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.
South Africa on Wednesday confirmed that Madagascar had requested assistance with scientific research on Artemisia – the herb used in the production of COVID-Organics.
Addressing the issue, Health Minister Zweli Mkhize said South Africa had agreed that its scientists will only assist with analysis of the herb.
“We received a call from the government of Madagascar, who asked for help with scientific research. Our scientists would be able to assist with this research. We will only get involved in a scientific analysis of the herb. We are not at that point yet,” Mkhize tweeted.
The now controversial herb has been donated by the Malagasy government to a number of African countries amongst them: Equatorial Guinea, Republic of Congo and Guinea-Bissau – the latter received a consignment meant for the ECOWAS region.
The African Union, AU, have confirmed that they are in talks with Madagascar over COVID-Organics, the island nation’s purported herbal cure for COVID-19.
A May 4 statement by the AU said it was in contact with Antananarivo “through its embassy in Addis Ababa, with a view to obtain technical data regarding the safety and efficiency of a herbal remedy, recently announced by Madagascar for the reported prevention and treatment of COVID19.”
AU and Malagasy diplomats have held meetings in Addis Ababa with the view to getting necessary information regarding the remedy.
“Once furnished with the details, the Union, through the Africa Centres for Disease Control and Prevention (Africa CDC), will review the scientific data gathered so far on the safety and efficacy of the COVID-19 Organics.
“This review will be based on global technical and ethical norms to garner the necessary scientific evidence regarding the performance of the tonic,” an AU statement further disclosed.
Meanwhile, the World Health Organization, WHO; have reiterated its caution against people putting their faith in herbal remedies that have not been scientifically tested.
In a statement, WHO said despite supporting all efforts – including traditional medicines – in search for treatments, it was important that any purported treatments be thoroughly tested.
In his last address, President Rajoelina said Madagascar was building a factory to scale up production. He also said the cure was to undergo clinical trials and that aside the drinks, injection options were being pursued. Over half-dozen African countries have expressed interest in it.
Credit: VILLAGE REPORTER
A Ugandan court last week ordered lawmakers to pay back money they had awarded themselves to combat coronavirus. Meanwhile, in Malawi, President Peter Mutharika announced Covid-19 cash packages for the poor to help them survive the pandemic over the next three-months.
The high court in Uganda has ruled that MPs must pay back any money they received as part of a package they approved to fight coronavirus in their constituencies, local media reported.
An allocation of 2.4 million euros was paid into the individual accounts of lawmakers earlier in April, according to The Observer newspaper. It must be repaid or transferred to national or district Covid-19 taskforces.
The money was initially approved as part of a bigger budgetary package and was intended to be used for sensitisation about the virus.
However, the payment irked President Yoweri Museveni, who described it as “morally reprehensible”.
Some MPs had already refunded the money. Opposition lawmaker Bobi Wine described the payment as “wrong and immoral”, saying he would return the money and not participate in such a “vile” fraud.
Uganda has confirmed 79 cases of coronavirus with no deaths, according to the latest statistics from the Africa Centres for Disease Control and Prevention.
Malawi’s emergency cash transfer programme
Authorities in Malawi on Tuesday announced cash payments would be made to the most vulnerable, helping them cope during the Covid-19 crisis.
President Peter Mutharika said vulnerable households would be paid 43 euros per month for a three-month period, according to the Nyasa Times.
Malawi’s government has been blocked by the country’s courts from implementing a coronavirus lockdown because no assistance was provided for those in need.
The Community Working Group on Health (CWGH) has described as unfair the steep prices that some private health facilities are charging individuals for COVID-19 tests.
Investigations by NewZimbabwe.com showed that some private medical health centres were demanding up to US$25 per person for a COVID-19 test.
President Emmerson Mnangagwa last week extended the lockdown by a further 14-days but allowed industry and commerce to resume operations while complying with set health guidelines to curb the spread of the COVID-19 virus.
Some of the guidelines include tests for the coronavirus for all employees returning to work, wearing of face masks by all people in public spaces, and maintenance of social distancing.
However, taking advantage of the new government guidelines, some health facilities with testing machines have steeply hiked their prices, a move which has been strongly condemned by CWGH director, Itai Rusike as most of the test kits were donated equipment.
"Zimbabwe's poorly resourced COVID-19 response is inevitably shifting the burden to the most vulnerable and precarious people, households and businesses," he said.
Rusike also described as draconian, the rule to force people to wear face masks when they leave their homes. The government has announced a 12-month prison sentence for anyone caught in public without a face mask.
The CWGH director said the public and other stakeholders should not be mere bystanders when the government was announcing COVID-19 decisions.
"They need to be informed about the decisions and make sense of how to implement them, to plan for the pandemic and its impact on their own lives and work.
"So for the general public in Zimbabwe to have trust and support for any strategy for the next phases of the COVID-19 response, calls for a multi-sector taskforce to engage stakeholder and community representatives through genuinely open deliberative processes," he said.
Rusike said the government's decision on measures taken on the lockdown should have explicitly addressed how different interests and risks were being balanced.
Contacted for a comment, Health Ministry secretary, Agnes Mahomva said she could not make a comment as she was in a meeting.
Credit: New Zimbabwe
Since President Muhammadu Buhari came to power in Nigeria in 2015, anti-corruption has been at the heart of his administration. However, a lot of effort is focused on grand corruption at the higher levels of governance and politics. There is less emphasis on the less-talked-about but vulnerable areas such as the health sector.
We have been involved as researchers in an extensive study of health sector corruption in Nigeria. The study interacted with front-line health workers and health policy makers and managers. The aim was to systematically identify the different types of corruption occurring in the Nigerian health sector, and rank them based on how damaging they can be to the health sector.
The drivers and potential solutions to these health sector corruption problems were also identified, as well as recommendations on how to mitigate corruption in the sector. In the end we hope to explore and bring to the fore feasible grassroots solutions to the problem of health sector corruption in Nigeria.
In the war against COVID-19, health system resilience, accountability and integrity are more important than ever. The health systems of some high-income-countries have become overwhelmed by the rising number of infected persons and deaths from the disease. Weaker, corruption-prone and less resilient health systems of many low and middle income countries are even more vulnerable. Some may even collapse.
Research has underscored the vulnerability of Nigeria’s health system. A consistently solid and accountable health system has eluded the country. The requisite health resources are also in short supply.
The reality is that citizens, health workers and international development partners worry that Nigeria’s health system is very weak and may be unable to adequately combat COVID-19.
Money management issues
Contributing to the weakness of the system is the federal and state governments’ very low budgetary allocation to the health sector.
Nigeria’s health sector appropriation in the 2020 budget is 4.5% of the total federal budget, about N427.3 billion. This is far below the 15% agreed in the 2001 Abuja Declaration, when African Union member countries pledged to improve spending on their health sector and urged donor countries to scale up support.
Following recent collapse in the international price of crude oil, the budget has now been revised downward.
Concerns about budget are valid. But of equal weight is the issue of the optimal management of presently allocated funds. This continues to be an underlying problem.
In a paper published last year health workers and decision makers set out to explain the reasons that corruption persists in the healthcare sector.
They identified the top 49 corrupt practices in the Nigerian health system. These included absenteeism, procurement-related corruption, under-the-counter payments, health financing-related corruption, and employment-related corruption.
Discussions with health workers in an ongoing study on COVID-19 spanning different regions in Nigeria echo these findings. Health workers have indicated that there are structural and facility-level corruption and accountability issues that they have to work with routinely. These compromise their efforts to do their jobs as healthcare providers, including containing COVID-19 and its impacts.
We also found that there were high levels of distrust in the government, poor welfare conditions for health workers and health service users, and a lack of proper equipment.
What needs to be done
Patricia Garcia, a leading figure on global health issues, believes that for most developing countries, “with more money comes more corruption”.
Nigeria is certainly a case in point.
So what can be done about it?
The previous journal publication on Nigeria noted that front-line workers and policymakers agreed that tackling corrupt practices requires a range of approaches.
Garcia herself advocates an incremental approach to tackling the problem.
We could start from the bottom up, taking small steps. We need rigorous research methods to prove or disprove that a strategy works. Addressing and ending corruption will require the participation of researchers from several disciplines and multiple approaches, and the commitment of funders to supporting serious research. Corruption in global health should not continue as an open secret, it has to be confronted and brought to light.
The rapid spread of COVID-19 in Nigeria calls for sincerity on the parts of the authorities, the health workers and citizens. It also demands vigilance from civil society organisations and the mass media to foster accountability.
During the Ebola outbreak, Transparency International reported how systemic corruption in West Africa’s health sector undermined the response. Unfortunately, the lessons seem to have parted with the epidemic. We hope that lessons from dealing with COVID-19 will strengthen the health system in Nigeria and put in place stiff anti-corruption measures.
We will undertake further studies on health system corruption and accountability through a new project that is funded by the UK’s Joint Health System Research Initiative, entitled “Understanding and eliminating health sector corruption impeding UHC at district level in Nigeria and Malawi: institutions, individuals and incentives”.
Obinna Onwujekwe, Professor of Health Economics and Policy and Pharmaco-economics/pharmaco-epidemiology in the Departments of Health Administration & Management and Pharmacology and Therapeutics, College of Medicine, University of Nigeria; Charles Orjiakor, Lecturer , University of Nigeria, and Prince Agwu -, Researcher in the Department of Social Work, University of Nigeria
This is not the first time ratings agencies have adopted a procyclical approach – that is, one in which bad news is simply piled on bad news.
During the 2008 global financial crisis, ratings agencies were accused of aggressively downgrading countries whose economies were already strained. Reports by the European and US Commissions found evidence that their decisions worsened the financial crisis.
Nobel laureate Joseph Stiglitz has also accused rating agencies of aggressively downgrading countries during the 1997 East Asian financial crisis. The downgrades were more than what would be justified by the countries’ economic fundamentals. This unduly added to the cost of borrowing and caused the supply of international capital to evaporate.
In addition to the issue of timing, the effectiveness and objectivity of the rating methodology continues to be questioned by policymakers. Their methodological errors in times of crisis, together with the unresolved problem of conflict of interests, leave both issuers and investors vulnerable to losses.
The procyclical nature of ratings needs to be put under check to avoid market panic. The devastating effects they add on economies that are already strained has to be challenged. The coronavirus pandemic is yet another episode to prove this.
Ten African countries have been downgraded since the COVID-19 pandemic started – Angola, Botswana, Cameroon, Cape Verde, Democratic Republic of the Congo, Gabon, Nigeria, South Africa, Mauritius and Zambia.
But, in my view, the downgrade decisions reflect monumental bad timing. I would also argue that, in most cases, they were premature and unjustified.
Since international rating agencies have tremendous power to influence market expectations and investors’ portfolio allocation decisions, crisis-induced downgrades undermine macroeconomic fundamentals. Once downgraded, like a self-fulfilling prophecy, even countries with strong macroeconomic fundamentals deteriorate to converge with model-predicted ratings. Investors respond by raising the cost of borrowing or by withdrawing their capital, aggravating a crisis situation.
South Africa was stripped of its last investment grade by Moody’s. The rating agency cited a rising debt burden of 62.2%, which was estimated to reach 91% of GDP by fiscal 2023; and structurally weak growth of less than 1%, which was estimated to shrink to -5.8%. It was hoped that Moody’s would delay its rating action to see the impact of the coronavirus onshore and the country’s policy responses. The procyclical effect of the downgrade magnified the impact of the lockdown. Fitch further pushed it deep into junk a week later.
Fitch cut Gabon’s sovereign rating to CCC from B on 3 April 2020. The rationale for the downgrade was that agencies expected the risks to sovereign debt repayment capacity to increase due to liquidity pressure from the fall in oil prices.
Moody’s revised Mauritius’s sovereign rating outlook from Baa1 stable to negative on 1 April 2020. Moody’s said the downgrade was driven by the expectation of lower tourist arrivals and earnings due to the coronavirus. Both would have a negative impact on the country’s economic growth.
Nigeria was downgraded by S&P from B to B- on 26 March 2020. The reason was that COVID-19 had added to the risk of fiscal and external shock resulting from lower oil prices and economic recession. Yet the investment grades of Saudi Arabia and Russia were spared.
S&P also downgraded Botswana – one of the most stable economies in Africa – which had an A rating. The agency cited weakening fiscal and external balance sheets due to a drop in demand for commodities and expected economic deceleration because of COVID-19. Botswana’s downgrade came four days after it went into a lockdown and before it had recorded a confirmed case of COVID-19.
These downgrades deep into junk impose a wave of other problems, worse than COVID-19. They cut sovereign bond value as collateral in central bank funding operations and drive interest rates high. Sovereign bond values are grossly discounted, at the same time escalating the cost of interest repayment instalments, ultimately contributing to a rise in the cost of debt. A wave of corporate downgrades also follows because of the sovereign ceiling concept – a country’s rating generally dictates the highest rating assigned to companies within its borders.
In response to the procyclical COVID-19 induced downgrades, African countries need to implement these four measures.
First, to curb the procyclical nature of rating actions that disrupt markets by triggering market panic, the timing of rating announcements needs to be regulated. Regulators of rating agencies such as the Financial Sector Conduct Authority in South Africa have the power to determine the timing of rating. In times of crisis, rating agencies should defer publishing their rating reviews as markets have their way of discounting risk when fundamentals are conspicuously changing.
Second, the rules of disclosure and transparency should be enhanced during rating reviews. Rating methodologies, descriptions of models and key rating assumptions should be disclosed to enable investors to perform their own due diligence to reach their own conclusions.
Third, in collaboration with other market regulatory bodies in the financial markets, transactions that unfairly benefit from crisis-driven price falls should be restricted. This includes short-selling of securities – a market strategy that allows investors to profit from securities when their value goes down.
Lastly, African countries need to develop the capacity for rigorous engagement with rating agencies during rating reviews and appeals. They need to make sure that the agencies have all the information required to make a fair assessment of their rating profiles.
The African Union and its policy organs need to fast track the adoption of its continental policy framework of mechanisms on rating agencies’ support for countries. This will assist them to manage the practices of rating agencies.
Royal Dutch Shell has cut its dividend for the first time since the 1940s after a first-quarter loss – and warned virus-ravaged oil prices will take time to fully recover.
The Anglo-Dutch group sank into a $24-million ($29.5-million) net loss in the three months to March – when oil went into freefall on tumbling demand and a price war between producers Saudi Arabia and Russia.
That contrasted sharply with profit after tax of $6.0 billion in the same period a year earlier, the London-listed giant added in a statement.
Earnings on a current cost-of-supplies (CCS) basis – stripping out changes to the value of oil and gas inventories – sank 46 percent to $2.9 billion in the reporting period, Shell said.
The energy titan, which axed spending last month in response to the oil crash, said it had slashed its shareholder dividend by 65 percent to 16 cents per share, from 47 cents in the fourth quarter.
“As a result of COVID-19, there is significant uncertainty in the expected macroeconomic conditions with an expected negative impact on demand for oil, gas and related products,” Shell said.
“Furthermore, recent global developments and uncertainty in oil supply have caused further volatility in commodity markets.”
It warned that the pandemic would spark a difficult second quarter — with no price bounceback in prospect.
“It would be too naive at this point in time to say: we know what is happening, this is just another downturn, things will bounce back, and we will get to where we were before,” van Beurden told Bloomberg TV.
“I think that would be an inappropriate conclusion to draw at this point in time.”
The coronavirus pandemic is likely to last as long as two years and won’t be controlled until about two-thirds of the world’s population is immune, a group of experts said in a report.
Because of its ability to spread from people who don’t appear to be ill, the virus may be harder to control than influenza, the cause of most pandemics in recent history, according to the report from the Center for Infectious Disease Research and Policy at the University of Minnesota. People may actually be at their most infectious before symptoms appear, according to the report.
After locking down billions of people around the world to minimize its spread through countries, governments are now cautiously allowing businesses and public places to reopen. Yet the coronavirus pandemic is likely to continue in waves that could last beyond 2022, the authors said.
“Risk communication messaging from government officials should incorporate the concept that this pandemic will not be over soon,” they said, “and that people need to be prepared for possible periodic resurgences of disease over the next two years.”
Developers are rushing to make vaccines that may be available in small quantities as early as this year. While large amounts of vaccine against the 2009-2010 flu pandemic didn’t become available until after the outbreak peaked in the U.S., one study has estimated that the shots prevented as many as 1.5 million cases and 500 deaths in that country alone, the report said.
The report was written by CIDRAP director Michael Osterholm and medical director Kristen Moore, Tulane University public health historian John Barry, and Marc Lipsitch, an epidemiologist at the Harvard School of Public Health.
South Africa is seeking to create a new thriving national airline out of the ashes of its current state-owned carrier, which is technically insolvent and on the brink of being placed in liquidation by administrators.
An ideal replacement for South African Airways would have both public and private owners, maintain the country’s trade connections and make a profit, the Department of Public Enterprises said in a statement on Friday. The plan has the backing of SAA’s near 5,000-strong workforce, the ministry said, without mentioning the business-rescue team that has been running the airline since December.
“The old SAA is dead, there is no doubt about that,” Public Enterprises Minister Pravin Gordhan said by phone from Pretoria, the capital. “But what will take its place may be some or all of the old SAA and maybe some other airlines too.”
SAA’s administrators, led by Les Matuson and Siviwe Dongwana, were working on a recovery plan for the perennially loss-making carrier before the Covid-19 crisis forced the grounding of all aircraft. They began the process of liquidating the airline last month after the government refused to provide a bailout package, and have asked all employees to agree to severance packages.
That offer remains on the table, a spokeswoman for the administrators said when asked to comment on the DPE’s statement. Labor groups have yet to sign up to any deal, and two of the biggest have approached the Labour Court to have the retrenchment notices deemed illegal, according to the News24 website.
The National Union of Metalworkers of South Africa and the South African Cabin Crew Association argue that as the business-rescue practitioners haven’t submitted their recovery plan for SAA, widespread job cuts are inappropriate, News24 said.
South Africa’s whole aviation industry has been plunged into crisis by the coronavirus pandemic. SA Express, part of the wider SAA group, has been placed in provisional liquidation, while low-cost operator Comair Ltd. said on Thursday it’s selling assets and in talks with lenders to shore up a precarious financial position.
FlySafair, another budget carrier, is calling for the state to waive fees while planes are unable to fly to help the industry shore up cash reserves. South Africa is operating a phased reopening of the economy after imposing a strict lockdown to contain the coronavirus, but the resumption of domestic air travel is expected to be far down the agenda.
Gordhan didn’t give details on how a new SAA could be created, calling it a “complex issue.” He praised the current version’s efforts transporting medical supplies and repatriating citizens stranded by the coronavirus, saying South Africa needs “a national flag carrier that is a source of pride.”
Foremost composite e-commerce giant, Konga has recorded another first in Africa’s e-commerce market, with the launch of a live online product auction.
The initiative, another ground-breaking innovation from Konga, will debut this Friday, May 1, 2020 by 5pm on its online platform – www.konga.com and across its social media channels – Instagram, Twitter, Facebook and YouTube. Equally important, the live auction is a monthly feature which will afford eager shoppers a chance to stake their claims for the exciting products on offer on a monthly basis.
Already, anticipation and excitement is sky-high for the debut edition of the auction tagged Konga Last Price.
Prince Nnamdi Ekeh, Co-CEO, Konga Group, says the initiative is further proof of Konga’s boundless strategies to raise the bar in the e-commerce market and excite its customers globally without stories.
‘‘This live online auction across social media and our website is another first from Konga. This is another addition to being the first to pioneer the marketplace structure in the African e-commerce market six years ago for others to follow and the fusion of online and offline in creating a world-class composite retail platform, among others.
‘‘With this live auction – Konga Last Price, the first in Africa, we are further expanding the scope of e-commerce and giving our customer base an additional reason to smile. It has certainly come to stay as a monthly feature and we encourage all Nigerians to join us on the various social media channels and on the Konga website for this exciting initiative. It promises to be a world-class and unforgettable experience, with a huge number of genuine products across categories to be auctioned at mouth-watering prices,’’ he said.
For this inaugural edition, Konga has put up a number of eye-catching products across multiple categories for Nigerians to smile home with after weeks of the lockdown occasioned by the COVID-19 pandemic.
Also in store for participants is a surprise product. As a matter of fact, the Konga Last Price live auction will feature three sessions.
They include a live auction across its social media channels – Instagram, Twitter, Facebook and YouTube; a timed auction on the Konga website and a flash sale on social media involving no bids which will run concurrently with the social media live auction.
For the latter two – the timed auction on the Konga website and flash sale on social media, price slashes will be announced at the commencement of the live auction. Bid winners will follow the regular check-out process and can use the Payment on Delivery option.
However, intending participants on the social media live auction are expected to submit their bids via comments with their name, phone number, product and bidding price, with each participant allowed to purchase a maximum of three products per category.
Subsequently, bid winners will be contacted for payment confirmations via bank transfers at the end of the social media live auction.