What’s the risk of coronavirus in Kenya and Uganda?

As the novel coronavirus (COVID-19) has marched through China and Europe, Uganda has avoided any cases to date, and Kenya has only had three cases Like everyone else in the region, I’ve been wondering whether this is likely to continue, and what might happen if the disease did arrive at scale.  I wanted to collect a number of resources that I’ve found useful in thinking about this in a single place.  I am not an epidemiologist and am not making any predictions about the geographic spread of the disease.

Is coronavirus likely to spread to the region?

There are two factors which may play to Kenya and Uganda’s advantage when it comes to preventing the arrival of additional coronavirus cases in the area.  First, the virus has been spreading globally when infected individuals travel between countries.  Both countries have relatively few direct flight links outside of the continent.  Kenya has closed its borders to non-residents as of March 15, and is requiring all travelers to self-quarantine for 14 days.  Uganda is requiring travelers from countries with current coronavirus cases to self-quarantine as well.

World-airline-routemap-2009
Map of global flight paths from Wikipedia.  It’s from 2009, the most recent map available, but the general patterns presumably still hold true today.

Second, in countries currently affected by coronavirus at scale, the disease has also been spreading among communities in contact with an infected person.  However, there’s some tentative evidence that this type of spread is only happening in relatively cool climates. A new paper from Sajadi et al. (2020) notes that all cases of community transmission have been concentrated in a narrow band with temperatures around 10 degrees Celsius / 50 degrees Fahrenheit.  This may be because the coronavirus can’t survive as long outside the body in warmer temperatures.

If this finding holds true, it suggests that if additional infected individuals do travel to Kenya and Uganda, the coronavirus may not spread significantly beyond them.  However, there is still a great deal of uncertainty here, and we shouldn’t trust that warm weather will prevent community transmission.

Are Kenya and Uganda prepared to track the spread of the virus?

There’s reason to be optimistic about public health capacity to track potential coronavirus cases.  Both countries already have infectious disease surveillance infrastructure in place at the international airports due to the recent Ebola epidemic in the nearby DR Congo.  All travelers to Nairobi and Entebbe must report their travel histories, share contact information, and go through a thermal screening at both airports.  Of course, airport screening won’t stop all infected people from entering the country because some may not have symptoms yet, but it’s still useful for surveillance.

In addition, both countries are building on much longer histories of population-level disease surveillance, including those for polio and HIV / AIDS.  As this article from Think Global Health notes,

Because of the robust responses to these diseases, many African countries are starting from a very different baseline than twenty years ago. Although this has not generally included support for ICU-level care that will be required by the sickest people with COVID-19, what these investments have supported are increasingly human resource for health, supply chains, information and surveillance capacities for prevention, detection and long-term response capacity against diverse infectious threats.

Finally, because the onset of the epidemic has been delayed here, both countries have had more time to prepare.  The Africa Centres for Disease Control have been running online trainings for healthcare workers about the coronavirus, and have also developed and distributed coronavirus test kits to most countries across the continent, including Kenya and Uganda.  Both countries have already banned international conferences, and Kenya has also opened a 120-bed isolation center for potential patients. 

What happens if coronavirus does spread within the region?

If community transmission of coronavirus does occur within Kenya and Uganda, one of the main risks is that it may overwhelm healthcare systems with people seeking care.  Taking early preventative measures to slow the spread of the virus makes it more likely that sick people can access care when they need it, as this graph from Our World in Data shows.  Unfortunately, Kenya and Uganda are grappling with weak health systems and poverty, both of which may make it more difficult to contain the virus if it does arrive.

A graph showing that

In both countries, health systems tend to be underfunded.  In Kenya, significant revenue comes from user fees, which discourage poor people from accessing healthcare.  Uganda abolished user fees for healthcare in 2001, but poor people still find it difficult to access care. Kenya is doing fairly well at providing essential medicines, but Ugandan clinics often lack drugs.  The number of intensive care unit (ICU) beds in both countries is low, and only 23% of Ugandan ICUs have ventilators.  On any given day, nearly half of healthcare workers in both countries are absent from their jobs, often because of poor pay and long commutes.  If coronavirus spreads among the population and leaves many people in need of hospitalization, it’s clear that the health systems will struggle to keep up.

Poverty can also make it difficult for people to take other steps to keep themselves safe from coronavirus.  Only 14% of Kenyans have access to soap and water at home, and in Uganda only 8% of families with young children have access to soap and water at home.  Hand sanitizer is available in shops, but not widely used.  Without well-functioning state-run social safety nets, most people also don’t have the luxury of taking time off from work to rest if they are sick.  This both increases the risk that the disease will spread, and makes it more difficult for infected people to recover. Informal insurance within families and religious groups can mitigate this somewhat, but churches have also been vectors for infection in the US and South Korea, meaning that this insurance mechanism could possibly increase the risk of contacting the disease.

Even without cases of coronavirus in the region, the social and economic impacts of the disease are already being felt.  Xenophobic statements about Chinese residents have been reported in Kenya.  And in both countries, an economic slowdown is expected as traders have been cut off from Chinese imports.  The indirect economic effects as people lose their livelihoods may be just as serious as the disease itself.  It’s important for both countries to continue expanding their social safety nets and ensure that healthcare is affordable, even if coronavirus never comes ashore. 

Interesting academic articles for February 2020

Here’s what I’m looking forward to reading this month!

Kobina Aidoo and Ryan Briggs.  2019.  “Underpowered: Rolling blackouts in Africa disproportionately hurt the poor.”  African Studies Review.

Electricity demand exceeds supply in many parts of Africa, and this often results in rolling blackouts. This article argues that blackouts tend to concentrate on poorer places within countries, due to both economic and political factors. This argument is tested with an analysis of electricity availability across thirty-two neighborhoods in Accra and survey data from thirty-six African countries. Across these analyses, poorer people with a grid connection experience lower electricity supply than richer people. This article concludes by discussing implications for research on electricity availability, policymakers working on energy, and the distributive politics literature.

J. Andrew Harris, Catherine Kamindo, and Peter Van der Windt.  2020.  “Electoral Administration in Fledgling Democracies: Experimental Evidence from Kenya.”  Journal of Politics.

We examine the effects of national voter registration policies on voting patterns with a large-scale experimental study. Together with Kenya’s electoral commission, we designed an experiment in which 1,674 communities were randomized to a status quo or treatment group, receiving civic education on voter registration, SMS reminders about registration opportunities, and/or local registration visits by election commission staff. We find little evidence that civic education improves registration. Local registration visits improve voter registration, a relationship that increases in poorer communities. Moreover, local registration increased electoral competition and vote preference diversity in down-ballot contests in the 2017 Kenyan elections. Our results suggest that status quo voter registration policies constrain political participation and competition, and that inexpensive policy changes may attenuate the effects of such constraints.

Jeremie Gross, Catherine Guirkinger, and Jean-Philippe Platteau.  2020.  “Buy As You Need: Nutrition and Food Storage Imperfections.” Journal of Development Economics.

In this paper, we investigate whether and how a more steady supply of foodgrain in local markets impacts the nutritional status (measured with body-mass-indexes) of both children and adults, in a context characterized by large seasonal fluctuations in the price and availability of foodgrain. Taking advantage of the random scaling-up of a program of Food Security Granaries in Burkina Faso, we reach three conclusions. First, especially in remote areas where local markets are thin, the program considerably dampens nutritional stress. The effect is strongest among children, and young children in particular, for whom deficient nutrition has devastating long-term consequences. Second we argue that it is a change in the timing of food purchases, translated into a change in the timing of consumption, that drives the nutritional improvement. A simple two-period model shows that, once we account for various forms of storage costs, an increase in nutrition does not necessarily require larger quantity of food purchases or even consumption. Our last and unexpected conclusion is that the losses associated with foodgrain storage do not stem from physical losses in household granaries but rather from inefficient seasonal bodymass fluctuations. One plausible mechanism behind this particular storage imperfection rests on the households’ urge to consume readily available foodgrain.

Moses Khisa.  2020.  “Politicisation and Professionalisation: The Progress and Perils of Civil-Military Transformation in Museveni’s Uganda.”  Civil Wars.  

Problems of civil-military relations have been at the centre of recurring political crises in contemporary Africa. Routine military intrusion in politics characterised the first four decades of independent Africa. Citizens suffered at the hands of the armed forces, infamous for widespread human rights violations. One key response to this dual civil-military problem was to pursue a strategy of politicising the armed forces in order to make them a) subordinate to civilian authority and b) organically close to the public and protective than predatory. This also entailed the militarisation of politics ostensibly to bring the political class into closer conversation and collaboration with the military. To what extent did this strategy contribute to transforming civil-military relations? Taking the Ugandan case, this article argues that transformation was attained in making the military more respectful of citizens’ rights while simultaneously creating a fusion with the ruling class thereby subverting the very goal of professionalism.

Josephine Ahikire and Amon A. Mwiine.  2020.  “Gender equitable change and the place of informal networks in Uganda’s legislative policy reforms.”  Effective States in International Development working paper #134.

Uganda has had an uneven history and experience around gender equity policy reforms, particularly, from the late 1980s and early 1990s to-date. These range from the countrywide constitutional review processes of the early 1990s, legislative activism and reforms around domestic relations, land/property rights, and women’s access to public position, to mention but a few. While some of these gender reforms (commonly promoted through women’s collective mobilisation) were successful, other legislative initiatives faced intense resistance. This paper compares three policy cases – the 1997 Universal Primary Education policy, the 1998 legislative reform around spousal co-ownership of land and the 2010 Domestic Violence Act. Drawing on feminist institutionalism, the paper explores how gender norms operate within institutions (both formal and informal) and how institutional processes construct, reproduce or challenge gender power dynamics in policy reforms. The paper examines the place of informal networks and raises critical questions regarding ways in which women emerge as critical actors in securing and consolidating gender change, the strategies they draw upon to negotiate resistance, and whether the nature of policy reform influences the kind of resistance and (in effect) counterstrategies used to negotiate resistance to gender change. We also assess the implications these legislative processes have for activism around gender equity reforms. Findings indicate creative ways through which women draw on informal networks and networking practices to influence gender equitable change, often revealing the micro, subtly gendered dynamics that animate success or failure of a particular policy reform. We argue that the nature of policy reform, e.g. gender status policies or doctrinal policies, determines the nature and process of policy adoption.

Eric Mvukiyehe and Peter van der Windt.  2020.  “Assessing the Longer Term Impact of Community-Driven Development Programs: Evidence from a Field Experiment in the Democratic Republic of Congo.”  World Bank Policy Research working paper #9140.

Community-driven development programs are a popular model for service delivery and socioeconomic development, especially in countries reeling from civil strife. Despite their popularity, the evidence on their impact is mixed at best. Most studies thus far are based on data collected during, or shortly after, program implementation. Community-driven development’s theory of change, however, allows for a longer time frame for program exposure to produce impact. This study examines the longer term impact of a randomized community-driven development program implemented in 1,250 villages in Eastern Democratic Republic of Congo between 2007 and 2012. The study team returned to these villages in 2015, eight years after the onset of the program. The study finds evidence of the physical endurance of infrastructure built by the program. However, it finds no evidence that the program had an impact on other dimensions of service provision, health, education, economic welfare, women’s empowerment, governance, and social cohesion. These findings suggest that, although community-driven development programs may effectively deliver public infrastructure, longer term impacts on economic development and social transformation appear to be limited.

Cyril Brandt and Tom De Herdt.  2020.  “Reshaping the Reach of the State: The Politics of a Teacher Payment Reform in the DR Congo.”  Journal of Modern African Studies.

We analyse the politics of the reform of teacher payment modalities in the Democratic Republic of Congo (DRC) in light of the uneven territorial reach of the DRC state. The reform focused on extending this reach by paying all teachers via a bank account, replacing longstanding shared governance arrangements between state and faith-based organizations with a public-private partnership. By using qualitative and quantitative data, we map the political practices accompanying the implementation of the reform. While the reform itself was officially deemed a success, its intended effects were almost completely offset in rural areas. Moreover, governance of teacher payments was not rationalized but instead became even more complex and spatially differentiated. In sum, the reform has rendered governance processes more opaque and it deepened the existing unevenness in the geography of statehood.

Michel Thill and Abel Cimanuka.  2019.  “Governing local security in the eastern Congo: decentralization, police reform and interventions in the chieftaincy of Buhavu.”  Rift Valley Institute.  

In the Democratic Republic of the Congo (DRC or Congo), security governance is competitive, fragmented and marked by violence. Multiple actors—state and non-state—vie for influence and many areas of the country lack effective structures to ensure that their residents live in safety and security. In this context, the threat and use of violence has become central to the state’s efforts to maintain social control and public order. This tendency has come to shape the troubled relationship between Congolese citizens and the army and police, reflected in numerous fraught day-to-day interactions. Two ongoing processes— administrative decentralization and police reform—have been designed to turn a page on past practices, bring government and security closer to the population and, consequently, improve this relationship. While they have had some successes, they also risk the re-creation of existing governance dynamics within newly empowered local administrative and security-related entities.

Mary Hallward-Driemeier, Anna Kochanova, and Bob Rijkers.  2020.  “Does Democratization Promote Competition? Indonesian Manufacturing Pre and Post Suharto.”  World Bank Policy Research Group working paper #9112.  

Does democratization promote economic competition? This paper documents that the disruption of political connections associated with Suharto’s fall had a modest pro-competitive effect on Indonesian manufacturing industries in which his family had extensive business interests. Firms with connections to Suharto lost substantial market share following his resignation. Industries in which Suharto family firms had larger market share during his tenure exhibited weak improvements in broader measures of competition in the post-Suharto era relative to industries in which Suharto firms had not been important players.

Anne Buffardi, Samuel Sharp, Sierd Hadley and Rachel A. Archer.  2020.  “Measuring evidence-informed decision-making processes in low- and middle-income countries.”  Overseas Development Institute.

The evidence base on the practice of evidence-informed decision-making (EIDM) in international development is limited. Previous work has identified multiple roles that evidence could play; principles and desirable decision-making practices; and individual, interpersonal, organisational and contextual factors thought to influence the interpretation of evidence and decisions. Despite a proliferation of frameworks and guidance, there is a relative dearth of research on the extent to which and how they are applied in practice, at what cost and with what effects. EIDM faces measurement challenges, including investigation into largely undocumented and sometimes unobservable processes, multi-finality and equifinality (multiple pathways to multiple outcomes), often along extended time horizons, in addition to difficulties establishing counterfactuals. In the health sector, current indicators tend to cluster around two ends of a long change pathway: tracking upstream activities and immediate outputs, and downstream changes in health coverage and outcomes. Building on existing systems, future efforts could be directed at the ‘missing middle’ in measurement, filling notable gaps in defining what constitute quality EIDM processes, minimising biases in measuring these processes and investigating how evidence-informed recommendations make their way through the policy process.

Matteo Alpino and Eivind Moe Hammersmark.  2020.  “The Role of Historical Christian Missions in the Location of World Bank Aid in Africa.”  World Bank Policy Research Group working paper #9146.

This article documents a positive and sizable correlation between the location of historical Christian missions and the allocation of present-day World Bank aid at the grid-cell level in Africa. The correlation is robust to an extensive set of geographical and historical control variables that predict settlement of missions. The study finds no correlation with aid effectiveness, as measured by project ratings and survey-based development indicators. Mission areas display a different political aid cycle than other areas, whereby new projects are less likely to arrive in years with new presidents. Hence, political connections between mission areas and central governments could be one likely explanation for the correlation between missions and aid.

Abhishek Nagaraj and Scott Stern.  2020.  “The Economics of Maps.”  Journal of Economic Perspectives.  

For centuries, maps have codified the extent of human geographic knowledge and shaped discovery and economic decision-making. Economists across many fields, including urban economics, public finance, political economy, and economic geography, have long employed maps, yet have largely abstracted away from exploring the economic determinants and consequences of maps as a subject of independent study. In this essay, we first review and unify recent literature in a variety of different fields that highlights the economic and social consequences of maps, along with an overview of the modern geospatial industry. We then outline our economic framework in which a given map is the result of economic choices around map data and designs, resulting in variations in private and social returns to mapmaking. We highlight five important economic and institutional factors shaping mapmakers’ data and design choices. Our essay ends by proposing that economists pay more attention to the endogeneity of mapmaking and the resulting consequences for economic and social welfare.

Africa Update for February 2020

Here’s the latest edition of Africa Update!  We’ve got 1.4 million resumes to review in Nigeria, the (possible) end of tsetse flies, Kenya’s first online archive of LGBT+ life, anti-colonial acronyms, and more.

West Africa: Ghana is trying to raise US$3 billion in investment with a new bond targeted at the diaspora.  Unfortunately that money might go to vanity projects like replacing all of the country’s still-functional electronic voting machines. Burkina Faso is taking a big gamble in arming local vigilantes to fight Islamic rebel groups. Unemployment is a serious problem in Nigeria, where 1.4 million people recently applied for 5000 civil defense jobs.

Central Africa:  Rwanda is still trying to make English the official language used in schools, despite rich evidence that students learn best in the language they speak at home.  Rwanda is also locking up and abusing children living on the streets in the name of “rehabilitation.”  Burundi’s Pierre Nkurunziza isn’t running for president again in the next elections, but he is getting a golden parachute with a lifetime salary and a luxury villa after stepping down.

orthodox christmas
Loved this beautiful photo of an Ethiopian Christmas celebration, via Girma Berta

East Africa: Sudan is opening up its gold market and doubling civil servant salaries while slashing fuel subsidies in an attempt to jump-start its moribund economy.  Check out this a great cartoon about the upsides and downsides of urbanization in Ethiopia.  In Kenya, gambling is increasingly seen as a chance to learn a livelihood outside of state-funded patronage networks.  Kenya’s foreign policy towards Somalia has grown increasingly bellicose over recent years.  This was a heartbreaking piece about the civilians killed by US airstrikes in Somalia.

Southern Africa: A new law means that South Africa can block refugees from seeking asylum if they engage in political activism in their home countries.  Meet the activists fighting for the rights of domestic workers in South Africa.  In Lesotho, the prime minister has resigned after evidence came out that his current wife may have had his ex-wife murdered so that she could be the official First Lady.  The billionaire Zimbabwean owner of Econet is paying the country’s striking doctors to return to work out of his own pocket.  Zimbabwe has run out of money to deport undocumented immigrants, leaving many of them languishing in jail for months.  In a landmark ruling, the high court in Malawi has ordered the country to re-run its recent election.

taxes
Tax revenues are quite low in many African countries compared to the OECD average of 34% of GDP (via The Economist)

Politics & economics: Check out this interactive map of upcoming elections across Africa.  Here’s a good summary of the political history of African states before colonization.  What are some reasons to be optimistic about economic growth and life expectancy in Africa?  This is some useful background on West African countries’ plan to replace the CFA currency with the eco.  As transport routes with China are shut due to coronavirus fears, many Ugandan traders are also facing shortages of imported goods.

Environment & resources: Climate change is almost uniformly a bad thing, but one possible exception is that rising temperatures might kill off the tsetse fly and end the spread of sleeping sickness across Africa.  In Uganda, people in gold mining communities are being poisoned by the mercury used to refine the gold.  The DRC’s long-delayed Inga III mega-dam project has just been pushed further down the road with disputes among the major contractors about the dam’s design.

research
Research interlude: here’s some interesting data from Joy Owango

Health:  A new study in Liberia finds that motorcycles are still more efficient than drones for transporting medical supplies.  In Zambia, rates of stroke are rising as the population ages, but there are only five neurologists being trained to deal with this.  Meet the researchers who are coordinating the African fight against coronavirus at the Institut Pasteur in Senegal. This Nigeria researcher is working to develop anti-cancer drugs from indigenous African plants.

Gender: Meet 14 inspiring women in science from across Africa.  What can African governments do to reduce the burden of unpaid care work for women and girls?  Women who run for political office in Uganda can increasingly expect to face online harassment from men.  In Tanzania, women often don’t ask to use contraception because they feel that their husbands won’t approve.  Climate change might increase the risk of premature births in countries like the Gambia, where many women are subsistence farmers who work outside all day and can’t avoid increased temperatures.

colonization
BRB, ROFL, SMH (via Suhayl)

Globalization:  The Oxford English Dictionary is adding dozens of words from Nigerian English in recognition of the language’s global use.  Here’s how American consulting firms helped Angola’s Isabel dos Santos try to legitimize the money her family had corruptly acquired.  Meet the Soviet-era architects who shaped the visual landscapes of Accra and Lagos.  Read about the 10 critical issues which will shape China-Africa relations in 2020.  Here’s why the Gambian Minister of Justice sued Myanmar at the ICC to force the country to stop persecuting the Rohingya.

Culture: Check out KumbuKumbu, the first online archive of LGBT+ life in Kenya.  What are the top 10 things to know about getting young Kenyans engaged in politics?  This was a lovely essay about polychronic time-keeping and food in South Africa.  Meet the first professor with a PhD in African indigenous astronomy.  I can’t wait to watch the Netflix adaptation of Nnedi Okorafor’s Binti trilogy!

What’s driving the locust crisis in East Africa?

locusts-update
Mapping the spread of locusts, via The Independent

East Africa is currently dealing with giant swarms of locusts, which will descend on an area and eat huge amounts of vegetation before moving on to the next.  This poses an enormous risk to subsistence farmers in the region, only partially mitigated by the fact that it’s the dry season and the main crops aren’t growing yet.  According to Cyril Piou at The Conversation,

As a rough estimate, a swarm of one billion insects covers approximately 20km² and will eat 2000 metric tons of vegetation each day. In the past few weeks, parts of Kenya have received swarms that cover more than 100km², so their feeding will have been devastating.

Where are the locusts coming from?

The current invasion of desert locust originated along the Red Sea, in Yemen and Oman, during the 2018 to 2019 winter. The rains, brought by the October 2018 cyclone Luban, produced areas full of vegetation where the locusts could feed, breed and [seek additional food].

From January 2019, small swarms spread in the Arab Peninsula, along the Red Sea and even reached Iran and Pakistan. Other swarms stayed in the Arab Peninsula where they reproduced and multiplied.

In June, the locusts crossed the Red Sea or the Gulf of Aden, which is just a few hours of flight for the locusts, and started to spread into the Horn of Africa. They invaded the North of Somalia and Ethiopia where floods in October and November created good conditions for desert locust to continue to multiply. The large swarms that have invaded Kenya since December are a result of this.

It’s possible to use ground surveys and satellite data to find the locusts when they’re young, before they start swarming, and kill them with targeted applications of pesticides.  Once they’ve begun to swarm, the only control option is spraying pesticides across the entire affected area, which is much worse for the ecosystem.

This is ultimately a crisis of state capacity.  Yemen and Somalia are particularly poorly placed to undertake preventative work.  Northern Kenya receives a small fraction of state funding compared to the central regions, and the government’s response to the 2019 drought and famine in the region was slow and entirely lacking in transparency.  There’s not much reason to hope for a more proactive response to locusts.

The Kenya-Uganda dairy war continues

USAID Measuring Impact Conservation Enterprise Retrospective
Ugandan farmer Simeo Ntawuruhunga stands next to one of his dairy cows (via USAID)

For two countries nominally in the same free trade area, Kenya and Uganda spend a lot of time squabbling about agricultural exports.  The latest front is milk exports, where Kenya has been blocking Ugandan imports over claims that Uganda actually lacks the capacity to produce enough milk to export, and has been relabeling foreign milk powders instead.

David Ndii has an insightful take on this issue at The Elephant.  He notes that the real issue in Kenya is politics, not economics.  The country’s largest milk producer, Brookside Dairy, is owned by the family of the president, and has raised consumer milk prices by nearly 100% over the last decade. This has attracted the attention of Ugandan exporters.  As he writes,

More fundamentally, why the Kenyan market is attracting Ugandan milk has little to do with Uganda’s demand-supply balance, and everything to do with Kenya’s consumer price. As observed earlier, the retail price of processed milk has doubled from Sh65 to Sh120. In Uganda, a litre of processed milk retails at between USh2,800 and USh3,000 which translates to an average of Sh80, i.e. Sh40 per half-litre packet, compared to Sh60 in Kenya. Ugandan producers are not obliged to satisfy their domestic market when a more profitable market is available across the border. If consumer prices had increased at the rate of inflation faced by Kenyan manufacturers, as measured by the producer price index (2.5 per cent per year), the retail price in Kenya today would be in the Sh70-75 range, which is well below the Uganda retail price.