainty about this new crisis. Therefore, citizens were not likely to serve as active volunteers. Innovative programs such as volunteer banks and those that had government officials serve as volunteers incentivized local residents to participate in the prevention and control of COVID‐19. These programs also built long‐term volunteer pools for subsequent efforts by local governments and community‐based organizations. Public sector leaders should design similar innovative programs to encourage and facilitate volunteering and citizen participation.

Providing Data Infrastructure and Digital Tracking Platforms

The implementation of the Zhejiang health QR codes created the data infrastructure and digital tracking platform for community‐based organizations to participate in the prevention and control of COVID‐19. Individual citizens could also use their cellphones and the code to guide their own activities and behavior. This innovative use of big data and information technology connected the groundwork of community‐based organizations to the macro‐level management of local governments. The public sector should consider similar initiatives to provide necessary and direct information for citizens and community‐based organizations to jointly participate in the prevention and control of COVID‐19.

Building Trust and Long‐Term Capacity of Community‐Based Organizations

Community‐based organizations’ quick and effective involvement in Zhejiang's responses to COVID‐19 as largely built on their previous experiences in working with local governments in response to natural disasters. Therefore, the public sector should build trust with community‐based organizations and invest in their long‐term organizational capacity. This is crucial for effective community responses to future disasters and emergencies. The research process of this study is also an example of how well‐established university‐government partnerships could help researchers and public managers build trust and jointly carry out important applied research project to facilitate policy innovation and diffusion.

Conclusion

The COVID‐19 crisis presents a paramount challenge to our society and exposes many problems of our administrative system. Solving these problems will require scholars and practitioners to revisit the key assumptions and issues in public administration. More than ever before, COVID‐19 teaches us the lesson that successful societal responses to crisis require both effective government actions and citizens’ voluntary cooperation (Moon 2020). The evidence and experiences in Zhejiang highlight the importance of community‐based organizations in facilitating the coproduction of COVID‐19 responses between the government and its citizens.

For scholars who study coproduction and government‐nonprofit relations, the experiences in Zhejiang offer invaluable opportunities to advance our general understanding of coproduction and the role of community‐based organizations in disaster response. Cheng (2020, 4) proposed that one of the key questions for studying coproduction from a comparative perspective is “how should we envision coproduction when the scale of population moves to another order of magnitude in Asian and African countries?” In Zhejiang, digital governance and the implementation of Zhejiang QR health codes provided the information platform to help address the scale problem for coproduction. However, will the digital divide and privacy concerns further complicate the social equity implications of coproduction, especially in localities where citizens are less equipped with digital devices and capacities? (Clark, Brudney, and Jang 2013; Gazley, Lafontant, and Cheng 2020). More studies are needed to examine this intersection between administrative reforms and coproduction.

Second, the experiences in Zhejiang point to the importance of conceptualizing coproduction as a dynamic and multistage concept. Community‐based organizations are likely to play different roles at various stages of public service provision (Cheng 2019). Finally, as the responses to COVID‐19 are shaped by their historical and institutional contexts (Moloney and Moloney 2020), future research should examine how mandated versus voluntary coproduction and state‐lead versus community‐led coproduction work in different countries and cultural contexts (Souza and Neto 2018). Local experimentations stimulated by the COVID‐19 crisis provide an ideal context to study these complex interactions for coproduction research.

Facing such a large‐scale natural disaster like COVID‐19, no sector or country can respond to it on its own. The evidence and experiences in Zhejiang suggest that there are solid steps public managers can take to better integrate citizens and community organizations in their responses to COVID‐19. These lessons are important not only for provinces and localities in China but also for other countries and regions around the world as our fight against COVID‐19 continues.