COVID-19 in low- and middle-income countries. It's time to take action.

It’s been more than six months since the novel coronavirus was confirmed in Wuhan, China, and more than three months since the World Health Organization (WHO) declared a global pandemic. We first published a call to action on March 17 when 179,111 cases and 7,426 deaths had been confirmed. Since then, more than 10 million cases have been confirmed and more than 500,000 people have died as a result of the virus.¹

Although some countries appear ready to move on from the virus (despite encouragement from public health experts to maintain efforts to reduce its spread), others are just beginning to feel its effects. Cases are rising in many low- and middle-income countries (LMICs), exacerbating the widespread harm already caused by preventive lockdowns and a global recession.

World Bank economists predict that the pandemic will push 71 million people into extreme poverty, resulting in the first increase in global poverty since 1998, alongside dramatic deteriorations in LMICs’ economic growth.

While many experts believe that COVID-19 is likely to cause more suffering in LMICs than in high-income settings, the philanthropic response has not adequately reflected this distribution of impact. Over 74 per cent of the philanthropic funding compiled by Candid has been granted to organizations in high-income countries.² This means that there are outstanding opportunities for impact-oriented philanthropists to help people in LMICs.

In this blog, we categorize the impacts of COVID-19 in LMICs into three main themes: direct health effects, indirect health effects and economic effects. We look at how different countries have been impacted by the pandemic and highlight the best opportunities we’ve found for philanthropy to make a meaningful difference.

Direct health effects

Whilst LMICs appear to have some advantages when it comes to fighting a pandemic, including relatively younger populations³ and past experience in managing contagious outbreaks such as Ebola, they also face distinct challenges.⁴ These include relatively limited health system capacity,⁵ populations that may have weakened immune systems due to illnesses like malnutrition and diabetes,⁶ and lower trust in public health authorities.⁷ For instance, the average number of doctors per 10,000 inhabitants is 37 doctors in Europe compared to less than 1 in Africa.

Testing is also low and uneven across regions and countries.⁸ This makes it challenging to understand the true burden of COVID-19 across and within countries, reducing the ability of governments and other actors to allocate resources where they are needed most.

Countries affected by ongoing conflict and with large populations of displaced individuals may be particularly vulnerable. In places like Syria and Yemen, humanitarian assistance is desperately needed.

One highly impactful NGO tackling this issue is the International Rescue Committee (IRC). IRC has a strong track record of providing humanitarian aid and relief to vulnerable populations, including experience fighting Ebola in African countries. Founders Pledge recently hosted a conversation with David Miliband, the IRC’s President and CEO, to learn more about how COVID-19 is affecting fragile settings and how the IRC is responding to the pandemic. Listen to the recording here.

Indirect health effects

While global attention is focused on combating COVID-19, it’s vital not to lose sight of other health burdens. Roberton et al. (2020) estimate that hundreds of thousands of children may die in low- and middle-income countries as COVID-19 reduces access to and demand for routine health services.⁹ Public health officials fear a surge in preventable diseases including measles, polio and cholera.

The WHO warns that disruptions to anti-malarial programs, if all bed net distribution were halted and access to medication fell drastically, could mean that deaths from malaria double and rise to levels not seen in 20 years. Fortunately our recommended charities, Against Malaria Foundation and Malaria Consortium, with robust distribution networks and relationships with local partners, are still working to deliver life-saving interventions across Africa and Asia.

With COVID-19 creating widespread fear, anxiety and isolation, mental health issues have also escalated, especially for those already facing precarious livelihoods. StrongMinds, our recommended charity for mental health, has adapted its programs in Uganda and Zambia to deliver teletherapy sessions, public education campaigns and digital messaging tools. StrongMinds have also prioritized data collection and monitoring to ensure that these new digital tools are effective now and can be incorporated into post-COVID programming to reach many more individuals.

Economic effects

The economic effects of national and global shutdowns have already led to reductions in household incomes¹⁰ and food security.¹¹ Governments tasked with supporting hundreds of millions of newly unemployed workers must do so with severely constrained resources.

There are several reasons for these effects. First, capital inflows have dramatically decreased. Remittances to LMICs are projected to fall by 19.7 per cent, from $544 billion in 2019 to $445 billion in 2020, reducing the income of many vulnerable households. At the same time, foreign direct investment is predicted to decrease by by 35 per cent.

Second, many LMICs are reliant on exports such as commodities and tourism. Exports comprise 25 per cent of sub-Saharan Africa’s GDP and 80 per cent of its goods and services are exported to the rest of the world. Flower sales have collapsed in Kenya and Ethiopia; tourism in places like the Bahamas and the Maldives (accounting for 70 per cent and 28 per cent of GDP, respectively) has been decimated; and declining commodity prices have raised concerns about the many countries that rely on exports of raw materials.

Third, employment in the informal sector is extremely high (informal workers comprise about half of Latin America's workforce) and these individuals are largely excluded from government recovery programs. According to the United Nations Development Programme (UNDP), 55 per cent of the world's population lack access to social protection and income losses may exceed $220 billion in LMICs.

Fourth, it’s important to bear in mind that vulnerable individuals likely cannot abide by strict social distancing and lockdown rules. For many, the desperate need to earn a daily income and access food outweighs the risks of contracting a disease by not social distancing. Stories from India show that many are more concerned about hunger than the virus when faced with strict lockdown measures. Due to this, lots of our recommended charities have integrated interventions to fight malnutrition using key community workers - one such example is Helen Keller International. We also believe a particularly cost-efficient donation opportunity in India is the Mahila Sewa Housing Trust, which provides a family with one month’s rations and sanitation supplies for about $20.

These economic ramifications will be felt both in the short-run and long-run. While economic growth is deteriorating as we speak, LMICs will also experience set-backs in human capital and infrastructure, which may hinder long-term potential for economic development. In addition, the economic effects will have implications for the stability of governments that require sustained economic growth to maintain legitimacy.¹²

Overcoming the challenges

The case numbers suggest that, even as most high-income countries have bent the curve, the COVID-19 pandemic is on an upward trajectory in many LMICs. These countries were already vulnerable due to smaller government budgets, lower health system capacity and large populations of informal workers. Now they face a triple threat of direct health effects, indirect health effects and severe economic shocks from the global recession. And yet more than 70 per cent of philanthropic activity has focused on combating COVID-19 in wealthier countries. Impact-minded philanthropists can take action by leveraging their resources to provide critical healthcare and economic relief for the global poor.

Although the challenges are daunting, they are not insurmountable. As co-managers of the Founders Pledge Global Health & Development Fund, we dig into the complex issues surrounding global poverty to identify opportunities where funding can lead to substantial improvements in the lives of the world’s most vulnerable individuals. It is crucial to recognize the specific challenges facing each context so that we can understand where philanthropy can make the greatest difference.

It is important to note that we have not reviewed the organizations highlighted in this blog specifically for their work on alleviating the effects of COVID-19. Our recommended giving opportunity for COVID-19 response efforts is the COVID-19 Global Impact and Innovation Fund, which is designed to achieve impact in line with evolving global needs.

Notes

1. Johns Hopkins Center for Systems Science and Engineering, “COVID-19 Map,” Johns Hopkins Coronavirus Resource Center, accessed June 19, 2020, https://coronavirus.jhu.edu/map.html. ↩

2. Note that this does not account for the funding categorized as “unknown recipient” or “multiple recipients,” and may underestimate the funding disbursed outside the United States. Candid provides information on its sources here. ↩

3. The median population age is 20 in Sub-Saharan Africa and 29 India, compared to 38 in the US and 40.5 in Britain. Current data suggest that the fatality rate of COVID-19 increases with age, implying that countries with younger populations may be relatively less affected. However, these statistics come from higher-income countries where co-morbidities are less prevalent than they are in LMICs, so speculation that the fatality rate will be lower is highly uncertain. ↩

4. Kevin Watkins, “Africa Faces a Catastrophe to Dwarf Others,” Financial Times, March 20, 2020, https://www.ft.com/content/d8891a18-6fbf-4462-9b9c-4aefe20733e9. ↩

5. Elizabeth E. Cameron et al., “Global Health Security Index” (Nuclear Threat Initiative, Johns Hopkins Center for Health Security, and Economist Intelligence Unit, October 2019). ↩

6. Selene Ghisolfi et al., “Predicted COVID-19 Fatality Rates Based on Age, Sex, Comorbidities, and Health System Capacity,” preprint (Public and Global Health, June 7, 2020), https://doi.org/10.1101/2020.06.05.20123489. ↩

7. Amy S. Patterson, “The Coronavirus Is about to Hit Africa. Here Are the Big Challenges.,” Washington Post, February 18, 2020, sec. Monkey Cage, https://www.washingtonpost.com/politics/2020/02/18/coronavirus-is-about-hit-africa/. ↩

8. Matthew M. Kavanagh et al., “Access to Lifesaving Medical Resources for African Countries: COVID-19 Testing and Response, Ethics, and Politics,” The Lancet 395, no. 10238 (May 30, 2020): 1735–38, https://doi.org/10.1016/S0140-6736(20)31093-X. ↩

9. Timothy Roberton et al., “Early Estimates of the Indirect Effects of the Coronavirus Pandemic on Maternal and Child Mortality in Low- and Middle-Income Countries,” Preprints with The Lancet, April 21, 2020, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3576549. ↩

10. Akhand Tiwari, Rahul Chatterjee, and Graham A. N. Wright, “Coping with COVID: A Story That Focuses on the Low and Middle-Income Segments and Their Remarkable Achievements, Underlying Challenges, Shocking Misery, and New Opportunities amid COVID-19,” https://www.microsave.net/wp-content/uploads/2020/06/Coping-with-COVID-19.pdf. ↩

11. United Nations, “The Impact of COVID-19 on Food Security and Nutrition” (United Nations, June 2020), https://www.un.org/sites/un2.un.org/files/sg_policy_brief_on_covid_impact_on_food_security.pdf. ↩

12. Institute for Economics & Peace, “COVID-19 and Peace” (Institute for Economics & Peace, June 2020), http://visionofhumanity.org/app/uploads/2020/06/COVID19-and-Peaceweb.pdf. ↩