Impacts of physical distancing for COVID-19 in Africa

As efforts to develop a vaccine or cure for COVID-19 intensify, countries are relying on physical distancing among other measures to slow down COVID-19 transmission. Physical distancing, by definition, reduces physical contact between individuals. In Africa, the stringency of these measures ranges from isolation and quarantine policies to partial and full lockdowns. While physical distancing has been shown to reduce infectious disease transmission, it also has unintended and negative health and socio-economic impacts. These undesirable impacts are of great concern in Africa because the continent has several vulnerabilities: 42% of the population living below the international poverty line, its informal settlement population represent 25% of all such populations across the world, an informal sector accounting for 84% of all employment, underfunded health systems and inadequate social safety-nets, among others. This blog presents some of the key findings from a rapid literature review on the health and socio-economic impacts of physical distancing in Africa.

Health system impacts: Movement restrictions have disrupted supply chains for healthcare commodities and reduced access to essential health services. This poses a threat to vulnerable groups, such as people with chronic diseases, the elderly, pregnant women and children, all these groups seek health services often. Adverse health outcomes associated with movement restrictions are exemplified in reports of increased maternal mortality due to an inability to access health facilities in Uganda, a 40% reduction in mobile family planning services by an NGO in Kenya and an increase in mental health conditions reported in countries including South Africa, such as increased reports of anxiety due to the lockdown. These adverse impacts are additional to an expected increase in unwanted pregnancies, child mortality, malaria  and deaths. These consequences can be attributed in part to disruptions in routine childhood immunization, mass insecticide-treated net distribution, and reduced uptake of contraceptives.

Economic impacts: Microeconomic impacts due to physical distancing include a considerable decline in household demand, especially among vulnerable groups, which tend to spend money only on food and essential household items. Reduction in demand leads to lost income for businesses, which is detrimental in Africa where the informal sector, small and medium enterprises provide 80% of the jobs and a majority of the poor and other vulnerable groups, such as youth, residents of informal settlements and refugee camps, and internally displaced populations rely on daily wages from the informal sector work. A reduction in spending leads to business closures and widespread job losses, which disproportionately affects women, the greatest proportion of informal sector workers particularly small-scale trade. Estimates suggest that 23 million people in Sub-Saharan Africa (SSA) will be pushed into extreme poverty due to COVID-19 in 2020.

Food and nutritional security: With informal and smallholder farmers comprising 60% of the population of SSA, movement restrictions will lead to labour shortages that will in turn negatively impact labour-intensive food production and processing. Insufficient allowance for movement exemptions to obtain food supplies in several African countries has led to spoilage of agricultural produce in depots and farms. Disruption in imports and local production and distribution of food supplies leads to price fluctuations. With over 50% of acutely food-insecure people across the globe living in Africa, stringent physical distancing measures threaten to make a dire situation worse. The poor, including people living in informal settlements and humanitarian settings, will bear the greatest burden of hunger. Children who depend on school meals also face an increased risk of hunger. Already, survey respondents in 12 African countries reported reducing food intake due to physical distancing-related challenges.

Education impacts: With school closures, leveraging technology to ensure learning continues through remote learning initiatives is challenging, especially for poor households. Only a third of the SSA population has smartphones, less than 40% have access to a radio or television and internet access is limited. These limitations further aggravate the already existing inequalities in access to education between better off (largely urban) and worse off (largely rural) regions. Children from poor households, especially girls who have lower school completion rates than boys, face a higher risk of dropping out of school after the pandemic due to economic hardship.

Gender impacts: Women and girls bear a greater burden of the socio-economic impacts of COVID-19. In African countries, gender norms assign caring and domestic responsibilities to women and girls. The amount of unpaid care by women will inevitably increase during the COVID-19 pandemic, and with school closures, domestic responsibilities will negatively impact girls’ learning. Physical distancing measures have also led to a rise in gender-based violence, with a significant increase in cases reported in Kenya and South Africa. With school closures, adolescent girls are at greater risk of sexual abuse, which can result in unintended pregnancies.

With inadequate health system capacity in most African countries, reducing the spread of COVID-19 is crucial. However, due to vulnerabilities, direct COVID-19-related mortality and morbidity may be less severe than the negative impacts of strict COVID-19-related physical distancing measures. Where feasible, governments should consider adapting less stringent measures, such as curfews rather than lockdowns, to protect an operational informal economy and maintain the livelihoods of the majority of the population. Relaxation of physical distancing restrictions must be accompanied by the promotion of public health measures to reduce transmission, such as proscribing minimal proximity distances in public and shared spaces, hand and cough hygiene, and use of masks in public places. Actively engaging communities -- including vulnerable groups -- and local leaders to encourage adaptation of realistic physical distancing measures will enhance effective and disability-inclusive communication of risk, as well as compliance. It will also lead to cooperative responses to COVID-19 -- including community-driven responses -- that are sensitive to specific vulnerabilities, including the gender impact of COVID-19. While social protection measures are required, it is imperative that these measures are responsive to gender and to vulnerable groups.

A detailed report and policy brief on ‘the Health And Socio-Economic Impacts Of Physical Distancing In African Countries And How They Can Be Mitigated can be accessed here. The report was published in partnership with KEMRI-Wellcome Trust and AAS through the support of DFID East Africa Research Fund (EARF).

^{Photo Credit: REUTERS/Feisal Omar}

Evelyn Kabia, Health Economist, KEMRI Wellcome Trust Research Programme.

Evelyn is a research officer in the Health Economics Research Unit (HERU) at KEMRI Wellcome Trust Research Programme. She has a keen interest in health financing, health policy, health equity, and gender. She is currently working on a study that aims to explore informal payments (petty corruption) for healthcare in Kenya and their implications on equitable access.  Evelyn has a bachelor’s degree in Nursing from the University of Nairobi, a post-graduate diploma in project management from the Kenya Institute of Management, and a Master of Public Health (Health Economics) from the London School of Hygiene and Tropical Medicine.