Addressing Healthcare Vulnerabilities in Africa (AHCV)

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    Food insecurity during COVID-19 in Cameroon: factors and adaptation strategies
    (African Economic Research Consortium, 2024-04-09) Atanase, Yene; Michelle, Eke Balla Sophie
    Despite the introduction of agricultural policies, social safety net programmes, investment in agricultural infrastructure, and support measures for small farmers, the country continues to face high levels of food insecurity. Agricultural policies have been hampered by corruption, mismanagement of resources, and lack of monitoring and evaluation, leading to mixed results. Social safety net programmes have faced problems of exclusion and lack of transparency in the distribution of aid. Investment in agricultural infrastructure has been delayed and poorly maintained, limiting its impact on the food supply chain. Support measures for small-scale farmers have encountered obstacles such as lack of access to credit and appropriate training. These failures in the implementation of previous policies have serious consequences for the health, well-being, and socio-economic stability of the most vulnerable populations. It is, therefore, necessary to analyze the trajectory of household food insecurity in Cameroon, in order to better understand the factors and coping strategies that enable households to maintain or improve their food security over time. This may be useful for guiding policies and programmes aimed at reducing food insecurity and strengthening household resilience to shocks and crises. To this end, we used data from a two-round telephone survey of Cameroonian households. In the first round of the survey, 2680 households were interviewed between 1 and 28 February 2021. In the second round, 1861 households from the first round were interviewed between 21 June and 21 July 2021. Using these data, several factors can be identified: (i) the characteristics of the household, including the age of the head of household, the size of the household, the sector of activity of the head of household, insurance, and mutual insurance, access to the internet, area of residence (ii) shocks can be a loss of income, the death of a household member, loss of employment, an increase in the price of inputs, an increase in the price of food consumed. Households may also use a variety of coping strategies, such as savings, stored food, borrowing, government and NGO assistance, remittances, and loans.
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    Effects of COVID-19 on Household Welfare in Benin: A Microsimulation Approach
    (African Economic Research Consortium, 2024-04-09) Honlonkou, Albert N.; Bassongui, Nassibou; Daraté, Corrine B.
    Benin recorded the first confirmed case of COVID-19 on March 16, 2020 and the first death was recorded on April 6, 2020. The evolution of the pandemic was characterised by two waves: the first wave started by a rapidly growth of the number of infections and deaths during May to September 2020 before slowing down. The second wave spanned from June to August 2021, where both the number of new cases and deaths increased more than in the first wave. The Benin’s government responses to contain the spread of the pandemic were, but not limited to the closure of land borders, the closure of schools, the prohibition of public gatherings, restrictions on public transportation, the closure of restaurants and bars, systematic wearing of masks and hand disinfection. The COVID-19 testing convenient was made at a cost of 45 USD and the COVID-19 testing or vaccination was mandatory to access all public services on September 13, 2021. All these policy responses to contain the pandemic may have many economic and social implications. We use a microsimulation approach to determine the effects of the pandemic on the households’ income and health expenditures. This policy brief presents the main findings and highlights some lessons for policy.
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    Addressing the Drivers of Food Security in Zambia During the COVID-19 Pandemic
    (African Economic Research Consortium, 2024-04-09) Bwalya, Richard; Chitalu, M. Chama-Chiliba
    Since the onset of the COVID-19 pandemic, there have been growing concerns about the impact of the pandemic on household food security (Nguyen et al., 2021; Cable et al., 2021; and Paslakis et al., 2020). Available studies show that economic effects of the COVID-19 pandemic is proportionately affect members of the society, depending on factors such as socio-economic status, livelihood strategies, and access to markets. However, though informative, these studies tend to be based on small sample sizes, limited geographical coverage or both, and thus less useful for informing the design of effective recovery strategies that lead to more resilient national food systems (Bene et al. 2021). As a contribution to addressing this information gap, this paper investigated changes in household food security and its drivers in Zambia between the pre pandemic and COVID-19 periods, with the objective of identifying significant drivers of food security and understand how they changed during the pandemic.
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    Catastrophic Effects of COVID-19 Health Expenditure Shocks and Multidimensional Poverty in Ghana: What Financing Mechanisms Mattered?
    (African Economic Research Consortium, 2024-04-09) Ayanore, Martin; Avenyo, Elvis; Osei, Davina
    In Ghana, both direct and in-direct effects of the pandemic on health and health outcomes became prolonged during the second and third waves of the pandemic. Despite seemingly obvious disruption this brought to the health system and health care utilisation, there is paucity of published literature on the effects to household health expenditures among diverse socio economic groups, including the poor. No known study has examined the magnitude and extent to which these possible payments, if they existed impacted the vulnerable, particularly poor households. Also, several key questions remain answered in the literature. To what extent has COVID-19 impacted on out-of-pocket (OOP) payments as a share of total household expenditures during the pandemic? What are the determinants of COVID-19-related CHEs? How did CHE shocks impact multi-dimensionally poor households and how did they mitigate such shocks? This policy brief answers these questions and examines the policy implications of financing mechanisms and their impact during health emergencies.
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    Dualism of the Health System in Benin: Collaboration or Competition?
    (African Economic Research Consortium, 2024-04-09) Alakonon, Calixe Bidossessi; Gbeto, Josette Rosine Aniwuvi; Bassongui, Nassibou; Alinsato, Alastaire Sèna
    Like all countries, Benin faces a growing demand for health services due to population growth and health crises. Estimates from INStAD (National Institute of Statistics and Demography) show that the total population of the Republic of Benin was 11,884,127 inhabitants in 2019, with an annual intercensal increase of 3.5%. Though some improvements have been recorded these last decades, Benin still characterized by high general and specific mortality rates. According to the fifth Demographic and Health Survey in Benin (EDSB-V, 2017/2018), the infant and child mortality rates were 96‰, i.e., approximately one in ten children does not reach their fifth birthday. This is much higher than the rate of 25‰ to be reached in 2030 according to target 3.2 of the SDG3 objective. Additionally, the maternal mortality rate was 391 deaths per 100,000 live births, which is still far from the target of 70 percent thousand live births to be achieved with target 3.1 of the SDG3 goal by 2030 (INSAE and ICF, 2019).
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    Effect of COVID-19 on Catastrophic Medical Spending and Forgone Care in Nigeria
    (African Economic Research Consortium, 2024-04-09) Edeh, Henry C.; Nnamani, Alexander Uchenna; Ozor, Jane O.
    According to World Health Organization (WHO, 2005; 2010; 2017), countries need to fund their health systems through general revenues or premium contributions of social health insurance, complemented with government revenues, to achieve UHC and financial protection. However, government funding for health in Nigeria remains generally inadequate and many households still suffer financial hardship resulting from high OOP medical spending (Edeh, 2022). OOP medical spending in Nigeria is still up to 75%, which is well above the WHO recommended 15-20% for the achievement of financial protection (World Bank, World Development Indicator (WDI), 2021). This excess reliance on OOP spending for medical bills tempts households to forgo medical care, deepens unequal access to quality health care and exposes Nigeria households to incurring catastrophic health expenditure (CHE) (Amos et al., 2016). The COVID-19 pandemic may have worsened the situation, since it led to decline in household income. Hence, our study estimates the effect of COVID-19 on catastrophic medical spending and forgone medical care in Nigeria.
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    The Impact of COVID-19 on Food Insecurity in Burkina Faso
    (African Economic Research Consortium, 2024-04-09) Nikiema, Pouirkèta Rita; Dedewanou, F. Antoine
    In Burkina Faso, agriculture is an important pillar of the national economy and is fundamental to food security. The sector generates one third of the country's GDP and employs 80% of the active population but supports mainly subsistence livelihoods. However, agricultural production and food security are highly dependent on weather shocks. Rainfall variability reduced agricultural production between 6% and 15% in 2019 (Food Crisis Prevention Network, 2020) and this in turn might have tipped 10.1% of population into food insecurity. In addition, over the past five years, the country has been affected by violent terrorist attacks and regional unrest. The combination of insecurity and violence led to the closure of schools, internally displaced people (around 1.7 million people) and shutdown of health centres. These recurrent and violent adversely affected households’ livelihoods in several regions within the country.Food insecurity is a common social issue affecting several African households. COVID-19 reduced people's ability to meet their food needs, which could continue to exacerbate food and nutrition insecurity in the country.
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    From Crisis to Coverage: Kenya's Healthcare Revolution
    (African Economic Research Consortium, 2024-04-09) Muriithi, Moses; Oleche, Martine; Kiarie , Francis; Mwangi, Tabitha
    In Kenya, the majority of the households are unable to afford health care due to financial constraints as demonstrated by a high health finance vulnerability index. The existing health financing model that is heavily reliant on out-of-pocket payments, therefore, presents a significant barrier to healthcare access. The situation is especially critical when the country is faced with a health shock like the recent COVID-19 pandemic. Developing nations like Kenya are characterized by high poverty and unemployment rates further worsening the financial ability of the citizens to afford healthcare. To ensure equitable and quality healthcare access to all as envisaged in Sustainable Development Goal 3, Kenya must urgently reform its healthcare financing system, reducing the burden of out-of-pocket expenses and embracing more sustainable funding sources.
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    Handwashing and Household Health Spending under Covid-19 in Cameroon
    (African Economic Research Consortium, 2024-04-09) Estelle, Ndonou Tchoumdop Michèle; Dumas, Tsambou André; Rodrigue, Nda’chi Deffo; Benjamin, Fomba Kamga
    Despite its proven effectiveness in preventing several diseases, including COVID-19, the distribution of hand-washing systems was not at the forefront of the health measures put in place in Cameroon. At the time of COVID-19, the acquisition of handwashing devices at home was the responsibility of households because they were not part of the equipment distributed free of charge such as masks or hydroalcoholic gel. As a result, the acquisition of handwashing facilities required enormous financial resources for households whose incomes were already declining due to the adverse effects of the crisis. The objective of this study was to assess the impact of the adoption the handwashing device on household health expenditures in Cameroon during periods of severe restrictions related to COVID-19.
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    Health Expenditure Shocks Worsened Household Poverty Amidst COVID-19 in Uganda
    (African Economic Research Consortium, 2024-04-09) Mpuuga, Dablin; Nakijoba, Sawuya; Yawe, Bruno L.
    Amidst the COVID-19 pandemic a lot changed regarding health care financing, both globally and nationally – in Uganda. Households faced unprecedented economic constraints and were forced to make hard expenditure choices including whether and how to spend on health care. Relatedly, the number of poor Ugandans increased from eight million in 2016/17 to 8.3 million in 2019/20, but it was still not clear how much of this impoverishment can be attributed to health xpenditure shocks amidst the pandemic. In addition, Uganda has consistently fallen short on living up to the 2001 Abuja Declaration expectations of allocating at least 15% of her national budget each year to improving the healthcare system. The size of the health sector budget has been less than half of the declaration requirement for the past five years (see Figure 1). More precisely, the health sector budget as a share of the total budget and GDP has averaged 6.4% and 1.9% respectively in the financial years 2018/19 to 2022/23. The absence of a national health insurance scheme implies that a huge health care financing burden, is borne by the households who pay for health care directly by out-of-pocket payments (OOPs).