But with coffee shops closing worldwide, the coronavirus crisis is testing Rwanda’s top export.
COVID-19 and coffee in Rwanda
Rwanda appears to have been successful in keeping COVID-19 at bay so far. The Central African country of 12 million reported just over 250 cases as of early May.
In March the government locked down the capital of Kigali, halted commercial flights and banned domestic travel for all nonessential workers. Coffee production, which provides an income to 350,000 Rwandan farming families, has been allowed to continue – in modified fashion.
To analyze the effects of COVID-19 restrictions on Rwanda’s coffee industry, we drew on information from our five-year research project funded by the U.S. Agency for International Development and interviewed local collaborators and international industry experts.
As a critical sector of the Rwandan economy, coffee is a sensitive topic in the country, so our contacts in Rwanda preferred to speak anonymously. The quotes included here are drawn from our interview notes and their accuracy checked with our sources.
Our analysis finds that health restrictions are increasing coffee production costs in Rwanda and introducing delays to the global supply chain that consumers halfway across the world may eventually feel.
Open but restricted
Rwandan coffee farmers must adhere to social distancing guidelines during the May harvest, keeping coffee pickers one meter apart. As a result, according to two Rwandan coffee sector experts who work with farmers, they are hiring fewer workers. That may increase the time it takes to pick the same acreage.
Since not all workers in the coffee sector are considered essential, Rwanda’s strict travel restrictions are also slowing coffee’s journey from farm to cup.
“I cannot even legally drive out to our roastery, even though it is just a few kilometers away,” the manager of one Rwandan coffee roasting facility told us.
To avoid contact between buyers and farmers, some processing mills – which prepare fresh coffee beans, or “cherries,” for export and roasting by removing the skin and pulp – are asking farmers to deliver their harvest themselves, rather than send trucks for pickup.
Few farmers in Rwanda own cars or motorcycles – less than 3%, based on our research. So they must deliver their coffee on foot, traveling on average 3.5 miles. A round trip that normally takes minutes may now take two hours.
Once the coffee reaches the mill, hurdles to processing arise.
“My company has two agents who are allowed to travel to mills to oversee operations, but they must be tested for COVID-19” at police checkpoints when entering a new district, a Rwandan coffee buyer told us.
Sorting and milling of coffee is also likely to take substantially longer due to decreased staffing in compliance with social distancing regulations.
To keep on-site workers safe, mills are setting up hand washing stations and distributing hand sanitizer, but many are struggling to get required protective equipment like face masks, which have surged in price due to increased demand.
Global production disruptions
“We are preventing the economic activity that can reactivate the economy of coffee-producing regions,” warned Roberto Vélez Vallejo of Colombia’s National Federation of Coffee Growers – which sells coffee under the brand Juan Valdez – via Tweet.
To overcome such challenges, Rwanda’s coffee farmers are turning to mobile technology.
Despite pervasive poverty, many Rwandan coffee farmers own mobile phones, and the country has worked hard to build a robust mobile network even in rural areas. That’s a critical resource right now, since the Rwandan government has mandated that payments between coffee mills and farmers be cashless.
Rwandan coffee farmers are also benefiting from being highly organized. The country has many agricultural cooperatives, which in normal times meet in person, provide direct services and help farmers negotiate collectively with buyers.
Now, co-op leaders are using text messaging to share information about coffee prices, social distancing protocols and other coronavirus-related topics with members.
Neither technology nor unions can solve what is perhaps the biggest problem facing Rwandan coffee’s industry: a global coffee market in upheaval.
Across the United States and Europe – which together import over 60% of the world’s coffee – COVID-19 containment measures have shut down cafes, shifting where demand is located.
In the U.S., which has a US$47.5 billion coffee shop industry, about a quarter of coffee consumption normally takes place away from home. Recently, this figure has come close to zero.
To serve coffee drinkers stuck at home, roasters must pivot to online and grocery sales – a difficult transition, especially for small players competing with chains like Starbucks.
International uncertainty is trickling down to Rwandan farmers in the form of broken contracts. One major Rwandan coffee exporter told us several buyers had either reduced or delayed finalizing their planned purchases.
Ruth Church, of the U.S.-based Artisan Coffee Importers, which specializes in Rwandan coffee, said she worried her clients would reduce orders too, but has since gotten confirmation that they will maintain last year’s purchasing levels.
“That comes from the relationship they’ve been able to form with the farmer,” she said of her buyers. “They know producers are vulnerable.”
But, Church warned, “Others may be forced to cancel or reduce.”
Rwandan coffee is adapting to get coffee to market. Now they hope someone will buy it.
Bridget Vuguziga, an independent consultant based in Kigali, Rwanda, contributed to this analysis.
[You’re smart and curious about the world. So are The Conversation’s authors and editors. You can get our highlights each weekend.]
Andrew Gerard, Research Assistant, Department of Community Sustainability, Michigan State University and David L. Ortega, Associate Professor of Food and Agricultural Economics, Michigan State University
“We know how to bring the economy back to life. What we don’t know is how to bring the dead back to life.” – Nana Akufo Addo, president of Ghana
The total number of deaths in the coronavirus pandemic has passed the 250,000 mark. The health and economic calamity continues to evolve rapidly; the world is scrambling to understand it.
Even as there are signs that the curve is flattening in the U.S., scene of one-third of the world’s fatalities, estimates of how many will die have doubled from 60 to 120,000. Italy and Spain, two of the worst hit countries in Europe, have peaked.
California, the largest state in America, has flattened the curve, joining Asian nations such as South Korea, Taiwan, Japan and, of course, China. Europeans and North Americans are starting to emerge from lockdown. New Zealand claims to have totally eliminated community transmission of coronavirus.
But the virus is continuing to take its toll. The United Kingdom has passed the 20,000 death mark; Russia, which appeared initially to have escaped the worst, is battling with an outbreak that led President Vladimir Putin to declare that “we don’t have much to brag about.”
New infections and deaths are on the rise in Brazil and Ecuador, giving rise to fears that the third wave of the coronavirus will be experienced in the developing world.
Despite dire forecasts, Africa has so far experienced only a fraction of the number of cases seen elsewhere.
By late April, the known infections worldwide was 3.4 million and the number of deaths about 240,000. Africa had only 45,000 reported cases, with 1,800 deaths – less than one per cent of the total in both categories.
Though it is too early to claim anything conclusive, fears of a tsunami of cases in Africa have not been lost yet.
In a continent as large as Africa with 54 countries, it is hard to pinpoint what explains this. One possibility is that, other than South Africa and Ghana, there has been less testing. This is suggested by the fact that Africa’s morbidity rate – the number of people who die after contracting the virus – is around 5 per cent, compared to a world average of less than two per cent.
South Africa – with 90 deaths and about 5,000 cases – has a case fatality rate (CFR) of about 1.8 per cent, somewhat less than the rest of the region but close to the global average.
The global CFR could in reality be much lower, as it is believed that many more people have been infected than tested positive. This is certainly the case in the U.S. where, as more testing has been carried out, the CFR has decreased.
Further complicating the picture are suggestions based on data from New York, Italy, the U.K. and Spain that the actual number of deaths from COVID-19 is at least twice the official number. People who die at home or in nursing homes before they are tested are not counted.
Curve flattens in South Africa’s powerhouses
While the number of positive cases in South Africa has risen along with more testing, it is still not increasing at anywhere near the level of the worst hit regions.
Relatively speaking, South Africa has contained the spread since the first cases were brought in on a flight from Italy in early March.
The South African response was decisive and carefully thought out and much credit goes to President Cyril Ramaphosa and Health Minister Zweli Mkhize in the way they have led the response and mobilised the country.
Because of our history with the HIV/AIDS crisis, the country has some of the best infectious disease experts and epidemiologists in the world, exemplified by the husband and wife team of Salim Abdool Karim and Qarraisha Abdool Karim.
South Africa was also willing to learn from what worked in other countries such as South Korea and China.
Most experts agree that the lockdown has limited the spread of the virus, reducing infection rates and delaying the onset of the peak and buying us time.
But there is no cause for complacency. Professor Salim Karim has warned that preventing exponential spread in South Africa is very, very unlikely.
Professor Shabir Madhi, of Wits University, who is heading the public health subcommittee advising the president, estimates that up to 45,000 South Africans could die from COVID-19. That means the worst is yet to come.
Nigeria, with a long experience of dealing with infectious diseases – and a history of containing Ebola during the 2014 epidemic – has also flattened out the number of positive cases, although new cases continue to rise.
Still, there is growing concern out of the most populous State, Kano, where a number of elderly people, including some of the State’s most prominent citizens, have died in recent weeks. These deaths have been attributed to other causes but with the negligible amount of testing, we are unable to know for sure.
But while the continent’s two biggest economic powers are not typical, it is striking how uniform the African numbers are. No African country has yet been affected anywhere close to the scale of the worst affected countries.
The African Exception?
From the beginning, there have been warnings that Africa, with its dense urban slums, large numbers of people with chronic illnesses, and inadequate public health systems could be facing a catastrophe.
But this has so far proven not to be the case.
In response, there have been suggestions on social media that people are resistant to the disease by virtue of being black.
The U.S. is, sadly, proving the opposite. African-Americans are dying at alarmingly higher rates than other population groups.
In Chicago, about 70 per cent of deaths are black, while the city is only 30 per cent black. In Milwaukee in Wisconsin, where only 26 per cent are black, 73 per cent of those dying are black. In the nation’s capital, Washington DC, it is 44 per cent and 72 per cent.
Eugene Scott, in the Washington Post, puts this down to four factors that are specific to African-Americans: higher rates of underlying health conditions and less access to health care; blacks holding a lot of the “essential” jobs that make social distancing difficult; insufficient information from the government reaching the black community; and racial disparities in housing.
All of these factors are prevalent to an equal or even greater degree in South Africa, where housing for the majority of the population and the access to health care is often worse.
Unlike the Great Recession of a decade ago, all the major economies will be struggling or crashing at the same time. Kristalina Georgieva, IMF managing director, said 170 of its 189 member countries will suffer falling output in 2020. “The bleak outlook applies to advanced and developing economies alike. This crisis knows no boundaries. Everybody hurts”…
What is extraordinary is how much we still don’t know about the silent killer that the New York Times this week described as capricious: “The question of why the virus has overwhelmed some places and left others relatively untouched is a puzzle that has spawned numerous theories and speculations but no definitive answers.”
What seems to be the case is that Africa was the last continent to be affected because of proportionately fewer air links with the rest of the world. By moving to lockdown early on, many African authorities have slowed the spread of the virus in the general population, but we have to contend with the reality that the constrictions on economic activity cannot be sustained.
The Africa Centres for Disease Control has warned that it is too early to draw any firm conclusion, but there are a few clues as to what is going on in Africa.
Africa benefits from having a youthful population.
A Lancet Infectious Diseases paper found that globally, the case fatality rate for those under the age of 60 is 1.4 per cent. For those over the age of 60, the fatality rate jumps to 4.5 per cent. For those 80 and over, COVID-19 appears to have a 13.4 per cent fatality rate.
The global CFR among those under 20 is 0.2 per cent.
Africa has a median age of 19.4, against 40 in Europe. Of the continent’s 1.2 billion people, only about 50 million are over 60.
Africa might have benefited from being in the tropics and from the fact that the virus first struck during summer in the Southern Hemisphere.
Research from Johns Hopkins University in Baltimore indicates that higher temperatures and humidity are correlated with a lower rate of coronavirus spread, similar to the correlation between climate and the influenza virus.
This is confirmed by researchers from Spain and Finland, who found that 95 per cent of positive cases occurred at temperatures between -2 and 10 °C.
Researchers from Beihang University in China, found that in the early days of the outbreak, hot and humid cities saw a slower rate of spread than cold and dry ones.
If this is valid, this is an ominous sign for South Africa, as it heads into the winter months.
Several recent studies have suggested a link between the BCG (the Bacillus Calmette-Guerin) vaccine – which was developed to fight tuberculosis – and the rate of death from COVID-19.
Tuberculosis is caused by a type of bacteria, while COVID-19 is caused by a virus. But the BCG vaccine might help people build immune responses to things other than tuberculosis.
Medical researchers in the U.S. and U.K. concluded by analysing data from 178 countries that those countries that do not have a BCG vaccination policy saw ten times greater incidence of and mortality from COVID-19, compared with those that do. Some of the worst hit countries such as the U.S., Spain and Italy do not administer BCG.
Almost all African countries administer BCG, though some only began doing so in the 1990s.
This link has not been scientifically established, but clinical trials are now being held to determine whether those nations that make BCG vaccination mandatory at birth are less susceptible to high COVID-19 related deaths. If this could be conclusively shown, it would be a massive breakthrough.
A World On Life Support
The path of the coronavirus and response to the pandemic has devastated the global economy. The Financial Times describes it as the worst collapse since the Second World War, and the most difficult moment for the global economy in almost a century.
The International Monetary Fund (IMF) expects the global economy to shrink by 3 per cent this year. This is far worse than its 0.1 per cent dip in the Great Recession year of 2009.
The lockdowns, business shutdowns and travel restrictions are destroying demand, at the same time as a financial crisis is unfolding.
In a worst case scenario, the world is heading into a global Great Depression.
Unlike the Great Recession of a decade ago, all the major economies will be struggling or crashing at the same time. Kristalina Georgieva, IMF managing director, said 170 of its 189 member countries will suffer falling output in 2020. “The bleak outlook applies to advanced and developing economies alike. This crisis knows no boundaries. Everybody hurts,” she said.
The IMF predicts that worldwide trade will plummet by 11 per cent this year. Global manufacturing supply chains are being broken.
During the Great Recession, China continued to grow at 9 per cent. Although it is reopening its economy ahead of the rest of the world, China’s GDP plunged by 5.8 per cent in the first quarter of this year, dipping into recession for the first time in 44 years. Meanwhile, the country remains on guard against a second wave of infection.
The U.S. economy is at a standstill and economists are projecting unemployment to reach 20 per cent in the second quarter. The IMF expects the U.S. economy to contract by 5.9 per cent this year.
Most of Europe is on lockdown and Germany, France and the U.K. are in deep recession. The Eurozone will suffer a 7.5 per cent drop and Japan, 5.2 per cent. U.K. output could dip by 6.5 per cent this year.
Emerging markets and low-income nations across Africa, Latin America and much of Asia are at especially high risk.
On a more positive note, the recent monetary and fiscal policy responses from across the world have generated some optimism for a rebound.
The world is desperate for good news, but there will be no end to the pandemic and return to pre-crisis behaviour until a vaccine is developed, which could be well into 2021. The impact of the coronavirus is likely to be prolonged and the peaks could be followed by more peaks.
The IMF forecasts that there will be 5.8 per cent global growth in 2021, but this is at best a thumb-suck because there is still so much uncertainty.
Governments in the developed world have been willing to make massive interventions to stimulate demand and interventions by central banks to ensure liquidity by keeping the cost of borrowing low and financing credit supply.
The U.S. enacted three aid packages worth $2.7 trillion. The Federal Reserve has enacted a $2.3 trillion rescue package for the economy. But at least 32 million Americans have lost their jobs and there is more pain to come.
And President Donald Trump’s erratic moves could jeopardise a U.S. recovery, even as the rest of the world struggles to get back on its feet.
African Economies In Pain
Even though Africa is the continent least scarred by the health crisis, it could end up the most damaged by the economic calamity.
Emerging market assets have been precipitously dumped and there has been capital flight worse than during the Great Recession.
Commodity prices that have buoyed African economies for the last quarter century have collapsed. Major mining operations have been mothballed.
Nigeria, Africa’s largest economy, has been driven into deep recession by the oil price crash – and is expected to contract by up to 7 per cent this year. Angola has been battered as well.
The tourism industry, a key part of the economies of countries such as Kenya, Botswana, Tanzania, Namibia and South Africa, has shut down.
Remittances from diaspora communities have declined dramatically.
There has been a huge fall-off of trade with partners such as China, Europe and the U.S.
The World Bank predicts that growth in Africa could fall to between minus 2.1 per cent and minus 5.1 per cent, led by severe downturns in Nigeria, Angola and South Africa.
Africa’s domestic economies have had a stranglehold placed on them where countries have implemented social distancing measures, closed borders and imposed lockdowns.
The majority of Africans work and trade in informal markets, meaning that millions are now unable to work.
The African Union estimates that up to 20 million workers could lose their jobs. Even in developed countries, workers are just one pay-cheque away from being completely broke. The scale and impact in human terms are unimaginable.
People have no money to spend, further collapsing demand. There are signs of widespread hunger and the World Bank is warning of a food security crisis. Social and political unrest will surely follow.
And this is before the full health impact is felt.
The World Bank, IMF and African Development Bank have announced billions of dollars in emergency credit facilities to African countries and called for bilateral debt relief. But that will not be enough.
Kristalina Georgieva, managing director of the IMF, estimates that emerging countries may need as much as $2.5 trillion in support. African leaders are calling for, at the very least, a debt standstill.
The needs are insatiable – scaling up the health sector response, maintaining wage payments amidst a massive wave of firm bankruptcies, relieving social distress and growing hunger and poverty, all while protecting the overall stability of the financial system.
President Ramaphosa’s R500 billion social and economic package is intended to go some way towards alleviating the worst of the crisis in the short term but much will depend on its execution and the fiscal sustainability of the programme. Given the experience of the past decade, can we expect those implementing the programme to ensure that this massive pot of money will find its way to the intended recipients?
The early signs are not encouraging.
In order to pay for it, Ramaphosa has indicated that he will use whatever is available to prop up the economy and prevent social collapse, including IMF loans, but at some point the bill will come due.
Other African countries do not have our options. They are being called upon to drain their treasuries to provide support for the poor and unemployed and to bolster their health systems, just as tax revenues have literally collapsed. Ken Ofori-Atta, the Ghanaian Finance minister, says he is green with envy at the “unthinkable stimulus packages” being announced by the developed nations.
“Their generous tool kits are not available to us,” he laments.
Living With a Pandemic
There is great uncertainty about the speed of the recovery, largely because it depends on the continued path of the virus – and medical advancements that have not yet happened.
The world is desperate for good news, but there will be no end to the pandemic and return to pre-crisis behaviour until a vaccine is developed, which could be well into 2021. The impact of the coronavirus is likely to be prolonged and the peaks could be followed by more peaks.
With so much at stake, there is an unprecedented global race underway to produce a vaccine, with seven clinical trials underway, and a group from Oxford University providing the most optimistic timeline of about six months.
For Africa, the main lesson is, in the words of Ken Ofori-Atta, that it is time to challenge the unbalanced nature of the global architecture. Which means, perhaps, that the point is not to replace one overlord with another but to imagine a world order in which we all have a place at the table…
The ability of the virus to mutate and to come back, maybe in a more virulent form, is why the Asian nations emerging at the other end of the first wave are not dropping their guard.
The lockdown strategy has been implemented to flatten the curve – to prevent the pandemic occurring in a compressed time frame – and buy time to prepare health facilities for a spike in cases.
In the absence of a vaccine, therapies of existing drugs are being used for COVID-19 patients. But while studies are being fast-tracked around the world, they are not yet conclusive. The drug, remdesivir, originally developed to treat Ebola, is said to be showing some promising early results but other therapies such as the much touted hydroxychloroquine are still viewed with skepticism and only used to treat the most severe cases.
In the absence of a vaccine, attempts to move countries out of lockdown – which are now underway – have to be strategic, phased, targeted and managed on a long-term basis – and accompanied by widespread testing and surveillance and proper equipment for health care providers. Countries could also go back into lockdown if there are further spikes.
There will be no way forward without knowing where the enemy is – tracking the virus and isolating it. South Africa has one of the world’s most innovative programmes, sending 28,000 health workers into communities for screening and testing.
Some of what we know about catastrophic viral pandemics is drawn from the experience of the 1918 Spanish flu which killed between 50 million and 100 million people.
The flu came in three waves. The first relatively mild version was in March 1918 and it appeared to have run its course by the northern summer. The second more virulent and infectious version struck in September 1918 and the third continued through 1919.
The second wave came to South Africa via two troopships of soldiers who were returning from the Western front and stopped in Freetown en route, where the flu was raging. When they docked in Cape Town, they were quarantined, but not effectively, and set off a wave of infections that ended with the deaths of about 300,000 people – six per cent of the population of the country at the time.
Epidemiologists have puzzled over why the diamond miners in Kimberley, almost a quarter of whom died in the flu, died at 35 times the rate of the gold miners in Witwatersrand.
It is now believed that the miners on the Reef had already developed some immunity from the first strain that had traveled up from Durban earlier in the year. The more isolated Kimberley miners only experienced the second, more lethal wave.
The End of Globalisation?
In seeking to find a culprit for the pandemic, we do not need to look too far: the globalised economy, the era of free and easy travel and movement between countries spread the virus. Globalisation made the globe more vulnerable to a pandemic.
The upside of globalisation – the free movement of capital and ideas and the free trade that has driven the global economy since 1945 – is presently being reassessed in a harsher light. Some assume that the age of globalisation is now over.
French President Emmanuel Macron sees the crisis as an “existential event for humanity” that will change the nature of globalisation and the structure of international capitalism.
Is it likely that nation states will turn themselves into fortresses surrounded by moats to keep out aliens and foreigners? Depending on the devastation to economies and the forces of populist nationalism that will be unleashed by the pandemic, that could well be the outcome.
But it would hard to see recovery in such a world. It was a global trade war in the 1930s – spurred on by the U.S. Congress’ Smoot-Hawley Tariff Act – that was one of the major drivers of the Great Depression and helped set the stage for the Second World War.
The stronger argument is that the moment demands greater community between nations in fighting a common enemy. What the coronavirus has taught us is that the existential threats of the 21st Century, from the pandemic to climate change, are ones that threaten us all.
The very qualities required to defeat this virus – scientific knowhow, capable and responsible government, global solidarity, basic humanity – are what we need for survival and prosperity in the years ahead.
These are the very elements that are threatened that at this moment.
However, instead of co-ordinated policy responses from governments around the world, we see a fracturing of international co-operation.
We should not forget what the last quarter century of turbo-charged globalisation has brought us. It has lifted billions of people out of extreme poverty, not just in India and China, but in many other nations, and in large parts of Africa as well.
However, as the gap closed between the developed and the developing world, it brought stagnation and job losses to the middle and working classes of the U.S. and Europe, and widened inequality between a global super-class with unimaginable wealth and just about everybody else.
It also gave us the pandemic which, if nothing else, is a moment to reflect and reset.
One reason for pessimism is that the U.S., which was the prime mover and leader of the post-1945 world, has been missing in action.
Trump has steered the U.S. away from any constructive international role. He has rejected calls to create a global taskforce to deal with the pandemic and threatened to cut funding to the World Health Organisation in the middle of the worst health crisis in a century. While his administration’s incompetence at home has cost many lives, its reputation abroad has been badly tarnished.
Trump has dashed hopes that the world’s two leading economic powers will co-operate. He has indicated that he wants to run for re-election on a China-baiting platform, exacerbating the ill feeling that has been generated by the last three years of trade wars.
With the U.S. abdicating, many people are finding it hard to imagine a globalised world without a hegemon, which is why many believe China will takes the U.S.’ place in a new global order. Xi Jinping has, for the last three years, already emerged as the most outspoken champion of globalisation.
But to be the leader of a free world, one must also possess the magic ingredient of soft power, which presupposes an admiration for one’s system of governance. China, with the recent experience of the Hong Kong protests and the many thousands of Muslim Uighars still in detention, not to mention its initial lack of transparency around the outbreak of the coronavirus, might not be best placed to lead the new world order.
There’s also a lot of anger towards China right now. Oby Ezekwesili, Nigeria’s former minister of Education and a former vice president of the World Bank, has argued that China should pay compensation to Africa for failing to transparently and effectively manage the global catastrophe.
For Africa, the main lesson is, in the words of Ken Ofori-Atta, that it is time to challenge the unbalanced nature of the global architecture. Which means, perhaps, that the point is not to replace one overlord with another but to imagine a world order in which we all have a place at the table, and in which the two greatest powers find it in themselves to work together, and with the rest of us, for a common humanity.
If there’s any upside to the unprecedented uncertainty gripping the world right now, its that the economic fallout has opened up a new debate about the right sort of policies to have. Its time to think creatively about what we can do and where we want to take this country, this continent and this planet. Its time for new thinking, imagination and boldness.
Mcebisi Jonas is the chairman of MTN and former deputy Mminister of Finance in South Africa.
Google and Facebook have told most employees to keep working from home for the rest of the year as part of a response by the tech giants to the deadly coronavirus pandemic.
Chief executive Sundar Pichai told Google staff at an all-hands meeting that its remote work policy will be extended until 2021, the Silicon Valley giant confirmed Friday.
Any return to offices was expected to be incremental and staggered, according to the company.
The news came along with US media reports that Facebook is also letting workers tend to their jobs remotely for the rest of this year.
Google employees who need to return to offices will be able to do that in the next month or two, with added safety measures in place due to coronavirus concerns, but most of the staff will continue working from home.
Facebook’s updated plan is to re-open offices in early July, but let people work from home if they prefer until 2021, according to reports.
Evidence from low- and middle-income countries suggests that digital and mobile communication technology can improve management of diseases. It is also particularly useful in medical emergencies. It has the potential to increase access to healthcare where resources are scarce and systems are under stress.
One aspect of this technology is “mConsulting”: mobile phone consultation with healthcare providers. mConsulting has been found to improve management of chronic and non-chronic communicable diseases. Other research shows that it increases use of maternal and neonatal services and expands vaccination coverage among hard to reach communities.
We conducted a study to explore whether mConsulting has the potential to improve healthcare in Nigeria, where the use of mobile communication technology has expanded rapidly. We looked at what’s already available and how users and providers perceive this mode of healthcare consulting. We interviewed mobile consulting providers, policy makers, users of mobile health and other stakeholders. The study explored perceptions, availability and operations of mConsulting services in Nigeria.
We found that mConsulting is likely to improve accessibility to healthcare. But it was introduced into Nigeria without a policy and regulatory framework to assure quality.
Mobile health consulting in Nigeria
The concept of mConsulting is still relatively new. But various forms of healthcare delivery through electronic platforms have been gradually introduced into the Nigerian scene with labels such as eHealth, ehealth4everyone, digital health, telemedicine and others.
In Nigeria, there are 15 functional mConsulting services operated by groups of private doctors. There are different ways of using the services. These include web chats, text messages, specialised apps, video calls and audio calls. The services include drug prescriptions, patient referrals, patient follow-up and provision of information about hospitals.
Only a few of the mConsulting services in Nigeria do not charge fees. Charges range from as low as N147 ($4) to as high as N344,000 ($950).
Respondents in our study perceived mConsulting to have a number of benefits. Access to healthcare was one. This is not only about getting medical help at any time: it’s also about the availability of quality and specialist services and bringing emergency care within reach.
Some stakeholders said that health facilities and resources were overstretched. They believed that mConsulting could reduce the burden on health workers and increase the income pipeline of physicians. This could strengthen the healthcare system.
It could also reduce the costs of using medical services, such as transport to facilities and waiting time.
They said it could contribute to better health outcomes, with better diagnosis and management of conditions. It could also reduce exposure of patients to risks associated with hospital visits, such as infections.
Perceived risks and barriers
Despite the benefits of mConsulting, participants mentioned some barriers too.
Some expressed distrust about this approach to medical consultations. They believed that physical interaction between physicians and patients was the most credible and reliable way of assessing a person’s health.
Lack of technology infrastructure and the digital divide, especially in rural communities, was another barrier. Where the facilities for mConsulting were not available and affordable, only a limited segment of the population would have access.
The human resources capacity for mConsulting was another concern. Many service providers rely on doctors who split their time between regular and mobile consultations. With the shortage of doctors in the Nigerian health system, dividing the time of the hospital workforce with mConsulting engagement puts more pressure on existing human resources. Some service providers also opened their platforms to both local and international clients, making it difficult to supply the demand.
The danger of misdiagnosis was seen as a barrier to mConsulting. Important information could be missed and errors could be made. Also, clients could mislead mobile consultants by not divulging all the relevant information. Even when using mConsulting in emergency care or for first aid, there could be a danger of receiving the wrong advice.
Data security and privacy is a major problem in Nigeria. Some participants believed that online materials and platforms were susceptible to abuse.
There were variations in stakeholders’ awareness of policy and regulations governing mConsulting in Nigeria. There have been suggestions at the National Council of Health that states should introduce eHealth into their healthcare delivery framework. Yet, after more than a decade of deliberations about it, policies are yet to be formulated specifically to govern this sector of healthcare.
Policy gaps and the way forward
The participation of the private sector has made it an imperative to have clear-cut policies to protect the public as users of mobile consulting services. The entrepreneurs who invest in these services also need protection.
mConsulting policies must cover training, credentialing, quality control, maintenance of electronic infrastructure, remuneration and protection against fraud.
Training curricula for healthcare professionals, especially doctors, nurses and pharmacists, must incorporate digital literacy and interaction with patients at remote sites. In the interim, short term training programmes can be organised for those already in the workforce. The agencies that regulate different cadres of health professionals should have clauses in their codes of ethics about mConsulting and eHealth in general.
Adequate remuneration is vital to sustaining mConsulting services and protecting members of the public against fraud or price gouging.
An effective policy environment is key to ensuring that mConsulting expands equal access to healthcare. A vision for mConsulting and eHealth needs to be integrated with the framework of the Abuja Accord to drive the achievement of healthcare for all.
Funke Fayehun, Senior lecturer, University of Ibadan, University of Ibadan; Akinyinka Omigbodun, Professor of Obstetrics and Gynaecology, University of Ibadan & Professor of Reproductive Health Sciences, Pan African University Life & Earth Sciences Institute (PAULESI), University of Ibadan, and Eme Theodora Owoaje, Professor , University of Ibadan
Mukuru, one of the largest international money operators and remittance companies in Africa, has confirmed that it has acquired Zoona’s operational assets in Malawi along with the technology systems that support its Malawian operations.
Mukuru did not reveal how much it paid to acquire Zoona’s Malawian technology systems or assets.
Zoona, which has worked with Mukuru for four years as a partner, is an Africa-based fintech that enables entrepreneurs to bring safe and reliable financial services to underserved communities in Malawi and elsewhere.
In a statement yesterday Mukuru CEO Andy Jury said the acquisition will extend Mukuru’s African footprint deep into the urban and rural areas cross Malawi.
“This acquisition will bring the benefits of our extensive products and cutting-edge technology to the citizens of Malawi – giving them better options and safe mechanisms to send money to loved ones and ultimately uplift their communities,” he said.
Following the acquisition, Zoona Malawi’s agents will operate as Mukuru agents benefiting from a wider product range to offer customers backed by Mukuru’s trusted and established brand name.
In addition, agents will benefit from being part of the Southern African Development Corporation (SADC) regional network, increasing their regional exposure and potentially boosting earnings over time.
Vantage Capital, announced that it has fully exited its investment in Vumatel, the largest fibre-to-the-home network provider in South Africa. The company was established in October 2014 by Niel Schoeman and Johan Pretorius, industry veterans who had previously started up the Birchman Group and Conduct Telecom before creating Vumatel.
Vumatel started out its life rolling out South Africa’s first fibre optic network to homes in Parkhurst by partnering with internet service providers who provided connectivity to their residential customers whilst Vumatel remained the owner and operator of the infrastructure.
At the time of Vantage’s investment in 2016, Vumatel had deployed its open-access fibre optic network across fourteen suburbs in Johannesburg, passing 16,000 homes and had secured around 4,000 subscribers. It had also received an equity investment from Investec Equity Partners.
Whilst banks were unwilling to fund the company at this early stage in its life, Vantage recognised the tremendous potential of the business and supported it with R250m ($17m) of capex funding to accelerate its rollout. Today, just four years later, Vumatel has become the largest provider of fibre to the home in the country. Over the life of Vantage’s investment, the number of homes passed has grown forty-fold and the number of subscribers fifty-fold as the company has laid thousands of kilometres of cable. Vumatel has also played a major role in upgrading the infrastructure of South African schools by providing free uncapped fibre services to public and private schools that its networks bypass.
In 2018, Vumatel was recognised with a prestigious award from the South African Venture Capital Association for the best medium-sized South African growth champion.
Last year, CIVH majority owned by Remgro acquired full ownership of Vumatel after initially securing a 34.9% stake in 2018. Vantage’s investors were beneficiaries of this transaction from both ends as Vantage had in a separate transaction provided New GX, a black owned and controlled investor, with mezzanine funding to part-finance their fibre-related assets including local manufacturing capacity.
Vantage exited the New GX transaction in 2018 and last week, Vantage’s mezzanine facility was refinanced by Vumatel after it secured substantial funding from a consortium of South African banks.
To date, Vantage has now successfully exited twelve investments across its three generations of mezzanine debt funds generating cumulative proceeds of R4.2bn ($360m) and x-money of 2.3x (1.8x in dollars).
Luc Albinski, co-Managing Partner at Vantage Capital, pointed out that “Vumatel is one of our many success stories, where we have supported businesses with mezzanine debt to achieve their growth ambitions. In this investment, we saw the opportunity to partner with an exceptional management team in a fast-growing sector and we are proud of the role Vantage played in unlocking the exceptional growth that Vumatel has since delivered.”
Warren van der Merwe, co-Managing Partner at Vantage Capital, added: “The Vumatel investment is an excellent case study of how mezzanine debt can unlock growth opportunities where banks remain risk-averse. In this way, Vantage plays an important role in supporting mid-size corporates before they are sufficiently established to fully fund their operations and growth ambitions with bank debt.”
Hugo van den Heever, Associate Partner at Vantage Capital, added “we have focused a lot of attention on the technology infrastructure sector with its high growth potential. In line with our pan-African mandate, we have looked at opportunities across the continent including markets such as Nigeria, the East African Community and Egypt. We hope to be able to announce further investments in this sector shortly.”
Nigeria’s five-year naira futures slid past 550 to the dollar on Thursday after the central bank weakened the currency on the derviatives market across maturities, traders said.
The bank weakened the currency on average by 73 naira across tenors, traders said, with the one-year maturity revised by 27 naira. The 5-year naira future weakened to 569 per dollar, traders said, from 413 naira in the previous session.
Airports in Nigeria will remain closed for an additional four weeks as part of the measures to control the spread of the novel coronavirus, the government said on Wednesday.
The extension is the second since March 23 when the Nigerian government suspended all of its commercial flights.
Boss Mustapha, secretary to the government of the federation, said the federal government decided to extend the flight ban after due consultation.
“We have assessed the situation in the aviation industry and have come to the conclusion that given the facts available to us and based on the advice of experts, the ban on all flights will be extended for an additional four weeks,” Mustapha said.
The Nigeria Center for Disease Control announced on Wednesday that the country has recorded 3,145 case of COVID-19 with 103 deaths.
To control the spread of coronavirus, the Kenyan Ministry of Health COVID-19 Taskforce implemented initial prevention and mitigation measures. These included encouraging the public to wash their hands, wear face masks and stay home.
But not everyone will be able to adhere to these because they rely on a daily wage and cannot afford to stay home. Many of these people live in Nairobi’s low income settlements which are overcrowded and where sanitation and social distancing measures are near impossible to maintain. COVID-19 would spread rapidly under these conditions.
To make sure this doesn’t happen, health authorities need timely data to design policies and interventions that are easily understood and relevant to the lives of urban slum inhabitants.
Along with our colleagues at the Population Council (an organisation dedicated to carrying out research on critical health and development issues), we worked with the government’s taskforce committees to do just that. We used rapid phone-based surveys to collect information on knowledge, attitudes, practices and needs among 2,000 households in five Nairobi urban slums. The survey will be conducted every 2 to 3 weeks over the coming months as the pandemic unfolds in Kenya.
Some of our key findings so far are that prevention methods are being adopted by most, but people are starting to struggle: many are missing meals, have lost work and say that the cost of living is going up.
It’s vital to have this information as it will help to inform prevention, control and mitigation measures during epidemics. A recent example is from the Ebola response, where surveys identified the prevalence of misconceptions about Ebola transmission and prevention, the need to prevent stigmatisation of Ebola survivors, and to foster safer case management and burial practices.
What people are saying
One of our key findings so far was that most people are adopting prevention practices, including social distancing, hand washing and wearing face masks. For instance participants reported that – compared to before COVID-19 – they: saw less of family (56%), saw less of their friends (87%), avoided public transportation (76%) and stayed at home more (85%).
But staying at home is proving more difficult. In the day before the survey, 79% had left the house; 37% left once, 24% left twice, 39% left three times or more. Of those that left home, 34% travelled outside of the slum where they live, suggesting significant travel around Nairobi.
When it came to wearing face masks, 89% said they had worn one in the last week, 73% said they always wore the face mask when outside of the home. Of those who did not always wear a face mask, the reasons were mainly that they were uncomfortable (57%) and unaffordable (19%).
Hand-washing was also a widely adopted practice: 95% said most public spaces have hand-washing stations, 76% said they washed their hands more than seven times a day, and 88% said they always used soap. Only 5% of participants say they wash their hands between 1 and 3 times per day. Barriers to regular handwashing were a lack of access to water at home (25%) and that they couldn’t cannot afford (32%) extra soap or water.
Hand sanitisers were used far less: 40% of participants said they don’t use them because they’re too expensive (83%) or not available in shops (24%).
The pandemic is clearing having a negative impact on people’s health and economic and social status.
Most people who responded to our survey (68%) said they had had skipped a meal or eaten less in the past two weeks because they did not have enough money to buy food. Only 7% had received any type of assistance – such as cash, vouchers, food and soap – and only half said the assistance given was enough to cover their households’ most important needs.
Participants expressed their single biggest unmet need was food (74%) followed by cash (17%). This may be related to 77% of participants reporting increased food prices and 87% noting household expenditures increased, as well as more than 4 out of 5 participants reporting complete or partial loss of income or employment.
Women may be disproportionately affected with increased time spent on chores (67% vs 51% of men) and more women reported a complete loss of income or employment compared to men.
When it came to how well-informed people are of the illness, we found a big majority knew that fevers (83%) were a symptom. But less knew about difficulty breathing (48%) and coughs (52%).
We also found that young people were less likely to think they were at high risk of becoming infected compared to older people. We identified two other persistent myths: 27% thought that coronavirus was a punishment from god and 13% thought it could not spread in hot places.
Based on our findings, we recommend that the Kenyan government continue its public education campaigns, with a focus on:
Clarifying that everyone can be infected with COVID-19 and pass on the virus to others, even if they themselves are not at high risk from severe illness.
Recognise that people are starting to be flooded with information on COVID-19 from all sources. This suggests that messaging can be refocused toward accurate prevention measures and accessing social protection.
Given the high rates of people forgoing food, and experiencing a complete or partial loss of income, assistance must be provided so as to avoid a secondary humanitarian crisis. It is particularly important that assistance gets into the hands of women to help them cope with these challenges.
Current assistance efforts are reaching less than 10% of the participants and should be ramped up in a coordinated way.
Kenya is facing a double burden of communicable and non-communicable diseases. Clustering of infections (such as HIV or TB) and noncommunicable diseases such as diabetes or hypertension is now common. This is putting pressure on the overstretched healthcare system.
In spite of this, many individuals with noncommunicable diseases remain undiagnosed for a number of reasons. These include unfamiliarity with symptoms, lack of testing equipment, and costs associated with the tests.
Recent statistics show that just over half a million adults were living with diabetes in Kenya in 2019. About 40% were unaware of their condition. Deaths from cancer are estimated at 7% while cardiovascular diseases account for 13%.
Overall, almost half of hospital admissions and about 55% of deaths in Kenya are associated with noncommunicable diseases.
This leaves countries like Kenya in a particularly vulnerable position when it comes to the severity of COVID-19. Globally, evidence shows people with underlying medical conditions such as cardiovascular disease, hypertension, diabetes or cancers are at a higher risk of COVID-19.
Is the health system in Kenya prepared?
Even before the COVID-19 pandemic reached Kenya, access to chronic care, especially for noncommunicable diseases, was challenging. This is worse for patients with more than one chronic disease.
Kenya’s health system is fragmented and largely designed to manage individual diseases rather than managing patients with multiple diseases. This is partly due to health system challenges such as staff shortages, inadequate or dysfunctional medical equipment, drug stock-outs and unskilled providers.
Unlike HIV, tuberculosis and malaria, access to care for most noncommunicable diseases such as diabetes is a major problem especially among the poor. Findings from our study at Mbagathi district hospital in Nairobi revealed some of these challenges.
A 52-year-old female patient said:
My HIV/AIDS care is provided free of charge but other diseases such as diabetes I pay for.
Another 58-year-old male patient said:
Every time I use KSh.1500 (US$15); consultation fee is KSh.300 ($3); I buy drugs for three months and that costs KSh.300 ($3).
During the COVID-19 pandemic, access to care may be even more difficult due to overwhelmed health systems, lockdown and curfews as well as fear of infections. Currently, preparations are being made to prevent or manage COVID-19 cases. But little is said about protocols to manage patients with chronic conditions.
It’s important to strengthen the healthcare system in Kenya to offer integrated care that addresses not only the COVID-19 pandemic but also chronic illnesses.
Management of COVID-19 should take account of other conditions. The current funding such as the $50 million provided by the World Bank should provide horizontal treatment and care. It should address all conditions rather than only prioritising COVID-19 cases.
Integrating care means that individuals could get access to testing and medical care for COVID-19 as well as other conditions such as diabetes or hypertension.
The Kenyan government must also provide healthcare workers with adequate personal protective equipment and address staff shortages by hiring more unemployed doctors and nurses.
And healthcare providers with chronic conditions must be relieved from being at the frontline in managing COVID-19 cases. If this is not possible, providers must be well protected to avoid being infected.
Collaborating with communities and local administrations will help in reporting and tracking cases or deaths, and citizens who defy government laws. Community health workers can sensitise community members and individuals at risk of COVID-19 on preventive measures.
Finally, the police force in Kenya should be made aware that, even during the COVID-19 pandemic, patients with chronic diseases need constant engagement with hospitals. Lockdowns or curfew measures should be sensitive to these populations.