International Development Committee inquiry: secondary impacts of coronavirus in developing countries

Evidence submission from the Institute of Development Studies

The Institute of Development Studies (IDS) is a global research and learning organisation for equitable and sustainable change. IDS is ranked best international development policy think tank (2019 Global Go To Think Tank Index) and first in the world for development studies by the QS University Rankings, with the University of Sussex.

Secondary impacts on non-coronavirus healthcare; community trust and engagement in non-covid healthcare provision

The Covid-19 pandemic has undermined capacity and efforts to address other health needs that are just as pressing as the virus itself, particularly in low- and middle-income countries (LMICs), according to new research published in September 2020 by IDS researchers for the Social Science in Humanitarian Action Platform (SSHAP), funded by Wellcome Trust and FCDO.. The pressure on governments to act on Covid-19 now to save ‘immediately identifiable lives’ rather than ‘statistical lives at risk’ has had, and will continue to have, harmful short- and long-term consequences for other areas of health.

The IDS/SSHAP research finds that:

Certain interventions in response to Covid-19, such as ‘lockdowns’ and resource diversions, have more direct and obvious impacts on other areas of health although other key pillars of effective epidemic response (e.g. surveillance and risk communication) can serve to sideline other health priorities if integrated approaches are not taken.
LMICs are particularly vulnerable to broader health impacts from vertical responses as these interventions interact with already weak health systems and baseline health, social and economic vulnerabilities to produce even worse outcomes.
The younger average age of populations in many LMICs appears to make them less medically vulnerable to Covid-19 overall, yet they face serious health risks from other conditions. For perspective, 190 thousand Covid-19 deaths are expected in Africa, while in 2018, over 2.7 million (mostly preventable) child deaths occurred on the continent. Therefore impacts of the Covid-19 virus itself, and responses to address it, need to be considered in the context of existing disease burdens in each context (e.g. of malaria, TB, malnutrition etc.)
Responses to prevent and/or contain Covid-19 need to be integrated into health systems rather than exist parallel to them. This makes it imperative that donors take this opportunity to strengthen health systems, double down on commitments to primary care and Universal Health Coverage, and address social determinants of health, such as nutrition, housing and sanitation.
Predictive modelling of broader health impacts suggest the world could see an additional 1.2 million mostly preventable child deaths, nearly 57 thousand additional maternal deaths, 1.4 million additional deaths to TB, a doubling of malaria cases in

Africa, and decreases in life expectancy for people with NCDs among other impacts.

Overall, the research signals that donors including FCDO should pay more attention to secondary health impacts than they currently are and make sure that ‘vertical’ Covid-19 responses (decisions, measures and actions taken solely with the purpose of preventing and containing Covid-19) do not exacerbate broader health and development problems.

The IDS-led Coalition for Religious Equality and Inclusive Development (CREID), funded by FCDO, found that religious minorities groups have faced negative impacts by the secondary impacts of Covid-19.

In Pakistan, Hazara Shias, who were blamed for the spread of Covid-19 through misinformation campaigns built on pre-existing prejudices against this minority and a poorly managed public health response, found themselves firstly experiencing appalling quarantine conditions. Volunteers from within the community stepped up to help those caught up in these centres. Conditions were considered so compromising that some camps were subsequently burnt down. Even once lockdown measures had eased, Hazara Shias experienced ongoing suspicion and prejudice when it came to accessing non-Covid-19 related healthcare. For example, a pregnant mother was advised to disguise her Hazara Shia identity in order to access a life-saving scan.
In Iraq, already vulnerable religious minorities, such as the Yazidis, saw Covid-19 add additional strain to a crippled health infrastructure while those still living in displacement camps (nearly 800,000 in Iraqi Kurdistan) experienced poor healthcare and increased mental health problems relating to lockdown measures.

Secondary impacts of Covid-19 on livelihoods and food security

The poor and the near poor have little ability to withstand the economic shock of Covid-19. Many of those who escaped extreme poverty in recent years are still vulnerable to falling back into it. Estimates suggest that between 71 million and 395 million more people will fall into extreme poverty, most of whom are in Sub-Saharan Africa. The number of people facing acute food insecurity could double to more than 260 million in 2020.

Lack of access to social protection contributes to people’s vulnerabilities to the shocks posed by Covid-19. Around 55% of the world’s population have no or inadequate social protection, especially in Africa, where 80% aren’t covered. Covid-19 has exposed serious gaps in social protection systems, especially in relation to access for informal sector workers, part-time workers, temporary workers, and self-employed workers. The social protection response to Covid-19 has been uneven, with Africa having the lowest levels of coverage at 2% for cash and 5% for cash and in-kind measures combined.

On rural livelihoods in Africa, the Agricultural Policy Research in Africa (APRA) Programme, funded by the FCDO has produced new research on the Impact of COVID-19 on Food Systems and Rural Livelihoods in Africa after conducting household-level telephone interviews in June-July 2020, in seven countries (Ethiopia, Ghana, Kenya, Malawi, Nigeria, Tanzania and Zimbabwe).

From the households surveyed they found that:

Covid-19 had largely negative effects on food systems and rural livelihoods and for many there was a decline in the number of buyers and traders coming to their village
A sizeable proportion of respondents in Ethiopia, Kenya and Malawi received some assistance from the government to mitigate the effects of Covid-19, while over 60% of respondents in Nigeria, Tanzania and Zimbabwe reported receiving no assistance from any sources.
Most Kenyan respondents reported significant reductions in availability of several important food groups, especially dark green, leafy vegetables and fruits.
Responses by a sizeable number of households in Kenya (16%), Malawi (30.7%) and Nigeria (18%) indicate that they “went without eating for a whole day because of a lack of money or other resources” after the Covid-19 crisis began.
At least 42% of all respondents in all seven countries experienced some rise in the cost of living following the start of Covid-19.

Among religious minority communities, CREID has found that Covid-19 response measures are having a significant and long-lasting impact on livelihoods and food security for those who already experience socio-economic exclusion on the basis of class and caste. These include but are not restricted to daily wage labourers, farmers and small business owners.

In Pakistan, Christian and Hindu sanitation workers working in quarantine centres, morgues and hospitals were laid off, or experienced delayed payment of their wages (which meant their families went hungry and could not access medicines when sick). They were given no time off, and no protective equipment for despite their high levels of exposure to Covid-19.
In Karachi, Pakistan, Hindu vendors were arrested by local police for trying to keep their food stalls functional as there was no financial compensation from the government for small businesses, some of which provide the only source of income for their families.
Low-wage Christian workers in Pakistan including hairdressers and beauty salons, found themselves borrowing money from relatives to survive.
In India, Christians cannot access constitutional state benefits, and those who worked in sanitation were forced to work without PPE
In Iraq, business closed (including a century-old pottery run by a member of the Kakai religious minority), farmers faced bankruptcy (caught between increasing attacks from Daesh and Covid-19 restriction measures) and factory closures left families relying on their neighbours for food.

Secondary impacts of Covid-19 on women and children; levels domestic abuse, gender-based violence and exploitation of women and children

Working with religious minority groups IDS partners through CREID have identified a significant rise in domestic violence and rape including in Iraq, Myanmar and Nigeria. Lockdown measures, lack of income and lack of access to services such as refuges and hotlines compounded a pre-existing problem, where many women have few rights and little recourse to justice.

Produced for the FCDO, IDS recently published a report on social impacts of Covid-19, including the secondary impacts of Covid-19 on women and girls in low and middle-income countries. It highlights a significant risk of reversals in progress over the last decades in women’s and girls’ economic empowerment, voice, and agency, and the limited gains made in gender equality and women’s rights. This is particularly true if measures are not taken quickly to address the immediate and longer-term impacts of the pandemic on them. The current lack of gender-disaggregated data makes it difficult to know the true impact, but we do already know there has been:

Reduced services to respond to gender-based violence
Reduced access to sexual and reproductive health services (with many health centres closed during lockdown, including Pakistan, Uganda, Ghanan, Zimbabwe
School closures mean lack of education for girls and in some cases increased risk of child marriage
High risk of unemployment
Increase in care burden due to school closures and loss of informal and formal childcare arrangements

This submission draws on evidence from IDS researchers including:

Professor Melissa Leach, Director, IDS, member of WHO Social Science Expert Group and lead researcher for the Social Science in Humanitarian Action Platform (SSHAP)

Dr Mariz Tadros, Director of the IDS-led Coalition for Religious Equality and Inclusive Development (CREID).

John Thompson, Research Fellow, IDS, and Joint Co-ordinator of the Future Agricultures Consortium.

Brigitte Rohwerder, Research Officer, IDS, and researcher for the K4D (Knowledge and Evidence for Development) programme.

For further information relating to this evidence submission please contact: Sophie Robinson, External Affairs Officer, s.s.robinson@ids.ac.uk or +44 (0)1273 915763.