The results of the latest regional and local government elections in Namibia show just how much the political landscape has changed in the country since independence from South Africa in 1990.

The South West Africa People’s Organisation (Swapo) – the former liberation movement that has governed the country since independence – used to win by huge margins. But, increasingly, Namibians are losing trust in its ability to run the country. They are making different political choices.

For the first time, Swapo suffered numerous defeats at regional and local levels of government in elections held last month. The loss of control over several second tier levels of governance and even more on the local level bordered on humiliation.

This increases the influence of other parties dramatically and will have an impact on Namibia’s future governance. The fact that Job Amupanda, a social movement activist in his early 30s, is the new mayor of Windhoek’s municipality, points to how dramatic the changes are.

Swapo’s poor showing in this year’s regional and municipal elections mirrors its humiliation in the 2019 national polls. From the whopping 80% it won in 2014, it got only 65%. President Hage Geingob was reelected with a humiliating 56% (2014: 87%).

The results were driven by growing corruption, governance failures and abuse of office. The lack of good governance and poor delivery has been exacerbated by a fiscal crisis and recession since 2016.

Electoral blow

Many of the country’s 14 different regions are spatial hubs for culturally and linguistically distinct groups. Their voting behaviour, to some extent, reproduces existing identities. Up until fairly recently, Swapo was the only party with support among almost all population groups, and in the urban “melting pots”. This seems over.

For the 14 regional councils, which are the second tier of government, Swapo’s votes dropped from 83% in 2015 to 57%. The elected council members appoint three representatives each to the National Council, the upper house of parliament, where Swapo currently holds 40 of 42 seats. This will change fundamentally, and it is likely to just secure an absolute majority.

The southern regions of Hardap and //Karas went to the Landless People’s Movement. Central-western Erongo went to the Independent Patriots for Change, which also made some inroads in Swapo’s northern strongholds. Kunene in the north west went to the People’s Democratic Movement. Swapo also lost its absolute majority in the central and eastern Khomas, Omaheke and Otjizondjupa regions.

There are 57 municipalities in Namibia. In the local authority elections Swapo garnered just 40% (2015: 73%) of votes. It maintained full control only 20 of the 52 municipalities (out of 57) and town councils it previously held.

Most urban centres, including Walvis Bay and Swakopmund, went to other parties or coalitions.

A disaster was the loss of the capital Windhoek. From holding 12 of the 15 seats in the municipality since 2015, Swapo now has only five.

Early warning signals

Swapo’s loss of appeal among both urban and rural voters started with the national elections of 2019. It has now taken an unexpected dramatic turn with the regional and local election results.

The results of last year’s national election showed wear and tear on the part of the party.

Panduleni Itula, a Swapo member who stood as an independent candidate, scored almost 30% of votes, personifying the dissatisfaction among party followers. Expelled since then, he formed a new party, the Independent Patriots for Change.

The People’s Democratic Movement more than tripled its parliamentary seats as the official opposition. The Landless People’s Movement, a new force, became the third strongest party.

Self-righteousness and intimidation

Following the poor electoral showing last year, Geingob reassured citizens “I have heard you”. He declared 2020 the “year of introspection”.

Yet, since late November 2019, more details emerged over the scale of corruption in the infamous #fishrot scandal, Namibia’s biggest bribery scandal. Two ministers and several leading officials of state-owned enterprises were implicated.

Panduleni Itula, a former Swapo official, is among the new breed of politicians offering an alternative. Hildegard Titus/AFP via Getty Images

Geingob’s proclaimed introspection was limited to an internal self-examination by government, with no visible results. This infuriated Namibians.

Party leaders continued to brush aside the dissatisfaction and resorted to blaming scapegoats.

Deflection and scapegoating

Addressing soldiers at the end of August, defence minister Peter Hafeni Vilho accused the country’s minority white community, supporters of “regime change”, “misguided intellectuals” and “unpatriotic” citizens of being bent on seeing the government fail.

He linked the white community to all governance failures, arguing that they alone were responsible for the current inequalities. This provoked a rebuke pointing to the government’s failures.

The party’s spokesperson Hilma Nicanor accused “outside forces” of trying to unseat the “victorious” governing party.

In mid-October Geingob bemoaned the growing number of whites (estimated at less than 5% of the population) registering as voters. He claimed they intended to support anything but Swapo, and declared

I will not forget that. People are declaring war against Swapo.

Martin Shalli, the former commander of the Namibian army, speaking at a rally in early November, urged the crowd to slit the throats of Swapo defectors. Public outrage forced him to apologise on national television.

It speaks in favour of Namibians that such intimidation did not prevent them from voting for the parties of their choice. This makes democracy the winner and Swapo the loser.

The future of Namibia’s democracy

Swapo’s downfall from an undisputed hegemonic liberation movement in power since independence means that Namibians are entering a new era. The elections in November 2020 have indeed put Namibia’s political culture at a crossroad.

For starters, it is not yet sure how the Swapo-led central government will relate to the regional and communal governments it has lost to the opposition.

Frustrated members of the Swapo establishment have suggested that the party, which controls the central government, should make the fiscus withhold funds to financially starve towns and regions governed by other parties.

This stresses the emerging centrifugal tendencies, fuelling regional if not tribal animosities. It is not in keeping with the “One Namibia, One Nation” slogan from Swapo’s anti-colonial struggle days.

Notably, Geingob dismissed such suggestions, declaring that all those elected into office are supposed to serve all people and no funds will be withheld. This is encouraging at a moment when Namibia enters a new democratic turf.

The four years on the road to the country’s next National Assembly and presidential elections in 2024 might be bumpy. But democratic hiccups are part of a healthy pluralism.The Conversation

 

Henning Melber, Extraordinary Professor, Department of Political Sciences, University of Pretoria

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Dec 07, 2020

A United Nations commission has voted to remove cannabis from a list that categorized it as one of the most dangerous drugs, a move that recognizes the plant as having medicinal value.

Experts say that the vote will have no immediate impact on loosening international controls because governments will still have jurisdiction over how to classify cannabis. But many countries look to global conventions for guidance, and United Nations recognition is a symbolic win for advocates of drug policy change who say that international law is out of date.

The UN Commission on Narcotic Drugs (CND) yesterday voted to remove cannabis from the list of the world’s most dangerous drugs.

The Vienna-based UN agency said in a statement that out of its 53 member states, 27 voted in support and 25 against the reclassification of the drug, with one abstention from Ukraine.

The US and European nations were among those who voted in favour, while China, Egypt, Nigeria, Pakistan, and Russia were amongst the countries that opposed.

Canada and Uruguay have already legalised the sale and use of cannabis for recreational purposes and Mexico and Luxembourg appear set to follow suit.

The development comes after the World Health Organisation (WHO) in January 2019 had recommended the deletion of “cannabis and cannabis resin” from Schedule IV of the 1961 Convention on Narcotic Drugs.

Substances classified as Schedule IV are a subset of Schedule I drugs. That means not only are they considered to be “highly addictive and highly liable for abuse,” they’re also labeled as “particularly harmful and of extremely limited medical or therapeutic value.”

“This is welcome news for the millions of people who use cannabis for therapeutic purposes and reflects the reality of the growing market for cannabis-based medicinal products,” a group of drug policy advocacy organizations said in a news release.

“We welcome the long-overdue recognition that cannabis is a medicine,” Ann Fordham, executive director of the International Drug Policy Consortium, said in a statement. “However, this reform alone is far from adequate given that cannabis remains incorrectly scheduled at the international level.”

 

CNN

Dec 07, 2020

China's exports rose at the fastest pace in almost three years in November, as strong global demand for goods needed to ride out the pandemic landed the world's second-largest economy a record trade surplus.

A brisk factory recovery in China from coronavirus shutdowns earlier this year has far outpaced reopenings seen in major trading partners, many of which are still struggling with outbreaks.

Exports in November rose 21.1% from a year earlier, customs data showed on Monday, the fastest growth since February 2018. It also soundly beat analysts' expectations for a 12.0% increase and quickened from an 11.4% increase in October.

The strong exports come despite the yuan hovering near multi-year peaks against the dollar, which would be welcome news for policymakers concerned about the impact of a weakening greenback on China's trade competitiveness.

Imports rose 4.5% year-on-year in November, slower than October's 4.7% growth, and underperforming expectations in a Reuters poll for a 6.1% increase, but still marking a third straight month of expansion.

Analysts say improving domestic demand and higher commodity prices helped buoy the reading.

"We believe China's export growth could remain elevated for another several months due to the worsening COVID-19 situation overseas," the note said.

However, they noted some signs that demand for these pandemic-related goods was losing momentum.

The firm shipments led to a trade surplus for November of $75.42 billion, the largest since at least 1981 when Refinitiv records began. It was also wider than the poll's forecast for a $53.5 billion surplus.

China's exports were supported by strong overseas demand for personal protective equipment (PPE) and electronics products for working from home, as well as seasonal Christmas demand, Nomura analysts said in a note.

Booming sales of fridges, toasters and microwaves to households across the locked-down world have helped propel China's manufacturing engine back to life, super-charging demand for key metals like steel, copper and aluminium, after a sharp slump early in the year.

In another sign of buoyant trade, China's export surge and the low turnaround rate of containers from abroad have triggered a recent shortage of containers domestically, state media China Daily reported.

A spate of early indicators showed China's economic recovery from the coronavirus pandemic has stepped up, with manufacturing surveys showing new export orders expanding at a faster pace for November.

That comes despite a sharp appreciation in the yuan in recent months, which some fear could hit exporters. Some firms reported that a strong yuan squeezed profits and reduced export orders in November, the statistics bureau said this week.

The yuan has booked six straight months of gains, its longest such winning streak since late 2014, and is trading at 2-1/2 year highs.

The strong exports widened China's trade surplus with the United States to $37.42 billion in November from $31.37 billion in October.

Chinese buyers nevertheless stepped up purchases of U.S. farm produce including soybeans to fulfill China's pledge in the initial trade deal it signed with the United States in January this year.

While a Biden administration is expected to soften some of the rhetoric seen in strained U.S.-China trade relations in recent years, there are no immediate signs the President-elect intends to unwind the punitive tariffs introduced under the Trump administration.

Although China's imports were weaker than expected, volumes continued to rise on a sequential basis, said Louis Kuijs of Oxford Economics.

"We expect goods imports to grow further into 2021, underpinned by strong domestic demand, with imports of capital goods to be better supported than those of commodities," Kuijs said.

China's iron ore and copper imports both fell in November from the previous month, customs data showed. Crude oil imports in rose as customs continued to clear a backlog.

 

Reuters

Dec 07, 2020

Smartphone shipments into Nigeria increased 13.7% quarter on quarter (QoQ) in Q3 2020 to almost 3 million units, according to the latest figures from global technology and consulting services firm International Data Corporation (IDC).

The firm's newly published Quarterly Global Mobile Phone Tracker shows that Nigeria's smartphone market remained healthy in the third quarter as vendors shifted their model portfolios to entry-level and mid-range devices.

Transsion's Tecno, Itel, and Infinix brands dominated smartphone shipments in Q3 2020 with a combined 76.4% share. Samsung placed second with 7.0% share and Xiaomi placed third with 5.3%. Chinese brands continue to invest in the country as they attempt to penetrate the market and gain a foothold.

The average street prices of smartphones declined marginally (0.3%) as the dollar exchange rate remained high. The increase in VAT by 2.5 percentage points also had a negative impact on prices. With the relaxation of COVID-19 measures, the majority of consumers returned to the physical retail channel in Q3 2020, leading to a 21.5% QoQ increase in retail sales.

Feature phone shipments rebounded strongly in Q3 2020, with shipments increasing 21.2% QoQ to account for 56.0% of the country's overall mobile phone market. Feature phones remained resilient as they continue to be the preferred secondary phone in an environment of declining consumer purchasing power and rising unemployment. The major players in the feature phones space in Q3 2020 were Tecno with 49.7% share, Itel with 34.8%, and Nokia with 8.2%.

"In light of the economic hardships caused by the COVID-19 pandemic, vendors continued to ship more affordable devices priced below $200 as they sought to address demand for cheaper models and penetrate consumer segments with lower purchasing power," says George Mbuthia, a research analyst at IDC. "This strategy of offering more devices in the entry-level and mid-range price bands (<$200) ensured a faster market recovery from the weak performance seen in Q2 2020, which was heavily impacted by COVID-19."

IDC expects Nigeria's overall mobile phone market to grow 3.1% QoQ in Q4 2020, with feature phone shipments increasing 1.9% and smartphone shipments growing 4.7%. "Promotions from the end of November through the festive month of December will support the market's growth in Q4 2020," says Ramazan Yavuz, a senior research manager at IDC. "COVID-19 will continue to pose a threat to the overall economy and, in particular, to mobile phone markets. However, smartphone shipments will remain resilient in 2021, with customers moving from feature phones to smartphones and data usage increasing in the medium term."

Dec 04, 2020

Namibia is putting 170 live elephants up for sale to curb rising tusker populations under pressure from drought and territorial conflict with humans.

An advertisement for the sale of 170 "high value" elephants was carried Wednesday by a state-owned daily newspaper, New Era.

The ministry says the elephants are being sold "due to drought and increase in elephant numbers coupled with human-elephant conflict incidences".

The sparsely-populated semi-arid southern African country is home to some 28,000 elephants, according to official estimates.

Environment Minister Pohamba Shifeta told AFP that the government backed the policy of selling live animals after being criticised for shooting elephants to control overpopulation.

"We decided - after research - to sell them instead," he said.

The elephant population had dwindled to about 5,000 animals at independence in 1990, but increased phenomenally thanks to a globally-lauded conservation programme.

The advertisement said pachyderms on sale would comprise entire herds in order to preserve the important social structure in elephant communities - infants or juveniles will not be left behind.

Shifeta warned that Namibia would not recklessly sell the elephants to buyers, saying "we have to make sure that the country is conducive".

For export purposes, the buyers must ensure that CITES requirements are met by both exporting and importing states for the trade to be authorised, according to the notice.

In October, 100 wild buffalo went up for sale in Namibia.

Last year the government offered for sale around 1,000 animals including 600 buffalo, 150 springboks, 60 giraffes and 28 elephants.

 

AFP

 

Dec 04, 2020

Ghanaians go to the polls Monday with incumbent President Nana Akufo-Addo and former president John Mahama as front-runners.

Akufo-Addo’s party has campaigned mainly on his education initiatives, while Mahama’s has focused on job creation and attacking his opponent's record on corruption. But the familiar faces have also made voter apathy an issue.

Ghana's government this week announced Monday, Dec 7, would be a public holiday - to help get voters to the polls to choose the next president.  

Despite more than 17 million registered voters and 12 presidential candidates, authorities are battling voter apathy with familiar front-runners from the last two elections.   

Incumbent President Nana Akufo-Addo of the New Patriotic Party (NPP) is facing off against his predecessor, John Mahama of the opposition National Democratic Congress’ (NDC).

Mahama won in the 2012 election and then lost to Akufo-Addo in the 2016 election.   

Journalist Al-Smith says, despite his efforts to raise awareness of COVID-19's effects, it has been a struggle to get Ghanaians to take the virus seriously, especially as the election has taken center stage 
Off

Kojo Asante, with the Ghana Center for Democratic Development, says there is fatigue, mainly among the middle classes.

"The first few hours is always a good indicator of whether people will eventually go out," said Asante. "If they see the crowds are behaving and then they get feedback that it is very easy to go and vote and so, then they might eventually still go out, even if they had decided not to."

Despite the challenge, Asante says their pre-election survey shows Ghanaians are concerned about issues such as improving infrastructure and employment.

The survey pointed to positive responses on the ruling NPP’s handling of COVID-19, power supplies, and education. 

But the public was less impressed with Akufo-Addo’s record on inflation, inequality, and corruption. Attacking Akufo-Addo on corruption was a focus of Mahama’s campaign, along with job creation. But risk consulting group Songhai Advisory’s Kobi Annan says both men have underperformed in office. 
 
"It's a difficult choice for a lot of people. Neither of them have performed fantastically during their terms of office, and I think it will come down to primarily sentiments around things like education, corruption, job creation. I think job creation and education in particular - those affect more people day-to-day than corruption does," said Annan.

Under Mahama’s presidency, there was an energy crisis, corruption scandals and a currency devaluation.  

In 2016, the NPP won by about one million votes and with high expectations for Akufo-Addo to stamp out corruption.

But in the weeks leading up to this year’s election, the opposition NDC made corruption allegations against Akufo-Addo.  Ghana’s anti-corruption special prosecutor resigned just three weeks before the election, alleging political interference.   

While Akufo-Addo denies any corruption in his administration, analysts say it’s hard to know if the claims will impact the vote.   

Regardless of the result, or voter turnout, analysts are expecting Ghana’s election to be fair and peaceful – as with the last two elections.  

Maame Gyekye-Jandoh is head of the University of Ghana’s Political Science Department.

"Emotions may run high, but based on these past precedents, these past good precedents, I believe that the election will be peaceful, and the results will be considered credible and legitimate," said Gyekye-Jandoh.
 
The University of Ghana published a voter survey that gave the NPP an estimated 11% lead over the NDC with five percent of voters undecided.

 

Culled from VOA

Dec 03, 2020

China has overtaken the U.S. to become the EU's biggest trade partner while the rest of the world slides into the red due to the Covid-19 pandemic.

The country pushed past the United States in the third quarter to become the European Union's top trade partner, as the pandemic disrupted the US while Chinese activity rebounded.

Over the first nine months of 2020, trade between the EU and China totalled 425.5 billion euros ($514 billion), while trade between the EU and the United States came in at 412.5 billion euros, according to Eurostat data.

GDP Growth by Country

These figures show the year-on-year change in GDP for some of the world's richest countries, with China's economy larger than it was a year ago while others have seen massive decline 

For the same period in 2019, the EU's trade with China came in at 413.4 billion euros and 461 billion euros with the US.

Eurostat said the result was due to a 4.5 percent increase in imports from China while exports remained unchanged.

'At the same time trade with the United States recorded a significant drop in both imports (-11.4 percent) and exports (-10.0 percent),' Eurostat said.

The EU has been China's top trade partner since 2004 when it overtook Japan, but this is the first time the inverse has been true, France's Insee statistics agency said Wednesday.

After a Covid-19-related shock in the first quarter the Chinese economy has rebounded, with the economy growing year-on-year in the third quarter.

Insee said Chinese imports from Europe picked up in the third quarter, while purchases of personal protective equipment had boosted Chinese exports.

China Wind Turbine Production Getty

Workers are seen during the production process of wind turbines during a government organised tour at Goldwind Technology in Yancheng, in Jiangsu province on October 14

China's economy has grown 4.9 per cent in the third quarter from last year proving the country is back to its pre-pandemic trajectory with consumer spending and industrial production going back to normal levels.

The figures are far more favourable than the dire economic data coming out of most Western countries, showing how China has bounced back quickly despite being the first country to suffer the coronavirus outbreak.

As the virus spread across the globe, China started to bring the outbreak under control and began to reopen its economy, growing 6.8 per cent in the first quarter of this year, and 3.2 per cent in the April-June quarter.

China has been widely condemned for its handling of coronavirus.

After initially covering up the outbreak, Beijing obscured an investigation into how it started and published infection rates which have been widely questioned and partly blamed for the West's slow response to prepare for the pandemic.

Since China fought off the outbreak, Chinese firms have taken advantage of their good fortune while their global rivals grapple with reduced manufacturing capacity.

Chinese firms have benefited from strong global demand for masks and medical supplies, with exports rising 9.9 per cent in September from a year earlier while factory activity also picked up.

The country's technology sector has also taken advantage of the work-from-home phenomenon with apps including DingTalk and WeChat bringing in huge revenues.

Now the International Monetary Fund is projecting China's economy to expand by 1.9 percent in 2020 which means it'll be the only major world economy to grow this year.

It comes as a new study that found traces of coronavirus in US blood samples from December last year is adding to the growing evidence that the virus was circulating for months before China announced its existence, casting more shadows over the truth about the pandemic and fuelling suspicions of a cover-up by Beijing.

Claims the global outbreak began in a livestock market in Wuhan last winter have crumbled in the face of scientific evidence proving the virus was all over the Western world weeks and even months before China declared the first cases to the World Health Organization on December 31.

Research published on Monday revealed that 39 blood samples taken between December 13 and 16 last year in California, Oregon and Washington state had tested positive for Covid antibodies, meaning the people who gave them had been infected weeks earlier.

The evidence is the earliest trace so far of the virus on US soil, and a further 67 samples from between December 30 and January 17 tested positive in Connecticut, Iowa, Massachusetts, Michigan, Rhode Island and Wisconsin.

It adds to a growing body of proof that the virus had spread thousands of miles outside of China long before its existence was acknowledged. Scientists in Italy say they now have proof the virus was there in September 2019, traces of it were found in Brazil in November, a French hospital patient had it in his lungs in December, and the virus was present in sewage in Spain in January.

 

Source: AFP

Dec 02, 2020

Over the years, the vacation rental industry became a huge business, with millions of tourists choosing fully furnished homes or apartments instead of a traditional hotel or motel experience.

However, the COVID-19 outbreak caused an enormous financial hit to the entire market, cutting down revenues of both the big players like Airbnb or Booking.com and smaller vacation rental owners and property managers.

According to data presented by Stock Apps, the revenue of the global vacation rental industry is expected to plunge by $35bn in 2020, a 42% drop year-over-year.

Airbnb, Booking.com, and Expedia Witnessed a 90% Plunge in Reservations

The vacation rental segment includes private holiday homes and houses and short-term rental of private rooms or flats through online marketplaces like Airbnb and Booking.com or in travel agencies.

In 2017, the entire industry generated $78.7bn in revenue, revealed the Statista data. In the next two years, this figure rose by 7% to almost $84bn.

However, vacation rental companies had a rough start to 2020. After a promising first few weeks of 2020, the initial wave of the COVID-19 caused massive cancellations of stays, with even the market’s biggest players witnessing colossal reservation drops.

In week 14 of 2020, short-term rental bookings on the Expedia platform saw a 94% drop year-over-year. Two other travel industry giants, Airbnb and Booking.com, followed with a 93% and 91% plunge, respectively. The strong negative trend continued between June and September after the coronavirus pandemic ruined what is typically a peak summer travel period.

As of week 35, there was a 62% YoY drop in short-term rental bookings on the Airbnb platform. However, Booking.com and Expedia witnessed even more significant losses, with their reservations plunging by 66% and 86% in this period.

Tourism revenue1

Tourism revenue2

Tourism revenue3

Statista data show the global vacation rental industry is expected to witness a recovery in 2021, with revenues growing by 36.7% to $66.9bn, still $17bn under 2019 levels. In the next three years, this figure is forecast to rise to $88.4bn.

The average revenue per user in the vacation rental segment is forecast to amount to $111.1 in 2020, a slight increase in a year. By 2025, this figure is expected to rise to $117.

The Number of Users to Plunge by 42% to 445 Million

Although the initial wave of the COVID-19 caused massive reservations drops in the first months of 2020, statistics show the number of users is expected to stay deep below the last year’s levels.

In 2017, almost 750 million people chose vacation rentals instead of hotels and motels. Over the next two years, this figure rose to 777 million.

However, Statista estimates the number of users in the vacation rental segment to plunge by 42% YoY to 445 million in 2020 and remain under 2019 levels in the next three years.

In global comparison, the United States represents the world’s largest vacation rental market, expected to generate $9.5bn in revenue in 2020, a 45% plunge in a year.

To fight the spread of COVID-19, some US states placed restrictions on short-term rentals, which caused massive complaints from the companies operating in the market. In Florida, property owners and a vacation rental management company even filed a federal lawsuit against the governor, accusing him of violating their constitutional rights.

The Chinese market, the second-largest globally, is forecast to witness a 43.5% drop YoY, with revenues falling to under $5.3bn. Japan, the United Kingdom, and Germany follow, with $3.2bn, $2.6bn, and $2.5bn in revenue in 2020, respectively.

South Africa faces a quadruple burden of disease: HIV, tuberculosis (TB), noncommunicable diseases such as Type 2 diabetes and injuries. South Africa has more people living with HIV than anywhere else in the world. Around 13.5% of the country’s total population has HIV.

Many of these patients are co-infected with TB and are also at risk of developing noncommunicable diseases. This can be attributed to a massive rise in noncommunicable diseases, including diabetes.

Research shows that in South Africa, a growing number of people with HIV are developing noncommunicable diseases – especially among poor populations in low urban socio-economic settings and rural areas.

The increase in number of people with multiple chronic diseases demands better, integrated and patient-centred care. But the country’s public health system – which caters for most of the population – is overstretched and uncoordinated. Patients accessing care from public hospitals experience longer waiting times, fewer screenings and drug stock-outs.

To get a better understanding of how patients are impacted by the lack of integration in the public health system, I recently conducted an ethnographic study among people living with HIV and diabetes in Johannesburg, South Africa. I wanted to document their experiences of accessing care for multiple chronic diseases. I observed patients as they visited different clinics and went to their homes to observe how they managed their diseases there.

My findings confirm previous research showing that care for patients with more than one disease is fragmented. The patients I followed often had to make multiple visits to health facilities for each illness they had. This was challenging given that these patients needed routine medical care and treatment for each disease. It cost them time, effort and lost wages.

The situation was exacerbated by socio-economic factors such as poverty, unemployment and food insecurity. These factors made it difficult for patients to manage their illnesses at home.

Chronic care and self-management

My research looked at patients at a public tertiary hospital in Soweto, South Africa. The hospital houses a number of speciality clinics. Patients reported many challenges accessing health services for their multiple illnesses.

The first challenge related to fragmented care at the tertiary hospital. This was partly due to the structure of the tertiary hospital which offers specialised care. Although diabetes and hypertension were managed together in one clinic, patients had to visit other clinics for any other illness that they had:

I attend different clinics … HIV clinic, diabetes clinic and podiatry clinic.

Service providers at the specific clinics rarely collaborated in managing patients. This was attributed to poor communication between the clinics and the lack of a centralised patient information system. As a result, some patients reported receiving conflicting information from different clinics:

The problem is that one doctor will tell you to do this and another asks you to do a different thing.

Some primary health care clinics in Soweto provided comprehensive HIV services. But comprehensive diabetes care was only provided at the tertiary hospital. This was due to drug stock outs and nurses lacking skills in managing diabetes at primary clinics. As a result, many patients with diabetes were referred to the tertiary hospital, though they could easily be managed at primary clinics.

The distance to the tertiary hospital and transport costs were other challenges hindering patients’ access to care. Many patients missed their clinic appointments.

Conducting observations in patients’ homes provided more insights on the difficulty of accessing care and self-management at home.

Poverty, unemployment and food insecurity emerged as key problems. For example, many patients couldn’t afford the recommended diet. Others couldn’t afford a simple meal as described below:

Nobody is guaranteed of eating in our house. We depend on a feeding programme in a nearby public primary school. Sometimes, we miss the food. This is why I have to skip taking my insulin because if I take it [without eating], my body gets weak, I shake and feel like going mad.

In many households, there were at least two people with chronic conditions. At the same time, more than half of the participants were unemployed, while some relied on social welfare grants provided to the elderly by the South African government. The grant was said to be insufficient given that many households were not only poorer but also larger in size. As a result, managing chronic conditions was difficult because of limited shared resources.

Some participants were the main breadwinners or caregivers in their households. They prioritised taking care of other household members, while neglecting their own health.

These findings highlight how social, economic, and medical complexities come together to shape health and illness in Soweto. In other words, chronic diseases such as HIV and diabetes interact with one another in a context of poverty, inequality and inequitable access to healthcare or what has been called “syndemics”. Medical anthropologists have clearly demonstrated that chronic conditions are rarely an isolated problem, but part of a complex mix of biological, social and economic factors.

Adding the COVID-19 pandemic into this mix has made the whole situation even more complex. Unemployment has risen and the Hospital Association of South Africa has warned that many people have been arriving late with very serious health conditions due to concerns around COVID-19 infection during clinic visits.

Strengthening primary healthcare

Stronger chronic care is needed at primary healthcare clinics in South Africa. This can be done by ensuring consistent and adequate drug supplies, sufficient equipment and trained staff. This will ensure that patients get care closer to their homes. In addition, patients need to be educated about self-management at home.

Specialists at tertiary hospitals must engage and communicate among themselves when managing patients with multiple chronic diseases, and engage with providers at primary care clinics. This is important given that some patients may still need to visit both primary clinics and tertiary hospitals for specialised care.

Strengthening communication within the health system broadly, and clinics specifically, is paramount. This is important to ensure that clinicians know when patients visit other clinics and what medicines they are taking. This will minimise conflicting recommendations provided to the patients.

Clinicians could use phone calls or social media platforms to communicate with patients at home. This might reduce unnecessary physical contact during COVID-19 pandemic.

Healthcare providers must understand patients in their socio-economic and cultural contexts. This calls for training clinicians on structural competence and cultural humility.

Lastly, policy makers must address unemployment and food insecurity in South Africa. Moreover, people working on health promotion and disease prevention can collaborate with community networks which have been developed during the COVID-19 pandemic for screening and contact tracing. These networks can help connect individuals facing tough economic situations to existing support groups; or linking the sick to hospitals.The Conversation

 

Dr. Edna N Bosire, Researcher, Developmental Pathways for Health Research Unit (DPHRU) & DSI NRF Centre of Excellence in Human Development., University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

World AIDS Day this year finds us still deep amid another pandemic – COVID-19.

The highly infectious novel coronavirus has swept across the world, devastating health systems and laying waste to economies as governments introduced drastic measures to contain the spread. Not since the HIV/AIDS pandemic of the 1990s have countries faced such a common health threat.

This explains why UNAIDS has selected the theme “Global Solidarity, Shared Responsibility” for this year’s World AIDS Day.

Infectious diseases such as these remain a major threat to human health and prosperity. Around 32.7 million people have died from AIDS-related illnesses in the last 40 years. At the time of writing, 1.4 million people had already died from COVID-19 in just one year.

These diseases take incredible expertise, collaboration and dedication from all levels of society to track, understand, treat and prevent.

The HIV/AIDS response played out over a much longer trajectory than COVID-19. But it is, in some respects, a shining example of what can be achieved when countries and people work together. The work of organisations such as the World Health Organisation, UNAIDS and the International AIDS Society help to coordinate rapid sharing of information and resources between healthcare providers and communities.

The Global Fund and PEPFAR have mobilised resources that have helped to reduce morbidity and mortality in low- and middle-income regions. AIDS-related deaths have declined worldwide by 39% since 2010.

These and other groups have also fought against high drug prices that would render medication inaccessible to many in the developing world. In South Africa, the epicentre of the HIV epidemic, a day’s supply of the simplest antiretrovirals cost about R250 in 2002. Today easier, more palatable treatment taken once per day costs a few rands.

Collaboration and co-ordination has also meant that medications have been developed and tested in populations across the world. And once available, global guidelines and training opportunities ensure that healthcare provision and quality is standardised.

Many of these achievements did not come without a fight. Dedicated and sustained activism, at a political and community level were required to drive down drug pricing for the global South and is constantly required to ensure inclusive distribution of resources.

The corollary is also true – areas where the world continues to struggle arise predominantly where there’s a lack of solidarity and agreement. These include a lack of political support to implement evidence-based protection mechanisms for vulnerable or stigmatised populations. For example the legalisation of homosexuality. This results in continued but avoidable HIV infection and related mortality.

These lessons need to be taken on board as the world prepares for the next phase of managing COVID-19. All the interventions that helped contain and manage HIV and AIDS are critical in ensuring that no country, regardless of developmental status, and no population, especially those that face stigma and battle to access healthcare services, are left behind.

Building on existing systems

The lessons learnt from HIV and AIDS can be used to inform the COVID-19 response as the challenges are similar.

Many of the ongoing COVID-19 vaccine trials are taking place in multiple countries, including South Africa. The capacity to conduct these studies, including the clinical staff and trial sites, are well established as a result of decades of HIV/AIDS research. There are fears that developing nations might be excluded from accessing an effective COVID-19 vaccine. But global mechanisms are now in place to avoid this and to, instead, encourage and enable global solidarity, some of which were championed by the HIV/AIDS response.

The Access to COVID-9 Tools (ACT)-Accelerator, established by the World Health Organisation in April 2020 in collaboration with many other global organisations, governments, civil society and industry, have committed through the pillar known as Covax, to equitable distribution of a COVID-19 vaccine as well as diagnostic tests and treatments. These global institutions and mechanisms require continued support.

With the deployment of an effective vaccine, an end to COVID-19 might soon be in sight. For HIV, vaccine development has been more complex and disappointing. The global community needs to remain committed to promoting access and support for the many incredible prevention and treatment options that are available. The unprecedented effort on the part of private industry in the COVID-19 vaccine response shines a light on what can be achieved when all interested parties engage. The HIV and TB vaccine endeavours need a similar effort.

These are not the only pandemics the world will face. In fact, there are strong predictions that the emergence of new pandemics will increase in the future. This is due to the effects of globalisation, climate change and proximity to wildlife.

The best hope for humanity is to not lose sight of what these pandemics cost us in terms of loved ones, in terms of freedom and economically. We must prepare now collectively across countries and across all levels of society. These preparations need to be grounded in the lessons learnt from HIV/AIDS and re-learnt from COVID-19.

Social solidarity

The success of the global response to current and emerging pandemics will rely on the ability of the less vulnerable to acknowledge their shared responsibility and respond to those calls.

An important truth of the HIV epidemic is that it doesn’t discriminate. No infectious disease acknowledges political borders and everybody is at risk of being infected or affected. If nothing else, because of this we need to continue to work together on a global scale knowing that “no one is safe, until everyone is safe”.

 

Carey Pike, Executive Research Assistant at the Desmond Tutu Health Foundation contributed to this article.The Conversation

Linda-Gail Bekker, Professor of medicine and deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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