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12 October 2020 | Story Andre Damons
Prof Ivan Turok
Prof Ivan Turok, National Research Foundation research professor at the University of the Free State (UFS) and distinguished research fellow at the Human Sciences Research Council (HSRC).

New evidence provides a detailed picture of the extraordinary economic fallout from the COVID-19 pandemic. All regions lost about a fifth of their jobs between February-April, although the cities began to show signs of recovery with the easing of the lockdown to level 3. Half of all adults in rural areas were unemployed by June, compared with a third in the metros. So the crisis has amplified pre-existing disparities between cities and rural areas.

Prof Ivan Turok, National Research Foundation research professor at the University of the Free State (UFS) and distinguished research fellow at the Human Sciences Research Council (HSRC), and Dr Justin Visagie, a research specialist with the HSRC, analysed the impact of the crisis on different locations in a research report (Visagie & Turok 2020).

The main conclusion is that government responses need to be targeted more carefully to the distinctive challenges and opportunities of different places. A uniform, nationwide approach that treats places equally will not narrow (or even maintain) the gaps between them, just as the blanket lockdown reflex had adverse unintended consequences for jobs and livelihoods.

According to the authors, the crisis has also enlarged the chasm between suburbs, townships and informal settlements within cities. More than a third of all shack dwellers (36%) lost their jobs between February and April, compared with a quarter (24%) in the townships and one in seven (14%) in the suburbs. These effects are unprecedented.

Government grants have helped to ameliorate hardship in poor communities, but premature withdrawal of temporary relief schemes would be a serious setback for people who have come to rely on these resources following the collapse of jobs, such as unemployed men.

Before COVID-19

In February 2020, the proportion of adults in paid employment in the metros was 57%. In smaller cities and towns it was 46% and in rural areas 42%. This was a big gap, reflecting the relatively fragile local economies outside the large cities.
Similar differences existed within urban areas. The proportion of adults living in the suburbs who were in paid employment was 58%. In the townships it was 51% and in peri-urban areas it was 45%.

These employment disparities were partly offset by cash transfers to alleviate poverty among children and pensioners. Social grants were the main source of income for more than half of rural households and were also important in townships and informal settlements, although not to the same extent as in rural areas.  

Despite the social grants, households in rural areas were still far more likely to run out of money to buy food than in the cities.

How did the lockdown affect jobs?

The hard lockdown haemorrhaged jobs and incomes everywhere. However, the effects were worse in some places than in others. Shack dwellers were particularly vulnerable to the level 5 lockdown and restrictions on informal enterprise. This magnified pre-existing divides between suburbs, townships and informal settlements within cities.
There appears to have been a slight recovery in the suburbs between April-June, mostly as a result of furloughed workers being brought back onto the payroll. Few new jobs were created. Other areas showed less signs of bouncing back.

Overall, the economic crisis has hit poor urban communities much harder than the suburbs, resulting in a rate of unemployment in June of 42-43% in townships and informal settlements compared with 24% in the suburbs. The collapse poses a massive challenge for the recovery, and requires the government to mobilise resources from the whole of society.


News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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