Why it’s crucial to shield the elderly from coronavirus infection in Africa
The centralised distribution of social grants in SA exacerbates the threats to the elderly in rural areas
A common global Covid-19 risk factor, independent of region, is that faced by the elderly. Older people are at a higher risk of contracting severe forms of the disease not only because age itself is a factor, but also because they are more likely to have other underlying conditions that increase the probability of death.
A Covid study in China from 1,590 laboratory-confirmed hospitalised patients from 575 hospitals found that 25.1% of the sample presented at least one comorbidity, of which the most prevalent was hypertension (16.9%), followed by diabetes (8.2%), both more common among older patients. The study concluded that among the confirmed cases of Covid, patients with any comorbidity yielded poorer clinical outcomes than those without.
According to World Health Organisation (WHO) regional director for Europe Dr Hans Kluge, the countries most affected by the pandemic are among the top 30 countries with the largest percentage of older people. More than 95% of deaths have occurred in those older than 60 years.
The pandemic is also likely to adversely affect the economic wellbeing of older people (particularly in developing countries) because of the high levels of unemployment and household dependence on pension, social grants and/or remittances. A UN policy brief on the impact of Covid-19 on older people shows that the pandemic may significantly lower older people’s incomes and living standards, as less than 20% (globally) of those of retirement age receive a pension.
The elderly play multiple roles in society as caregivers, volunteers and community leaders. In African communities, they are often the primary caregivers to grandchildren whose parents have migrated (both locally and internationally) to greener pastures. These greener pastures often provide remittance opportunities for elderly relatives back home. The World Bank predicts that Covid now threatens the livelihoods of those dependent on remittances because of the precipitous collapse of the global economy.
In some African countries, such as SA and Egypt, pensions and social security systems are available for older people. In SA an old-age pension is provided for everyone above 60 years, even those who were not in formal employment, while most other African countries do not have social security systems of this scale. The distribution of SA social grants in rural areas has become a double-edged sword — monetary relief but also one of the greatest threats to elderly people for contracting Covid, as collection has been centralised at post offices.
In Spain, Italy and the UK death rates soared because of the rate of infection spread (R) among the elderly, who were invariably concentrated in care homes and were accessing hospital treatment for other conditions and then spreading the disease.
The transmission dynamics in African countries are markedly different. Universally, however, death risk is highest where concentration densities are highest among the elderly. Across the continent, it is imperative that we optimise distribution mechanisms for social grants or remittances to the elderly in a way that reduces their vulnerability. Nothing could be more urgent given the irreplaceable role the elderly play in maintaining the social fabric.
Since the outbreak, centralised distribution of social grants in SA has posed a threat to the elderly of rural areas, resulting from three major risk factors: the mode of transport used to collect pension grants, queuing to collect those grants, and places where money is collected, which are typically over-crowded and where social distancing is not readily observed
Transport in rural areas is predominantly public, especially for social grant beneficiaries. Most rural areas are at least 5km away from towns where essential economic and social activities are conducted. In deep rural areas old bakkies are often used, in addition to minibus taxis, to transport people to and from town. There is often only one bus serving multiple communities, which leaves at dawn and returns to the community in the afternoon. People are forced to either take that bus or a bakkie (at double the cost).
Social distancing becomes impossible for these communities, especially on the days of social grant distribution, as everyone is forced to be in town to access cash. In this context, the SA rule of vehicles only being allowed to operate at 70% capacity has become nullified. Passenger demand often overwhelms the driver, who is forced to ignore the rule. These buses/bakkies become overloaded, increasing the probability of infection spread. Moreover, the vehicles pass through many different communities in one trip. The chance of contracting Covid-19 rises with every minute near someone infected because the volume of virus copy in the air increases without an escape route.
Cash collection sites are then often overcrowded too, and pensioners spend most of the day queuing. Once the grant is received grocery shopping must be done — in different shops with hundreds of different people from other communities, compounding the risk of increasing R exponentially.
Pension fund or social grants to the elderly should be introduced across the continent. Where they exist in countries such as SA and Egypt, the distribution mechanisms should be transformed to reduce contagion risk.
Efficient distribution arrangements for old-age social grants/pension payments are undoubtedly required, though the challenges for introducing them remain notable. An increase in mobile services is required to ensure access to cash for more isolated older people or those with limited mobility. This will help reduce exposure risk associated with using public transport or standing in long queues among the elderly.
Community-based services and support should be maintained insofar as is possible. Information on protective measures and on how to access services must reach older people. This can be achieved by working with community workers, organisations and trained volunteers, as well as local radio/television broadcasters and newspapers.
Overall remittances into African countries have been adversely affected by the pandemic. While some governments in Africa have resorted to increasing social grants, providing food relief schemes and tax reductions, they have not solved the underlying problem of long-term structural unemployment across the Southern African Development Community (Sadc) region. Maintaining sustainable income through remittances, social grants and pensions is therefore critical. Developing more efficient ways of distributing social grants, particularly to the older people who are at a higher risk, is a start. Embracing digital cash may benefit not only the elderly but all those depending on social grants to counter the risk of infections from crowded spaces.
With limited resources, it is proving challenging to confront the virus. Therefore, it is imperative that measures be taken to ensure vulnerable people in isolated communities are not forced into confined and concentrated spaces.
• Dube is lead researcher and Ngqwala data analyst in the governance insights & analytics division at Good Governance Africa.