If African Governments Won’t Act, the People Will

On April 14, Ugandan President Yoweri Museveni announced he was adding three weeks to the country’s initial two-week lockdown. The restrictions were among the strictest on the continent—dusk-to-dawn curfews, public and private transportation grounded, the closure of all but the most essential businesses—but Museveni insisted the additional time was needed to “help us to defeat this virus decisively or, if not defeated totally, to prepare better as to how to cope with it.” Leaders across sub-Saharan Africa have taken the same gamble, calculating that their citizens’ threadbare resources could last long enough to give officials the time they need to slow the spread of the virus and cobble together a more sustainable response. And they seem to have widely succeeded, at least in gaining the first objective. There is an emerging consensus in the region that the early lockdowns successfully reduced the number of new infections and clearly communicated the seriousness of the pandemic to citizens—particularly in communities dangerously short on health workers and hospital equipment.

But as the weeks drag on and restrictions are lifted slowly, if at all, desperation has grown and so has people’s outrage. Demonstrations have sprung up in Zimbabwe and Uganda, as citizens protest their government’s failure to support them through the lockdowns. The early lockdown orders often overlooked the needs of the sick, the pregnant, and the large portions of the population dependent on wages from informal jobs to feed their families. It didn’t help that many countries enforced their lockdowns with guns and tear gas. “There is this adoption of what is going on outside Africa—locking down economies, leaving the essential businesses to run—but you have to have a strategy to ensure your citizens are able to feed themselves amidst the lockdown,” said Lynda Iroulo, a research fellow at the GIGA Institute for African Affairs in Hamburg, Germany. In too many places, that strategy was slow to materialize, leading global officials to warn of worst-case scenarios that involved dozens of countries descending into famine.

The repeated extensions, like Uganda’s, signal something more alarming: a breakdown in the agreement citizens thought they were entering with their governments when the lockdowns began—that officials would take extraordinary measures to lessen the costs as rapidly as possible. Instead, community leaders in countries as varied as Kenya, Nigeria, Uganda, and Zimbabwe worry that their governments have arrived at the limits of their lockdowns without workable next steps. They accuse their governments of prolonging lockdowns—inadvertently spurring widespread hunger, fueling domestic violence, and reversing hard-won gains against other infectious diseases, such as tuberculosis and malaria—without capitalizing on that time to examine early data and develop strategies that would allow a return to relative normality while containing the spread of the coronavirus.

That means millions of Africans may soon emerge from lockdowns poorer, hungrier, and at no less risk of contracting COVID-19 than when they entered. This fear is compounded by the worsening situation in countries like Ghana, which actually had cohesively mapped out the next phase of its response. Cases there have spiked from 1,042 on April 19, the day before restrictions eased, to 6,269 a month later.

In response, local nonprofits and community groups are increasingly marshaling their own resources to meet the mounting needs of their members. These informal services they provide—from delivering hot meals to medicine—are far from comprehensive and are a struggle to sustain, but they are critical not only to rescue the most vulnerable but as a form of activism that allows them to set the terms for what a localized response should look like.

Milly Katana, a Ugandan public health expert, long fought for access to lifesaving antiretroviral medicine for HIV patients. The region has a history of community-led responses, pressuring governments to expand proven treatment strategies and ensuring marginalized groups were not excluded from services, and Katana is certain the most successful coronavirus responses will follow a similar script.

“People will come and be at the forefront of advocating for better management of the disease,” she said.

A new blueprint endorsed by the World Health Organization (WHO) attempts to help guide countries toward this next phase, describing a general trajectory that includes rapidly increased testing, which could inform localized strategies to respond to specific transmission patterns, while lifting the broader restrictions causing unintended harms. South Africa and Ghana have provided early examples of how to translate this template into actual policies.

When Ghana locked down its two major cities, Accra and Kumasi, in late March, officials began rapidly ramping up testing for the virus and tracing of people who had come into contact with those infected. That gave the government the confidence to begin easing the lockdown on April 20, well ahead of much of the rest of the subcontinent. South Africa, which is currently in the midst of a phased easing of its own shutdown—which began March 26—has also unveiled a $26 billion stimulus plan it hopes will reverse some of the harm done by its restrictions. To help fund it, the government has approached the International Monetary Fund for the first time—the country should be eligible to apply for more than $4 billion in financing.

Current shortcomings reflect decades of underinvestment in the health sector, leaving it to communities to figure out how to cope with the consequences of understaffed health centers and shortages of essential medicines. Though it is too early to say if the approach in Ghana or South Africa will actually work, the pressure for more governments to adopt comprehensive post-lockdown strategies has increased amid evidence that without a vaccine COVID-19 could “smolder in transmission hotspots” for years, according to Matshidiso Moeti, WHO’s regional director for Africa. She said countries like Cameroon, South Africa, and Algeria, but also smaller nations, will need to be able to rapidly detect and contain flare-ups or risk seeing their health services regularly overwhelmed with COVID-19 patients. The regimes dragging their feet fret about overstretched domestic resources and warn they can get little help from international bodies at the moment. But the current shortcomings also reflect decades of underinvestment in the health sector, leaving it to communities to figure out how to cope with the consequences of understaffed health centers and shortages of essential medicines.

Activists in the countries that are struggling to emerge from lockdowns warn that the regimes are throwing together piecemeal approaches that threaten to leave swaths of people stranded.

In Zimbabwe, where the government has twice extended the country’s lockdown, officials announced this month that businesses could reopen but only after all of their employees had been tested. While government tests are available, Jestina Mukoko, the chairperson of the Zimbabwe Human Rights NGO Forum, said the reality is that the burden of paying for the testing is falling on the businesses and the fear is they will push it to their employees—an impossible burden in a country where large numbers can barely afford to buy food. The country’s vast informal sector, meanwhile, remains shuttered.

In Kenya, the security services threw people into quarantine centers if they exhibited symptoms or if they broke curfew. They eventually emerged with outsized bills for the cost of the stay in cramped, unsanitary quarters. And in Uganda, the government mandated that people wear masks when they leave their houses—but without providing supplies to already overstretched citizens. Museveni’s administration has since announced it will provide people with masks, but the process could take weeks.

They are not the only governments that are floundering. Administrations from Mozambique to Togo have struggled to identify a post-lockdown strategy. In its place, however, spontaneous, uncoordinated community efforts to address specific problems have emerged.

The outset of the pandemic was marked by innovations or interventions to meet the emerging understanding of the virus and the risks it posed. Markets were rearranged to reduce the risk of exposure, and tailors began stitching together masks. Even in Ghana and Liberia, where governments mounted more aggressive responses, universities started producing hand sanitizer to supplement those efforts.

As the crises have multiplied amid the lockdown, interventions across the subcontinent have expanded to include food delivery and cash transfers for the most vulnerable. In Uganda, a network of young HIV activists are filling dwindling ARV prescriptions for patients trapped in their homes. In Zimbabwe, one woman living on the outskirts of the capital, Harare, is running an informal kitchen feeding dozens of people each day. Even in South Africa, where the government has done more to strengthen the social safety net than most, some people are still facing dire food shortages, which has spurred solidarity networks to help feed those most in need.

As the crises have multiplied amid the lockdown, interventions across the subcontinent have expanded to include food delivery and cash transfers for the most vulnerable. The Mombasa-based NGO Muslims for Human Rights, known as Muhuri, had a coronavirus crisis management team organized before the virus even reached Kenya, said Abubakar Zein, the executive director. A day after the first case was confirmed, Muhuri was ready to begin assisting anyone who needed help in the districts where it worked, primarily in the country’s Coast Province along the Indian Ocean. Its early focus was on improving sanitation in areas where clean water was a luxury—so it distributed small water tankers alongside messages about hand-washing.

Even as Muhuri’s activities have grown to include transferring cash to the most vulnerable and monitoring human rights violations, Zein acknowledges the scale of Kenya’s need overwhelms what his organization can offer even in the seven districts where it works.

It is a pattern playing out across the continent. Organizations and individuals can supplement government programs; they cannot replace them. But “in showing how it can be done, it’s agenda-setting,” Zein explained. That agenda is to constantly remind the government of its obligation to protect its citizens.

Already, the community groups have made progress on that front. Amid public pressure and the threat of a court case, the Kenyan government ended its policy of charging outrageous fees for its enforced quarantines. In Zimbabwe—where few citizens knew how to access coronavirus treatment—Mukoko’s network convinced officials to compel the national broadcaster to regularly provide this information. Another Kenyan NGO, the Green String Network, replaced early posters the government had created warning about COVID-19, which were adapted from other countries, with more culturally appropriate messages.

“We don’t have enough resources to resolve most of our problems,” Zein said. “But we have enough intellectual input and persuasion to ask important questions and influence people to think like us.”

They also have the lessons of earlier social movements to draw on, particularly the push by Katana and other activists to overcome HIV denialism or government disinterest and expand testing and access to lifesaving treatment regimens. Like those earlier generations, Zein said, community-based groups are prepared to leverage whatever is necessary—demonstrations, lawsuits, pressure from international allies—to compel faltering governments toward a compassionate, comprehensive strategy and to ensure more than misery emerges from the lockdowns.