Africa's Hidden Victims:

Healthcare Workers Struggled Amid Lack of PPE, Salary Delays, and Disappearing Hardship Pay

By Patrick Egwu, Linus Unah, Sally Hayden, and Maurice Oniang’o

Africa’s Hidden Victims was produced and co-published in collaboration with Journalists for Transparency, a project of Transparency International, and is being co-published with 100Reporters and Africa.com.

Every morning during the coronavirus pandemic, Mpho Mokgotsi feared leaving her home for work at Hillbrow Community Health Centre in Johannesburg, a hospital and testing centre for Covid-19 in Gauteng province.

Back in April 2020, the 55-year-old nurse became infected while responding to Covid-19 patients at the hospital. Mokgotsi was transferred to Baragwanath Hospital in Soweto, Africa’s largest hospital with about 7,000 staff and 3,500 beds. Two weeks later, two of her children tested positive for the virus.

“It was one of the worst fears of my life,” she said.

The burial of a coronavirus victim is carried out by a healthcare team wearing protective gear in Gulu, Northern Uganda. Photo by Sally Hayden.

Over the last year of pandemic, historically underfunded health systems in parts of Africa stretched to the breaking point under the strain. In many cases, frontline health workers lacked adequate protective equipment for much of the pandemic, putting their lives at risk. They faced long hours–with some working 14 days straight–without insurance or employment benefits. When they did contract Covid-19, healthcare workers complained, they were left to fend for themselves, in the absence of dedicated facilities for their treatment.

To date, the African continent has counted 5.36 million cases and 140,000 deaths, though medical workers say the real figures are likely far higher, as a dearth of tests left victims uncounted.

Dennis Cheruiyot, who works in the clinical office in Uasin Gishu District hospital in Kenya’s Rift Valley, said that early on, health workers in the isolation ward had to work 14 days without a break, deeming the conditions “a great injustice to us.”

According to Kenya’s Ministry of Health, by January, more than 3,068 healthcare workers had been infected with Covid-19 while 32 had died.

Robert Ugwu, head of resident doctors at the University of Abuja — Nigeria’s capital city — reported that “the situation was actually very terrible” and that protective gear including

head covers, face masks, gowns and boots were “grossly inadequate,” forcing many doctors to attend to patients with little protection.

Doctors, he added, see their work as a calling and “just have to do what they can do to actually save life.”

A frontline worker who handled patients in intensive care units in a large Covid-19 facility in Abuja said PPE were “heavily rationed” outside the Covid-19 facilities. The health worker spoke on condition of anonymity, citing fear of retaliation for speaking to journalists.

As the population of patients increased, the doctor to patient ratio ballooned. We have a problem with human resources. We have a problem with financial resources.

Santos Okot Lapolo
Task Force Chairman and President's Representative in Gulu

Uganda’s first Covid-19 death was only confirmed in July 2020, with the number of cases staying relatively low, but the country still struggled.

Healthcare staff remained desperate for more protective gear, vehicles and fuel, thermometers, and ICU beds. Uganda had only 55 ICU beds in total, for a population of roughly 44 million people, at the beginning of the outbreak.

The situation in Gulu, a city in Uganda’s impoverished north, epitomized problems in the healthcare system. Staff there worked for months on end without salary. The government initially hospitalized both suspected and confirmed cases of Covid-19. Patients complained that hospitals lacked food and water. Some tried to escape simply to avoid starvation.

In September last year, Gulu’s hospitals ran out of space and started rejecting patients. Desperate victims of the virus “are calling me left and right,” with some threatening to commit suicide, one member of the city’s coronavirus task force wrote in their group WhatsApp at the time.

Santos Okot Lapolo, the task force chairman and the president’s representative in Gulu, called the city “the epicenter” of the crisis in September 2020, because it was receiving patients found to be positive during mandatory testing at the South Sudanese border.

“We are overwhelmed, we are overwhelmed,” he said. “The treatment center is full.” As the population of patients increased, the doctor to patient ratio ballooned.

“We have a problem with human resources. We have a problem with financial resources,” Lapolo said. “Kampala sent us some support but it’s not reaching expectations.”

Lapolo would later die of coronavirus himself.

As of December 2020, over 38,000 healthcare workers in South Africa had tested positive for the virus, with more than 390 dead, according to President Cyril Ramaphosa.

Corruption has aggravated the risks for healthcare workers. In South Africa, politicians and companies close to the ruling party have recently been implicated in tender and contract scams linked to the supply of PPE and other medical supplies, with several suspended as a result.

In Kenya, 15 senior officials at the Kenya Medical Supply Authority (Kemsa), the government agency mandated with procurement and distribution of supplies to public hospitals, came under investigation over the alleged misuse of more than 7.8 billion shillings (USD $71 million) earmarked for treating Covid-19.

A medic sits at a checkpoint between Uganda and South Sudan, where truck drivers have their temperature taken before moving on for a coronavirus test. Uganda closed its borders in March 2020 to everyone except cargo planes and truck drivers. Photo by Sally Hayden

“It is not surprising that it happened because the system itself is very weak and vulnerable to corruption,” said Kavisha Pillay, the head of stakeholder relations and campaigns at Corruption Watch, a South African anti-corruption organization. “And our procurement systems, not just within the health sector but all sectors, are particularly vulnerable.”

Pillay said the pandemic has exacerbated the inequality within the public health system. Early on , Corruption Watch raised concerns that corrupt officials might exploit the pandemic to their personal advantage.

“Definitely health workers are the ones at risk because they don’t have the proper equipment to work with or proper supplies and infrastructure,” said Pillay, who has been monitoring Covid-19-linked corruption with her team.

Pillay’s organization also works with law enforcement agencies and the office of the auditor general to take action on corruption related to Covid-19. In July 2020, public officials and private contractors were arrested by security agents over fraud in the procurement of PPE for health workers in the frontlines of the Covid-19 pandemic.

“The issues are still here with us and it doesn’t quite seem like it’s going away anytime soon,” Pillay said. “When we talk about these things [corruption] and no one is prosecuted and made to pay, then we haven’t really done much and that’s why we have to keep looking into their activities as the pandemic goes on.”

More than one year after the outbreak of the pandemic, cases of corruption around Covid-related issues are still emerging. A report released in April by the Financial Transparency Coalition [FTC], a coalition of civil societies working to end illicit financial flows, reveals a broad lack of accountability in the use of Covid emergency funds.

A truck driver is tested for COVID-19 on the border of Uganda and South Sudan. Photo by Sally Hayden

Nine countries – South Africa, Sierra Leone, Kenya, Bangladesh, India, Nepal, Honduras, Guatemala, and El Salvador – were surveyed in the report, which showed that an average of 63 percent of Covid funds went to big corporations while just 2 percent of Covid emergency funds were allocated to the informal sector, even though they make up the workforce.

Peggy Pillay (no relation to Kavisha), convener of Johannesburg Against Injustice, whose group has led protests on Covid corruption, said frontline health workers “are sacrificing everything” to save lives and so their health and “welfare must be prioritized.”
Those found guilty of corruption related to Covid should face prosecution and punishment, she said, adding, “Our children and the future generation deserve better.”

South Africans are growing frustrated with the unchecked corruption, and are increasingly disillusioned. “And now with the pandemic raging, what we have seen is that corruption is increasing,” she said.

The corruption and perilous working conditions that led health and trade unions in the country to walk out in October last year have not abated.

The pandemic exacerbated chronic understaffing in the health sector, said Khaya Xaba, the national spokesman of the medical workers union in South Africa. Healthcare workers “are losing their lives and getting infected by the virus on a daily basis,” he said.

While Mokgotsi and her colleagues have seen improved welfare packages, including the payment of their hazard allowances and provision of PPE at the hospital they work in, unions representing healthcare workers in Limpopo, the northernmost part of South Africa, were only able to fend off government budget cuts to the region’s health budget by threatening to strike.

Nathan Onyachi, the Director of Gulu Regional Referral Hospital, Northern Uganda, where Covid-19 patients went on strike at conditions. Photo by Sally Hayden

Incensed by a rise in deaths among healthcare workers, lack of protective gear and the absence of insurance to cover frontline health workers, nurses and clinical officers in Kenya downed their tools in early December 2020. Doctors also joined other healthcare workers on strike two weeks after their attempt in negotiation with the government failed. After 70-days of protest, the workers called off the strike in February.

The government had promised allowances to healthcare workers during the pandemic period. But healthcare workers have faulted the criteria used to give the allowances, which were only disbursed for three months.

The danger is hardly over, as South African braces for a threatened third wave of the pandemic. Just 2.23 million people, under four percent of the population, have received at least one dose of vaccine, but the government prioritized healthcare workers as it rolled out the vaccine.

At least now, Mokgotsi said, “you can be confident and assured while leaving your home for work.”

However, Mokgotsi has lost several colleagues to COVID-19.

“We put our lives on the line when people are at home with their families,” she said. “We are here to save lives and it looks as if nobody cares about us.

“If we are really essential workers, they should treat us that way,” she said.

“We put our lives on the line when people are at home with their families. We are here to save lives and it looks as if nobody cares about us.”

Africa’s Hidden Victims was produced and co-published in collaboration with Journalists for Transparency, a project of Transparency International, and is being co-published with 100Reporters.

Africa's Hidden Victims is a three-part series on the collateral victims of a health care crisis, with reporting from four countries.

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