By Peete Molapo
The Covid-19 pandemic has all the trappings of a black swan event. It has upended everything. Despite some positive interventions in the form of new vaccines, there is still no sign the pandemic will soon go away. Wave after wave of highly contagious new variants are now becoming a norm. Lesotho is now in the midst of a third wave. Although I am an optimist that sooner than later this runaway disease will be stopped in its tracks, a lot of damage will have been inflicted, especially in those countries that are ill-prepared for it. Experience from elsewhere shows that preparedness for Covid-19 revolves around three strategic areas: saving lives, safeguarding livelihoods, and maintaining macroeconomic stability. It is around the first two areas I would like to assess Lesotho’s preparedness for Covid-19 based on the limited information I managed to gather. Issues around macroeconomic stability will be considered later.
The National Covid-19 Secretariat (NACOSEC) report of 30 June 2021 on the situation of Covid-19 in Lesotho shows that since the beginning of the pandemic the country has had 11 283 positive cases, 6 447 recoveries, 329 deaths and 109 886 tests conducted. According to the report, the infection rate currently stands at 1, 9 percent and by end of June there were no new recoveries or new deaths reported. There is still yet no new update. The positivity rate that reached peaks of 25 percent and 47 percent in the first and second waves respectively, had dropped to zero on average between April and June 2021 but the testing ratio was a paltry 5, 6 percent of the susceptible population. Despite the three months respite, all signs are that this insidious disease is once again rearing its ugly head. As I am writing this paper people are now being infected and dying in numbers in neighbouring South Africa and transmission into Lesotho including new deaths now happening. It is no more an issue of harrowing statistics alone but of people we know as relatives and friends passing on almost daily.
My greatest worry is whether or not Lesotho is prepared for the third wave. This against the backdrop of muddling around in the preceding waves. In any situation of uncertainty, a minimum level of preparedness is required. Based on experience of the past two episodes I am the opinion that Lesotho is one of the least prepared countries in the region to face the pandemic. In the first wave it was the first country in the region to declare a total lockdown even before it had the first case of infection. Some people even complained that the response was premature and uncalled for while others like me were of the view that the initiative demonstrated foresight and decisiveness of government to pre-emptively take position against the dreadful novel virus. No sooner, I took umbrage at noticing total bafflement by authorities to even lay down the basic institutional framework for management of the impending crisis. In the ensuing confusion there were accusations and counter-accusations about corruption and diversion of funds to activities that had nothing to do with the pandemic like the enjoyment of sumptuous meals.
The private sector attempted to come to the party but had to retract due to lack of transparency and direction from government. Bewildered and at a loss, the hapless nation helplessly stood and watched the unfolding saga. When the storm eventually struck, there was total pandemonium. People got infected and so many died, I would say gratuitously, because of government dawdling. Among the fundamental obligations of government enshrined in our constitution is the right to life and protection of health. It is the duty of our government to save Basotho lives from any form of danger at any time. When people died because of lack of basic equipment like oxygen and availability of beds, let alone the more expensive stuff like ventilators, one started to wonder whether the political leadership is aware of its responsibility.
As if rubbing salt into the wound, the new year ominously welcomed us with the second wave. In likeness with the first wave which was fuelled by Easter holidays, the main culprit this time was the influx of people flowing into Lesotho from South Africa for Christmas holidays.
I would say authorities were again caught napping as thousands of Basotho entered the country at formal and informal entry points without being tested. We all witnessed very embarrassing and surrealistic scenes when Basotho drowned trying to cross flooded rivers on matrasses.
There was zilch coordination between Lesotho and South Africa. While our government advised Basotho to enter the country freely through formal entry points without any restrictions, South African authorities on the other hand apprehended them for lack of travel documents and other crass considerations. It is common knowledge that Basotho were callously treated. Consequently, many people preferred to cross at informal entry points without being screened or tested.
It is also instructive to note that so many Basotho were mercilessly fleeced of their hard-earned money by unscrupulous border control officers who used the opportunity for rent-seeking.
Immediately after all these, the whole country plunged into a second wave. Compared with the first wave which peaked with 382 confirmed cases per day, the second wave set a highest peak of 3,181 new cases per day. Just as it happened in the first wave, the majority of sick and infected people were left to their own devises.
Many people resorted to traditional and other informal curative medications from which they expected to find help. Coordination and communication channels between government agencies dealing with the pandemic and the people were nowhere near effective.
Many people lost lives due to lack of trained personnel, oxygen, ventilators, poorly equipped Covid-19 treatment centres and lack of information about where to find help. Those who could afford sent their patients to Bloemfontein while those who could not, faced a natural death sentence if not lucky to survive. During this time Covid-19 demonstrated yet again the glaring gap between the haves and the have-nots in Lesotho.
The foregoing serves to demonstrate that generally, the handling of the Covid-19 pandemic in Lesotho has been poor. By now lessons must have been learnt on how to pull up our socks. In line with the internationally accepted practice, my advice to government in handling this pandemic is to urgently put its act together in the following well known key intervention areas.
Effective prevention of the disease – In order to achieve what is now termed ‘’flattening the curve’’ containment of the disease has been achieved through isolation, contact tracing, social distancing, quarantining, surveillance and detection, as well as aggressive vaccination. Protocols have been developed in Lesotho for these responses or strategies.
Unfortunately, implementation has been and continues to be very weak. A lot of work still needs to be done in this area including making it legally binding to wear masks in all public places. Enforcement of protocols happens to be the challenge and this poses a high risk of infection. Besides the above strategies, one very important strategy to contain the contagion is effective border control. By virtue of its coterminous border with South Africa, Lesotho is very vulnerable to transmission of all forms of disease from that country. All Covid-19 pandemic waves have started in South Africa before afflicting Lesotho. As long as there is laxity in enforcing protocols and no effective strategy for controlling our borders, especially the informal entry points, Covid-19 transmission from South Africa will never be contained.
Strengthening of the health system and clinical management of cases – It goes without saying that without a strong health system as well as effective and efficient cases management system the disease cannot be contained. I have been enthralled to learn that at long last there has been some progress in this area. I have been informed that most if not all hospitals are now open for treatment of Covid-19 patients.
This was not the case before. Also, the oxygen production plant has been recently opened which is very much applauded. Although one would say Rome was not built in one day, there is still a lot of ground to cover in order to achieve what I would call the minimum preparedness threshold. The country still precariously depends on South Africa on almost everything. Critically important types of equipment such as ventilators still remain a challenge. The same applies to trained medical personnel, especially the nursing staff.
Strengthening of the health system is one area where collaboration between government and the private sector is also of critical importance. Recently it was announced with fanfare that a private sector fund named Sesiu has been established to assist government on Covid-19 interventions.
While commendable in every respect, I have been disappointed to learn that due to disagreements on logistics and procurement requirements between the fund management and the Ministry of Health, the fund is not yet operational. Further, I have been authoritatively informed that some private sector agents also attempted to donate to government 150 ICU beds which were sadly declined, perhaps for other motives not at all related to the pandemic.
This is absurd. For collaboration between government and the private sector to thrive, the former has to ensure transparency and accountability. Without these two key principles such cooperation is bound to be a pipedream only.
Effective communication – From experiences elsewhere, we learn that inadequate risk awareness and information can significantly weaken the Covid-19 response interventions. Unlike communication and awareness campaigns on HIV Aids, information dissemination to the public on Covid-19 has not been equally aggressive. This is one area where collaboration with the private sector can also provide a dividend. Effective communication should be smart – meaning simple, measurable, achievable, realistic and timely to all relevant stakeholders. In Lesotho print media, radio, chiefs and community-based councillors can be the most effective mediums through which to disseminate information about Covid-19. Private sector funding can play a very effective role to facilitate.
Ensuring data availability – In preparation of this paper I have struggled a lot as I could not find supporting data. The NACOSEC website was not helpful at all. The effectiveness of any response on the pandemic such as Covid-19 is highly dependent on transparency and coordination among partners and stakeholders as well as the quality and amount of information that is available at any given time.
Data availability on Covid-19 is a serious problem in Lesotho. NACOSEC has to work hard to develop a data management system and dissemination to all stakeholders including the general public. The Covid-19 Situation Report that I learn is for internal use, is but a high-level presentation and devoid of depth. Most of the issues I have touched upon in this paper are not covered by that report at all. Perhaps it serves a different purpose.
Strong institutional structures – Strong institutional structures are a prerequisite for effective Covid-19 interventions. As mentioned above, Lesotho is very weak in this area. Government wasted a lot of time and money harping on the development of an institution that one thought would be responsible for the implementation of its policy on Covid-19.
To date, I have not seen such a policy except what is called a National Covid-19 Strategy. The strategy spells out strategic objectives and actions but I have never seen a report from NACOSEC that speaks to that strategy. At times I wonder what was the purpose NACOSEC was formed.
Ideally, NACOSEC is supposed to be an implementing agency of the national strategy derived from national Covid-19 policy, having its own operational independence, budget, coordinating the pandemic related activities, and operating as a centre of excellence on good management practices of the pandemic. All of these is not happening as administratively I understand it tenuously reports to both the cabinet and Ministry of Health.
Lastly, while lives have to be saved, livelihoods also need to be safeguarded. Both are two sides of the same coin. Lockdowns and other restrictions are meant to save lives but they also disrupt the economy including livelihoods. As a result, a very delicate balance has to be maintained between them. In many developing countries safeguarding livelihoods in the midst of the pandemic has proved to be a hard nut to crack. Needless to say, there is no policy or strategy for livelihood protection against the pandemic in Lesotho.
At the height of the first and second wave all that Basotho witnessed was one could term an unsavoury competition among politicians donating food parcels and other items. This has become the new norm. It is really unfortunate for politicians in Lesotho to use the Covid-19 pandemic for political expediency rather than develop and implement a national policy and strategy for safeguarding Basotho livelihoods during these difficult times.
While it is common knowledge that the country is facing financial distress, what is annoying and disheartening is the insensitivity of political leadership who lavishly and ostentatiously spend the scares financial resources of the country without regard of the welfare of its people.
Anyway, to everything there is a time.
[i] Dedicated my late friend and doctor, Dr John Badia who fought hard to save Basotho lives against the pandemic.