COVID-19. What consequences for the African continent. Part Two The impact of Covid 19 on Africa's social, political and health systems

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Un mosaico di situazioni contraddittorie documentate da testimonianze di prima mano e accuratamente analizzate per offrire un'informazione approfondita sulla politica, economia e scoperte scientifiche di un mondo in evoluzione pieno di paradossi.

Fulvio Beltrami

Fulvio Beltrami
Originario del Nord Italia, sposato con un'africana, da dieci anni vivo in Africa, prima a Nairobi ora a Kampala. Ho lavorato nell’ambito degli aiuti umanitari in vari paesi dell'Africa e dell'Asia.
Da qualche anno ho deciso di condividere la mia conoscenza della Regione dei Grandi Laghi (Uganda, Rwanda, Kenya, Tanzania, Burundi, ed Est del Congo RDC) scrivendo articoli sulla regione pubblicati in vari siti web di informazione, come Dillinger, FaiNotizia, African Voices. Dal 2007 ho iniziato la mia carriera professionale come reporter per l’Africa Orientale e Occidentale per L’Indro.
Le fonti delle notizie sono accuratamente scelte tra i mass media regionali, fonti dirette e testimonianze. Un'accurata ricerca dei contesti storici, culturali, sociali e politici è alla base di ogni articolo.

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COVID-19. What consequences for the African continent. Part Two The impact of Covid 19 on Africa's social, political and health systems

In the first part of the research on the impact of the Covid19 pandemic on Africa, we examined the purely economic aspect. In this second part we will examine the social, political and health aspects related to the economic problems created by the pandemic

di Fulvio Beltrami

covid19, africa, public health, social unrest, pandemy, who, youth revolution, african diaspora

COVID-19. What consequences for the African continent. Part one

Fulvio Beltrami 27 juillet 2020

(Article original publié en italien sur Il Faro di Roma (http://www.farodiroma.it/centinaia-di-milioni-non-hanno-accesso-allassistenza-sanitaria-o-allacqua-pulita-limpatto-del-covid-19-sui-sistemi-sanitari-dellafrica-di-f-beltrami/) 

Dependence on imports of food and pharmaceutical products

In West Africa and the Sahel region, an estimated 11.4 million people need immediate food assistance. This situation is likely to get worse, mainly due to the impact of the pandemic. By June-August 2020, 17 million people are expected to be in a critical food security situation.

The countries already affected by the pre-pandemic food crisis are most at risk: (Niger, Mali, Burkina Faso) where 2.5 million children are undernourished. Countries heavily dependent on food imports (Mauritania, Liberia, Sierra Leone, Gambia) will suffer if traffic and transport restrictions reduce access to markets or if producers of agricultural products, such as rice, impose export restrictions or bans, as happened during the 2008 food price crisis. Only countries with good agricultural production capacity (Ivory Coast, Senegal, Ghana, Cabo Verde) will be able to revive local production and, in part, to replace food imports from the West and Asia coming to the aid of other nations to alleviate the risk of famines.

Many African countries could witness rising food price inflation due to the supply chains involved. When the Ebola epidemic hit West Africa in 2014, the prices of basic food products increased dramatically. The price of rice has increased by over 30% and cassava by 150%. Since the current crisis threatens food supply chains, speculative accumulations can occur and price increases can trigger.

In turn, higher food prices are likely to signal imminent shortages. These effects can aggravate each other in a vicious circle that can cause social unrest. In addition, the drop in imports of food and basic consumer goods could further increase inflation and adversely affect businesses and consumers.

Localized price increases due to panic purchases of food in Rwanda and South Africa have required governments in these countries to impose fixed prices for basic items such as rice and cooking oil. In addition, many small importers, traders and poor consumers in countries such as Mozambique, Niger, Nigeria and Uganda are seriously affected by the crisis while making a living by trading Chinese products such as textiles, electronics and household items.

Pharmaceutical products and protective equipment are imported largely from Europe and other countries affected by COVID-19. As the global demand for these products increases rapidly, the increase in prices can lead to a decrease in availability for Africa. The medical aid offered by China through the logistical management of Ethiopia represented a short-term solution to better tackle the containment of the epidemic, but in the medium term they will not solve the problem as extemporaneous gifts dictated by political marketing lacking a long-term strategic health vision.

African countries import about 90% of their pharmaceutical products outside the continent. Medical and pharmaceutical products are imported from the EU 27 (51.5% of total imports), from India (19.3%) and, to a lesser extent, from Switzerland (7.7%), from China (5, 2%), the United States (4.3%) and the United Kingdom (3.3%) (Court of Auditors, 2020 [12]). By the end of March, the African Center for Disease Control (CDC) and WHO had performed over 75,000 COVID-19 tests across the continent.

The partnership between the Jack Ma Foundation and the Prime Minister of Ethiopia has provided each of the 55 member states with 20,000 tests, for a total of 1.1 million additional tests. However, despite the great medical help promised by traditional donors and China, diagnostic materials, personal protective equipment and other medical equipment are in short supply.

For example, according to the WHO, fewer than 2,000 fans need to serve hundreds of millions of people in public hospitals in 41 African countries, compared to over 170,000 in the United States. Unlike the Ebola outbreak in 2014, the global nature of the current pandemic and the recent restrictions on the export of COVID-19-related medical supplies adopted by European countries, the United States and India, are negatively affecting Africa. The only luck the continent has is that the evil virus is struggling to spread like in Asia, Europe and the Americas.

Social impact on the main financial flows: foreign investments and remittances from the diaspora

None of the major sources of development finance has kept pace with population growth. In 2018, on average, African governments reported revenues of USD 397 per capita compared to over 15,000 for European and high-income countries. Not only do Africans have fewer external sources of funding, but their ability to mobilize national revenues through private savings or taxes has declined with the decline in African real per capita growth after 2015.

The contraction in economic activity will reduce Africa's internal tax and non-tax revenue and the reduction may be more than proportional to the contraction in GDP. A reduction in economic activity will reduce the tax bases and generally reduce the relationship between tax and GDP. The crisis will also affect non-tax revenues, in particular rents resulting from the exploitation of natural resources. This will result in the inability for governments to strengthen Public Health to prevent any Covid19 waves or other epidemics.

Private savings will also be affected by economic disturbances without income support measures that most governments may find difficult to finance. The suspension of economic activities that repress wages and business revenues, which are not accompanied by the cancellation or restructuring of debt and rent payments, is likely to reduce household savings by increasing the risk of extreme poverty.

Private foreign investment will be affected by economic conditions both in Africa and in the investor countries. If COVID-19 continues to act as a brake on high-income countries, less funds will be available for investment in Africa, while persistent risk - real or perceived - and lower growth prospects in Africa will reduce its attractiveness of investments. OECD expects global foreign investment flows to decrease by more than 30% in 2020, even in the most optimistic scenario. UNCTAD estimates a drop of up to 40% compared to 2020-21.

The remittances of the African diaspora in the West, Middle East and Asia, could decrease if the economic depression in the OECD countries and in the oil-producing countries worsened in the post-pandemic period producing the loss of work of African migrants or reducing their wages by reducing the cash flow available to families left in Africa.

Remittances are the main source of external financial flows to Africa (USD 82.8 billion in 2018 only from the United States and Europe). They represent up to 5% of GDP in 13 countries. Egypt and Nigeria make up 60% of the total remittances that flow to the continent. Furthermore, remittances tend to be much more stable as a source of revenue than other external financial flows that have increased almost steadily since 2000.

However, the economic downturn and confinement measures that prevent the African diaspora from working and making money will reduce remittance inflows from Africa in the coming months. The World Bank estimates that remittance flows to sub-Saharan Africa will decrease by 23% in 2020, compared to 20% globally. This decrease will aggravate the already precarious economic situation in Africa, increasing the percentage of people in extreme poverty. Informal workers who supplement their low monthly earnings with remittances from the diaspora are the most exposed to the economic crisis that their brothers and sisters are facing abroad.

Impact on health systems

The growing number of COVID-19 patients is likely to overcrowd healthcare facilities and patients with high-load diseases such as AIDS, tuberculosis and malaria may not have adequate access and / or treatment. Patients with other active diseases such as Lassa2 fever in Nigeria and Ebola in the Democratic Republic of the Congo3 can also be affected.

The health crisis could have an impact on the treatment of other diseases in Africa. In Europe, governments have postponed non-urgent treatments until after the blockade. When Guinea faced the Ebola crisis in 2013-14, primary medical consultations decreased by 58%, hospitalizations by 54% and vaccinations by 30% and at least 74,000 cases of malaria did not receive treatment in medical centers public. Furthermore, the implementation of blocking policies could have a negative impact on other infectious diseases, such as tuberculosis.

The full impact on the health of the pandemic in Africa is not yet known. However, many African countries will need international support and resources to minimize loss of life and protect and restore livelihoods. Since the impact of the virus has so far been more severe for older populations, some analysts predict that the health impact of COVID-19 for Africa may actually be less than in China or European countries, due to the different demographic characteristics of the continent.

While the percentage of the European population over 50 is 40%, it is only 10% for sub-Saharan Africa. However, the advantage of a younger population can be offset by the fact that many people's immune systems it is severely weakened by other conditions such as malnutrition or HIV and by the more limited ability to test, protect, treat and cure. Indeed, Africa is the least prepared region in the world to face and manage the impacts of a global pandemic, and therefore major initiatives to mobilize national and international resources to support fragile national health systems must be prioritized and coordinated at the level continental.

The countries of West and Central Africa may have useful lessons to offer from their recent experience with the 2014-16 Ebola crisis. WHO has recognized how the fight against the Ebola virus has contributed to significant developments, such as infrastructure and skills for laboratory tests, capacity exchanges between countries, partnerships between technical agencies, international organizations and the private sector and public health awareness among population. For example, the mining sector in Guinea has played an important role in addressing the Ebola epidemic and that experience and institutions created at the time are now being mobilized to combat the current pandemic.

Local health systems in Sierra Leone have provided effective responses, with community care centers testing, treating and isolating patients. The Democratic Republic of the Congo has also shown an ability to respond to the Ebola epidemic that started in 2018. Unfortunately, the health response has been hampered by the two evils that have plagued the DRC for 20 years: corruption and low intensity wars in the eastern provinces.

Added to this was the ominous influence of the religious sects that hindered the work of doctors and the Ministry of Health by stating that Ebola was a virus brought by the Europeans or Rwandans to exterminate the Congolese population and steal their lands. This conspiracy theory has pushed a part of the population in eastern Congo to attack and set fire to Ebola treatment centers. After the first epidemiological wave is wiped out, now Congo has to face a second one in the middle of the measles epidemic and the Covid pandemic19. Unfortunately, funding to combat this triple virological threat is penalized by the purchase of weapons, many of which are "Made in Italy".

Informal work and social vulnerability

The informal workforce is most vulnerable due to poor health and safety conditions at work and the lack of safety nets. About 86% of total employment in Africa is informal, with a maximum of 91% in West African countries. As more and more African countries experience coronavirus blockade, survival for many can be threatened not only by COVID-19, but also by the inability to work. Various African countries, such as Senegal, have opted not to apply the total lockdown by imposing an evening curfew and strict preventive hygiene measures. This allowed the economy and, above all, informal workers to continue their activities.

It is in the countries that have chosen total lockdown such as Uganda or Rwanda that informal workers such as traders, retailers and manual workers are among the hardest hit due to the inability to work. Given their poor working and living conditions, informal workers are unlikely to be able to take many of the precautions suggested by health authorities, such as social removal or self-isolation. They will no longer be able to resume small businesses once the total lockdown is over.

Informal workers are not accounted for and do not benefit from social protection measures. The absence of safety nets to deal with the consequences of this shock will therefore worsen its consequences on large segments of the population. The International Labor Organization has estimated that 82% of Africans are without social protection and that only a small part of the economically active population is covered by mandatory social security schemes, most of which are old-age pensions.

Increased inequality and risk of social unrest.

The COVID-19 crisis risks deepening inequality within African countries and increasing social unrest. The poorest in Africa are the most at risk. Without strong political intervention, the crisis could exacerbate resentment among the most vulnerable communities. South Africa, currently the African country most affected by the infection, ranks among the 5 most unequal countries in the world. South Africa's initial spike in COVID-19 cases may have primarily affected the richest and most mobile population internationally, but if the virus is not contained and community transmission intensifies, it could pose a high risk for the low-income population which relies on public transport, has no savings, must continue to work, cannot afford hygiene products, lives in large families and lives in informal settlements.

Pre-existing social and political vulnerabilities risk amplifying the effects of the crisis. The World Bank estimates that the COVID-19 crisis could push 49 million people globally into extreme poverty in 2020, of which nearly 23 million in sub-Saharan Africa (World Bank, 2020. The most exposed countries are South Sudan, Democratic Republic of the Congo, Sudan, Nigeria, Mali, Niger, Central African Republic, Burundi, Libya, Ethiopia, Liberia, Chad due to poverty, existing armed conflicts, low agricultural productivity, endemic youth unemployment, large concentrations of displaced people in the camps refugees, dictatorships, poor government transparency and trust in public institutions.

If in Mali we are witnessing a social revolution with uncertain outcomes, other African countries may run the risk of serious social upheavals. For example in Sudan, where the secular revolution was carried out halfway or in Uganda where the population is tired of the "Father of the Nation", Yoweri Kaguta Museveni, who has been in power for 33 years. Museveni has just declared his intention to enter the fifth presidential term in 2021... The continuity of apartheid in the economic sector in South Africa and the failure to improve the conditions of the black masses are factors that, combined with the health crisis, create the risk of strong social unrest. Various North African countries are also at risk: the monarchical system in Morocco, the unfinished revolution in Tunisia, the generals' dictatorship in Algeria. In these countries there is also the risk of an extremist drift to the full advantage of radical Islam.

The pandemic is already having an impact on humanitarian assistance. For the most vulnerable populations, international support to limit the spread of the virus at an early stage will be vital, as well as improving the transparent orientation and communication of public health by public authorities. Unfortunately, few international NGOs are able to offer valuable help. Among them MSF and Medicus Mundi. In Italy only in CUAMM - Doctors for Africa is able to help African countries to fight the pandemic.

Almost all of the projects funded by the EU, USAID, UN agencies and AICS are in fact blocked or activities are slow. The majority of expats have fled Africa, giving an extremely negative signal to local populations. According to various African experts, the Covid19 pandemic will increase hostilities towards Western NGOs that are increasingly proving unable to face African development-oriented challenges, focusing on emergency and assistance.

This will add to the trend recorded in the last 5 years by the main western donors to progressively narrow the field of action of NGOs as the Chinese model has made the humanitarian sector "not convenient" to win the commercial and strategic war in Africa against Beijing. This trend of western donors is not declared for political convenience, but methodically implemented through the silent but deadly progressive decrease in funding for NGOs.

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