COVID-19, corruption and Zim health sector crisis

Men wear protective masks as they walk down a deserted street on the first day of the 21-day nationwide lockdown aimed at limiting the spread of coronavirus disease (COVID-19) in Harare, Zimbabwe, March 30, 2020. REUTERS/Philimon Bulawayo

CORRUPTION is one of the factors stifling development in Africa. However, COVID-19 exposes the extent to which corruption has contributed to the destruction of State institutions’ capacity as the public health system, which the poor depend on, struggle to deal with the viral infections to save lives. The Zimbabwean healthcare crisis, and the country’s poor response to the pandemic better illustrate the situation of many African countries.

The COVID-19 pandemic is affecting everyone’s life, with the poor the most affected. Countries are battling to contain the rates of infection and loss of life. Most are on lockdown to restrict people’s movements and minimise infections. While the rich and the poor are both affected by the virus and lockdown measures, it is the latter who suffer most.

In Africa the poor depend on the incapacitated public health systems while the rich can use their wealth to access quality private healthcare, including abroad. Secondly, the poor are the most economically affected as most depend on income generated in the informal sector which has been seriously affected by the lockdown measures. Against this backdrop, some countries (such as South Africa) adjusted their measures to allow segments of informal sector traders to operate during the lockdown. However, the country-specific adjustments do little to support most of the poor.

The COVID-19 outbreak

Ever since its outbreak in the Chinese city of Wuhan at the end of 2019, there are currently over 200 000 deaths from slightly over three million confirmed cases globally (end of April 2020) according to the Johns Hopkins University. The global epicentre of the viral infections has shifted from China to Europe, and then to the US. The US is now the leading country in terms of confirmed cases (over 900 000) and deaths (over 50 000).

In Africa there are currently more than 30 000 confirmed cases, with South Africa leading with more than 4 500. Although many African countries have few confirmed cases, there is fear that as many people get infected the public health sectors will not cope, leading to many deaths and economic disruptions that affect millions of the continent’s poor.

Some governments, especially in the global north, have released multi-billion-dollar stimulus packages to support their hard-hit economies and boost the capacity of their health sectors to fight the pandemic and save lives. Many poor African countries do not have resources to fight COVID-19. Their health sectors are under-resourced and mismanaged. The countries also lack resources to stimulate their economies, most of which will need “intensive care” to resuscitate after the pandemic. They also do not have resources to introduce programmes to support the poor economically during the lockdowns.

If gold rusts, what then will iron do?

The global impact of COVID-19 is tremendous. It has ravaged economies, with the livelihoods of millions affected. In the US, over 26 million people filed for unemployment benefits. Millions have lost their jobs or means of income across the globe as people were forced to remain at home as part of social distancing measures.

While rich nations can put together programmes to support their poor during the crisis, many African governments do not have reserves to do the same for the poor whose precarious livelihoods have been affected by lockdown measures.

Millions of Africans who make a living in the informal sector have lost their sources of income due to the lockdowns. Many households will suffer from hunger and malnutrition the more they stay at home.

The pandemic has exposed the structural inequalities in many African countries. The lockdown measures favour the middle class and the rich who can continue to have income while working from home or can use their savings to buy necessities during the lockdown period.

Most of the poor who are confined in their homes, with security forces lurking in their streets to enforce compliance, have become more vulnerable. They do not have savings or adequate supplies of food to sustain them in times like these.

This also exposes the limits of the “settler models” in southern Africa which left many black Africans landless and dependent on wage employment. With the capitalist sector unable to absorb all the labour, many Africans make a living in the precarious informal sector. The combination of the effects of COVID-19 on the informal sector, and the inability to produce food for household consumption and sale has left many households vulnerable to food insecurity and poverty.

In the global north, COVID-19 has overwhelmed the healthcare systems, triggered shortages of critical medical supplies, personal protective equipment and many deaths. Some governments announced more stimulus packages to fight the virus and boost their economies.

In Europe, several governments injected hundreds of billions of Euros while the US government approved a stimulus package amounting to over US$2 trillion. These countries draw from their reserves to respond to the challenges presented by the pandemic. Despite this, their health systems are not coping with the rate of infections with many people dying. If gold (rich nations) rusts, what then will iron (poor Africa) do?

Confirmed cases are slowly rising in Africa. However, there is concern that if many people get infected, the pandemic can inflict more damage (in terms of deaths and economic recession) at a scale greater than what we have seen in the global north. Many poor people live in crowded spaces (a legacy of colonialism and economic inequality) where social distancing is difficult to enforce. Because of poverty and poor health, many of the poor have underlying medical conditions making them vulnerable to COVID-19.

Early data from the US shows that the coronavirus is disproportionately killing African-Americans with poverty and prior medical conditions part of contributing factors. In Chicago, Illinois, seven in 10 patients who died from coronavirus were African-Americans although they are 30% of the city’s population. In Louisiana they constituted 70% of the deaths despite accounting for 32% of the population.

The BBC has also reported that emerging evidence in the UK suggests that “more than a third of patients who are critically ill in hospital with the virus” are ethnic minorities (black, Asian etc). This evidence warns of the disastrous impact COVID-19 can have on Africa if the virus infections spike.

The public health systems, which the poor rely on, do not have the required capacity to deal with the pandemic and save lives. Most countries simply do not have the required facilities and equipment to test and treat the infected, including personal protective equipment for health workers. This means that when the poor go to hospitals after contracting the virus, they will not get adequate treatment to save their lives. Some among the middle class and the rich can use their medical cover and savings to access private healthcare. Nonetheless, in many countries even the private healthcare is ill-prepared to deal with an outbreak of coronavirus. With many countries under lockdown, even the rich (including the corrupt) cannot use their wealth to access quality care abroad as they normally do.

Zimbabwe’s response to coronavirus

An analysis of the coronavirus updates by the Zimbabwean Ministry of Health and Child Care confirm the argument of this article. The country has 31 confirmed cases from slightly over 6 000 cumulative tests and 4 deaths. The number of confirmed cases is low. But to what extent is that number a true reflection of the rate of infections in the country? Zimbabwe does not have the required testing capacity, let alone treatment facilities for those infected by Covid-19. The number of tests done thus far is very low. The World Health Organisation (WHO) recommends more testing to detect cases before it is too late.

The online news website, New, reported (11 April 2020) that the Zimbabwe Association of Doctors for Human Rights (ZADHR) wanted the government to investigate a case of a 79-year old man who died in a Bulawayo hospital due to Covid-19 complications. Their concern was that it was discovered five days after his burial that he had died of coronavirus. They also feared that he may have infected health workers who treated him without knowing that he had the virus. Their other point of concern was that the country had limited facilities for treating patients with Covid-19. Thus, there is limited diagnostic facilities for Covid-19 in the country, especially outside Harare. The country is not able to diagnose cases on time, with medical services not prepared to deal with the pandemic.

Even before the pandemic started, the Zimbabwean government had struggled to provide health workers with better working conditions and medical supplies, leading to crippling strikes with devastating effects to health delivery. Since the outbreak of Covid-19 health workers in other African countries have also called their governments to provide medical supplies and personal protective equipment needed. The United Nations, among other multilateral institutions, has pointed to the seriousness of the African situation and called for donors to support African countries with resources needed to deal with the effects of coronavirus, including economic recovery. Recently, Chinese billionaire Jack Ma donated medical supplies to African countries to assist with capacity for testing and care for the infected. Nevertheless, many African governments are simply inadequately resourced with their public health systems not prepared for a pandemic like Covid-19.

Corruption and the public health system

The causes for the decay of Zimbabwe’s public health system are debated. Some point to sanctions imposed by western countries post fast-track land reform programme which started in 2000. Others, to economic mismanagement by the ZANU PF government. However, one of the factors with devastating effects on the economy and public health delivery is corruption. Transparency International’s 2019 Corruption Perceptions Index ranks Zimbabwe at position 158/180 relative to other countries, with a score of 24/100 in terms of the perceived level of public sector corruption [on a scale of 0 (highly corrupt) to 100 (very clean)]. President Mnangagwa has described corruption in Zimbabwe as ‘deep rooted’, pointing to the extent it has permeated all levels of society and state including the police, National Prosecuting Authority, and the judiciary.

State resources are lost through corruption leaving the government unable to provide essential services like quality public health, which the poor depend on. Corruption is incubated by the economic crises and weaker state institutions including those constitutionally mandated to fight graft. The failure to successfully prosecute cases of corruption involving high profile individuals, most of whom are politicians or politically connected to ZANU PF, has further eroded public confidence in the government’s willingness to fight the scourge. The government is accused of ‘catch and release’, denoting hurried arrests followed by unsuccessful prosecution or even failure to bring the accused before the courts. Recently the Justice Minister, Mr Ziyambi Ziyambi, acknowledged the government’s failure to convict high profile individuals who use their resources to fight back.

While we have always known that corruption does affect our economy and threatens public life, Covid-19 has exposed the extent to which the scourge threatens human life. Additionally, corruption should be treated as a national security threat. It has ravaged state institutions to the point that they cannot defend citizens’ life against the invading pandemics such as Covid-19. We have seen the same with past disasters such as cholera and cyclone Idai. Thus, the nation should unite against corruption.

The current pandemic has demonstrated that we are all victims of corruption, rich or poor. With the global lockdown in full force, even the rich and corrupt cannot use their resources to access quality health care outside the country like they normally do. We all depend on local health care services whose quality, unfortunately, is bad. Even the private health care service, which the rich can use, has also suffered from under-investment. Indeed, if private health care offered quality services the rich and powerful, including the political elite, would not waste scarce foreign currency on health care in countries like South Africa, India, Singapore and China.

 Clemence Rusenga is a post-doctoral research fellow with the NRF Chair in Land Reform and Democracy in South Africa at the Centre for African Studies, University of Cape Town. He writes in his personal capacity.