SOCIO-ECONOMIC IMPACTS OF THE EBOLA VIRUS DISEASE ON AFRICA · 2014-12-22 · Socio-economic...

December 2014

SOCIO-ECONOMIC IMPACTS OF THE EBOLA VIRUS DISEASE ON AFRICA

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Economic Commission for Africa

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© United Nations Economic Commission for Africa, 2014Addis Ababa, EthiopiaAll rights reservedFirst printing December 2014

Language: English

ISBN: 978-99944-61-43-1 eISBN: 978-99944-62-43-8

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Layout and design: Carolina Rodriguez Silborn and Pauline Stockins.

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Socio-economic Impacts of the Ebola Virus Disease on Africa

ContentsFigures, tables and boxes iiiAcronyms and abbreviations vIAcknowledgements viiForeword viiiExecutive summary x

1. INTRODUCTION 2 Background 2 Objectives and scope of the study 3 Structure of the report 4

2. CONCEPTUAL FRAMEWORK AND METHODS FOR ANALYSING IMPACTS 5 Conceptual framework 5 Economiceffects 5 Socialeffects 7 Intangibleeffects 7 Methods for analysing impacts 9 Descriptivequantitativeandqualitativeanalysis 10 Surveyonnon-affectedcountries’preparednessandonindirecteffectsofEVD 10 InternationaltransmissionoftheEVDeffect 10 Perceptionsanalysisbystatisticaltextmining 10

3. RECENT DOCUMENTS ON EVD IMPACTS IN GUINEA, LIBERIA AND SIERRA LEONE 11 Guinea 11 Liberia 12 Sierra Leone 12 Key conclusion—more than EVD at work 13

4. EVD EPIDEMIOLOGICAL SITUATION AND RESPONSE IN THE THREE COUNTRIES—AND OTHER GLOBAL KILLERS 14 Epidemiological situation 14 Scale of the response 16 How the EVD toll compares 17

5. MACROECONOMIC IMPACTS OF EVD 21 GDP 21 Investment, savings and private consumption 21 Inflation, money and exchange rates 22 Publicfinance 22 Publicrevenue 22 Publicspending 24 Fiscaldeficits 24

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Debt burden and debt alleviation 24 Labour supply and productivity 25 Poverty and inequality 26 Contingencyandrecoveryplans 26 Survey on non-affected countries’ preparedness and on indirect effects of EVD 26 Economiceffects 26 Socialeffects 26 Specialmeasures 27 Economic effects of EVD on West Africa and the continent 27

6. Gender and health systems analysis of EVD’s impacts 29 Gender dimensions—women bear the brunt 29 Cross-Bordertrade 29 Mining 30 Agriculture 30 Unpaidcarework 31 Vulnerability of African health systems 31 Under-infrastructured 31 Under-staffed 32 Under-resourced 34 Under-integrated 35

7. Perceptions analysis 36 Sentiment analysis 37 Recurrent topics 40

8. Policy recommendations 42 Epidemiological 42 Economic 44 Social 46 Intangible 48

Appendix 49 I.Sectoralanalysisofeconomicandsocialimpacts 49 II.Tablesandsources:PledgesanddisbursementstocontaintheEVDoutbreak 60

References 64

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Figures, tables and boxesFIGURESFigure1AnalyticalframeworkfortheEVDoutbreak 6

Figure2EVDcasesinGuinea,LiberiaandSierraLeone 15

Figure3EVDinfectionsamonghealthcareworkers 16

Figure4PledgesanddisbursementstocontaintheEVDoutbreak 18

Figure5In-kindcontributions 20

Figure6Debt-to-GDPratiosforthethreecountries,2013 25

Figure7SimulatedgrowthforWestAfricaandAfrica 28

Figure8Numberofhospitalsper100,000inhabitants2013 32

Figure9Numberofmedicaldoctorsper10,000inhabitants,2006–2013 32

Figure10ThemainhostcountriesofthedrainofmedicalskillsfromAfrica,excludingNorthAfrica 33

Figure11Shareofhealthspendinginnationalbudgets,2011(%) 34

Figure12SentimentscoresandscoresofothertopicsinarticlesaboutEVD 36

Figure13Sentimentscorescomputedonarticlespublishedinsideandoutside EVD-affectedcountries 38

Figure14WorldcloudofnewsonEVD 39

Figure15Scoresofeconomic,socialandmedicaltopicsinthesampleofarticles 41

FigureA1Sectoralinterconnections 50

TABLESTable1GDPprojections,Guinea(%) 23

Table2GDPprojections,Liberia(%) 23

Table3GDPprojections,SierraLeone(%) 23

TableA1Contributionsofmultilateralorganizations 60

TableA2Contributionsofbilateralpartners 61

TableA3Contributionsofinternationalprivatesectorandcharity/foundations 62

TableA4ContributionsoftheAfricanprivatesector 63

TableA5SomeAfricancountries’pledges 63

BOXESBox1StoppingEVDinitstracks:Nigeria’sexperience 3

Box2StigmaafterrecoveringfromEVD 8

Box3RoyalAirMaroccontinuesflyingtoEVD-affectedcountries 9

Box4BrusselsAirlinesservingthethreeaffectedcountries 37

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Acronyms and abbreviationsAfDB AfricanDevelopmentBank

ASM ArtisanalandSmall-scaleMining

AUC AfricanUnionCommission

DRC DemocraticRepublicoftheCongo

ECA UnitedNationsEconomicCommissionforAfrica

ECOWAS EconomicCommunityofWestAfricanStates

EVD EbolaVirusDisease

FAO FoodandAgricultureOrganizationoftheUnitedNations

GDP GrossDomesticProduct

HIPC HeavilyIndebtedPoorCountries

HIV/AIDS HumanImmunodeficiencyVirus/AcquiredImmunodeficiencySyndrome

IMF InternationalMonetaryFund

OCHA OfficefortheCoordinationofHumanitarianAffairs

OECD OrganizationforEconomicCooperationandDevelopment

SMEs SmallandMedium-sizedenterprises

SARS SevereAcuteRespiratorySyndrome

UK UnitedKingdom

UN UnitedNations

UNCT UnitedNationsCountryTeam

UNDP UnitedNationsDevelopmentProgramme

DESA UnitedNationsDepartmentofEconomicandSocialAffairs

UNMEER UnitedNationsMissionforEbolaEmergencyResponse

US UnitedStatesofAmerica

UNWomen UnitedNationsEntityforGenderEqualityandtheEmpowermentofWomen

WAMA WestAfricanMonetaryAgency

WEFM WorldEconomicForecastingModel

WHO WorldHealthOrganization

AlldollaramountsareUSdollarsunlessotherwiseindicated.

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AcknowledgementsThisstudybytheUnitedNationsEconomicCommissionforAfrica(ECA)waspreparedundertheleadershipofCarlosLopes,ECA’sExecutiveSecretary,withthecloseinvolvementofAbdallaHamdok,DeputyExecutiveSecretaryofECA.TheECAEbolaTaskTeam,setupinSeptember2014bytheExecutiveSecretarytopreparethestudy,benefitedfromtheguidance,supervisionandcoordinationofDimitriSanga,DirectoroftheECASub-RegionalOfficeforWestAfrica.

TheECAcoreteamcomprisedAbbiKedir,AboubacryLom,CarlosAcosta,CarolineNgonze,FrancisIkome,IssoufouSeidouSanda,JackJonesZulu,Jean-LucMastakiNamegabe,JosephFoumbi,KatalinBokor,MamaKeita,MedhatEl-Helepi,NassirouBa,RajMitra,XiaoningGongandZachariasZiegelhöfer.

An ECA survey on non-affected countries’ preparedness and on indirect effects of EVD was conductedthroughtheAfricanCentreforStatisticsandadministeredthroughtheSub-RegionalDataCentresoftheECASub-RegionalOfficesunderthe leadershipof theirrespectivechiefs:NassimOulmane(NorthAfrica),SizoMhlanga(SouthernAfrica),GuillermoMangue(CentralAfrica),AndrewMold(EasternAfrica)andAboubacryLom(WestAfrica).

UsefulcommentsandsuggestionswerereceivedfromtheECASeniorManagementTeamandstaffinvariousdivisionsandsub-regionalofficesofECA.

WeareparticularlygratefulfortheexchangesofinformationandviewsonthesubjectobtainedduringdeskvisitsbytheECATaskTeaminthethreemostaffectedcountries—Guinea,LiberiaandSierraLeone.SpecialmentiongoestotheUnitedNationsDevelopmentProgramme,UnitedNationsCountryTeams,teams,andhigh-levelgovernmentofficialsandexpertsinministries,agenciesanddepartmentsinthesecountries.

ThereportwouldnothavebeenpossiblewithoutthecontributionofDr.FodeBangalySako,AliouBarry,DembaDiarra,CollenKelapile,CharlesNdugu,MarcelNgoma-Mouaya,JimOcitti,BruceRoss-Larson,CarolinaRodriguez,PaulineStockinsandthewholeECAPublicationUnit.

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FOREWORD

Beyond thedeath toll of the current outbreakof Ebola Virus Disease (EVD), the diseasehas notable impacts on the three affected

countries—Guinea, Liberia and Sierra Leone—through two channels. First, the health andhumanitarianresponserequireshumanandfinancialresourcesthatwereunplanned,aswellasreallocationof resources slated for other developmentefforts. Second—perhaps worse—is the alarmismsurroundingtheoutbreakofacommunicablediseasewithnoknowncureorvaccine.Thissecondchannelcan have a tremendous impact on socio-economicconditionsnotonly in the three countries but alsointheirneighbours,WestAfrica,thecontinent—andeventheworldatlarge.

Earlier studies of this outbreak which was firstofficially acknowledged inMarch of this year havethreedrawbacks:theyofferlittleinsightintoeffectsonWestAfricaandvirtuallynothingcontinent-wide;their projections can draw only on very few andspottydata;and(inviewofwhentheywerewritten)theymakethestrongassumptionthattheepidemic

islikelytospread,heavilyunderestimatingresponsesfrom governments and development partners, andthewaveofremittancessentbythediasporatotheirfamiliesbackhome.

To widen and update these findings, the UnitedNations Economic Commission for Africa (ECA) hasconducted a studyon EVD’s actual socio-economiccosts and their effect on growth and developmentprospects.Theaimwastopresentanevidencebasefromwhich to devise policy options to accompanytheaboveresponses.

Based on primary data and information collectedduringECAEbolaTaskTeammissionsinOctober2014(Liberia and Sierra Leone) and November 2014(Guinea) andmyown tour inOctober 2014of thethree countries, this study shows that althoughEVDhashighmortalityandcausesuntoldsufferingamong thosedirectly affected, it isnot thebiggestkilleramongcurrent (orpast)diseases.Throughaneconomics lens, italsorevealstheeffectofcurrentresponses,andtheminimalimpactofEVDonWest

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Africa and the continent (given the small weightsofthethreeeconomies,actualEVDprevalenceandencouragingnationalandinternationalresponses).

Butthestrugglehasalongwaytogobeforewecandeclare the crisis over: losses in productivity andadversechangestosocialconstructsandbehaviourneed to be remedied, particularly in the threecountries,while thevulnerabilityofhealth systemsacross Africa is a crucial problem as very few arewell placed to absorb an EVD-induced shock (asseen in the ECA survey on non-affected countries’preparednessandonindirecteffectsofEVD).

Thisoutbreakunderlinestheneedforcountriesandtheirpartnerstoreconsiderthedevelopmentprocess,including decentralizing development efforts andnotjuststructures.Nigeria’ssuccessintacklingEVDshowed that decentralization canwork against theoutbreak,aslocalauthoritiesdidnothavetowaitforagreenlightfromthecentralgovernmenttoimposequarantineandothercontainmentmeasures.

This outbreak is certainly a challenge, and theinternational community has a moral obligationto support affected countries, but it has notfundamentallydisruptedthe“Africarising”economicnarrative, despite alarmism in some quarters. Andif there isone lesson Iwould liketounderline, it isthis—the need to communicate properly and soavoidthedestructiveeffectsofanypossible“Ebolapanicdisease.”

Ihopethatthisdocumentcontributestothateffort.

Carlos Lopes

UnitedNationsUnder-Secretary-Generaland

ExecutiveSecretaryofECA

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The Ebola Virus Disease (EVD) outbreak inWestAfricahastheworstdeathtollsincethediseasewasdiagnosedin1976.Italsohasfar-

reaching socio-economic consequences. Althoughthediseaseisstillunfolding,severalstudiesonthoseimpacts have been conducted this year, includingthosebytheWorldBank,theInternationalMonetaryFund(IMF),theWorldFoodProgramme(WFP)andtheFoodandAgricultureOrganizationoftheUnitedNations(FAO).CountryReportshavebeenpreparedby United Nations Country Teams (UNCTs) underthe leadership of theUnitedNationsDevelopmentProgramme (UNDP) country offices and theWorldHealthOrganization(WHO).

ButfewerreportshavefocusedonWestAfrica,andvirtuallynoneonthecontinentofAfrica.Moreover,mostearlyprospectsandprojectionsonEVD’ssocio-economic impactswere based on patchy data andreflected uncertainty about the disease’s futureepidemiologicalpath.

ItisagainstthisbackgroundthattheUnitedNationsEconomic Commission for Africa (ECA) began thisstudy. The overall objective is to assess the socio-economic impacts on countries and Africa as awhole, both the real costs entailed and growthand development prospects, so as to devise policyrecommendations to accompanymitigationefforts.The findings and conclusions of the study willbe adjusted and updated until the crisis is over,culminating in a fully fledged evaluation of theimpactsoncetheoutbreakiscontained.

EPIDEMIOLOGICAL SITUATIONAccordingtotheWHOSituationReport(3December2014),17,111caseshadbeenidentifiedinthethreecountrieswithwidespreadandintensetransmission(10,708 laboratory confirmed), and 6,055 deathsreported. The mortality rates vary by country—Guinea, 61% (1,327 out of 2,164); Liberia, 41%(3,145outof7,635);andSierraLeone,22%(1,583outof7,312)—withanaveragemortalityrateinthethreecountriesof35%.Thesethreecountrieshavecommoncharacteristicssuchaspoliticalfragilityandarecenthistorymarkedbycivilwarandweakenedinstitutional capacity. Eight cases, including sixdeaths, have been reported in Mali. Outbreaks inSenegal,NigeriaandtheDemocraticRepublicoftheCongo(DRC)weredeclaredoveron17October,19Octoberand15November,respectively.

SCALE OF THE RESPONSEInviewofthespeedyandgeographicalspreadoftheepidemic, the international community has scaledup its efforts to contain the outbreak, and evenmoreneedstobedone.TheInter-AgencyResponsePlan forEbolaVirusOutbreakstipulatedafinancialrequirement of $1.5 billion for the three countriesand the African region over September 2014–February2015.

GiventhesizeoftheoutbreakanditspotentialtobeexportedtoanyothercountryinAfricaortheworld,pledgesarecomingincontinuallyfrommultilateral,bilateral and private organizations. The Africancontinentisalsobeingmobilized.Besidespledgesbyindividualcountries,itsbusinesscommunitypledged

EXECUTIVE SUMMARY

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$32.6 million at an African Business RoundtableheldbyECA, theAfricanDevelopmentBank (AfDB)and the African Union Commission (AUC) in AddisAbaba on 8 November 2014. In-kind contributionsfromthesepartners,suchasmedicalequipmentandhealthpersonnel,havealsobeenmade.

ECONOMIC IMPACTS ON THE THREE COUNTRIESReflecting alarmism owing to the disease, as wellas EVD-related mortality and morbidity, economicactivity has shrunk. This contraction reflectsmultiplecross-currents: fallingsales inmarketsandstores; lower activity for restaurants, hotels, publictransport,constructionandeducational institutions(also caused by government measures such as astate of emergency and restrictions on people’smovements); and slowing activity among foreigncompaniesasmanyexpatriatesleave,withaknock-onfeltinlowerdemandforsomeservices.

• Public finance. The outbreak entails loweredrevenuesand increasedexpenditure,especiallyin the health sector, putting extra pressureon fiscal balances and weakening the state’scapacity tocontain thediseaseand tobuttresstheeconomyvia,say,fiscalstimulus.Thethreecountries have resorted to external support tobridgethefinancinggap.

• Public revenue. The fall inpublic revenuemayamount to tens of millions of dollars—a non-negligibleproportionofgrossdomesticproduct(GDP)forthreesmalleconomies.Thisreductionstems from slower economic activity and acontraction of the tax base in most sectors,notably industry and services. To that may beaddedweakertaxadministration,sothatfewertaxesarecollectedonincome,companies,goodsand services and international trade, as wellas fewer royalties collected on the dominantnaturalresourceactivities.

• Public spending. Ontheothersideofthecoin,thecrisistriggeredbytheepidemiccallsforheavypublicspendingonhealthtocontainthedisease,whilesocialprotectionneedsgrowquickly.Othernon-health expenditure may also emerge, e.g.relatingtosecurityandfoodimports.

• Fiscal deficits. Through its adverse effects onpublic revenue and spending, EVD is puttingthebudgetunderheavypressure, substantiallywideningthefiscaldeficit.

• Investment,savingsandprivateconsumption.Inthefaceofloweredpublicrevenueandincreasedoutlays, the crisis may divert public spendingfrom investments in physical and humancapital to health and other social expenditure.Foreign and domestic private investment isalso declining in the short term, often out ofalarmismpromptedby thedisease.Authoritiesinall three countrieshave reportedpostponedorsuspendedinvestmentinmajorprojects.

• Labour supply and productivity. The crisis hascut the labour supply (including expatriates),potentially loweringthequantityandqualityofgoods and services, especially public services.EVD-related mortality and morbidity have cutthe number of farmers available to work inagricultureandtakenanextremelyheavytollonhealthworkers.

• Inflation,moneyandexchangerates.Inflationarypressures are mounting as the crisis spreads,underminingcompetitivenessforbusinessesandtraders and reducing households’ purchasingpower. External assets have been substantiallyreduced and local currencies depreciated asforeign trade tumbles and demand rises fordollars. Countries’ currency reserves have alsobeenhit.

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SOCIAL IMPACTS ON THE THREE COUNTRIESEVD risks causing a rise inmorbidity andmortalityfromdiseasesnotrelateddirectlytoEVDitself,giventhe following combined effects on regular healthcareprovision:

• Fewer people are seeking formal medicalattentionbecauseoffearorthestigmaofbeingexposedtothedisease.

• Weakeninghealthservicescanallowtheincidenceofotherdiseasestorise,includingmalaria,denguefever and yellow fever, and push up the riskslinkedtofewervaccinationsandtolesspervasiveantenatalandchildhealthcare,allofwhichcanraisematernalandinfantmortalityrates.

• Asignificantshareof thedeathsreportedhavebeen of medical personnel and specializeddoctors, hampering countries’ capacity torecuperatefromthiscrisis.

TheEVDoutbreakhascurtailededucationalservices.The implications for educational outcomes are notyetclear.Therelatedeconomiclossesbornebythenational budget are high aswages to teachers stillneedtobepaidandfacilitiesmaintained.Evenworsemaybefutureproductivitylosses,reflectingthelowereducation of those who do not return to school,whichwillalsorequireheavyadditional investmentinanattempttobringeducationaloutcomesbacktopre-outbreaklevels.

Unemploymentandcommercialclosureshaverisen.Many businesses or branches are shutting everyweek,andeventhosestayingopenhavecutstafforreducedworkinghours.Thelargestproportionofthepopulation exposed consists of rural families whodependonsubsistencefarming.Suchpeopleseldomhavemuchstocktofallbackonandhaveseenmostoftheirsavingseroded.Andasmarketshaveclosedfor weeks and economic activity has contracted,producers of perishable products cannot sell theirproduce,affectinghouseholdsecurity,particularlyinborderareas.

The crisis is leaving behind a growing number oforphans, who will require targeted support—boththem and the families looking after them. Finally,stigmaisgrowinginsidecountries,andthosesavinglives are the most affected: doctors and healthworkers are being treated by the population aspotential vectors of infection, making it hard forthemandtheirfamiliestoleadanythingapproachinganormallife.

EFFECTS ON ECONOMIC PROSPECTS IN WEST AFRICA AND THE CONTINENTAlthough Guinea, Liberia and Sierra Leone havesufferedseriousGDPlosses,theeffectsonbothWestAfricaandthecontinentasawholewillbeminimal,partlybecause,onthebasisof2013’sestimates,thethreeeconomiestogetheraccountforonly2.42%ofWestAfrica’sGDPand0.68%ofAfrica’s.

Thus, if the outbreak is limited to these threecountries, the sizeof its impact onGDP levels andgrowth will be extremely small. ECA simulationsbasedona“badscenario,”whereallthreecountriesrecord zero growth in 2014 and 2015,suggest thatthegrowtheffectforthesetwoyearsforWestAfricawillbeonly-0.19and-0.15percentagepoints,andfor Africa as a whole a negligible -0.05 and -0.04percentage points. In short, at least in economicterms, there is no need to worry about Africa’sgrowthanddevelopmentprospectsbecauseofEVD.

POLICY RECOMMENDATIONSPolicy recommendationsand responses to theEVDemanatingfromtheanalysisarepresentedbelowinverybroadstrokesandunderfourmajorheadings.

EPIDEMIOLOGICAL

• Governments and partners should ensure thatall infected people access timely treatment indesignated medical facilities, while preventingnewinfections.Theyshouldalsoabidebystrictburialprotocols,includingtherequirementthatburialsofvictimsonlybeconductedbytrainedpersonnel, to avoid further contaminationthroughinteractionwithdeadbodies.

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• Countriesshouldcarryoutadetailedstock-takingexercisetoidentifythevariousactorsoperatingin their territory so as to establish what eachactor is doing, how they are doing it and theimpactthattheirinterventionsarehaving.

• Countries and their partners should devisestrategies forcollectinganddisseminatingsolidsocio-economic data. Urgent steps should betaken to strengthen the statistical systems ofthethreeaffectedcountries,includingtheircivilregistration systems. Other African countriesshouldalso strengthen their statistical andcivilregistrationssystemstobettermanageanyEVDorotherdiseaseoutbreaksinthefuture.

• Countries should develop systems for trackingmorbidity in the population in real time,particularlyforcommunicablediseases.Thecostofnothavingasystemthatcanpickupinfectionsatanearlystageandcollectsubsequentreal-timedata can have disastrous health consequencesandserioussocio-economicimpacts.

• Affectedcountriesshouldstepuptheresilienceof their health systems to deal with EVD andnon-EVDdiseasessuchasmalaria,HIV/AIDSandtuberculosis(thesethreehaveclaimedfarmorelivesthanEVD).

• Countries should explore innovative financingstrategies and domestic resource mobilizationto ensure that right amounts of resources aredeployedtothehealthsectoringeneralandtoEVDinparticular.

ECONOMIC

• In devising fiscal measures, the threegovernments should include social protectionand safety net programmes to help families ofvictimsandtheirimmediatecommunities.

• The governments and their partners shouldinvestinbuildingskillsandhumancapitalinthethree counties in the short, medium and longtermsoastoenhancelaboursupply.

• The monetary authorities should cut interestratestoboostgrowth.

• Tourism authorities should refocus theirefforts on strategies to increase connectivityamong them and the countries of the regionmore broadly, and on business-friendly travel,such as easing procedures for entry visas andencouragingcompetitiveratesathotels.

• Governments should reinforce border healthchecks rather than shut down borders, giventhehugedamagetoeconomicactivitythatsuchclosure entails, in affected and non-affectedcountries.

• Thethreecountriesshouldaddvaluetoexportproductssoastotakeadvantageofpreferentialtradearrangements, suchas theAfricaGrowthandOpportunityAct.

• Bilateral and multilateral creditors shouldseriouslyconsidercancellingthethreecountries’externaldebts.

• The three governments and their partnersshouldengageinfoodaideffortsandemergencysafety nets to address acute food shortages,particularlyamongthemostvulnerablegroups,suchaschildrenatriskofmalnutrition.

• Thethreecountries’governmentsshouldprovidespecial incentive packages to their farmers tohelprelaunchtheiragriculturalsectors.

• The threegovernments shoulddevise recoverycontingency plans for quickly reviving theireconomies, which may require them to revisetheirmedium-,andpossiblylong-term,nationaldevelopmentplans.

SOCIAL

• Strengthening health systems in the threecountries and elsewhere should be prioritized.This should not focus on preventing anotherEVDepidemicbutonenhancingthecapacitytoaddresspublichealthissuesofanykind.Hence

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EVD should not be tackled in isolation fromother killer diseases such asHIV/AIDS,malaria,pneumonia and diarrhoea, especially amongchildrenandwomen.

• African countries should seriously consider themeritsofdecentralizingtheirhealthservicestoenhancehealthresponsecapacitylocally.

• Countriesshouldreceivesupplementaryfundingtoreachtheexpectedstandardsforpublichealth,bothforemergencyresponseandregularcare.

• Socialresponsesshouldnotfocusonindividualsdirectly infectedby thevirus,butalsoconsiderthose indirectlyaffected—amuch largergroup.Forthosedirectlyaffected,policiesshouldaimatahousehold,notindividual,approach.

• The role of social protection and targetedsafety netswill be crucial in addressing groupsdisproportionally affected by the outbreak andinmonitoringtheriseinthenumberoforphansowingtoEVD.

• Steps must be taken to ensure that the EVDoutbreakdoesnot igniteafoodandnutritionalcrisis.

• Governmentsandlocalauthoritiesshouldensurethat children return to school and that theeducationaloutcomeshurtbyEVDarebroughtbacktopriorlevels.

• Governments need to establish or strengthengender-responsive disaster risk-reduction andmanagementstrategies.

• Authorities should expand economicopportunities for women, by recognizing andcompensatingwomenfortheunpaidcareworkthey do, and by providing gender-responsivesupportservices.

• All levels of government should strengthenwomen’s agencybybuilding their ability to act

on opportunities, and by challenging harmfulsocial and cultural norms thatplacewomenatelevatedriskofinfection.

INTANGIBLE

Tooffset stigmaat home and improveperceptionsabroad,thestudyrecommendsthat:

Ongoing individual and joint efforts by pan-Africaninstitutions, particularly the AUC, AfDB and ECA,needtomakemoreeffortto“settherecordstraight”onEVD.Thisrequiresthemtopresentmoreaccuratedataandinformationonthediseaseanditsimpact.

Thesethreeinstitutionsneedtodevelopamediaandcommunicationsstrategytoputoutanobjectivebutconstructive narrative on EVD. Media presence ofthethreeinstitutions’leadersshouldbespotlighted,includingjointappearancesinhigh-profileAfricanandnon-Africanmedia.Sucheffortsshouldbereplicatedsub-regionally by heads of regional economiccommunitiesandotherAfricaninstitutions.

African media and communication houses—printandaudio-visual—shouldbeencouragedtoprovideaccurate and fact-based accounts on EVD. Theyshouldcoverprogressmadetoreverseitsspreadandimpact.

TheAUC,AfDB,ECAandotherAfricanbodiesshouldconsiderajoint,moredetailedanalysisofthesocio-economic,politicalandculturalimpactsofEVDwhenthecrisisiscontained.Suchastudy,basedonprimarydata generated by African institutions, will enablethecontinenttotelltheEVDstoryinanobjectiveandnuancedmanner,puttingAfrica’s interestsfirstandsteeringclearofthedistortionsandmisperceptionsthathavegrownuparoundthedisease.

African leaders should ensure effectiveimplementationof the decisions of the emergencysession of the Executive Council of the AfricanUnioninAddisAbabaon8September2014,ontheEVD outbreak (Ext/EX.CL/Dec.1(XVI)). This relates

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especiallytotheneedtoactinsolidaritywithaffectedcountries, including breaking the three countries’stigmatizationandisolation,andstrengtheningtheirresilience(andthatofthecontinentmorebroadly).

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INTRODUCTION

BACKGROUND

Africa is experiencing its worst outbreak ofEbola Virus Disease (EVD) since the diseaseappeared in 1976.1 West Africa—the

epicentre—is experiencing its first outbreak,whichbeganinMarch2014.CaseshavebeenreportedinGuinea, Liberia, Mali, Nigeria, Senegal and SierraLeone,andafewinnorthernDemocraticRepublicofCongo(DRC).

The2014outbreakinWestAfricahastakenahorriblehumantoll.AlthoughoriginatinginruralGuinea,theoutbreakhashithardestLiberiaandSierraLeone,inpartbecauseithasreachedurbanareasinthesetwocountries, a factor that distinguishes this outbreakfrompreviousepisodesthatwereshortandmainlyrural.InaccordwithreportsfromtheWorldHealthOrganization(WHO),affectedcountriesareclassifiedinto three: those with widespread and intensetransmission (Guinea, Liberia and Sierra Leone);thosewithaninitialcaseorcases,orwithlocalizedtransmission (DRC,Mali, Nigeria and Senegal); andthosewithneighbouringareasofactivetransmission(Benin, Burkina Faso, Côte d’Ivoire, Guinea-BissauandSenegal)(WHO2014,18September).

Beyond the terrible toll on lives and suffering, theepidemic is alreadyhavingameasurableeconomicimpact, as seen in forgone output, higher fiscaldeficits and lower real household incomes. Grossdomesticproduct(GDP)andinvestmentareexpectedtodecline.Pricesofstaplegoodsarealreadygoing

1 TheEbolavirusoutbreakwasfirstreportedin1976inYambuku,avil-lageinDRC,neartheRiverEbola,hencethename.Sincethen,therehavebeenmorethan20Ebolaoutbreaks,mainlyEVDhasbrokenoutmorethan20times,mainlyinEastandCentralAfrica.

up, food supplies are dwindling and jobs are lostas some countries close border posts (WFP 2014)to prevent propagation of the virus, as companiesshutter and as people’s freemovement is banned.Cross-border markets have been closed, strippingvendorsoftheironesourceofincome(WHO2014,18September).Theworst-hitsectorsareagriculture,transport,tourism,trade,miningandmanufacturing.

Panic and confusion can be as disruptive as thedisease itself. Studies of past outbreaks, such asSevere Acute Respiratory Syndrome (SARS) in2003,haveshownthatlethaldiseaseslackingacure,likeEVD, tendtoprovokeoverreactionseven if theriskoftransmissionislow.

Most of the early projections of EVD’s economicimpacts depend on patchy data and so are highlyuncertain about the disease’s epidemiological path(GovernmentofSierraLeone:MinistryofHealthandSanitation2014).Theymakeabasicassumptionthattheepidemicislikelytospreadfastanddonotgivefulljusticetotheswiftpolicyreactionortothehealthandhumanitarianresponsesfromgovernmentsanddevelopmentpartners.

Forexample,onthebasisofasectorcomponentsmodel,theWorldBankinOctober2014estimatedthetwo-year(2014–2015)regionalfinancialimpactto be $32 billion if the virus continued surging inGuinea, Liberia and Sierra Leone and spreadingto neighbouring countries (World Bank 2014a).However, this estimate turned out unrealisticgiven actual EVD prevalence. The World Bankstudyalsounderestimatedthepotential impactofcontainmentmeasuresbythecountries—especially

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after Nigeria’s state of emergency declaration inAugust(box1)—andofinternationalinterventions.In early December the World Bank updated thisanalysis,implyingforgoneincomeacrossthethreecountriesoverthetwoyearsofmorethan$2billion(WorldBank2014b).

Given when they were written, the early studiesgenerally failed to incorporate the changes inbehaviour seen in response to the outbreak.Most early projection models also ignored otherresponses, such as heightened remittances fromthe diaspora in supporting their families back inthe affected countries, governments’ budgetaryreallocations towards health care and emergencymanagementanddonors’additionalfunding—allofwhichhavelimitedtheexpansionofaffectedareas.Theseresponsesshouldnowbeusedandintegratedintothenewgenerationofprojections.

ItisagainstthisbackgroundthattheUnitedNationsEconomicCommissionforAfrica(ECA)preparedthisstudy,whichbuildsonthefindingsofECAEbolaTaskTeam missions to Liberia and Sierra Leone (6–15October) and Guinea (12–15 November), and theECA Executive Secretary’s visit (22–25 October) tothethreecountries.

OBJECTIVES AND SCOPE OF THE STUDYTheoverall objective is to assess the socio-economicimpacts of EVD not only on the countries withwidespreadandintensetransmission,butWestAfricamorewidelyandthecontinentasawhole—boththerealcostsaswellasgrowthanddevelopmentprospects.

The study looks at the outbreak’s impacts—qualitativeandquantitative—endeavouringtograspthe interrelations among them by investigatingmechanisms and channels of transmission, whiletryingtocapturetheirsize.Analysingthesefindings,the study offers recommendations to mitigate thedisease’simpacts,includingbuildingmoresystematiccopingandresponsemechanisms.

Despite uncertainty surrounding some of thisstudy’s estimates and analysis, they are useful forpolicymakers(ofaffectedandnon-affectedcountries)tobetterunderstandtheimpactsofanEVDoutbreakon socio-economicdevelopment andperformance,allowing them to plan ahead and devise strategiesformoreresiliencetoEVD.Thestudy’sfindingsandconclusionswill be updated until the crisis is over,culminating in a fully fledged evaluation once theoutbreakiscontained.

BOX 1 STOPPING EVD IN ITS TRACKS: NIGERIA’S EXPERIENCENigeriahasbeenlaudedasoneofthesuccessstoriesincontainingthecurrentspreadoftheEVDwithinitsbordersrelativetoGuinea,LiberiaandSierraLeone.ThisismostlyattributedtobraveanddecisiveNigerianleadershipfromthepresidencytothelowestechelonsofpower.Theleadershiptookhardandsometimesunpopulardecisions,e.g.puttingschoolactivitiesonhold,discouraginghandshakesandrestrictingmovementofdeadbodiesfromaffectedtonon-affectedregions—thetotalaggregateeffectsofthesemeasureshelpedtobringEVDundereffectivecontrol.

Byitssheereconomicsizeandawelldecentralizedgovernancestructure,thecountryalsowasableatshortnotice—particularlyintheaffectedregions—tomobilizeanddeployvariousresourcesincludinghumanandfinancialresources.Theseinterventionswereunderpinnedbyarelativelyfunctionalhealthsystemthataidedinprovidingenabledaneffectivemulti-sectoralresponsetothedisease.Inaddition,variousstakeholders,includingtheprivatesector,playedacriticalroleinarrestingthespreadofEVDbyjoininghandsworkingwiththegovernmenttoprovideacoordinatedresponseintermsoffinancialresourcesandequipmentnecessaryforacombativeactionagainstEbola.

Source:Nwuke,2014.

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STRUCTURE OF THE REPORTThereportisstructuredineightchapters,includingthis introduction.Chapter2reviewstheconceptualframework andmethodology, and chapter 3 someliteratureonEVDsincethebeginningoftheoutbreak.Chapter 4 outlines the epidemiological situationandscaleof the response,whilechapter5offersamacroeconomicanalysisofEVD’simpacts.

Chapter 6 looks at gender dimensions and thevulnerability of African health systems, chapter 7presentsaperceptionsanalysisoftheoutbreak,andchapter8roundsoffwithpolicyrecommendations.

5


CONCEPTUAL FRAMEWORKTheEVDemergency is likelytogenerateastringofsecondary effects that threaten progress on socialoutcomes and hinder the economies of affectedcountriesforyearstocome.Althoughtheimmediateconcernduringtheoutbreak is tosave livesandtocontainthespreadofthedisease,itisimportanttounderstandhowthediseaseisaffectinghouseholdsandsocialinteractions,andthustheirlivelihoods.Acomprehensiveresponsetotheepidemicwillrequireimmediateemergencyactionscombinedwithmid-tolong-termperspectivestohelpthecountriestogetbackontracktoachievingtheirdevelopmentgoals.Figure 1 presents a conceptual framework withwhichtoanalysesomeof themainpotentialsocialandeconomicimpactsofEVDonaffectedcountriesandonAfrica.

ECONOMIC EFFECTS

The impacts on affected countries are severe.Most are driven by aversion behaviour, includingincreased labour absenteeism and reducedeconomicinteractionowingtoafearofcontractingthe disease. A slowdown in regular consumptionforces companies to cut working hours and layoffstafftomaintainoperations.Inturn,livelihoodsareaffected,informalitybecomesthenormratherthanthe exception and themarket respondswith risingprices,fuelledbyspeculation,lackofsupplyofgoodsandcurrencyfluctuations,affectingregulardomesticproductionpatterns.

Theaggregateeffectofthechangesinconsumptionpatterns can also have an impact on international

consumptionpatterns.RegulartradepartnersmaybedivertedfromdealingwithEVD-affectedcountries,inthe immediateperhapsbecauseofnewpreventiveregulationsandchanges in logisticalservices.Somecountries have already announced possible visarestrictionsforvisitorsfromaffectedregions.Planes,trainsandtrucks,carryingcargoorpeople,mayseetheiractivitiesreducedorsuspendedaltogether.

Thealteredbusinessenvironmentisnotlimitedtoanyparticular sector, though it affects somemore thanothers,varyingbycountryandreflectingtheeconomicstructure.Effectsareemergingintheprimarysector,such as agriculture, mining and forestry; in thesecondarysectorinmanufacturingandconstruction;and in the tertiary sector, usually tourism, financialservicesandtrade.Theripplesofeconomicdownturnarelikelytocross-cutarangeofsectors.

The crisis and economic downturn are influencinginvestment and capital flows. In the public sector,implementation of large-scale projects have beenaffected, both from a labour perspective and fromfinancialincapacitytomeetcostsowingtocurtailedpublicrevenue.Inturn,thisiscoolingtheeconomyand feeding back into the downturn, possiblydeterringforeigninvestment,reducingthecountry’sstockoffinancialcapital, increasingriskratingsandaffectingmonetaryandfiscalstability.

Fromacontinentalperspective,EVDcanalsoaffectregional integration: suspension of trade in goodsandservicescanforcetraditionalpartnerstolookforalternativesourcestomaintainsupply—underminingintegration and setting back economies’ movestowardstransformationandgreaterproductivity.

2. CONCEPTUAL FRAMEWORK AND METHODS FOR ANALYSING IMPACTS

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FIGURE 1 ANALYTICAL FRAMEWORK FOR THE EVD OUTBREAK

Source: ECA.

Africa’s Integration and Transformation

Migration

Decrease in educational outcomes

Decrease in health

outcomes

Reduced outcomes on

social protection

Household income, food and nutrition

Incremental dropouts

Reduced school

attendance

Increased morbility

Increased mortality

Increased labor

absenteeism

Changes in production

pattern

Changes in domestic

consumption patterns

Changes in international consumption

patterns

Investment patterns

Changes in capital �ows

Incremental cost of health

systems Gender

Increased preasure on

Health systems

Cohesion Stigma Risk perceptions

Government / Security

Uncertainty

Incremental costs to Governments and Society

Intra African and Intercontinental Trade

TransportTrade

Turism

AgriculturalIndustryMiningKnowledge transferMeetingsNot tending to regular

pathologies, malaria, vaccination, etc.

Ebola Virus Disease Outbreak

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SOCIAL EFFECTS

Fromasocialperspective,theimmediateandmostdirect consequence of the outbreak is a rise inmorbidity and mortality for those infected. Giventhe aggressive nature of the virus, it is medicallyexpectedthatvictimsofEVDshowsymptoms2–21daysaftercontactwiththevirus,but inmostcasessymptoms appear 8–10days after exposure.Giventhe high mortality rate of around 37%2 (thoughvarying sharply by country), the outbreak couldcausemajorlossoflife.

The treatment of patients requires a very delicateand comprehensive protocol that demandsspecializedtrainingandequipment,ideallyprocuredbefore an outbreak to provide for incrementalcapacitybuildingof thehealthsystem.Thecurrent(post-outbreak) mode of acquisition generates anaccumulativeburdenonregularhealthbudgetsanda shift of resources, exerting a pressure on healthsystemsthatinevitablyaffectsregularhealthserviceprovision.Hencenationalcapacitytocareforotherinfectiousdiseases(suchasmalariaandyellowfever)and regularhealth services (suchasantenatal careandvaccinations)areaffected,potentiallygeneratingariseinmorbidityandmortalityresultingindirectlyfrom EVD. These cases, however, would not beregistered as related to EVD. To fund the healthresponse, governments of affected countries aremobilizing resources by cutting funds from otherareas such as public works and by increasing thefiscaldeficit.

Beyondthehealthsector,provisionofsocialserviceshas been restricted to control the spread of thedisease.Theprovisionofsocialprotectionschemesand social safety nets may also be affected bothoperationallyandfromanoutcomeperspective.Theinterruptionofdelivery—owingtoshiftedresourcesor lack of capacity to respond to emerging health

2 According to WHO, the average EVD case fatality rate isaround50%.Casefatalityrateshavevariedfrom25%to90%inpastoutbreaks.Upto2November2014,thefatalityrateofthecurrentepidemicwas36.9%,afigurethatmightbeun-derestimatedowingtounderreportingofcases(WHO2014,5November).

needs—candisruptproductivesafetynetsandaffectongoingcommunityinitiativesthatrequirecontinuityfor success. Asset-building and cash-transferprogrammesbecomeafundamentalelementofthelivelihoodsofthemostvulnerable,andtheirvolatilityand discontinuation can affect the overall gains ofsocial outcomes, and even reverse the progressachievedovermanyyears.

Educational services have also been reduced: theimmediatebudgetlossesarenotyetknown—becauseteachers’ and others’ wages still need to be paidand facilities maintained. Many of these recurringoperationalcostsarestillbornebythegovernment.Nor are the immediate impacts on educational outcomesknown.

Further out the consequences could well be far-reaching, as the lack of educational activity mayincrease the probability of dropping out of school,as older children engage in support activities andtake a bigger role in providing for the household’slivelihood. The lost educational years may alsohavea life-longimpactontheperson’s incomeandperpetuate the intergenerational cycle of poverty.Thefutureproductivitylossesonlowereducationofthosewhodonotreturntoschoolwillalsorequireanincrementalinvestment,justtobringtheeducationsystemtoitspre-outbreakstatus.

The EVD outbreak therefore has potential indirectimpacts on human capital formation throughdeteriorated educational outcomes by affectingenrolment, age-appropriate attendance andeducationalgradeachievementsfordifferentcohortsofthepopulation.Further,schoolfacilitieswillhaveto be brought back to operational readinesswheneducational services are resumed, increasing theoutbreak’seconomicimpactoneducationalbudgets.

INTANGIBLE EFFECTS

Given the complexity and evolving nature of EVD,thediseasegenerates“intangibleeffects” forsocialcohesion, stigmatisation, governance and security,and risk perceptions. When evaluated with thesocialandeconomic impactsofEVD,the intangible

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effects couldworsen thehumanitarian crisis in theimmediatelyaffectedregion.

Social cohesion.SincetheoutbreakofEVDinearly2014, social gatherings such as weddings, churchmeetings, funeralceremoniesandmanycommunalactivitieshaveeitherbeenabandonedordrasticallyreducedinalltheaffectedcountries.Thishasseriousimplications for the social cohesion and trust thatactasaglueinsociety,particularlyforpost-conflictcountries such as Liberia and Sierra Leone. If notproperlymanaged, this outcome has the potentialto reverse gains made in establishing peace andsocial stability after the end of the civil war inthe two countries. Crucially, unless appropriateinformation and advice are provided to the publicon broadmeasures for containing the disease, thefoundations of social cohesion might be disruptedthrough community isolation and stigma—a recipeforinstabilityinaffectedandsurroundingareas.

Stigma.AnECATaskTeamthatwentonafact-findingmission (October and November 2014) to Guinea,LiberiaandSierraLeoneestablishedthatstigmawasaffectingmedicalprofessionalsaswellasrecoveredpatients. For instance,medical personnel (doctors,nurses and clinical officers) can be stigmatized bycommunitiesastheyareperceivedtobevectorsofthediseaseandhencepeopledonotwantanythingtodowiththem.ThisprejudicecouldwellaggravatethespreadofEVDaspeopleshunhealthfacilitiesforfearofcomingintodirectcontactwithmedicalstaff.

At an institutional level, quarantining patients andsuspected victims of EVD—though necessary for

containing the spread of the disease—can lead toviolation of fundamental human rights throughimposed restrictions on movement of people andrestrictionsontheireconomicactivities.InSeptemberSierra Leone, for example, imposed a three-daylockdownthatheavilyrestrictedmovements inandoutofaffectedareasaspartofanationalresponsetocontainthedisease’sspread.

Forisolationmeasurestowork,theyshouldbepartofa comprehensivepackage to include sustenanceofthepatientsandtheirimmediatefamiliesthroughprovisionofbasicneeds,suchasfoodandwaterforsanitation.Theymustalsobecarriedoutaftercloseconsultationwith communities to avoid a backlashthrough unintended outcomes such as communitydenialandconcealmentofsuspectedcases,puttingmore people at risk. Otherwise, isolating affectedpeople and communities can reinforce stigma,possiblyleadingtoviolence(asseeninLiberiaafewmonthsago).Insomeinstances,peoplefacestigmaeven after they have recovered from the disease(box2).

As in the early days of HIV/AIDS, the drivers ofstigma linked to EVD have to be identified if thebattleistobewononallfronts.Interventionshavetoeliminatethefearoftransmission,whichusuallydrivesstigma.Communitiesandindividualsshouldbe given the right information on the modes oftransmission and the supporting mechanisms forthosealreadyinfected.

Governance and security. Given that most of thehealth services in the affected countries have to

BOX 2: STIGMA AFTER RECOVERING FROM EVDHighschoolteacherFantaOulenCamaraspenttwoweeksinMarchfightingforherlifeagainstthedeadlyEbolavirusbutherdarkestdayscameaftershewascuredofthediseaseandreturnedtoherhome.

“Most of my friends stopped visiting. They didn’t speak to me. They avoided me”, the 24-year-old said. “I wasn’t allowed to teach anymore”.

Source:NicholsandGiahyue2014.

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BOX 3 ROYAL AIR MAROC CONTINUES FLYING TO EVD-AFFECTED COUNTRIESRoyalAirMoroccohasmaintaineditsflightstoGuinea,LiberiaandSierraLeonethethreemostaffectedcountriesbyEVD.Theairlinetookthisdecisionatatimewhentheywerehardhitbyahealthcrisisandriskedbecomingmoreisolated.Itscommitmenthasallowedinternationalassistancetoreachaffectedzones.Haltingflightswouldundoubtedlyhaveaggravatedanalreadyalarmingsituation.

Thedecisionhasbeensalutedbymanyorganizationsandhigh-leveldecisionmakers.

Source: Royal Air Maroc

be accessed locally, EVD has overstretched localauthorities’ capacity to respond well. The threecountrieshaveweakdecentralisationstructuresandincreasinglyrelyoncentraladministrationtoprovidemostof the servicesneeded fora response,whichdecentralisation has the potential to underminetheseauthorities’abilitytodeployresources.

Notably, health centres and government servicesin many affected communities are ill-equipped toprovideasemblanceofadecenthealthpackageandaccompanyingservices,suchaswaterandsanitationinanemergencysituation.

Apart from such governance challenges, EVD hassecurity implications. For instance, at the sub-regional level, immigration laws and regulationshavebeentightenedtocontroltheinfluxofpeoplefromaffectedcountries.Theseareforcingpeopletouseunconventional routes to crossbackand forth,posing heightened risk to areas that are currentlyfree from EVD. Yet countries in West Africa, as inmanypartsofAfrica,havelongandporousbordersthat are hard to police for illegal movement ofpeople and goods, increasing the risk of spreadingthevirus.Unrestrictedmovementofpeoplemayalsocompromisebordersecurity.

Risk perceptions. EVD is distorting businessperceptions of Africa in general and of thethree countries in particular, affecting long-terminvestmentdecisions.Forinstance,WHOnotesthat

some African airlines such as Kenya Airways havesuspended flights to affected countries because ofperceived transmission risks—unlike, say, Morocco(box 3).Many countries across the globe have puttough screening measures at their ports of entryforallpeopletheyregardathigherrisk,particularlythosecomingfromEVDregions.

Thesemeasuresdemonstratetheadverseeffectsofnegative perceptions and ignorance for economicactivity, and the losses associated with cancelledor delayed investment, for example, may well beimmense.TheyarealsotarnishingAfrica’simageasaregionwithhugepotentialforgrowthandbusiness,whichcouldbehurtpermanentlyifnocountervailingmessages are put out by African leaders and their

ownpeople.

METHODS FOR ANALYSING IMPACTSSo, how are all the above effects measured orotherwiseanalysed?Variouspartsof thisECA studydrawondifferentmethods.Underlyingallthemethodsisdataavailability,whichlargelydeterminesthetypeofmodeltobeadoptedinagivensurvey.Becausearaft of economic variables and sectors are affectedbyEVD, there is a temptation touseeconomy-widemodelstocapturetheessentialcomplexchangesandinterrelationshipsoftheoutbreak.

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Thisstudydrawsonfourapproaches:

DESCRIPTIVE QUANTITATIVE AND QUALITATIVE ANALYSIS

Used in the majority of Chapters 4, 5 and 6, thisapproachfolloweddevelopmentsinsocial,economicand intangible areas, and their interactions,based on the above framework. It alsoworked offmacroeconomic models.ECA used primary andsecondary data collected in affected countries bynational ministries, departments and agencies,with data fromUN agencies in the field aswell asother sources. For future versions of the report,secondaryinformationwillberegularlycompiledonkeyindicators3viafocalpointsestablishedduringtheEbolaTaskTeammissions.

SURVEY ON NON-AFFECTED COUNTRIES’ PREPAREDNESS AND ON INDIRECT EFFECTS OF EVD

Some neighbouring countries closed their bordersto EVD-affected regions. Others introduced healthscreeningsatairportsorevenregularcheck-upsviagovernment-providedmobilephones,likeMorocco.One element of the study is an ongoing surveyamongAfricancountriestoassessthepreparednessofnon-affectedand“mildlyaffected”countries(Mali,NigeriaandSenegal)toapossibleEVDoutbreak,aswellastheperceivedindirecteffectsemanatingfromtheirlinkstothethreeaffectedcountries.Thesurveyis being conducted by ECA Sub-Regional Officesand touches on issues such as the socio-economicsectors affected, special measures by government,direct costs of measures introduced and indirecteffectsofEVD.Preliminarysurveyresultsreceivedasof 30November2014arediscussed in the section‘Surveyonnon-affectedcountries’preparednessandonindirecteffectsofEVD.’

3 Numberofcases,fatalityrates,incrementalcostsofhealthcentres,number ofmedical staff, demand and supply for non-EVD–relatedhealthcare,schoolattendance,publicspendingonhealthcareandotherareas,domesticeconomicindicatorsincludingsectoralproduc-tionandinflation,tradeflows,andinvestmentflows.

INTERNATIONAL TRANSMISSION OF THE EVD EFFECT

The negative economic shock originating fromGuinea,LiberiaandSierraLeonehasbeentransmittedtocountrieswithwhichtheyhavestrongeconomicties (analysed further in the section Economiceffects of EVD onWest Africa and the continent).To assess the size of the effect on growth inWestAfricaandthecontinent,weusetheWorldEconomicForecastingModel (WEFM). TheWEFM consists of150-pluslinkedcountrymodels,andisregularlyusedbytheUNDepartmentofEconomicandSocialAffairs(DESA) and UN Regional Commissions to developeconomicprojectionsatglobal,regionalandcountrylevels. The model includes a detailed structure ofinternational links that provides a framework tostudy the international transmission of economicshocksoriginatingfromoneormorecountries.

PERCEPTIONS ANALYSIS BY STATISTICAL TEXT MINING

Statistical text mining (as used in Chapter 7,Perceptions analysis) contributes to a betterunderstandingoftheperceptionofEVD,andtheimageofAfrica,aroundtheworld.Takingalargesampleofarticles on EVD, ECA ran a standard statistical textanalysistool(availableintheRstatisticaltext-miningpackage)andcomputedstatisticsonthemostusedwords,recurrenttopics,frequenciesandproximities,etc.TheresultsprovidesomeperceptionsofEVDbyregionandhowthoseperceptionsevolved.

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The following non-comprehensive reviewof recent publications—mainly from theInternational Monetary Fund (IMF) and the

WorldBank—looksatsocio-economicimpactsinthe

threeaffectedcounties.

GUINEAEconomic impact. The economic situation in theEVD-affectedcountriesdeterioratedbecauseofthecombined effects of the disease and of prevalentstructuralproblems.Guinea isacase inpoint,withits structural problems of low energy availabilityandslowexecutionofstructuralreformstoimprovegrowthandreducepoverty.

InAugust2014,the IMFreviseddownGDPgrowthfrom4.5%to3.5%for2014(IMF2014a).InOctober,EVDledtoadownwardrevisionoftheWorldBank’s2014 GDP forecast from 4.5% to 2.4%, with 2%forecastedfor2015(WorldBank2014a),downfrom4.3%forecastbeforetheoutbreak.InDecembertheWorldBankcutthe2014growthprojectionfurther,to0.5%(WorldBank2014b).

These revisions suggest an income loss of$800 million—but are they predictable to thatdegree?Thatofcourseseemsunlikely,soitmaybebettertotakeWorldBankrevisionsaslowerboundsratherthanpointestimates.

Theindirectknock-oneffectsnotonlyhitinvestmentin the country but are also seen in lost jobs,underemployment and lower household and

individualincomes.WithinsixmonthsofthestartoftheoutbreakinMarch2014,householdincomelosswasat13%(UNDP2014).Thisismainlybecausethehouseholdmembersdisproportionatelyaffectedareintheeconomicallyactiveagegroup(15–49years).Wherelifeexpectancyislow,thisgroupiscrucialforhouseholdincome.

InOctober2014thefiscalimpactoftheoutbreakwasestimated at $120 million—$50 million attributedto revenue shortfalls and $70 million to increasedspending as part of the response (World Bank2014a).DirectEVD-relatedspendingin2014todatehasbeen$90million,including$10millionfromownresourcesandtherestfromdonors.Thefiscalimpactoftheoutbreakhasbeenheavy,atover$200million,takingtogetherfallingrevenues,increasedspendingandforgoneinvestment(WorldBank2014b).

Social impact. The social effects include behaviourchanges—sometimesviolent—drivenbyfear.Inthemountainouspartofthecountrywheretheoutbreakbegan,villageshiddenbydenseforesthavebeencutofffromtheoutsideworld.InSeptember2014,eightofficials and local journalists—part of a delegationsent to warn of EVD’s dangers—were killed by amobinthevillageofWomey,andthedismemberedbodies were dumped in a septic tank. In anothervillage, Koyama, the highest-ranking district officialwasheldhostage for hours under a hail of stones.It became impossible for the Red Cross and otherinternationalteamstoentervillagestoretrievesickpeopleorbodies.

3. RECENT DOCUMENTS ON EVD IMPACTS IN GUINEA, LIBERIA AND SIERRA LEONE

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LIBERIAEconomic impact. Some multilateral organizationsevenbeforetheoutbreakexpectedgrowthtoslow.The IMF, forexample, forecasteda slowdown from8.75% (in 2013) to 6% (in 2014) even before EVD.However, because EVD curtailed activity inmining,agriculture and services in the second half of theyear,itsubsequentlyreviseddownits2014realGDPgrowth forecast to 2.5% (IMF 2014c). In October,theWorldBankreviseddown its2014GDPgrowthforecastfrom5.9%beforethecrisisto2.5%(WorldBank 2014a) and further to 2.2% in December (WorldBank2014b).

However, as the epidemic may be abating in thecountryandwith somesignsofactivitypickingup,the World Bank’s 2015 forecast projects a slightuptick in growth to 3.0% compared with 2014.Though this is still far below its 6.8% GDP growthforecast from before the outbreak, it is higherthan its 1.0% forecast for 2015 made in October (WorldBank2014b).

Inflation increased to about 11% in June 2014and is expected to rise to 13.1% by the end ofthe year, according to the IMF (2014c). Importswere $200 million lower than in its previous pre-EVD projection for the same period. Private creditexpansion(anengineofGDPgrowth)fellto14%inJunefromayearearlier.

TheeffectsofEVDonthefiscalbalanceareharsh.Fiscalrevenueisprojectedtodeclinebyabout$46millionin2015andby$49.9millionin2016,forafiscaldeficitin2015ofatleast$93million(11.8%ofGDP).DirectEVD-related spending e.g for health, quarantinesecurityand food imports isputat$67million (IMF2014c).As inSierraLeone,pressureonthefinancialsector is increasing the volume of non-performingloansthreateningbanks’financialstability.

Socialimpact.TwodenselypopulatedneighbourhoodsofthecapitalsawriotsinAugustduetogovernmentquarantinemeasures (IMF 2014c).More generally,inflation has hit hard the poor and vulnerable,

underlining the need for a strong social protectioneffortaspartoftherecovery.

SIERRA LEONETheWorldBankreviseddownits2014GDPgrowthforecast from 11.3% before the crisis to 8.9% inOctober(WorldBank2014a)andto4.0%inDecember(WorldBank2014b).Theeconomicimpactsincludefallinggrowth,risingpricesandslippingbusinessandpersonalincomes.

Thegeneralmessageofthegovernment’spreliminaryassessment,publishedinOctober,isthatthecountrywill see reversals in gainsmade on theMillenniumDevelopment Goals and other economic metrics(GovernmentofSierraLeone2014).Thegovernmentestimates a growth decline from 11.3% to 6.6% in2014 mainly owing to the disruptions of economicactivities in key sectors such as agriculture,mining,construction, manufacturing, trade, tourism andtransport (Government of Sierra Leone 2014).The IMF country report of September indicates abroadlysimilargrowthdeclinefor2014,from11.3%to 8% (IMF 2014b). Its forecast for 2015 is a 2.0%contraction,contrastingstarklybothwithitsown8.9%forecastfrombeforetheEVDoutbreakandwiththe7.7%forecastinOctoberbytheWorldBank(2014b).

According to government officials (Government ofSierraLeone2014),panicbuying,supplyreductions,areaquarantinesandborderclosurespusheduptheinflationforecastfor2014from6.7%inJuneto7.5%inAugust2014.TheSeptember IMFfigureput therisehigherat10%attheendof2014,andpredictedelevatedinflationin2015(IMF2014b).

ContainingEVDledtorisesingovernmentspendingandcapitalspendingreallocatedfromotherprojects(such as those earmarked for long-term growth),widening the fiscal deficit even if risks to debt orfiscal sustainability are believed moderate. As inLiberia,thereissomefinancialsectorfragilityowingtostemmingfromincreasingnon-performingloans.

The balance of payments is suffering becauseof increased food and health-related imports

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(GovernmentofSierraLeone2014).TheIMF(2014b)projects the balance of payments shifting from aprogrammedsurplusof$38millionbeforethecrisistoadeficitof$72.4millionin2014.

Althoughtheclosingofoperationsbyminesandothercompaniesrunbymultinationalshasledtoadeclinein foreign direct investment, the offsetting role ofvoluntarydonationsandsupportfromdevelopmentpartnersshouldberecognized.Nationalrestrictionsonair,seaandroadtransport,andborderclosures,have also severely hit trade with neighbours andothercountries.Thecurrencydepreciatedrelativetointernationalcurrencies,whichare inhighdemanddomestically.Anotherobvious impactofEVD istheincrease in unemployment—24,000 redundanciesweremadeatSierraLeoneBreweryalone(NationalRevenueAuthorityofSierraLeone2014).

ExceptforGDPandinflation,therearenoindicativenumbersonmostofthenegativeeconomicimpactsof the disease. Other studies indicate the revenueimplications of EVD on Sierra Leone and haveidentifiedtransmissionchannels.Accordingtosomepreliminary country estimates, revenue is set todeclineby14.9%byend-2014,largelyowingtoEVD(NationalRevenueAuthorityofSierraLeone2014).InmonetarytermstheEVD-relatedrevenuelosswillbe$45.7millionin2014and$91.3millionin2015,or1%and1.6%ofnon-ironGDP(IMF2014b).

Social impact.Negative effects includemortality ofkeyhealthpersonnel,stretchedhealthinfrastructureand reversal of health gains as non-EVD healthdelivery is compromised. The education sector

sufferedbecauseofschoolclosuresanddelaystoordiversionsfromwaterandsanitationprojects.EVDisathreattosocialcohesionmainlyamongvulnerablegroups suchaswomenandchildren.Morewomenthan men are infected (51% vs. 49%), includingmore women in agriculture and trade than men(GovernmentofSierraLeone2014).

KEY CONCLUSION—MORE THAN EVD AT WORKThe three economies had structural problems—atthe root of most of their socio-economic issues—exacerbatedbytheoutbreak.Forinstance,Guinea’sstructuraltroublesareachronicelectricityshortageandlackofstructuralreform.In2013itsawasharpslowdown inminingactivity,mainlyowingto lowerbauxiteanddiamondproduction.

Yet these countries’ prospects (and those of otherAfricancountries)willbelargelysetbyotherfactorsnot related to EVD. Generally declining prices ininternational commodity prices, for example, willchallengemanyof thecontinent’scountries.Nor isitpossible(fromimpactstudies)tosingleoutEVD’simpact and project socio-economic trends on thatbasis. For instance, elections—planned for 2015 inEthiopia,Guinea,NigeriaandSenegalamongothercountries—often throw up uncertainties, affectinginvestmentandgrowthprospects,reflectingmainlydelayedinvestments.

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The epidemic was declared in Guinea inMarch2014 and quickly spread to SierraLeone, Liberia, Nigeria, Senegal (one case

importedfromGuinea)and, later,Mali.The largestand deadliest EVD epidemic in history, it can tearapart the social fabric of a country. It has claimedthe livesof thousandsofpeople (Figure2presentsthelatestdataforGuinea,LiberiaandSierraLeone),andpatientsstillflowintocentresofcare,whichareoverwhelmed.

It began with an isolated outbreak oflevel2,upgraded to level 3 (the highest) by the Director-General ofWHOon 24 July 2014. The epidemic isnowconsideredapublichealthemergencyofglobalscope.

The three countries’ public health systems arerelativelyunderdevelopedanddonothavethebasictoolstodiagnosepatients,performepidemiologicaltracingofthediseaseorcommunicatewithaffectedareas to collect or update data. Nor do they havethe basic skills to perform the essential tasks ofpublic health disease prevention and control.Among the main problems they face are lack ofskills in laboratories to perform rapid virologicaltests, of health workers and of trained personnelfor diagnosis, treatment, logistics managementand contact tracing—all of themcompounding thehealthcrisis.

Thesethreecountries,membersoftheManoRiverUnion, have other common characteristics suchaspolitical fragilityanda recenthistorymarkedbycivil war, loosening of ties between governmentand society, a “governance deficit” and weak

institutional capacity. A decade after the end ofregionalconflicts,ManoRiverUnioncountrieshavemadeprogresstowardsreconciliation,althoughtoomanypeoplearemarginalizedowingtopovertyandunemployment. Their lack of jobs—especially forwomen—weak institutionalcapacityandpaucityofresources to provide basic services (water, healthcare, education and electricity) and high levels ofcorruption arouse their populations’ discontent.Centralizedgovernmentandcitizens’distrustofthestateandpublicinstitutionscreatemistrustinsomecommunities,makingithardtoisolatepatientsandmonitortheircontacts.

EPIDEMIOLOGICAL SITUATIONGuineawasthefirstaffectedcountryintheManoRiverUnioninDecember2013.TheearliestreportedcasescamefromGuéckédou,MacentaandKissidougouintheForestRegionandlaterfromConakry,thecapital.On 21 March 2014, the government declared anepidemic after the InstitutPasteur in Lyon, France,confirmedthecasesonsamplesithadreceived.

According to WHO, despite stabilizing in somedistricts the virus still shows intense transmissioninGuinea,withthenumberofcasesfluctuatingbutstayinghigh.TransmissionishighinMacentainthesouthwestneartheLiberianborder.Transmissionispersistent in theneighbouringdistrictofKérouané,N’Zérékoré, Beyla, Faranah and Coyah. Conakryrequiressustainedeffortstofightthedisease.Siguiridistrict,ontheborderwithMali,hasreportednewconfirmedcases.Ahighlevelofvigilanceisneededthere,particularlybecauseof itsproximity toMali,whichhasreportedseveralEVDcases.

4. EVD EPIDEMIOLOGICAL SITUATION AND RESPONSE IN THE THREE COUNTRIES—AND OTHER GLOBAL KILLERS

15


Thenumberofnewcaseshasbeendecliningintheepicentre of the epidemic, Guéckédou. Out of 34districtsinGuinea,10arenotaffectedbythevirus,unlike Liberia and Sierra Leone, where all districtshavebeenaffected.

Sierra Leone washitby theoutbreak inMay2014,andhassinceseenitspreadquicklyinthethreemaintownsalongtheeasternborderregionnearKailahun.

AccordingtoWHO,transmissionofthediseaseishigh.Manyofthenewconfirmedcasesarerelatedtointense

transmissioninthewestandnorth.Transmissionalsoremains intense in the capital, Freetown, and highlevels of activity persist in the neighbourhoods ofBombaliandtheruralWest,PortLokoandTonkolili.Koinadugu and Kambia have reported some cases.The neighbouring regions of Kenema and Kailahunareseeingasharpdeclineinincidence,reflectingtheresponseeffortsthere,includingisolationofpatients,screening and contact monitoring, and robustpreventionandcontrolmeasures.

Total17,111 cases

2,801

79

1,255

5,978 1,374174

210

Con�rmed Probable Suspected Con�rmed Probable Suspected

35

Lib eria7,635 cases 3,145 deaths

1,583 deaths

1,327 deaths

278 cases confirmed in the past 21 days

Sierra Leo n e7,312 cases

1,792

3,042

Cumulative cases Cumulative deaths

1,374174

25

1,929

Con�rmed Probable Suspected Con�rmed Probable Suspected

35

1,117210

Total6,055 deaths

1,455 cases confirmed in the past 21 days

306 cases confirmed in the past 21 days

2,039 cases confirmed in the past 21 days

Guinea2,164 cases

FIGURE 2 EVD CASES IN GUINEA, LIBERIA AND SIERRA LEONE

Source: WHO, 3 December 2014.

16


Liberiaisthecountrymostaffectedbytheoutbreak,showing exponential growth in cases betweenthe first confirmed laboratory case on 13 March2014 and September 2014. According to WHO,the number of weekly cases dropped from mid-SeptembertolateOctober.Thisdeclinehaslevelledoff since then. Efforts to fight the disease are stillcritical,especiallyinthecapitalMonrovia.Incidenceis declining in theneighbouringdistrict ofMarigibibut high transmission persists.Other areas of hightransmissionincludeBomiandBongcounties.Lofa,however,hasseenasteadydeclineinnewcasesperweek(Sharmaetal.2014).

Forthethreecountries,Figure2shows17,111casesidentified(10,708laboratoryconfirmed),and6,055

deaths reported. In addition, 8 cases, including 6deaths,havebeenreportedinMali.

Atotalof622(ofwhich605inthethreemostaffectedcountries) health care workers are known to havebeeninfectedwithEVDasof30November2014inthethreecountries,withnearly3outof5ofthosedying(Figure3).ThelastwereinfectedinthedistrictofKérouanéinGuinea.Investigationsareunderwaytodetermine the sourceof exposure in each case.Earlyindicationsarethatasignificantproportionofthe infections occurred away from EVD treatmentcentres and other care facilities, which underlinesthe need to adhere to infection prevention andcontrolmeasures in all health institutions, not justEVD-relatedfacilities.

FIGURE 3 EVD INFECTIONS AMONG HEALTH CARE WORKERS

CASES

CASES

CASES

DEATHS

DEATHS

DEATHSGuinea 106 59

Liberia 361

CASES605

174

DEATHS339

Sierra Leone 138 10676.8%

55.7%

48.2%

Source: WHO, 3 December 2014.Note: Icons designed by Freepik.

SCALE OF THE RESPONSEInviewofthespeedyandgeographicalspreadoftheepidemic,theinternationalcommunityhassteppedup efforts to contain the outbreak, even as moreneeds to be done. According to the OCHA reporton overview of need and requirements for EVD as

of 8 December 2014, the, Inter-Agency ResponsePlan forEbolaVirusOutbreak stipulatedafinancialrequirement of $1.5 billion for Guinea, Liberia,Sierra Leone and the region for September 2014–February2015.Asof8December,nearlytwo-thirds(994.5million)ofthisamounthadbeenmetthroughresponseplanfunding.

17


Figure 4 and 5 do not include an exhaustive listof pledges which are coming in continuously. Forexample,on8November2014theAfricanbusinesscommunitypledged$32.6millionduringanAfricanBusinessRoundtableheldbyECA,AfDBandAfricanUnion Commission (AUC). Other leading Africanbusinesses may follow suit soon after consultingtheir boards. Multilaterally, the UN has set upthe UN Mission for Ebola Emergency Response(UNMEER),whichaimstotreattheinfected,ensureessential services, preserve stability and preventfurtheroutbreaks. IthasalsoestablishedtheEbolaMulti-PartnerTrustFundtooverseeacoherent,UN-wideresponse.

HOW THE EVD TOLL COMPARESThe world has been shaken by the contagion ofEVD,which isbecomingaquestionofglobalpublichealth, claiming more than 6,000 lives. Yet for allthe grief the disease is causing, its total mortalityandmorbidityare,sofaratleast,lowinaglobalandhistoricalcontext.

For example: the 1918–1919 influenza outbreak,also called “Spanishflu,”becameapandemic andclaimed about 30 million lives according to theInstitut Pasteur, and up to 100 million accordingto certain revisionist analysts. Itmaybe themostlethalpandemicofalltime,certainlyinsuchashorttime.Overalongerperiod,theBlackDeathcausedan estimated 50 million deaths during the 14thcentury(WHO2014).

More recently, the cholera epidemic that emergedin 1994 in theDRC after the Rwandan crisis ragedamongrefugees.Amongthe500,000–800,000whocrossedtheborderseekingasyluminthesuburbsofGoma,50,000diedwithinamonthofarriving,owingtoageneralizedoutbreakofcholeraanddysentery.

AccordingtoWHO,contagiousdiseasesindevelopingcountries still account for seven of the 10 main

causesofchildren’smortality.In2002,forexample,someoftheleadingkillerswererespiratoryinfections(1.9milliondeaths),diarrhoealdiseases(1.6milliondeaths) and malaria (1.1 million deaths). Yet non-communicablediseasesnowaccountformorethanhalfthedeathsinlow-andmiddle-incomecountries,killing around 29 million people every year versus36 million deaths from communicable diseasesworldwide(WHO2013).

WHO puts at 8.6 million the number of newtuberculosis cases across the globe in 2012 and at1.3millionthenumberofpeoplewhodiedfromthediseasethatyear.Some3.3billionpeopleworldwidearevulnerabletomalaria4:in2012,thediseasekilledabout 627,000 people, most of them aged underfiveandlivinginAfrica(WHO2013).Measlescaused145,700deathsworldwide in2013.ThenumberofdeathsowingtoSARSduringthatepidemic,despiteitswidefootprint,wasamodest774(WHO2013).

At the end of 2012, 35.3million people were HIVpositive,includingabout2.3millionnewinfections.5 Some1.7millionpeople,including230,000children,died from AIDS.More than two thirds of newHIVinfections are in Africa excluding North Africa ,accordingtoWHO.

Tobacco,too,isabigkiller:tobaccoconsumptionandsmoke exposure (passive smoking) claimmore than700,000 lives in theEuropeanUnion, and this in anareawithstronganti-tobaccolegislation(WHO2013).

Finally,morethan20millionpeoplearekilledorseriouslyinjuredbyroadaccidentseveryyearacrosstheworld,witheconomiccostsofaround$518billion—$65billionindevelopingcountries(WHO2013).

4 http://www.who.int/topics/millennium_development_goals/diseas-es/fr/

5 http://www.who.int/topics/millennium_development_goals/diseas-es/fr/

18


Major contributors in terms of pledges and disbursements by di�erent categories

Amount pledged ($million) vs. amount disbursed (%)

Amount pledged ($million)

INTERNATIONAL COMMUNITY EFFORTS TO CONTAIN THE EVD OUTBREAK

Contributions of Multilateral Organizations

Contributions of the African private sector

Wor

ld B

ank

$518

US$100 million

23.4%

Euro

pean

Uni

on In

stit

utio

n$459.8

9.98% ---

IFC/

Wor

ld

Bank

Gro

up

$450

Afr

ican

D

evel

opm

ent

Bank

(AfD

B)

$220

20.62%

IMF

$130

immediate

Cent

ral E

mer

genc

y R

espo

nse

Fund

(CER

F)

$15

ECO

WA

S

$9

Isla

mic

Dev

elop

men

t B

ank(

IDB)

$45

Contributions of Bilateral Partners

Uni

ted

King

dom

$360

8.7%

Uni

ted

Stat

es

$345

24.6%

Japa

n

$142

14.4%

Ger

man

y

$134

20.2%

Fran

ce

$124

37.8%

Chin

a

$123

6.5%

Swed

en

$67

13.2%

Cana

da

$58

88.1%

Net

herl

ands

$45

15.2%

Aus

tral

ia

$36

38.2%

Some African countries’ pledges

MTN

Gro

up

Dan

gote

$4.1Ec

onet

Wir

eles

s$2.5

The

Mot

sepe

Foun

dati

on

$1.0 $1.0 $1.0$1.0$1.0$1.0$1.0

Kola

Kar

im C

EO o

f Nig

eria

n co

nglo

mer

ate

Shor

elin

e En

ergy

Tony

Elu

mel

uFo

unda

tion

$0.6

The

Uni

ted

Bank

fo

r Afr

ica

(UBA

)

Sten

beck

Fam

ily

Afr

ixim

Ban

k

Coca

Col

a Eu

rasi

aan

d A

fric

a

Vit

ol G

roup

of C

ompa

nies

and

Viv

o En

ergy

Bots

wan

a

Côte

d’Iv

oire

Equa

tori

al G

uine

a

Ethi

opia

Keny

a

Nam

ibia

Nig

eria

Sout

h A

fric

a

Amount pledged:

=

US$10 million=

Amount disbursed:

Paul

Alle

n Fa

mily

Fou

ndat

ion

$100

2.9%

Bill

& M

elin

da G

ates

Fou

ndat

ion

$50

27.3%

Mar

k Zu

cker

berg

and

Pri

scill

a Ch

ang

$25

—

Silic

on V

alle

y C

omm

unit

y Fo

unda

tion

$25

0%

Goo

gle/

Larr

y Pa

ge F

amily

Fou

ndat

ion

$25

—

Child

ren’

s In

vest

men

t F

und

Foun

dati

on

$20

90.5%

Contributions of International Private Sector and Charity/Foundations

$10 $1.0 $2.0 $0.5 $1.0 $0.3$3.5$1.0$0.2Amount pledged:

FIGURE 4 PLEDGES AND DISBURSEMENTS TO CONTAIN THE EVD OUTBREAK

Source: See Appendix II

19


Major contributors in terms of pledges and disbursements by di�erent categories

Amount pledged ($million) vs. amount disbursed (%)

Amount pledged ($million)

INTERNATIONAL COMMUNITY EFFORTS TO CONTAIN THE EVD OUTBREAK

Contributions of Multilateral Organizations

Contributions of the African private sector

Wor

ld B

ank

$518

US$100 million

23.4%

Euro

pean

Uni

on In

stit

utio

n

$459.8

9.98% ---

IFC/

Wor

ld

Bank

Gro

up

$450

Afr

ican

D

evel

opm

ent

Bank

(AfD

B)

$220

20.62%

IMF

$130

immediate

Cent

ral E

mer

genc

y R

espo

nse

Fund

(CER

F)

$15

ECO

WA

S

$9

Isla

mic

Dev

elop

men

t B

ank(

IDB)

$45

Contributions of Bilateral Partners

Uni

ted

King

dom

$360

8.7%

Uni

ted

Stat

es

$345

24.6%

Japa

n

$142

14.4%

Ger

man

y

$134

20.2%

Fran

ce

$124

37.8%

Chin

a

$123

6.5%

Swed

en

$67

13.2%

Cana

da$58

88.1%N

ethe

rlan

ds

$45

15.2%

Aus

tral

ia

$36

38.2%

Some African countries’ pledges

MTN

Gro

up

Dan

gote

$4.1

Econ

et W

irel

ess

$2.5

The

Mot

sepe

Foun

dati

on

$1.0 $1.0 $1.0$1.0$1.0$1.0$1.0

Kola

Kar

im C

EO o

f Nig

eria

n co

nglo

mer

ate

Shor

elin

e En

ergy

Tony

Elu

mel

uFo

unda

tion

$0.6

The

Uni

ted

Bank

fo

r Afr

ica

(UBA

)

Sten

beck

Fam

ily

Afr

ixim

Ban

k

Coca

Col

a Eu

rasi

aan

d A

fric

a

Vit

ol G

roup

of C

ompa

nies

and

Viv

o En

ergy

Bots

wan

a

Côte

d’Iv

oire

Equa

tori

al G

uine

a

Ethi

opia

Keny

a

Nam

ibia

Nig

eria

Sout

h A

fric

a

Amount pledged:

=

US$10 million=

Amount disbursed:

Paul

Alle

n Fa

mily

Fou

ndat

ion

$100

2.9%

Bill

& M

elin

da G

ates

Fou

ndat

ion

$50

27.3%

Mar

k Zu

cker

berg

and

Pri

scill

a Ch

ang

$25

—

Silic

on V

alle

y C

omm

unit

y Fo

unda

tion

$25

0%

Goo

gle/

Larr

y Pa

ge F

amily

Fou

ndat

ion

$25

—

Child

ren’

s In

vest

men

t F

und

Foun

dati

on

$20

90.5%

Contributions of International Private Sector and Charity/Foundations

$10 $1.0 $2.0 $0.5 $1.0 $0.3$3.5$1.0$0.2Amount pledged:

20


FIGURE 5 IN-KIND CONTRIBUTIONS

Cuba

European Union

Ghana

Japan

Netherlands

South Africa

Sweden

United Kingdom

United States of America

Australia Cash given including funding to UK to build 100-bed clinic

165 health workers

Democratic Republic of Congo and East African Community 2,000 health personnel

Providing 2+ mobile laboratories for the detection of the virus

Hosts the UN Mission for Ebola Emergency Response (UNMEER) in Accra and has become a regional logistics hub for the response.

55,000 items of personal protective equipment

Providing supplies and marine ship for transporting them to West Africa

Cash includes funding for various logistical supports and for setting up a base camp in Monrovia for a total of 200 international health workers

1,100 health professionals; 1,700 beds; and 140,000 Personal Protective Equipment (PPE); 200,000 items of equipment; running a training centre in Liberia; and a sta�ng hospital for health workers

800 health workers; 77 beds

Field hospital with 40 beds; 6,400 heavy duty PPE; medical supplies with infection control commodities; ambulances, 4x4s and 100 motorcycles; pledges from private companies mobilized by Dept. Health; training of 94 participants from 16 countries

China Equipment and medical supplies sent; 2 mobile bio-safety laboratory supported; medical supplies and protective gear; food aid

Source: ECA compilations from Websites of organizations/countries. Note: Some of the icons used in this figure have been designed by Freepik.

21


The first observations from Guinea, LiberiaandSierraLeonesuggestthatEVDcanaffecttheeconomy inmultiplewaysandtovarying

degrees.6

GDPOwing in part to the alarmism sparked by thedisease, economic activity is declining, reflectingfalling transactions in markets, stores and shops,as peoplebegin to shunphysical contact. Services,including restaurants, hotels, public transport,construction and education, also suffer becauseof both panic and governmental measures, suchasastateofemergencyandrelatedrestrictionsonmovement and gatherings. Another economic tollcomes from foreign companies (and embassies)reducingoperations,astheycutstafftoaminimumand expatriates (including nonessential diplomaticstaff) leave, curtailing their demand for services.TheEVD-inducedshockstothelabourforce,publicfinance, investmentandsavingsmaycauseasharpfallinGDP,retardingdevelopment.

The impacts of the epidemic on GDP growthas estimated by the three countries’ nationalauthorities are in the range of 2 to 57 percentagepoints(i.e.,lowerthanwhatGDPgrowthwouldhavebeenwithoutEVD).Atpurchasingpowerparity,thisGDPlosscomestoaround$716millionforthethreeeconomies.8 Since the outbreak and subsequentslowing economic activity, all three countries have

6 Theappendixoffers furtherdiscussionof theeconomicandsocialimpactsbysector.

7 2.1%forGuinea,4.7%forSierraLeoneand4.9%forLiberia.8 ECAcalculationbasedonGDPatpurchasingpowerparityfor2013

fromAfDB,OECDandUNDP2014forthethreecountries,towhichpre-EVDandpostEVDgrowthratesfor2014fromnationalsourcesareapplied.

revisedoneormoretimestheirGDPprojectionsfor2014 (tables 1–3): Guinea revised its GDP growthfrom4.5% to3.5%and then to2.4%; Sierra Leonefrom 11.3% to 8% and then to 6.6%; Liberia from5.9%to2.5%andthento1%.

INVESTMENT, SAVINGS AND PRIVATE CONSUMPTIONInthefaceofloweredpublicrevenueandincreasedneedforasoundresponse,theEVDcrisisisdivertingpublic spending from investment in physical andhumancapital tohealthandothersocial spending.Foreign and domestic private investments, too,aredeclining, largelyoutofpanic. Thedecrease indomestic investment is likely to continue over themediumtermifinvestorsdonotgetfinancialsupporttoresumeactivities.

Authorities in all three countries have reportedpostponed or suspended investment in majorprojects in their countries. InGuinea, for example,the operations of a Rio Tinto project worth $20billion have been put largely on hold. The projectwas expected to double GDP in the coming years.Similarly, a Guinea Alumina Corporation bauxiteproject ledby theUnitedArabEmiratesandworth$5billionhaspostponeditsGuineanoperations.

InSierraLeone,constructionoftheKenema–Kailahunand and Matotoka–Kono roads; reconstruction oftheMakeni–Kabala road, Hillside Bypass road, andLumley–Tokeh road; and work on city and townstreetsintheprovincesandtheWesternAreahavebeensuspended(GovernmentofLiberia2014).

5. MACROECONOMIC IMPACTS OF EVD

22


Closures of overland borders to neighbouringcountrieshasbeendisastroustonumerousfruitandvegetableoperatorsinGuinea,whoareusuallywellorganized and prosperous, with substantial bankcredits, and selling their products over the border.Theclosureshaveledtospoiledproduce,indebtinginvestors(theyexpecttogeneratenocashuntilthecrisisabatesandwithhavenoimmediateprospectsofnewloans.)

Morewidely,families’consumptionandsavingshavebeenhitbythedisease,thoughmicrodataarehardto come by, owing to mortality and morbidity, andreducedeconomicactivity,workinghoursandincome.

INFLATION, MONEY AND EXCHANGE RATESAffected countries face inflationary pressures asthe EVD crisis spreads, inducing a competitivenessproblem for businesses and traders, and a fall inpurchasing power for households. External assetsmaydeclineandthe localcurrencydepreciatewithchecksonforeigntrade,andanappreciatingUSdollaronboosteddemandfora“safehaven”currency.Thecountriesmay also see their import cover fall (themonthsofimportscoveredbycurrencyreserves).

Centralbanksandministriesoffinancemayhavetosimulate demand and prevent excessive currencydepreciation (which feeds into inflation). InLiberia,for instance, monetary policy has been cautious:thecentralbankincreaseditsinterventionbyabout$9.7million toaddress JulyandAugust’spressuresonthe localcurrency, reflectingasurge indemandforforeignexchange(IMF2014c).

AlsoinLiberia,inflationisrising,pushedbyastrongpressure on food prices. Year-end 2014 inflationis now projected at 14.7% and to remain high atabout 10% in 2015. The country’s gross officialreservesareforecasttofallfrom2.8to2.6monthsof imports(IMF2014c).

The nominal exchange rate of the leone againstothercurrencieshasdepreciated,withanincreasedparallel market premium and consequent pass-

through effects on domestic prices (Governmentof Sierra Leone 2014). Still, effects vary amongcountries: Guinea, for example, was showing noclearinflationarypressuresinthefirstmonthsoftheoutbreak(PNUD-Guinée2014).

PUBLIC FINANCEAsseen,oneimpactofEVDistolowerpublicrevenueand raise expenditure, especially in health, puttingfurther pressure on the fiscal balance. This furtherweakens the state’s capacity to contain the diseaseor to buttress the economy against wider impacts(primarilyviafiscalstimulus).Ultimately,countriesfacedependenceonexternalsupporttobridgethegap.

PUBLIC REVENUE

The fall in public revenue may amount to tensof millions of dollars, a non-negligible proportionof GDP for three small economies. It stems fromfactors including slower economic activity followedby a contraction of the tax base in most sectors,notablyindustryandservices(oftenthemainpublicrevenuesources).Tothatmaybeaddedweakertaxadministration. Combined, these factors see fewertaxes collected on income, companies, goods andservices,andinternationaltrade,andfewerroyaltiescollectedonnaturalresources,usuallythedominantdriversofeconomicgrowthinthesethreecountries.

In actual numbers, in Sierra Leone the revenueshortfall owing to EVD is estimated at about$46millionand$91millionfor2014and2015,or1%and1.6%ofnon-ironoreGDP(IMF2014b).Estimatesfor Liberia indicate that government revenues for2014 will be $106.1 million lower than initiallyprojected (Government of Liberia 2014), or about5%ofGDP,whiletherevenueshortfallinGuineawasestimatedinAugust2014atabout$27million,or0.4percentagepointsofGDP(IMF2014a).TheNationalRevenueAuthorityofSierraLeone (2014) reporteda15% shortfall in tax collectionagainst the targetsset for July and August 2014; the Liberia RevenueAdministrationexpectsprojectedrevenuesfor2014todeclineby19%(GovernmentofLiberia2014).

23


Table 1. GDP projections, Guinea (%)

2014 2015Source of data Initial projection Projection after

outbreakInitial projection Projection after

outbreak

Guinean authorities 4.5 3.5 — —ECA 4.5 3.5 4.9 —World Banka 4.5 2.4/0.5 4.3 2.0/0.2IMF 4.5 2.1 4.3 4.1African Economic Outlook 4.2 — 4.3 —

— data not available.a The World Bank’s after-outbreak projections have two figures: the first from October 2014 (World Bank 2014a) and the second from December 2014 (World Bank 2014b).

Table 2. GDP projections, Liberia (%)2014 2015

Source of data Initial projection Projection after outbreak

Initial projection Projection after outbreak

Liberian authorities 5.9 1.0 — 0.0

ECA 7.3 1.0a 7.0 0.0

World Bankb 5.9 2.5/2.2 6.8 1.0/3.0

IMF 6.8 2.5 6.8 4.5

African Economic Outlook 6.8 — 8.2 —— data not available.a Based on discussions and exchanges with national authorities on assumptions and methodological soundness, ECA aligns itself with country estimates of the impact of the EVD. ECA simulations to capture the effects of the EVD crisis on West Africa and the continent are also based on country estimates as a starting point.b See note a,Table 1

Table 3. GDP projections, Sierra Leone (%)

2014 2015Source of data Initial projection Projection after

outbreakInitial projection Projection after

outbreak

Sierra Leonean authorities 11.3 6.6 8.9 —

ECA 11.9 6.6 11.6 —

World Bankb 11.3 8.0/4.0 6.8 7.7/-2.2

IMF 14.0 8.0 8.9 10.4a

African Economic Outlook 13.8 — 11.6 —— data not available.a This takes into account the sudden and quick catch-up of mining output, which was dormant in 2014.b See note a, Table 1

24


PUBLIC SPENDING

Againstthefallinpublicrevenueistheriseinpublicspending.Thehealthcrisistriggeredbytheepidemiccallsforsubstantialspendinginthehealthsectortocontainthedisease,atthesametimeastheneedforsocialprotectiongrows,giventhenumberofdeathsandfamilieshit,includinganincreaseinthenumberof orphans and number of poor. Other non-healthspendingmayalsoemergein,forexample,securityandfoodimports.

The inverse movements in revenue and spendingleavegovernmentswithnochoicebuttoreallocateto new needs some of the initially plannedspending,includingcapitaloutlays,whichcutspublicinvestment. The emphasis on health versus socialspendingvariesamongthethreecountries:inSierraLeone,forinstance,EVD-relatedspendingfor2014isputat$36million(72%directdisease-relatedhealthresponseand28%socialspending),andfor2015at$40.9million(100%socialspending)(IMF2014b).InLiberiatheauthoritiesestimatedirectEVDspendingat$79.7million,besides$20millionincashtransfersand$30millioninagriculturalstimulus(GovernmentofLiberia2014).TheGuineangovernmentputstheEVD-relatedbillat$134millionthroughtoFebruary2015(GouvernementdelaGuinée2014).

FISCAL DEFICITS

Through theaboveeffectsongovernment revenueandspending,EVDputsthebudgetunderpressureandwidens the fiscal deficit. The fiscal deficit (theoverallbalance includinggrants) in Liberia is set towiden by 4.7 percentage points from its originallyprojected7.1%ofGDP in2015,owingtoreflectingadditional financial needs,while the projection for2014remainsunchanged. InSierraLeonethefiscaldeficitisforecasttowidenby1.5and1.7percentagepointsin2014and2015(IMF2014b,IMF2014c).

DEBT BURDEN AND DEBT ALLEVIATIONPledges and contributions are key to bridging thefiscalgapsgeneratedbytheEVDcrisis—forexampletheIMF’s$300millionpledgemadeduringtheG20meeting of November 2014 in Brisbane, Australia.Similarly,inapressreleasedated2December2014(World Bank 2014c), theWorld BankGroup statedthatitismobilizingnearly$1billioninfinancingforthehardest-hitcountries.Thisincludes$518millionforepidemicresponse,andatleast$450millionfromtheInternationalFinanceCorporation—amemberoftheWorldBankGroup—tobuttresstrade,investmentandemploymentinthethreecountries.

Suchassistancefromthe internationalcommunity islaudableandmuchneededtobridgefinancinggaps.However,withpartoftheassistanceasloans,theEVDcrisis could possibly aggravate the three countries’debtburdens.TheWorldBank,forexample,providedcreditsupportof$40milliontoGuinea(WorldBank2014d) and of $20 million to Liberia (World Bank2014e). Similarly, the IMF approved EVD-relatedcreditstothethreecountriesof$41millionforGuinea,$49millionforLiberiaand$39millionforSierraLeone(IMF 2014d) andmade, during the G20meeting inBrisbane,anadditionalpledgeof$300millionforthethreecountries(acombinationofconcessionalloans,debtreliefandgrants).

The three countieshavebenefited from theHeavilyIndebted Poor Countries (HIPC) initiative and theMultilateralDebtReliefInitiativeinthepast10years.For example, owing to its eligibility for the HIPCinitiativein2012,Guineacuttheinterestpaidonitsexternal debt from0.7%ofGDP in2012 to0.2% in2014.Figure6providessome indicatorsof thedebtburden for the threecountriesbefore theoutbreak,showingapre-EVD(2013)externaldebtburdenintherangeof10to22%,foratotalofsome$2.6billion.

Still,itiscrucialthatthecrisisnotsparkdebtdistressnoroffsetanyofthefiscalgains(mainlyreduceddebt

25


servicing and thus higher development spending)generatedby these initiatives, because these gainsare crucial to poverty reduction and economictransformation.ItisinthiscontextthatECAappealstoallstakeholdersformoredebtcancellationforthethreecountries.

LABOUR SUPPLY AND PRODUCTIVITYEVDmaydecreaselaboursupply,potentiallyhurtingthe quantity and quality of goods and services,especially in the public domain. To reduce closecontact in workplaces, some public and privateinstitutions have asked some non-essential staff tostayathome;othershavereducedworkinghoursforallstaff,leadingtoafallinproductivity.

InSierraLeone,forexample,bankscuttheirworkinghoursandthustheirdailyservices.Andinlinewiththerestrictions imposedbythestateofemergencyinJuly2014,dailymarketswereclosedearlierthan

usual.Thesemeasureshadrepercussionsonworkers’productivity from all sectors as they had to leaveworkearliertocarryoutfinancialtransactionsbeforethe banks and markets closed. Some expatriateshave left, as seen, undermining labour supply andproductivityastheseworkersmaybehardtoreplaceintheshortterm.

EVD-related mortality and morbidity have hit thenumber of farmers who can work in agriculture(whether directly or through looking after lovedones). They have also taken away skilled workersfrom the labour market, especially (and tragically)in health, where nearly three out of five of thoseinfectedhavedied(seefigure3).Theultimateeffectof thedisease, in termsof labourandproductivity,is thus to hurt economic activity, the tax base andpublicrevenuecollection.

FIGURE 6 DEBT-TO-GDP RATIOS FOR THE THREE COUNTRIES, 2013

Source: Rapport Programme de Coopération Monétaire 2013, Agence Monétaire de l’Afrique de l’Ouest (AMAO) and ECA calculations. ECA calculations are from West African Monetary Institute (WAMI) debt structure), and external rate change given by IMF country report 14/300 for 2013, p. 15.

$1,564.7

$286

$371.6

$1,371.90

$195.9

14.6%

21.1%

7.8%

21.7%

10.0%

18.5%

$1,035.90

Guinea

Liberia

Sierra Leone

Internal debt

$ MILLION DEBT-TO-GDP RATIOS

External debt

$481.9

$1,407.5

$2,936.6

26


POVERTY AND INEQUALITYIn the short term, the epidemic is likely towiden income inequality and increase povertyin the three countries by impoverishing directlyaffected individuals and families, and by reducingconsumption and access to basic social services,especially among thepoor. In the longer term, thedisease’seffectonGDPgrowthmaywellbefeltonGDPpercapita.Andgiventhat incomedistributionis alreadyhighlyunequal, it is extremely likely thatthepoorwillbehithardest—underminingthesocio-economicdevelopmentgainsofrecentyears.

CONTINGENCY AND RECOVERY PLANS

In the face of the multiple economic impacts,beyond their short-term responses governmentsneed to devise recovery plans. These will aim tobringtheeconomybacktoitspre-crisisgrowthpathby providing support to consolidate the economicfabric,restoreconfidence,andresumeconsumption,investment and growth. Revisions tomedium-termeconomicplansshouldaimtostrengthenresilienceand response capacity to future, similar shocks.Already, theministersof financeofGuinea, LiberiaandSierra Leonehavemet toexploreapost-Ebolastrategy(IMF2014e).

SURVEY ON NON-AFFECTED COUNTRIES’ PREPAREDNESS AND ON INDIRECT EFFECTS OF EVDThe analysis in this subsection is based on an ECAsurvey of countries’ preparedness for an EVDoutbreakandon the indirecteffectsofEVD,whichwas launched inNovember2014 (and is still beingconducted)amongnearlyallAfricancountriesotherthanthosedirectlyaffectedbyEVD;15responded,thoughnotallfully.

It aims to inquire about how and the extent towhich the non-affected countries have been hitby the disease and have organized themselves forprotection against its spread and socio-economicconsequences.

The results are based on the 15 replies,9 pendinga more exhaustive response.10 As some countrieshavenotrespondedtoall thequestions,andwhileawaiting replies from the remaining countries, theanalysisispartial.

ECONOMIC EFFECTS

Somecountriesmaynothaverecentdataonmanyoftheeconomic indicatorsthatcouldhelpthemtoconcludewithcertaintytheeconomicimpactofEVD.Even if they have them, any economic worseningmay not stem directly from EVD—causality has tobeestablished.WestAfricancountriesneighbouringGuinea, Liberia and Sierra Leone may have felt alargerimpactgivetheirclosereconomicinteraction.The survey therefore focusedonperceptionof theauthoritieswhetheragivenindicatorhasbeenorislikelytobeaffectedbyEVDinthefuture.

Although all those responding are not very closetotheEVD-effectedcountries, those inWestAfricareported negative impacts on economic indicatorssuch as GDP growth, inflation and trade. Theyperceive tourism and transport as directly affectedsectors.Amongtherespondents, theauthoritiesofnon-WestAfrican countries think that thenegativeimpactofEVD is lessthanearlierexpected,even iftheyfeelthatEVDhascontributedtoslowerexportandimportgrowth.

SOCIAL EFFECTS

TheimpactonthesocialsectorowingtoEVDislikelyto be less visible, particularly in countries far fromthe three affected countries. However, countrieshighlighted some issues thatmay not be apparentthroughaggregateddata.

ToquestionsontheimpactsofEVDonroutinehealthdelivery systems,nearlyhalf the respondents statedthat they had introduced special precautionary

9 Angola, Burkina Faso, Burundi, Cameroon, Cape Verde, CentralAfrican Republic, Chad, Republic of the Congo, DRC, EquatorialGuinea,Gabon,Ghana,Gambia,Niger,andSãoToméandPríncipe.

10 Detailsonthequestionnairecanbefoundathttp://www.uneca.org/sro-wa/pages/evd-web-appendix.

27


measures (laser thermometers, protectionmaterial)at medical centres. These measures, however, donot seem to have taken away substantial resourcesfromregularhealthcareprovision.Furthermore,thesameproportionofcountriesreportedthattheyarerestrictingthemovementofpeoplebyclosingbordersor stopping direct flights to the affected countries.Noneofthemreportedintroducingvisabans.

SPECIAL MEASURES

All respondent countries reported taking specialmeasures for economic and health preparedness.Most have set up high-level, multi-governmentalcommitteesthatmonitorpreparednessforapossibleoutbreak. All the respondents have designed acontingency or an EVD prevention plan. Thesestrategieswerereportedtocost$1.7million intheCentralAfricanRepublic,$3.2millionintheDRCand$0.8millioninSãoToméandPríncipe.

MosthavealsointroducedsomesortofspecialhealthprogrammetoprepareforapossibleEVDoutbreakandidentifiedtreatmentandisolationcentres.Almostall countries have launched awareness campaigns:the DRC has established an EVD toll free numberthatpeoplecancallforinformationonthedisease;theCentralAfricanRepublicdeclared26Augustasa day for intensified communication on EVD; Chadinvolvespolitical,religiousandtraditionalleadersinactivitiesaimedatraisingpreventionawareness;andGhanahastrained10,000healthworkersand50,000volunteerstocarryoutadoor-to-doorcampaign.

Allcountriesreportedhavingsomesortofassistancefrom UN agencies and bilateral developmentpartners. Five countries (DRC, Equatorial Guinea,Gambia, Ghana and São Tomé and Príncipe) alsopledged financial support directly for the worst-hitcountriesorviaWHO.BurundiandtheDRCaresendinghealthworkers (250and300, respectively)tothethreecountries.

ECONOMIC EFFECTS OF EVD ON WEST AFRICA AND THE CONTINENTAlthough the three affected countries will beseriouslyhitbylostGDP,effectsonWestAfricaandthecontinentasawholearelikelytobeslight.

Based on 2013 estimates, the three countriestogetherrepresent2.42%ofWestAfrica’sGDPand0.68%ofAfrica’sGDP. The sub-region accounts for28.3%ofAfrica’sGDP.WestAfrica’sgrowthisrobust,with the fastest rate on the continent in recentyears—at6.7%in2012and2013—withprojectionsof6.9%and6.8%for2014and2015.

Africa as a whole has been recording excellenteconomic performance in the recent past, withgrowth averaging 5% ormore in the 2000s beforetheglobalfinancialcrisishit,andastill-high4.7%and4.0%in2012and2013.Forecastsfor2014and2015showapick-upto4.7%and5.0%(ECA2014f).

The continent’s performance is based on externalfactors such as favourable commodity prices andon internal elements including improved economicmanagement, enhanced ability to attract foreigninvestment and trade partnerships (notably fromemerging countries) and consumption boosted byanewlyemergingmiddleclass.IftheEVDoutbreakis contained to the three countries, its impacton the continent’s GDP growth will be extremelysmall,accordingtotheresultsofanECAsimulation,conducted in November 2014 using the WorldEconomic Forecasting Model (WEFM). The modelis used a framework for analysing internationaltransmissionofeconomicshocks.

Because all three EVD-affected countries havebeen revising downward the projections for theirGDPgrowth rate for2014and2015 (figure7), thesimulationlooksatabenchmarkscenariowhereallthreecountriesregisteragrowthrateof0%in2014and 2015; projected growth for the other Africancountriesremainsunchangedfortheseyears.

In the simulation, the disruptive effects of EVD ontheeconomiesofGuinea, Liberia andSierra Leone

28


Reduction in GDP Growth rates from Pre-EVD projections

0%

-2%

-4%

-6%

-8%

-10%

-12%

Sierra Leone Guinea Liberia West Africa Africa

20142015

are mirrored by negative shocks to investment,consumption,unemployment,inflationandpotentialoutput. The shocks are calibrated such that theymatchanegativeeffectonGDPgrowthinthethreecountries, which results in a zero growth scenario(tables 1–3).11 We assume that the non-affectedcountriesareonlyaffectedthroughtheinternationaltransmission of the negative economic shocksoriginatingfromthethreecountriesandthatthereisnocontagion.12

11 TheWEFM includes countrymodels forGuineaandSierraLeonebutnotforLiberia.Forthisreason,theshockoriginat-ing fromLiberiawasdirectly introducedto itsAfricantradepartnerswith a strength corresponding to the reduction inLiberianimportsandexports.

12 The extent to which the economies of the non-affectedcountriesarehitotherthanthroughinternationaleconomicintegration ishard toquantify.Thosechannelsmay includechanges in consumer sentiment, reduction in tourism andotherfactors.Seetheprevioussection.

ThisanalysissuggestsforGDPgrowthasmalleffectinWestAfrica(-0.19percentagepointsin2014and-0.15 percentage points in 2015), and a negligibleeffectinAfrica(-0.05percentagepointsin2014and-0.04 percentage points in 2015). These minimalimpactsareunsurprisinggiven the threecountries’smallGDPshares inWestAfrica’sandAfrica’sGDP,and the tremendous response at national andinternationallevelsincombatingtheepidemic.

Inshort, there is littleneedtoworryaboutAfrica’sgrowthanddevelopmentprospectsbecauseof theEVDcrisis.

Figure 7 Simulated growth for West Africa and Africa

Source: ECA simulations as of 30 November 2014.

29


Reduction in GDP Growth rates from Pre-EVD projections

0%

-2%

-4%

-6%

-8%

-10%

-12%

Sierra Leone Guinea Liberia West Africa Africa

20142015

Thischapter looksatkeycross-cuttingaspectssuch as gender and the vulnerability of thethreecountries’healthsystems.

GENDER DIMENSIONS—WOMEN BEAR THE BRUNTGenderandsexdifferenceshaveaprofoundimpactonhowwomenandmenexperience,respondtoandrecover from infectious diseases. Evidence revealsthe disproportionate risk of infection, duration,severity and mortality between women and menfrom emerging infectious diseases such as EVD(WHO2011).Thisdifferentiatedimpactisattributedto socially ascribed gender norms and behaviour;the gendered division of labour betweenmen andwomen;andgender-relateddifferencesinaccesstoand control over productive resources as primaryrights-holders.

In this light, the EVD outbreak poses anunprecedentedchallengeintheoverallachievementof gender equality and women’s empowerment.Theunpaidcareworkathouseholdandcommunitylevelsaswellasthegendereddivisionoflabourhaveledtowomenbearingthebruntoftheoutbreak(asevidencedbyUNWomen2014),whichreportsthatasmanyas75%ofEVDfatalitiesinLiberiaand59%ofthoseinSierraLeoneareamongwomen.Acrossthethreecountries,55%to60%ofthedeadarewomen(WashingtonPost2014).

Further,sharpretrogressionhasbeenexperiencedbywomenand theirhealth indicators, suchasmaternalmortality. With medical facilities overwhelmed,

expectantmothersareoftenleftwithoutpre-natalcare,obstetric services and new-born care, reversing theearlierprogresstowardstheMillenniumDevelopmentGoalonmaternalmortalityinallthreecountries.

Compounding this, an increased risk of gender-based violence and exploitation of girls and youngwomenhasbeen reported in thecountries,due inparttoisolationbyquarantineortoorphanhoodbyEVD. Women have also felt reversals in economicempowerment,owing to the shuttingofbordersaffectingcross-border trade (where themajorityoftraders arewomen), and in agriculture andmining(whichhavesignificantfemaleworkforces).

CROSS-BORDER TRADE

Informalcross-bordertradeinAfricaisestimatedat43%ofofficialGDP,placingitalmostatparwithformaltrade (Lesser and Moisé-Leeman 2009). Economicliberalizationpolicies,highunemploymentratesandrisingurbanizationintherecentpastformanyWestAfrican states have led to a hugeexpansionof theinformalsectorinrecentyears.Sustainedeconomicgrowth inWestAfricawill probablybe increasinglydriven by trade in non-traditional exports such asagriculturalproducts,livestock,fish,handicraftsandmanufacturedgoods(ECA,AUandAfDB2010).

Women dominate cross-border trade in West Africa(70% in the Mano River region), even though theireconomiccontributionishardlygivenduevalue.Theircontribution to national GDP amounted to 64% ofvalueaddedintradeinBenin,46%inMaliand41%inChad.ItisreportedthatinWestAfrica,femaleinformalcross-bordertradersemploy1.2peopleintheirhome

6. GENDER AND HEALTH SYSTEMS ANALYSIS OF EVD’S IMPACTS

30


businesses,andonaveragesupport3.2childrenand3.1dependantswhoarenotchildrenorspouses.

Of the 2,000women informal cross-border traderssurveyedbyUNWomenin2007–2009inCameroon,Liberia,Mali, Swaziland,TanzaniaandZimbabwe,agreat majority stated that the revenue from theirtradingarethemainsourceofincomeforthefamily;women tradersuse it tobuy foodandother itemsfor thehousehold,pay for school fees,health careservicesandrent,savein“susu”clubsandbanksandreinvestintheirbusinesses.

In short, the official closures of themajor bordersbetweenGuinea,SierraLeone,Liberia,Côted’Ivoire,SenegalandGuinea-Bissauhavedevastatingimpactsonhouseholdincomes.13

MINING

Women are involved in the extractive industries,especiallymining,althoughtheylackvisibilitypartlybecausetheyarelargelyinartisanalandsmall-scalemining (ASM), which in some countries is illegal.Guinea, Liberia and Sierra Leone are among 21African countries14with more than 100,000 ASMoperatorswithestimateddependants ranging from600,000to9millionforeachofthesecountries(ECAandAUC2011).

As most ASM operations operate in the informaleconomy, their contributions to local and nationaldevelopmentare typicallybelow the radarofmostdecisionmakers,governmentanalystsandthegeneralpublic. Nationally, ASM inputs to GDP and foreignexchange earnings, while rarely captured, can besubstantial:forinstance,whenhalfofthecombinedincomeexpendituresofthe50,000–75,000artisanaldiamond miners in Liberia was examined, morethan$13.5millionwas projected as being injected

13 Recentdataindicatethat30%ofhouseholdsinLiberiawereheadedbyawomanin2009,22%inSierraLeonein2008and17% in Guinea in 2012. - Source: World DevelopmentIndicators,WorldBank,http://data.worldbank.org/indicator/SP.HOU.FEMA.ZS,accessed25November2014.

14 Angola,Burkina Faso,CentralAfricanRepublic,Chad,Côted’Ivoire, DRC, Eritrea, Ethiopia, Ghana, Guinea, Liberia,Madagascar,Mali,Mozambique,Niger,Nigeria,SierraLeone,Sudan,Tanzania,UgandaandZimbabwe.

into local economies annually, creatingmarkets forlocally grown or supplied products and increasingthe cash component of household incomes. Also,ASM-injected capital probably stimulated localformal and informal enterpriseswith an additional$33.75 million in local Liberian economies (ECAandAUC2011).Additionally, of the582,000 caratsof diamonds officially exported from Sierra Leonein 2006, 84% originated from ASM operators(GovernmentofSierraLeone2011).

Conservative estimates suggest that women makeupmorethan40%ofthegreaterthan8millionASMworkforces in Africa, in roles such as prospecting,explorationandactualmining,aswellasmarketing(World Bank 2012). They work in a range offunctions, includingwage labourers, labourerspaidbyproduction,distributors(assuredbuyers),licence-holders, cooperatives, dealers and supporters(financiers, often licence-holders). For instance,ASMisSierraLeone’ssecondlargestemployerafteragricultureandprovidesalivelihoodforanestimated200,000–300,000individualsandtheirfamilies.

But EVD has forced many ASM operators—particularlywomen—toabandonartisanaldiamondandgoldminingaltogetherbecauseoftightbordercontrolsaimedatcurbingthespreadofthedisease,andrestrictionsonpeople’smovements.Beforethecrisis, artisanal gold mining—a female-dominatedactivity—provideda steadyand reliable income forwomen(Maconachie2014).

The downstream links between mining andagriculturehavealsobeenseverelystrainedby theoutbreak, as female artisanal operators combinefarming and mining, with proceeds from miningfrequentlyreinvestedintofarmingortheexpansionofcashcrops.

AGRICULTURE

Women account for 43%of the agricultural labourforce in developing countries and an estimatedtwo-thirdsof theworld’s600millionpoor livestockkeepers (FAO 2013).Gender issues fundamentallyshape the totality of production, distribution and

31


consumptionwithinaneconomybuttheyhaveoftenbeen overlooked in times of emergencies (Spence2012).KailahunandKenemadistrictsinSierraLeone,forinstance,havewomenmasterfarmersandheadsof household whose agricultural bases have beenseverely eroded and, in some cases, completelywipedoutbyEVDdeaths(AfDB2014b).

Additionally,restrictionsonmovementshaveledtothe lossof incomeofwomenwhoare traditionallybreadwinners in rural homes, as much-neededstaplefoodsrotawayforlackoftransporttomarkets.Similarly,restrictionsonthenumberoftraderswhogain access to some keymarkets in Liberia—in aneffort to avoid contagion—have resulted in heavylosses for women traders who comprise 70% ofthe traders. Finally, access to and control overland and other productive resources have becomeproblematic for EVD widows because customarylandlawsoninheritanceinGuinea,LiberiaandSierraLeonediscriminateagainstwomen.

UNPAID CARE WORK

Unpaidcareworkisareflectionofsocietalexpectationsof the unpaid productive and reproductive choresthat women and girls are required to undertakefor their male kin that determines a household’sabilitytosustainbasicdailyconsumption.Itis(moreoftenthannot)time,labouranddrudgeryintensivewithout corresponding entitlements (UAF-Africa2014).InGuinea, it is estimated that aworkloadof15–17 hours per day is borne bywomen in familyandprofessionalactivities.SimilarworkhourshavebeenreportedforLiberiaandSierraLeone.

Aswomenarepulledoutoftheirdailyworktocarefor sick family members or children orphaned bythedisease,theyhavelesstimetoearnmoneyandgrowandsellfood,whichcanleadtoincreasedfoodinsecurityandperpetuationofthepovertycycle.

VULNERABILITY OF AFRICAN HEALTH SYSTEMSTherapidexpansionofEVDrevealedthelowcapacitytoreactandmanageaninfectiousdiseaseoutbreakamong most African countries’ health systems,exposingfewmeans,evenmore limitedknowledgeamong health personnel and the systems’ lowrankingamonggovernmentpriorities.

Public health systems need to be reprioritized andstrengthened, as the following data show. Solidinstitutions are needed, providing preventive andcurative health services, and this can bemet onlythrough improving performance and efficiencyof the essential components of health systems.WHOconsiders six elementsessential:provisionofservices; health personnel; systems of informationandknowledgeonhealth;medicalproducts,vaccinesand technologies; health financing; and leadershipandgovernance.

UNDER-INFRASTRUCTURED

Withthesupportofpartners,Africancountrieshavebuiltahealth infrastructureofsorts,butat0.8theAfricanaveragedoesnotevenreachonehospitalper100,000inhabitants(WHO2014).Only13countriesexceed this standard, with Gabon having the bestoutcome; Guinea and Liberia are way below theAfrican average (Figure 8). Worse, this metric hasdeclined in Africa, down from 0.9 in 2013 (whenGabonhadfourhospitalsper100,000 inhabitants).Beyond this weak coverage is a stark problem ofaccess,notablyaveragedistancestoahealthservice,reflecting both geographical distribution and poortransportinfrastructure.

The technical facilities of many African countriesare not in good shape, too often equipped withlaboratories and radiological equipment scarcelyworkingowingtoalackofmaintenance.Onereasonisthatpayrollconsumesaheavyshareofthebudget:60–80% of most ministries of health, leaving fewresources for spending elsewhere (Gobbers andPichard 2000). The upshot is a heavy percentageof temporary staff, sometimes paid on piece rate

32


withoutfixed-termcontracts,andtraditionalhealersorpoorlytrainedhealthstaff.Sometimesservicesarecontractedout. In somecountriespoorlymanagedrecruitment—under the ministry in charge of the

public service—explains these inadequacies, seenamong all professions: doctors, nurses, qualifiedcaregivers, laboratory technicians, paramedics andsocialworkers.

Figure 8 Number of hospitals per 100,000 inhabitants 2013

The leading 10 The lagging 10

Gabon Libya Tunisia Namibia Côte d’Ivoire Kenya Ghana Botswana Sudan Seychelles

African average

3.5 2.6 2.3 1.9 1.7 1. 5 1.4 1.3 1.3 1.1

0.8

Benin Eritrea Guinea Liberia Malawi Uganda DRC Burkina Faso Ethiopia Senegal

0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.3 0.2 0.2

Source: WHO 2014. Note: Icons designed by Freepik.

UNDER-STAFFED

TheAfricanaverage fordoctors is reasonable,with2.6 doctors per 10,000 inhabitants, but not so fornursesandmidwives,asthesedoctorssuperviseonaverage12.0nursesandmidwives.WHO’sstandards

are for one doctor per 10,000 inhabitants, onenurseper300inhabitantsandonemidwifeper300womenofreproductiveage.Supportstaffinhealthunits (plumbers for drinking water and sanitation,electricians anddrivers, experts inhigh technologyforequipment)areinextremelyshortsupply.

Egypt Libya Tunisia Algeria South Africa Morocco Nigeria Namibia Botswana Cape Verde

28.3 1 9.0 12.2 12.1 7.8 6.2 4.1 3.7 3.4 3.0

Togo CAR Burkina Faso Mozambique Ethiopia Sierra Leone Niger Malawi Tanzania Liberia

0.5 0.5 0.5 0.4 0.3 0.2 0.2 0.2 0.1 0.1

2.6

The leading 10 The lagging 10

African average

Figure 9 Number of medical doctors per 10,000 inhabitants, 2006–2013

Source : WHO 2014. Note: Icons designed by Freepik.

33


Among countries affected by EVD, the ratios fordoctorsarefarbelowthataverage:Guinea(1.0),SierraLeone(0.2)andLiberia(0.1)(figure9).Indicatorsfornursesandmidwivesarealsoworrying:2.7inLiberiaand1.7 in Sierra Leone, not even a quarter of theAfricanaverage.Attheserates,medicalsupervisionandsupportaregrosslyinadequate.

Medical staff numbers are especially low in ruralareas, and doctors particularly prefer urban areas.Nursesandmidwivespractisemoreinthepublicthanprivatesector.Thepersonneldeficitiswiderinareaswithpoor livingconditions,whichare frequently inruralareas.Foreignpractitionersworkinthepublicandprivatesectors.

Doctors in the public sector also work privately inmost countries (not always fulfilling their publicserviceobligations). This “dual jobholding”usuallystemsfrompoorworkingconditionsandlowsalariesin thepublic sector. But the lack of evenwell-paidprivate jobs is the origin of their continual searchfor other more lucrative situations, which can beabroad,drainingthecontinent’smedicalbase(figure10). Still, there may be huge financial benefits tosending countries (at least in the short term): themassive recruitment of Ghanaian doctors by theUnited Kingdom between 1998 and 2002 made itpossibleforthecountrytosavenearly$172million(PerformanceManagementConsulting2010).

Source : Performance Management Consulting,www.performancesconsulting.com

Figure 10 The main host countries of the drain of medical skills from Africa (excluding North Africa)

France 24,494African doctors

United Kingdom 15,258African doctors

United States 12,813African doctors

Portugal 3,859African doctors

Canada 3,715African doctors

Australia 2,140African doctors

4,199 from Africa(excluding North Africa)






34


Yet the overall picture is not encouraging: Africahas 1.3% of the planet’s health workers butits global disease burden is 25% (PerformanceManagement Consulting 2010). The humanresourcedeficit isapressingburdenwith,attimes, devastatingconsequences.

UNDER-RESOURCED

Lackof funding isoneof themain reasons for theaboveunimpressivedataoninfrastructureandstaffperformance. States are themain funders of theirhealthsystems.Incountriesthathavedecentralizedmorethanothers,localcommunitiesalsocontributeto thehealth effort (although community health isfarfromapriorityinAfrica,despitethediscourse).

WHO calls on countries to devote at least 9% ofpublic spending to health—and to their credit,

manycountriesdoso(Figure11).Otherbodieshaveotherspendingtargets: theAfricanUnion10%andthe Economic Community of West African States(ECOWAS)15%.

In2011theserateswere19.1%inLiberia,12.3%inSierraLeoneand6.8%inGuinea,againsttheAfricanaverage of 9.7% (WHO 2014). These figures maythough be a shade misleading, as these amountsreflecthealthsystemreconstruction.InGuinea,theCoordination Body for the Combat against Ebolaargues that the truehealthbudget is only 2.7%ofnationalgovernmentspending.

Most African states thus spend less than $20 perpersonperyear,andsomelessthan$10—notevenhalf the $34–$40 needed for essential minimumhealthservices(AU2007).

Figure 11 Share of health spending in national budgets, 2011 (%)

Source : WHO 2014. Icons used in this figure have been designed by Freepik.

Rwanda Liberia Malawi Togo Lesotho Zambia Djibouti Namibia Burundi Madagascar

24 .0 19.1 17 .0 15.4 14.5 14.4 14.1 13.9 13.6 13.5

Nigeria & Uganda Egypt Morocco Kenya Angola São Tomé and Príncipe Libya South Sudan Eritrea Chad

6.4 6.3 6.0 5.9 5.6 5.6 4.5 4.0 3.6 3.3

9.7

The leading 10

African average

$

The lagging 10

The private sector (for-profit and religious) alsofinances health care. Owing to low salaries in thepublicsector,theprivatesectorhasbenefitedfromhuman resources moving from the other sector(and, as seen, some of these personnel use publicinfrastructure when practising privately). Thesepractices, which can increase the costs of healthcare,mayreducethecredibilityof formalhealth infavouroftraditionalpractitioners.

UNDER-INTEGRATED

In several countries, the health sector draws littlesupport from the other sectors. This indicates alack of a system-wide, overall approach integratingthe cultural dimensions of the people and thecontributionsofothersectorsforpromotinghealth

35


TheswiftadvanceoftheEVDepidemicisexplainednotonlybystrugglinghealthsystemsbutalsobythefailureofothersectoralpolicies.

Forexample,lowaccessratestosafedrinkingwaterand minimal attention to sanitation leave peopleseriouslyexposedtoinfection,asdoesmalnutrition.Economically, agriculture is oriented towards cashcropsforexportratherthanfoodcrops,whichdonotbenefitatallfromsupportmechanismsforproductionandmarketing,and thus theirexpansion is limited.Thisorientation reinforcesdependencyonexternalfoodandevenmoreonfoodaid,whichundermineslocal production. Health care poses environmentalproblemswithpoorlymanagedwaste.

Cross-border activities are very dense, and in thatsense integrated,which iswhyborder closuresaresuchadraconianmeasure.Suchdensityallowedthe

virustodisseminatefastinternationally:fromGuineait spread throughout Sierra Leone and Liberia. InJune2014,Guineahadonlytwocases,butthevirusthencamebackfromSierraLeonetospreadatgreatspeed throughout the Mano River region. Addedtothiswerecases importedfromLiberiatoNigeriaandfromGuineatoSenegal,whichdealtwiththemquickly.CaseshavealsobeenimportedfromGuineatoMali.

Thefailuretointegrateandcoordinateinternationalactivities is also apparent: theWest AfricanHealthOrganization, forexample,hasbeenunableto fullyplay its role of distributing resources in commonand reinforcing cooperation amongmember statesand third countries. Neighbouring countries havepreferredtoclosetheirborders,addingtothemiseryandsufferinghighlightedinearlierchapters.

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ItisimportanttoknowwhattheworldissayingabouttheEVDoutbreak—its“perceptions.”Aretheseopinions,expressedatdifferenttimesand

places,optimisticorpessimistic?

Tofindout,“sentimentanalysis”wasused.Thisisadataminingtechniquethathasreceivedrecognition,particularlyafterPangandLee’s (2008)paper.Alsocalled “opinionmining”, this uses natural-languageprocessingtechniquestodeterminetheattitudeofa

7. PERCEPTIONS ANALYSIS

>2015-2010-155-10<5No data

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Figure 12 Sentiment scores and scores of other topics in articles about EVD—published between March 2014 and 15 November 2014—

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speakertowardsatopicviamethodssuchasdetectionof keywords, computing similarities between textsbased on word frequencies and correlations, andother data mining techniques that have beenadapted to text documents. Theunderlying idea isthat,when the speaker ispositiveabouta subject,heorshewillhaveatendencytousemorepositivewordswhentalkingaboutit—andviceversa.

Other statistical techniques that allow automaticextractionandgroupingofrecurrenttopicsinatextwerealsoused.Theseincludeavariationofopinionmining that computes the frequencies of wordsrelated to a specific topic and the lingo algorithm(Osiński, Stefanowski and Weiss 2004), which canautomaticallyfindrecurrentphrasesinalistoftextsandclassifythetextsbytopicsbasedonsuchphrases.

SENTIMENT ANALYSIS

Basedon2,502newsarticlespublished inaffectedcountriesbetweenMarch2014andNovember2014and729newsarticlespublishedinvariouscountriesaroundtheworld,asentimentscorewascomputedusing the R text mining package and R sentimentanalysisplug-in.

Apreliminaryanalysisofawiderangeofinformationincludingnewsitems,reportsandstudiesabouttheoutbreak illustrates general sentiment in differentparts of theworld (figure 12). A high scoremeansthatpeoplearegloballymorepositivewhentalkingabout EVD and a low opinion score the opposite.Theopinionscore iscomputed fromthe frequencyof positive and negative words using text mining

Box 4 Brussels Airlines serving the three countriesBrusselsAirlinesisstillflyingtoConakry,MonroviaandFreetown.Itstwice-weeklyflightfromMonroviatoBrussels—nowtheonlyairlinkfromthecitytoEurope—isarealhumanitarianairbridge.Whileservingtheaffectedcountriesandthesub-region,theairlinehastakenthethreatofEVDseriouslyandmaintaineda continuous risk assessment and communicationwithorganizations tackling theoutbreak,includingBelgium’sownMinistryofHealthandMédecinsSansFrontières(DoctorswithoutBorders). The airline also works closely with local governments in the three countries on strictprecautionarymeasures.

Asof4November,BrusselsAirlineshadtemporarilysuspendedthereservationsof77“suspicious”passengerstryingtoflyfromthethreecountriesbutall77passengerswere laterallowedtotaketheirseatsasnonehadcontractedEVD,buthadbeeninfectedwithmorecommon,butlesslethal,diseasessuchasmalaria.

BrusselsAirlinesreliesonitscrewvolunteeringtooperatetheflights,andtodatehasalwaysfoundenoughofthemtomaintainafullschedule.Recentlyunderpressurefromstaffconcernedoversafety,ithasnotenvisagedcancellingflightsbutadjusteditsscheduletoavoidstaffmembersspendingthenightinaffectedareas.BrusselsAirlineshasredirectedthecrewswhichhadtostayingnearMonrovia,forexample, tohotels inotherWestAfricancountries, suchasGambia, SenegalorCôted’Ivoire,leadingtoatechnicalstopoverandaddinganhourtoitsflightbacktoBrussels.

Suchdecisionshavesetanexamplenotonlyofhumanitarianresponsibilitybutalsoagoodpracticefor corporate social responsibility, especially against the backdrop of a complex, humanitarianemergency.

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(Meyer,HornikandFeinerer2008)intheRstatisticalpackage(RDevelopmentCoreTeam2012).Thegraphalso shows scores of economic, social andmedicaltopics computed using a similarmethodology. Thescoreshavebeennormalisedsothatthesumofthescores is 100—i.e., only the relative values of thescoresaremeaningful.

ThemostpositiveregionisNorthAmerica,followedbyAfricaandEurope; the leastpositive isOceania.The regionswith the highest sentiment scores arealsothosewithcasesandwheretherearethemostnewsarticlesaboutit.Thenegativesentimentseemsmainly a fear factor and, the more the subject isdiscussed, the more that fear factor disappears.Peoplearelessalarmedwhentheyknowexactlywhatthediseaseisabout,howitspreads,howtoavoiditand,mostimportant,thatitcanbecontrolled.Thatfearfactormaybethemainchannelthroughwhichtheoutbreakmayimpacteconomiesofnon-affected

African countries as their inhabitants cancel travelandtheircompaniesdivertinvestment.

Such restrictions are already making it harder tomove health workers and supplies back and forthandtotrackthedisease,underminingeffortstoquellthe epidemic—although there are still some goodpractices(box4).Communicationaboutthediseaseisthereforeparticularlyimportant.

Sentiment in the affected and non-affectedcountries has followed similar trends (figure 13),but international sentiment has always beenmorepessimistic(anditwentdownmoresharplythanitsEVD-countrycounterpartinSeptember2014,whenthe first case was diagnosed in a major Westerncountry). It means that there is unnecessarypessimism in non-affected countries. But the twosentimentsareconverging,whichsuggeststhatthepessimism is dissipating as theworld learns to livewiththeepidemic.

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FIGURE 13 SENTIMENT SCORES COMPUTED ON ARTICLES PUBLISHED INSIDE AND OUTSIDE EVD-AFFECTED COUNTRIES


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FIGURE 14 WORLD CLOUD OF NEWS ON EVD


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The perception of the crisis can also be illustratedby a “world cloud” (figure14). Thehigh frequencyof words like “said” shows that people aremostlyreportingwhat they heard from others. The cloudalso shows that people tend to focus on healthaspects,ratherthaneconomicorsocialfactors.

Basedonthesamemethodologyasforthesentimentanalysis, scores have been computed, instead ofusingalistofwordsexpressingpositiveornegativesentiments,on setsofwordsexpressingeconomic,medicalandsocialconcernsabouttheEVD.Figure15illustrates the differences in the preoccupations

expressedinthearticlesdependingonwhethertheywere written by people living in the EVD-affectedcountries (“local news”) or people living outsidethem(“internationalnews”).

AsEVDisfirstamedicalissue,medicaltopicsdominate,in local and international news; international newsshowsmorefocusonmedicalaspectsthannationalnews.Thescoresonmedical topicsarehighat thebeginning of the outbreak, because at that timemostnewsarticlesincludedalongdescriptionofthedisease,itshistory,itshighlethalityandpropagationmechanisms. For example, a security messagereleased in March 2014 by the US embassy in

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ConakryconfirmedthepresenceoftheEbolavirusintheForestRegionofGuinea.Themessagecontinuedwithadescriptionof thesymptomsof thedisease,indicationsofmortalityratesandthewaythediseasespreads, and recommendations to avoid contactwith individuals showing symptoms until furtherinformationbecameavailable.15

In the same month, the first concerns about thevirus getting to theWestwere expressedwith thecaseofadoctorwhowentbackhomeafterworkinginEVD-affectedregionsandwasshowingsymptoms (RTNews2014).

Medical concerns showed slight decrease in May,September and November, but the scores wereconsistently high. It is around June that the phrase“out of control” started to be used consistently(MSF Canada 2014). Thismarks a period when themedicalconcernsstartedrisingagaininbothlocalandinternationalnews.InJuly2014thefirstcaseofEVDwas confirmed in Nigeria, validating the declarationand increasing international alarm. However, theNigerian case was well handled, proving to theinternationalcommunitythatitwasindeedpossibletocontrolthespreadofthevirusinacountryifadequatemeasures were taken (see box 1). In August 2014acasewasreported inSenegal,whichwasalsowellhandledusingcontainmentandtreatmentmeasures.

15 “SecurityMessage forU.S.Citizens:EbolaHemorrhagicFever”,USEmbassy, Conakry, http://searchabout.wc.lt/look/Conakry_Guinea_Ebola/Security_Message_For_U_S_Citizens_Ebola_Hemorrhagic__/aHR0cDovL2NvbmFrcnkudXNlbWJhc3N5Lmdvdi9lYm9sYWhlbW9yc-mhhZ2ljZmZ2ZXIuaHRtbA==_blog.

These two cases probably explain the decrease inthe concerns in international news for September,October andNovember, even thoughonly thefirsttrue EVD case in the US, confirmed in September,really caught the attention of Western citizens. InOctober2014,anarticlewaspublishedinaRwandannewspaper entitled “What’s WrongWith How theWestTalkAboutEbola?”(AllAfrica2014).Thearticlecited data from Google Trends, which tracks thepopularityofspecifictopicsinthenewsandTwitterstatistics,statingthat“theworldonlyreallystartedpaying attention to the Ebola epidemic when itinvolvedpatientsintheU.S.”.

Forsocialtopics,thehighscoresintheearlymonthsin local news mark the period where society wasstill absorbing the shock and trying to change itsbehaviour.Theneededchangesarenumerous,andthatthescoreswentdownquicklyshowsthatpeoplehavelearnedtolivewiththeepidemic.

Economic topics seemnot to be ofmajor concernin international newswhile local news put a lot ofemphasis on them.After the society has absorbedtheinitialshockoftheoutbreakandhaslearnedtolivewith, economic impacts have become amajorconcerninaffectedcountries.

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The socio-economic and intangible impacts ofEVD differ by country, by segment of societyand by economic sector. Responses should,

ideally,betailored,butasthecrisisisstillevolvingandgiven the scarcity of reliable data, such customizedrecommendationsareinfeasible.Thisreportthereforepresents its policy recommendations using broadbrushstrokesunderthefollowingfourheadings.

EPIDEMIOLOGICALEfforts should be made to ensure that all infected people access timely treatment in designated medical facilities, and that new infections are prevented. Healthfacilitiesshouldbebroughtclosertocommunities.

Detailed stock-taking should identify the actors in the three countries, to establish what the actors are doing, how they are doing it and their interventions’ impact.Thisneedstobeprecededbyawell-structuredanddetailedsocio-economicneedsassessment of the affected countries to establishtheirshort-,medium-andlong-termpriorityneeds,which will then serve as a guide for interventionby various stakeholders. These two processesaim at coordination, to ensure that interventionsare structured around priority needs of affectedcommunities. This step is needed because theoutbreak has attractedmultiple actors, particularlyto the three affected countries. As in other crises,thispresentscoordinationchallengeswhich,unlessmanagedwell,couldaggravateratherthanalleviateEVDimpacts.

Strategies are needed to collect and disseminate reliable data. The actual epidemiological scaleof EVD cannot be measured with precision, northe exact impact of interventions and, althoughaggregate numbers of infected people have beguntodecline in theaffectedcountries, a case-by-caseanalysis (particularly in Liberia and Sierra Leone,wherereportedcasesarehigherthan inGuinea) isneeded.Thereisanacuteshortageofreliabledataonsocio-economicsectorsinthethreecountries,partlyowing to suspension of many statistical activities.Thelackofreal-timedataonthenumberofdeathsby location and the causes of death has seriouslyaffected interventions tracking the infection andpromotingpreventiveandcurativemeasures.Healthinterventions depend on continuous gatheringof basic data on mortality by age, sex, locationand cause of death, including through functionalcivil registration systems. Components of thisrecommendationincludethefollowing:

• Systems to track morbidity in real time, particularly for communicable diseases, should be created. The cost of not having a systemthat can pick up infections at an early stageand maintain subsequent data on the diseasein real time has not only disastrous healthconsequences but also serious socio-economicimpacts.Continuousdatacollectionisrequired,particularlyinensuringthenumberofreported,confirmedandprobablecases,alongwithcloseattention to compiling EVD-related mortalityfor a correct understandingof the scaleof theproblem.Inaddition,household-andindividual-surveys need to continue for better policy

8. POLICY RECOMMENDATIONS

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interventionsbasedonevidencefromthefield.Analytical studies on household and individualwelfare assessments/challenges in relationtoEVDarebest tackledonly if surveydataareavailable.

• There is need to reconcile and harmonize data sources and strengthen the capacity of national statistical offices to process statistical data. In themedium to long term, ECA standsready, through its African Centre for Statistics,to support the affected countries in enhancingstatistical capacity via training in internationalstatistical standards. These efforts should becomplemented with early warning informationsystemsaboutthedisease.

• Epidemiological management and control of the EVD should start with a clear understanding of the disease profile, intensity and dynamics, including its strains. This calls for learningandrelearning of the disease patterns, mode andintensityoftransmission.Moreimportant,rightnumbers of epidemiologists, medical doctors,nurses and public health specialists should bemobilized from ECA African member statesandelsewhereandbedeployedintheaffectedcountries. The African Union Support to EbolaOutbreak in West Africa (ASEOWA) initiative—aimed at strengthening the capacity of localhealthsystemsintheaffectedcountries—shouldbe reinforced, including through increasedfundingbymemberstatesandpartners.

• Urgent steps should be taken to strengthen the statistical systems of the three countries, including reopening and strengthening their civil registration systems.Similarmeasuresshouldbetakeninnon-affectedAfricancountrieswithweakstatisticalandcivilregistrationsystems.

The drivers of EVD should be isolated from other diseases to avoid prescribing solutions to the wrong problems.StatisticalmodellingusingarangeofscenarioscanascertainthebeforeandaftereffectsofEVDinthethreecountries.Relatedtothisisthe

need to bolster the resilience of these countries’healthsystems,forEVDandnon-Eboladiseases.

Communities need to abide by strict burial protocols, including the requirement that burialsof victims should only be conducted by trainedpersonnel to avoid further contamination throughinteractionwithdeadbodies.Thespecialteamssetuptoconductburials inthethreecountriesshouldbestrengthenedandurgedtocontinueworkingwithlocal communities and health personnel to ensuresafe burials. Laboratory facilities and the hospitalinfrastructure in general should be resourcedwithmodern diagnostic equipment, and the skills ofmedical personnel should be upgraded to matchcurrentEVD-relateddemands.

More domestic resources should be mobilized to see to it that the right volumes and types are deployed to the health sector, particularly for EVD. Based on existing institutional frameworks suchas public––private partnerships, the Africa ChiefExecutive Officer Forum and philanthropic bodies(e.g., the Mo Ibrahim Foundation), the privatesectorandwealthyAfricanindividualcitizensshouldcontinuetoleverresources,astheydidinNovember2014 when representatives of the African privatesector,undertheaegisoftheAfricanUnion,gatheredin Ethiopia as part of the international effort tomobilizeresourceswithinAfricaandtodiscusshowtoredressthethreecountries’economicdecline.AsofNovember2014,theprivatesector inAfricahadpledgedfinancialresourcestotheAfricanUnion–ledPrivateSectorEbolaFund16of$32.6million.

16 MTNGroupand(AfDB($10millioneach),The);DangoteGroupandTrust ($3 million); EconetWireless ($2.5 million); Motsepe FamilyTrust,StenbeckFamily,AfreximBank,CocaColaEurasiaandAfrica,Vitol Group of Companies and Vivo Energy ($1 million); QualityGroup of Tanzania, Old Mutual Group, Nedbank Group USD),andBarclaysAfricaGroupLimited($500,000);andUnitedBankforAfrica($100,000) http://pages.au.int/ebola/news/message-of-African-Union-Commission-Chairperson-on-good-progress-on-AU-Private-Sector-Ebola-Fund

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Governments need to employ large teams of health service workers who can be trained and deployed quickly to give information on EVD to households in rural areas. Beyond offering jobs to thousands,thishas thepotential tohelppreventoutbreaksofinfectiousdiseasesinthefuture.

ECONOMICWest Africa and the broader African continent should not panic over declines in GDP growth owing to EVD.WhilethethreeaffectedcountrieswillsuffersteepGDPlosses,theeffectsonbothWestAfricaandthecontinentwillbeminimal:-0.19percentagepointsin2014and-0.15percentagepoints,respectively,in2015;and-0.05percentagepointsin2014and-0.04percentagepoints,respectively,in2015.

To boost the economy and counteract the damaging alarm-driven indirect effects, the best government measure is to build confidence. Economicrecoveryin the affected countries will start once the EVDoutbreakiscontainedanditsfulleconomicimpactsaredetermined.Aidalone isnotenough.Providingconsistent and regular—and when true, upbeat—messagesaboutEVDisextremelyhelpful.

Lessons from successful past recovery programmes should be levered in crafting workable responses to the EVD epidemic. For LiberiaandSierra Leonein particular, there are important lessons from thepast, given their success in reconstructing theireconomies after civil wars. These fragile and post-conflict countries managed to overcome the twinchallenges of keeping peace and rebuilding theireconomies,andsoknowtheeconomicmanagementstepstheycantaketorecover,thistime,fromEVD.ItisalsorealisticthattheywillbeonthesamerobustgrowthtrajectoryafterEVDiscontained.

• Fiscal measures need to include the introduction of social protection/safety net programmes to help families of victims and their immediate communities.Thereisaneedtotargetvulnerablegroupsthatdisproportionatelysufferedfromthecrisissuchasorphans,childrenwho lostoneparentandwomengivingcareat

huge risk to themselves. Other social groupshavealsolostemploymentowingtoEVDanditseffects on businesses and production. Supportshouldthereforeproviderobustsocialprotectionto facilitate the socio-economic recovery ofdeeply affected communities whose economiclivelihood is threatened. The internationalaid effort and domestic resource mobilizationwithin countries can be earmarked to suchinterventions.

• Countries not directly affected need to make budgetary reallocation for better preparedness and containment against an EVD outbreak. Thisisnoteasywhenmostofthemfacecompetingdemands to their stretched budgets, but it isbettertoactpreventively.Internationalsupporthelpsfillsomeofthespendinggapscreatedbythecrisis.

• Provide targeted incentives to attract domestic and foreign (foreign direct investment).investment. Affected governments shouldconsider tax holidays and subsidies forprospective national and foreign investors as astrategytoattractinvestment,possiblyavoiding(or being chased out of) these countries.Governments should establish investmentoffices,andlevernetworksof internationalandregionaldevelopmentbankssuchasAfDB.Theyneedtoattractinvestorstotakeadvantageoftheattractivepackagesandprofitableopportunitiesfor foreign companies in mining, agriculture,manufacturingandtourism.

• Cut interest rates to boost growth. Thiswouldhelp investors, particularly smallandmedium-sized entrepreneurs whose businesses havebeenhitbythecrisis.

• Countries should manage their exchange rates cautiously, avoiding hasty adjustment measures. Evenwiththecrisisandlowertrade,largefinancialinflows are supporting the currencies (e.g., theUS $450million from the International FinanceCorporation—seeFigure6).Modestdepreciationcanalsopromoteexportcompetitiveness.

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Bilateral and multilateral creditors should seriously consider cancelling the three countries’ external debts. Thesecountrieswillfindithighlyburdensometo meet their international debt obligations (seefigure6).Properlycrafteddebtcancellationpackageswouldhelpthemrefocustheirenergiesoncontainingtheoutbreak,andreleaseresourcestosupporttherebuildingoftheirfragileeconomies.ThisproposalisinlinewiththeG20countries’requestattheBrisbanesummit, and should not be offset against EVD-linked funding pledges from international financialinstitutions.Thepost-catastrophedebtreliefschemeforHaitiprovidesausefultemplate.

The three countries—and neighbouring states that lost their tourist status—should devise strategies to tighten connectivity between them and the broader region. They should also adopt business-related travel incentives, easing procedures forsecuring entry visas and encouraging competitiverates at hotels and on related tourist products.Carefullythought-outconfidence-buildingstrategiesshouldbeadoptedinthemediumterm,drawingonlessonsfromHaiti’srecoveryinitiatives.

Governments and development partners should invest in building skills and human capital in the short, medium and long term to enhance labour supply. Theyshouldinparticularprovidesupporttoartisanalminers,andboostaddedvalueandgenerateemployment inmining.Moregenerallytheyshouldoverseeimprovementsinsewageandsanitation.

The response effort should aim to reinforce border health checks instead of closing all borders, except when there are compelling reasons. Suchreinforcementshouldalsosupportmilitarypersonnelatcheckpointsandcoverhealthpersonnelassignedtoworkatthoseborders.

With many parts of the three countries suffering acute food shortages—given border closures and disrupted agricultural output—several measures should be taken:

• Boost country food aid efforts and emergencysafety net programmes to meet the needs ofthemostvulnerablegroupssuchaschildrenatriskofmalnutrition.Acommunityfocusiscrucialbecause many children are now cared for byneighboursandrelatives.

• Adopt food price policies including stabilizingmeasures,forriceparticularly.

• ScaleupsupporttotheWorldFoodProgrammeinprovidingfoodassistanceandfacilitatinglogisticsforinaccessibleareas.Suchfooddistributioncanhelpstabilizefoodprices.

• To avoid long-term dependence on food aid,facilitate imports of essential food items andmake themavailable to populations affordably.Suchmeasureswillbeaidedifbordersarekeptopenandtravelbanslifted.

African countries should strengthen regulatory mechanisms to identify and sanction economic actors charging higher rates to consumers.Thereismuchroomto improve the regulatorymechanismsthat countries can put in place to discourage suchresponses(e.g.,amongshippinginsurers).

Governments of affected countries should devise recovery plans to quickly revive their economies, which may require revisions to medium-or even long-term national development plans. Suchrecovery plans will aim to bring the economyback to pre-crisis growth by providing support forrestoring confidence and resuming consumption,investments and economic growth. More tightlytheyshouldaddressweakenedgovernmentrevenue,slowereconomicactivity,weakenedSMEs,reducedpurchasingpowerformanyhouseholdsandfarmers,apprehensivebehaviourofforeigncompanies(whichareusuallythedriversoftheeconomies),andfallinginvestment. Medium-term plans should aim to

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strengthenresilienceandresponsecapacityagainstfuture similar shocks, which may require supportfrominstitutionslikeECA.

In the medium and long term, these three governments, with partners’ support, should provide incentive packages to farmers to help relaunch agriculture, which is vital to long-term recovery. After the above short-termmeasures, inthe long term agriculture will need to be rebuilt,particularly as it is the economic mainstay. Somerecommendationsincludesupplyingkeyagriculturalinputs (e.g., via seed and fertilizer subsidies) andensuring property rights, particularly to widows.Complementary policies to boost welfare andproductivity include providing credit (e.g., throughmicro-finance institutions) and promoting labour-saving technologies. (Such measures have beenused after labour-supply shocks induced by deadlyinfectiousdiseasessuchasHIV/AIDS).

SOCIALThe crisis and the different scales it has reached evinces an important lesson: EVD is not necessarily a socio-economic crisis in itself—it only becomes one when health systems are unable to contain it. The capacity of countries like Nigeria andSenegal to put in place immediate responses thatprevented the outbreak from becoming a nationalcrisisisthestrongestevidenceoftheimportanceofstrengthening health systems across Africa. Hencethisstudyrecommendsthefollowing:

As national and regional priorities, public health systems continent-wide should be strengthened. Strong systems are crucial for reducing risks fromthe epidemic and to deal with it when peopleare exposed. Underpinned by well-trainedhealth personnel and appropriate infrastructure,particularly in rural areas, such systems arehallmarks of an effective response to the currentoutbreak,andfutureoutbreaksofanydisease.

Stakeholders should ensure that EVD is not tackled in isolation from other killer diseases such as HIV/AIDS, malaria, pneumonia and diarrhoea,

especially among children and women. Health-systemsstrengtheningshouldnotfocusnarrowlyonpreventinganotherEVDepidemic,butonenhancingsub-national, national and regional capacities inpublic health. Vertical funds, such as the GlobalFund toFightAIDS, Tuberculosis andMalaria,havehelped reduce the prevalence of these diseases,but to strengthen the foundations of nationalsystems, a wider approach is recommended. Onekeyelementistorebuildnationalcapacityandfosteranewgenerationofmedicalpersonnel,generatingincentives for them to become part of nationalhealthsystems,andsomakeupforthesetbacksonkeyoutcomeindicators.

Africa should seriously consider the merits of decentralizing health services. Theaimwouldbetoenhancehealthresponsecapacitylocally.

Countries should therefore be given supplementary funding to reach the expected standards for public health, both for emergency response and regular care. Goals on delivery standardsmust be tackledbeyondthehealthsector,andincludediscussionsofnationaldevelopmentplanning.Further,theroleofstatistics inpublichealthfinancing,effectivenessofservicedeliveryandtheworkforcewillbekeyasthecontinentseekstoprovideuniversalcoverage.

The three countries (and others with weak health systems) should be supported to deploy multi-pronged approaches to eradicate EVD. Suchresponses should go beyond the health sectorto include key social sectors and gender issues.For instance, water and sanitation are essentialin guaranteeing hygienic conditions in affectedcommunities,whileprovisionof foodandnutritionto infected peoplewould help them to build theirresilienceandcopingmechanisms.

Social responses should not focus just on individuals directly infected by the virus, but should also consider those indirectly affected—a much larger group. Social responses should consist of two keyelements: addressing the underlying causes of theoutbreak to avoid future crises (a health systemsand epidemiological perspective—see Chapter 4);

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and ensuring that policies and programmesestablishcommensurateresponsestominimizethesocial impact of an outbreak. The study suggests thefollowing:

• For the directly affected, policies should ensure a household rather than individual approach. Once amember of a family is lost to EVD, thelivelihood of the household is affected. Even ifthat personwas not financially contributing tothehousehold,theroleofcaringandprovidingin-kind contributions has to be assumed byanother member, which can then hit income,labour,educationandcare.

• Social protection and targeted safety nets—crucial for groups disproportionally affected by the outbreak—need to be created or beefed up. The number of orphans caused by EVDneeds to bemonitored. These childrenwill bevulnerable owing to the stigmaof the disease.Special grants should be considered for thefamilies and relatives that take them in. Forthose of adolescent age, measures should betakentoensuretheirenrolmentin,forexample,vocational trainingprogrammes, allowing themtojointhelabourmarket.

• Steps must be taken to ensure that the EVD outbreak does not ignite a food and nutritional crisis. Proper monitoring should be put inplace to ensure that any losses in subsistencefarmingare replacedbya regularflowofbasicfooditems.Further,specialattentionshouldbegiventopregnantandlactatingmothers,andtocontaintheriseinchildmalnutrition,particularlyduringthefirsttwoyearsoflifewhencognitiveandphysicaldevelopmentarecritical.

• Governments and local authorities should ensure that children return to school and that the educational outcomes hurt by EVD are brought back to prior levels. Theyshouldavoidclosing schoolswhenpossible as this increasesdrop-outs,withlong-termpersonalandnationaleconomicconsequences.

• Communities should be supported with counselling and related services. Thiswillhelpthem to overcome trauma and rebuild newfamilybonds,includingthroughadoption.

The EVD outbreak has had a disproportionate social impact on women, mainly because of their direct role in looking after the sick. EVDhasdisempoweredwomenand thismustbe rectifiedby, for example,putting them at the centre of post-crisis recoveryplans.Thestudyrecommendsthatgovernments:

• Establish or strengthen gender-responsive disaster risk-reduction and management strategies. These must ensure inclusion,engagementandempowermentofallmembersofsociety,givengenderrelations(aswomenandmendiffer inhow theyexperience, respond toandrecoverfromdisasters).

• Facilitate institutional frameworks. This willbe seen in non-discriminatory legal systemsthat support gender equality and women’sempowermentinallspheres,specificallyastheyrelatetolandandpropertyinheritance.

• Expand economic opportunities for women. This entails recognizing and compensatingwomen for the unpaid carework they do (anytransfers to help victims and communitiesrecover must compensate women for this lostrevenue), and providing gender-responsivesupportservicesinbusiness,agricultureandtheextractiveindustry.

• Strengthen women’s agency. Steps includebuildingwomen’s abilities to identify and actoneconomic,socialandpoliticalopportunities;challenging socio-cultural norms thatplace them at higher risk of infection andthat impede their capacity to benefit fromeconomicgrowth;andusinggender-sensitiveawareness-raisingmechanisms forpreventing(andrespondingto)infection.

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INTANGIBLEOne of the most powerful intangible impacts of the outbreak is its negative effects on the view of Africa as a continent on the rise. AsduringtheearlydaysofHIV/AIDS,characterizationsof“disease-proneAfrica”havebeenrevived.AlthoughtheoutbreakhasbeenlargelyconcentratedinthreeWestAfricancountries,somemedia(andgovernments)lumpAfricatogetheras one EVD-infested region, with the potential toeraseAfrica’srecentsocio-economicprogress.

Although the impact is admittedly heavy on Guinea, Liberia and Sierra Leone, the aggregate effect on West Africa and the broader continent is minimal—the continent is most likely to continue growing strongly. Africa’s rise is not under muchthreatfromEVDitself,butmorefrommisinformationand ensuing misperceptions. And so the studyrecommendsthefollowing:

• Ongoing individual and joint efforts by pan-African institutions, particularly the AUC, AfDB and ECA, need to make more effort to “set the record straight” on EVD. Thisrequiresthemtopresentmoreaccuratedataandinformationonthediseaseanditsimpact.

• These three institutions need to develop a media and communications strategy to put out an objective but constructive narrative on EVD. Media presence of the three institutions’leaders should be spotlighted, including jointappearances in high-profile African and non-Africanmedia.Sucheffortsshouldbereplicatedsub-regionally by heads of regional economiccommunitiesandotherAfricaninstitutions.

• African media and communication houses—print and audio-visual—should be encouraged to provide accurate and fact-based accounts on EVD. They should cover progress made toreverseitsspreadandimpact.

• The AUC, AfDB, ECA and other African bodies should consider a joint, more detailed analysis of the socio-economic, political and cultural impacts of EVD when the crisis is contained. Suchastudy,basedonprimarydatageneratedbyAfricaninstitutions,willenablethecontinenttotelltheEVDstoryinanobjectiveandnuancedmanner,puttingAfrica’sinterestsfirstandsteeringclearofthedistortionsandmisperceptionsthathavegrownuparoundthedisease.

• African leaders should ensure effective implementation of the decisions of the emergency session of the Executive Council of the African Union in Addis Ababa on 8 September 2014, on the EVD outbreak (Ext/EX.CL/Dec.1(XVI)).Thisrelatesespeciallytotheneedtoactinsolidaritywithaffectedcountries,includingbreaking the threecountries’ stigmatizationandisolation,andstrengtheningtheirresilience(andthatofthecontinentmorebroadly).

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The socio-economic impacts of Ebola VirusDisease(EVD)arefeltmainlybykeyeconomicsectors in Guinea, Liberia, and Sierra Leone

and their neighbours. The key sectors discussed inthisappendix(ingreatercountry-leveldetailthaninthemaintext)aretradeandmining,agricultureandservices.Thefigureshowssomeoftheinter-sectoralrelationships.

TRADE AND MININGThis section looks at the impact of EVD on tradeactivitiesof the three countries. It exploresaswellpossible effects on services and mining given theinterconnections, although the full extent of theimpactofEVDontradecannotbefullyassesseduntilthecrisisstabilizes.

Evidencesuggeststhattradehasbeenseverelyhitinthethreecountriesbythefollowing:

• Business closure is common and increasing.In Liberia for example, many businesses orbranchesareclosingeveryweek.Eventhosestillopenhaveseensteepdropsinactivityowingtoreducedworkinghoursandlowerstaffnumbers.

• Scarcityof commodities, food inparticular,haspushed up inflation, reducing competitiveness,hurtingexportsandcuttingthesurplusavailableforexport.

• Manyofficialbordercrossingsamongthethreecountries have closed, disrupting intra-countrytrade,drivingdomesticpricesup,limitingsupplyofgoodsandcurtailingvendors’incomes.Theseclosuresareexpectedtoworsenfoodinsecurity

in the three countries given the high level ofcross-border trade in agricultural commodities,includingstaplessuchasriceandpalmoil.

• Transport activity has fallen owing to tightrestrictionsonmovement,aswellaslesslabour,raising the cost of moving commodities andreducinggoodsavailability.

• Depreciating domestic currencies (stemmingfrom mounting demand for foreign currency)have mixed impacts on trade: they boostexports but hurt imports. The net impact onthemerchandisetradebalancedependsontheelasticityofexportsandimports.

GUINEA

Agricultural exports are declining. EVD has hithard rural areas including Gueckédou, Macenta,Nzérékoré, Boffa and Télémélé—the food basketnot only for Guinea but neighbouring regions too.Agricultural production in these areas has beenstronglyunderminedbymarket closures,deathsoflocalpeople,anddepartureofexpatriatesandlocalworkers.Keyexportssuchascocoaandpalmoilhavetumbledowingtoreducedproduction.Datasuggestproductiondecreasesforthemajornationalexportcommodities of coffee, palm oil and rice of 50%,75% and 10%, respectively. Potato output has alsoshrunk, hitting exports to Senegal, traditionally thedestination of half of Guinea’s potato production.Because exports drawmainly on surpluses as wellas existing stocks, the drop in exports of thesecommodities is probably even higher than the fall inoutput.

APPENDIX

I. SECTORAL ANALYSIS OF ECONOMIC AND SOCIAL IMPACTS

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FIGURE A1 SECTORAL INTERCONNECTIONS

Source: ECA.

Food insecurity increasesPoverty rises

Government budget decreases

Food Shortage+

Reduction of agricultural export

Reduction of mining

Reduction of export

Reduction of employmentwage

income

Reduction of purchasing power

Disruption of farming and

mining activities

Disruption of transport,

airports and seaports

Disruption of domestic and Int’l markets

Disruption of governments

services

EVD Socio EconomicImpact

Direct and indirect e�ects of sickness and death

Panic, prompting disorderly behavior

Agriculture Mining Transport Services ManufacturingClinics,

schools, banks, etc

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Asevidenceofthesharpdropinagriculturalexports,tradersinsouthernSenegalclaima50%dropinmarketactivities since early August owing to the borderclosurewithGuinea. Theyalso report that fruit andpalmoilfromGuineaarenolongeravailableinbordermarkets.Further,theclosureof16weeklymarketsinsouthern Senegal (along the borderwith Guinea) isexpectedtofurtherdisrupttradingandslowregionaleconomic activity, affecting not only Guinea andSenegal,butalsoGambiaandGuinea-Bissau.

Miningproductionandexports, too,havebeenhit.Accounting for 15% of GDP, mining’s pain comesmainlyfrompanicsurroundingthedisease’sspread.The cost ofmaritime freight has risen by 25–30%.Therepatriationofforeignpersonnelhasalsoshakenthesector.ItisreportedthatRUSSAL,amajorminingcompany,repatriated50%ofitsforeignstaff.AllthestaffofHenan-ChinaCompanywererepatriated,and51 employees of Société Aurifère de Guinée havealsoleftthecountry.

Moreover,many infrastructureprojectsandstudieshave been delayed, hitting mining productionseriously.Worse,asinvestmentinlargenew(iron-ore)miningprojectsislikelytobedelayed,medium-termGDPgrowthandgovernmentrevenueareprojectedto suffer. Closer in,mining revenue is estimated todecline from3.5%ofGDP in2013 to2.4% in2014(IMF2014c).Thedropinminingoutputisexpectedtohurtgovernmentrevenuebadly,giventhatminingcontributed around 20% of fiscal revenue in 2013.On thebrighter side,Guinea is not seeing amajorimpactonminingbecauseitsmainminesareawayfromareasathighriskofinfection.

Shippingserviceshavesuffered,witharounda60%reductionintrafficatConakryPortandacumulativelossofaround$3millionsinceMarch2014.Activityattheporthasfallenby32%and9.4%forcontainersand ships, respectively. Growth in services isprojectedtofallfrom6.7to3.8%,withthecategoriesoftransportandcommercestagnant.Insuranceandfreight fees have climbed steeply.On land, lengthybordercrossingtimeshavedrasticallyaffectedtradein agricultural products with the six neighbouringcountries.

There are no clear inflationary pressures evenif inflation was revised from 8.5% to 9.4%withpotential impact on exports competitiveness beingfeltasmodest.Governmentrevenuesareexpectedto be badly affected owing to lowmining revenueandtaxesoninternationaltrade.

Mining exports have not yet been affected involume terms but the sector is bearing additionalcosts.Exportsofagriculturalproductsarethemostaffectedwithexportsofcoffeeandcocoadroppingby58%and24%, respectively relative to the sameperiod lastyear.Foreigndirect investment is set tofallbyabout37%in2014.

Thehard-hitminingandagriculturalsectorswilllikelysee far lower export receipt sowing to the drop ininvestment. Falls inminingandagriculturalexportswill likelywiden themerchandise trade deficit andreduce the revenue of the international trade taxin 2014 (which contributes around 18% of totalrevenue).

Althoughitisstilltooearlytoassessthefullimpactofthesefactorsontradegiventhelackoffirst-handdata, theeconomicslowdown,combinedwithhighinflation, will most probably reduce trade activityfurther,fuellinginflation,foodinsecurityandpoverty,possiblysustainingaviciouscircle.

LIBERIA

Inflation is on the rise, from 10% to 14%. Thisposesaproblemof competitiveness forbusinessesand traders; and a fall in purchasing power forhouseholds.Thedomesticcurrencyhasdepreciatedby almost 15% and 9% since last December andFebruary, respectively. However, incoming financialassistanceanddiasporatransfersmayoffset,tosomedegree,emergingdemandforUSdollars.Inflationisdrivenbyincreasesinfoodprices.Thepriceofrice,forexample,hasgoneupby13%.Year-endinflationisnowprojectedat14.7%in2014andtoremainhighatabout10%in2015.

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Many companies are scaling down or onlymaintaininginvestments.Forinstance,ArcelorMittalhaspostponedfurtherinvestmentsto2016.Others,such as the world’s largest producer of palm oil,SimeDarby,havereducedinvestmentsowingtotheevacuationofmanagerialandsupervisorypersonnel,andshiftingthefocustomaintenance.Thiswillaffectexportsofpalmoilinthecomingyears.Suspensionofdevelopmentprojectshasmedium-termimpactsonexports.Severalofthem,especiallyintransportandenergy, and initiatives promoting trade facilitationand exports, have been suspended. Previouslyallocatedresources—physical,financialandhuman—have been diverted towards the new, immediateneeds.Forexternallyfinancedprojects,itisreportedthat contractors have declared force majeure andevacuated key personnel, putting construction onhold. Suspension of these developments, such asthe Mount Coffee Hydropower Plant and othermajor energy and road rehabilitation projects, andinitiativesonholdwillpushoutfurtheranypossibilityofreducingthecostsofdoingbusiness.

Services have contracted sharply as expatriateshaveleftthecountry,hittingtradeseverely.Tourismhas virtually halted,with the hotel occupancy ratestandingataround30%,downfrom70%earlier.ThenumberofweeklycommercialflightstoLiberiahasdropped from 27 before August to only six at thestartofSeptember.

Farmershaveabandonedtheirfarmsandharvest,inmostcasesaffectingagriculturalexports.Accordingto field observations by the Food and AgricultureOrganization of the United Nations (FAO) in LofaCounty—once Liberia’s bread basket—EVD hasheavilyaffected income, livelihoodsandagricultureowingtoenforcedterminationoffarmingactivities.The observations even indicate that savingsaccumulatedoverseveralyearsarefullyerodedforlack of income-generating opportunities. This hasdirectlyaffectedfoodsecurityandthelocaleconomy,asthesesavingswereessentialformicrotrade,foodprocurement, agricultural input purchases, agro-processingandsmallbusiness.

AccordingtoarecentreportbyMercyCorps(2014),EVD containment measures are even aggravatingfood security,market supply chains andhouseholdincomes in some of the affected regions: 90% ofhouseholdsreportedreducingtheamountofmealsand substituting preferred food with lower qualityor less expensive food asmeasures of copingwithdecreased income and rising prices. Buying andsellingactivitiesinlocalmarketshavebeenhamperedby sharply rising prices and reduced householdpurchasing power,making some goods unavailableowingtotransportandmobilityrestrictions(MercyCorps 2014). This has undoubtedly underminedinternal trade, hitting local traders, women andsmall-scalevendorsinparticular.

ThesupplyofgoodsinlocalmarketshasdeclinedalsoowingtoborderclosureswithGuinea,SierraLeone,andCôted’Ivoire,inadditiontotheclosureofweeklymarkets.Reportssuggestthatmarketsinthebordercounties of Lofa and Nimba have been severelyaffectedastheyusedtoheavilycountoncross-bordertrade forbuyingandselling,given theproximity tocross-border markets (usually with less expressivepricesthanbringingthemfromMonrovia).Currently,half of the vendors have changed their source forpurchasedgoodswithmostofnon-locallyproducedgoodsinLofaandNimbacountiesarebeingbroughtfromMonrovia.Thishasresultedinincreasedprices,causinga70%dropinsalesasreportedbyvendors.On informaltrade,nogoodsarecomingacrosstheborder,with the potential exception of cattle fromGuinea.

Internally, the supply of goods has been restrainedby transport challenges within the transportationservices. Given restrictions on movements, withmultiple checkpoints to contain the spread of EVD,trucks may now take two to three days to travelbetween Nimba andMonrovia; it used to take oneday.Thisiscausinglossofperishablegoodsowingtospoilage.Thenumberofcommercialtrucksoperatingatthemomenthastumbled,byperhaps80%.

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Estimatesofimpactsonagriculturalproduction,andthus exports, caused by disruptions to movementof the labour force, difficulties inmoving productsto ports and closure of cross-border markets, donotexist.However,theIMFhasrecentlyprovidedareductionestimateofaround20%inrubberexports,whichwere initiallyprojectedtobe$148million in2014. (Rubber is themajor agricultural export andthesecondsinglemostimportantexportcommodityfor Liberia, contributing around one quarter ofnational exports.) Rice, the country’smajor staple,has seen production severely disrupted owing tothe labour shortage, affecting both the harvestingand replanting for next session. Rice exports andreserves are expected to be severely affected,flaggingthepossibilityofaloomingfoodcrisis.Palmoilproductionandexportsareexpectedtobebadlyhitaswell,thoughtheeffectsseemnotsosignificant.Thesamecouldapplytoforestexports.

Theironore-basedminingsectorhasbeenhardhitwithoneof thetwodominantfirmsshuttingdownsinceAugust.Theotherdominantminingfirm,thoughontracktoachieveitsannualtarget,hassuspendedits investments that aimed to expand productioncapacitybyfive-fold,whichwillheavilyaffectfutureeconomic growth. Artisanal mining, including thatforgoldanddiamonds,hasalmostceasedoperationsowingtorestrictionsonmovementofpeople.

AccordingtotheIMF,theminingsectorisprojectedtocontractby1.3%in2014incontrasttoan initialgrowthprojectionofatleast4%.Thisisexpectedtoreduce the sector’s contribution toGDP from 14%in2013to11.5%in2014.Ironore–relatedrevenuewill likely decline from $43.8 million in 2014 to$28.1millionfor2015(IMF2014b).Miningexportsin2014willlikelyfallbyaround30%.Theimpactonnational export revenue is expected to be seriousgiven thehuge share ofmining in total exports: in2013, the sector contributed around 56% of totalexports—$599million.

According to the Ministry of Commerce, shippinglines still willing to travel to Liberia claim high riskinsurance for all incoming ships, pushing up prices

for all imported goods, including fuel. The volumeof incoming sea-borne containers is down 30%compared with normal levels—not drastic—butthiscould,though,reflectobligationstofulfilearlierschedulingcontracts.However,forwardschedulingissettoexperienceasharpdropperindicators.

Theexpected increaseddemandfor imported foodandthedropinforeigndirectinvestmentandexportswouldwidenthedeficitonthebalanceofpayments.

SIERRA LEONE

Domestic trade has been severely affected, asindicated by the drop in fuel sales of around27% since May 2014. Agricultural production hasbeen massively disrupted, particularly in the twoeastern districts—Kailahun and Kenema—whereEVD emerged, once considered the nation’s breadbasket. The twodistricts, home to one fifthof thecountry’s population, produce around19%of totaldomestic rice, the country’s major staple food.With the severe disruption, caused by quarantine-induced restrictions on farmers’ movements andothermovement restrictions, it is highly likely thatnationalriceproductionforthe2014/15seasonwillbegreatlyaffected,furtherwideningtheproductiondeficitandincreasingdemandforimports.Giventhelong-standing heavy dependence on rice importsto satisfy domestic needs and the closure of landborderstothetraditionalmainsourcesofimportedrice, it isexpected that rice supplywillbe severelycurtailed,pointingtoaloomingfoodcrisis.Asaresultof ongoing closure of markets and restrictions ofinternalmovement,foodtradehascrashed,causingacutesupplyshortages.Thericepriceisreportedtohave increased by about 30% in the EVD-affectedareas.

Mining,whichaccountsfor17–20%ofthenationaleconomy, is dominated by the iron-ore sector thatcontributesaround16%ofGDP.(Miningoperationsalsoincluderetile,limonite,bauxiteanddiamonds.)Government reports indicate littleeffectofEVDonminingproduction,andthemainminingcompaniesindicate businesses as intending to maintain their

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plannedproductionlevels.However,manyofthesefirmsareoperatingwithfewerexpatriatepersonnel.

There are difficulties in exporting and in collectingtax revenue given the slump in mining activity(Sichei 2014). The export difficulties for iron-oreminingcompaniesaremainlyowingtorisingmarineinsurance costs. Air travel bans and cancellationsof flights by major airlines serving the region havemadeitdifficultfordiamondcompaniestoshiptheirexportsabroad.Thetaxrevenuedeclinefor2014toSierraLeoneintheformofreducedminingroyaltiesandlicencesisprojectedtobe$15.1millionandthatforexportsofdiamondsandofironoreforthesameperiod,$29.1 million and $291.1 million. In August2014theEVD-relatedrevenueshortfallwasestimatedat1%ofnon-ironoreGDPinthesecondhalfof2014andwillincreaseto1.6%in2015(IMF2014a).

Services, which account for 30% of the economy,have been hard hit by EVD. The number of weeklycommercialflightshasdescendedfrom31tosixwithaseveredampeningeffectonthehospitalitysub-sector.Reportsindicateasteepdropinthehoteloccupancyrateto13%,fromtheyear-roundaverageof70%.

POTENTIAL IMPACT OF A SUSTAINED REDUCTION IN TRADE

Sustained reduced trade would potentially affectlivelihoods in the three countries. Some of thepotentialimpactsinclude:

Worsening food security.17 The reserve of rice,themajor staple in the three countries, has fallenworryingly. Giving output interruptions, impairedtrade of rice—particularly cross-border—wouldprobablyleadtofoodcrises.

Rising inflation. Reduced imports and domesticproduction would result in limited supply of abroad array of commodities, pushing up prices.Reducedtradeandmarketactivitieswouldhittrade-

17 About200,000peopleareexperiencing limited foodaccessas re-vealedrecentlybytheWorldFoodProgramme.Theanalysisindicatesthatifthediseasecontinuestospreadattheaveragerateobservedsincemid-September, around750,000people could lose access toaffordable foodbyMarch2015.Thiswouldbemainly fromdisrup-tiontothefoodtransportsystem,aswellasfromclosedcross-bordertrade.

related commercial operations further, worseningunemployment, especially as the informal sector isthemajorsourceofjobs.

Widening budget deficit and stalled economic growth. The budget deficit is expected to widenowingtoapotentialdropintheinternationaltradetax as a result of projected declines inmining andagricultural exports, andof royalty revenuesowingto interrupted mining production. Even if mixedimpacts are expected for the merchandise tradebalance,economicgrowthwilldecelerate.

SUMMING UP

TheimpactsofEVDareexpectedtobeharshinthethreecountriesowingtothecompoundedeffectofthreeregion-specificfactors:

Muchtradeinthethreecountriesisstillconductedthrough personal meetings and individualsapproachingmarketsandpurchasingproducts,thenreturning back home and trading their purchases.Quarantineandrestrictionsonpeople’smovementsareexpectedtohittradeharshly,withinandacrossEVD-affectedcountries.Thus,asa largepartoftherecentgrowth in thesethreecountries isdrivenbytrade across borders, which are now closed, theeconomic impact of EVD is probably greater thanexpertsmaythink.

Theimpactoffallingtradeisprobablyunderestimatedas official trade statistics do not capture informaltrade, including cross-border trade, which isestimated to contribute 20–72% of GDP in WestAfricancountries(SyandCopley2014).

GDPgrowthinthethreecountriesisfuelledlargelyby exports of agriculture, mining and oil. Thus ablockedtradesectorwillstalltheireconomicgrowth.

Awordofcaution:althoughmobilityrestrictionsarevitaltobreakthechainoftransmission,theyshouldbeappliedprudently—otherwisetheymaydomoreharm than good, for instance by blocking trade inessentialgoods,suchasfoodandmedicine.

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AGRICULTUREThe EVD outbreak is already threatening foodsecurity intheaffectedcountries,as justseen,andcould involve neighbouring countries such as Côted’Ivoire,Mali,NigeriaandSenegal.Ifnotaddressednow,consequencescouldleadtolong-lastingimpactsincludingdisruptionsinfoodtradeandmarketinginthethreecountriesandthesub-regionasawhole.

Foodpricesareontherisewhilelabourshortagesareputtingtheupcomingharvestseasonatseriousrisk(FAO2014a). The outbreak is reducing households’ability to produce food as movement restrictionsand fear of contagion are preventing communitiesfromworkinginthefields.Furthermore,movementof traders inruralcommunities isalsovery limited,which means that even if harvested (if at all),agricultural products may not be marketed. Inaddition, the ban on bush meat is expected todeprivesomehouseholdsofanimportantsourceofnutritionand income, especially in thedeep forestregionsofthethreecountries.

Borderclosuresadoptedbysomeneighbouringcountriesmayaffectfoodmarketsupplyasallthreecountriesarenetcerealimportersandcross-bordertradeisimportantforfood.Theseclosures,alongsideimpositionofquarantinezones and restrictions on people’s movements, haveseriouslycurtailedthemovementandmarketingoffood,promptingpanicbuying,foodshortagesandsteepfoodprice hikes for some commodities, especially in urbancentres(FAO2014b).

TheagriculturalsectorhasbeenhithardbyEVDinallthethreecountries. InLiberia,agricultureaccountsfor nearly 25% of GDP, and employs almost 50%of the workforce. Falling workforce mobility andrisingmigrationofpeopletosafezones,andforeigncompanies postponing investments owing to theevacuation of expatriates, have hurt exports anddomestic agriculture. As a result, the World Bankreviseditsgrowthexpectationsfrom5.9%to2.5%for2014.Also,owingtomanysmallfarmsthatproducefood for domestic consumption abandoned, it isexpectedthatLiberiawillexperiencefoodshortagesthatmayinturnleadtofurtherfoodpricepressures.

Similarly, Sierra Leone’s agricultural sector, whichfocuses on rice, cocoa and palm oil, accounts forabouthalf the economy.According to theMinistryofAgriculture, Forestry andFoodSecurity, the tworegions that were the epicentre of the outbreaktogether produced about 18% of domestic riceoutput. Quarantined zones restricted workers’movements and many farms were abandoned.Governmentreportsindicatethatricepricesjumpedby30%intheaffectedregions.

Guinea’seconomyislargelycomposedofagricultureand services. There has been a large reductionin production of cocoa and palm oil, the mainagriculturalexportsthatunderpintheeconomy.Oneeffectoftheeconomicslowdownwillbeaslowdownintaxrevenues.Atthesametime,thegovernmentwillhavetoincreasespendingtomeettheincreasedcostsoffightingthedisease.

According to the World Bank, the three countries’budgetdeficits are expected to increaseby1.8%ofGDPinSierraLeoneandGuineaandby4.7%inLiberia.Contraction of themajor economic sectors coupledwithasharpdecreaseinexportswillhurtGDPgrowth.TheWorld Bank has, for example, revised the 2014GDPgrowthprojectionfrom4.5%to2.4%

CHALLENGES FOR AGRICULTURE AND FOOD SECURITY

Many challenges have been recorded in the foodsector including on-farm labour shortages—a bigproblemasharvestingdependsonseasonalworkers.From September to December, depending on theregioninthethreecountries,isthetimetoharvestmaize and rice. This harvest has been seriouslycompromisedandinsomeareascropsarestillwaitingtobeharvestedasofNovember2014.Thisshortagehasbeenexacerbatedbymovementrestrictionsandmigrationtootherareas.

Otherchallengesincludedestabilizationoffoodpricesystemswheredisruptionofmarketlinkagesowingtotravelrestrictions,whichhasledtosharppricehikes;asteepdecrease in foodandcashcropproductionowing to panic and labour shortages; high food-

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producingareaswerecoincidentallythehardest-hitareas,especiallyinSierraLeoneandLiberia;lackoftransportforfood-surplusareastoshipoutsupply;and innutritionandhealth,unavailabilityofhealthclinics to diagnose diseases unrelated to nutritionproblems caused by EVD, which has increasedincidenceofthosediseases,mainlyamongchildren,raisingmalnutritionratesamongchildrenunderfiveintheregion.

GUINEA

Agriculture accounts for 25–30% of GDP andemploys 84% of the active population. The mainsubsistence crops are rice, maize, cassava, sweetpotato,yam,plantains,citrusfruits,sugarcane,palmkernels,coffeeandcoconuts.Theagriculturalsectoroffers several investment opportunities includingconstruction and management of processingcentres; construction and maintenance of storagefacilities; enterprises to produce agricultural inputsandpackaging;large-scaleproductionofcropssuchasfruits,vegetables,rice,cashew,coffee,cocoaandcotton; creation and development of agriculturalproduction poles to boost agro-industrial valuechains;andlivestockproductionandprocessing.

WiththeEVDshock,muchofthiscanchangeifthedisease is not curbed swiftly. Government reportsindicate a reduction in agricultural commoditiesenteringmarketsofthecapital,Conakry,thehubfortherestofthecountry.Thishasputupwardpressureonfoodprices.Guineaisrelativelybetteroffthanthetwoothercountriesforfoodimports:itsdependencyratioisaround16%.Itexportssmallvolumesofrice,maizeandmillettoneighbouringcountries.Buttheinformal trade channel with neighbours was veryactive, and so border closures have affected foodflows.

The country is richly endowed with mineralresources such as iron ore and bauxite, as well asstrong hydropower potential. Its economy is amixofagriculture,servicesandmining.Thepovertyrateishighatmorethan55%ofthepopulation.Recentincomegrowthhasnotmatchedthatinneighbouringcountries. EVD has therefore entered an already

shakeneconomy.

ThemaineconomicimpactsofEVDinGuineatodatehave been on agriculture and services. Because oftheimpactofEVDonfarmactivities,theWorldBankhasprojectedGDPgrowthfor2014todecreasefrom4.5%to2.4%.Projectedagriculturalgrowthfor2014has also been cut from 5.7% to 3.3%. Agriculturein EVD-affected areas has been hit by an exodusof people from these zones, affecting key exportcommodities such as cocoa and palm oil. Coffeeproductionhas also fallenbyhalf, from5,736 tonsto2,671tonsbetweenthefirstsixmonthsof2013andthefirstsixmonthsof2014(WorldBank2014a);cocoa production has declined by a third (from3,511 tons to 2,296 tons over the same period).Palm oil production has fallen by 75%. In someareasofthecountry,cropshavenotbeenharvestedbecause of the lack of labourers. In others, excesssupply of produce without available transport hascaused losses to farmers. The situation is dire andcompoundedsometimesbypanicandfear.

LIBERIA

Liberia is a small country with about 4 millionpeoplewhere70%of thepopulation isengaged inagriculture.Thesectorisforestbased,dominatedbytraditional subsistence farming systems (slash andburn) mainly in the uplands, and characterized bylabour intensity,shiftingcultivation, lowtechnologyandpoorproductivity.

Althoughproductionofrice,cassavaandvegetablesaccountsforabout87%ofcultivatedland,outputofthestaplefoodsremainsbelownationalrequirements.Small acreages of tree crops are maintained forgenerating cash income. Commercial agriculturalactivitiesarealmostexclusivelyplantationestatesofrubber,palmoil,coffeeandcocoa;thelattertwoareproducedexclusivelyforexport,andlittleornovalueisaddedtorubberandpalmoil.

Besides the plantation estates, very little privatesector investment has been made in agriculture,except for limited commodity trading that haspersisted over the years. Agriculture contributes

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42% of GDP. Rice and cassava, the main crops,contribute 22% and 23% of agricultural GDP; treecrops,e.g. rubber, coffeeandcocoa,makeup34%of agricultural GDP; livestock, 14%; and fisheries,3%.Forestrycontributesaround19%ofnationalGDP(MinistryofAgricultureofLiberia2013).

The livestocksub-sectorwasdecimatedbythecivilconflict, and the current livestock population isbelow 10% of national consumption requirements.Thefisheriessub-sectorisunderdevelopedwithonlyabout6.8%ofsustainableyieldharvestedannually.Land and water resources are abundant and offerpotential for expanding agricultural productiongreatly. An estimated 600,000 hectares of land forirrigation exist, with less than 1% of it developed(MinistryofAgricultureofLiberia2013).

Liberiaseemsthehardesthitofthethreecountriesandsomeofthefood-producingareaslikeBarekeduin Lofa county and Dolo in Margibi county werecordonedoff,makingfoodmovementsverydifficultoreven impossible toMonroviaandotherpartsofthecountry.LofaandMargibiproducearound20%of Liberia’s rice and largely meet their own ricedemand,whileproducingnumerousothercropsandtradingwithcross-bordermarketsanddomestically.The FAO Monrovia local office reported that EVDeffectspreventedwomenfarmers’associationsfromrepayingtheirloans,especiallyinFoyadistrict(Lofacounty)wherethefirstcaseofEVDwasdiagnosedinthecountry,inMarch2014.

Thepalmoil sectorhasbeenhit.AlthoughGoldenVeroleum is continuing its operations, Sime Darby,whose activities are near several affected areas,is slowing its activities. These are the two maincompanies in the palm oil sector with more than7,000workers. One can imagine the devastation iftheyclosed.Rubber,Liberia’ssecond-leadingexport,has largely continued activities, although recentEVD cases in Kakata in the centre of the rubber-productionregioncouldslowproductiondrastically.Timberoutput,whichhasdroppedsince2013owingto governance issues and transport bottlenecks, isbased in the largely unaffected southeast and has

avoidedanymajorimpactssofar.

Governmentreportshaveindicatedthatdistributionof imported food fromMonrovia’s seaport to ruralmarketshasbeencutsharply.Astheportisthekeysource of rice supplies for rural areas, this createdshortages that contributed to food price risesaround the country. A rapidmarket assessment byFAO(FAO2014a)indicatedthatpricesofsomefooditemslikecassavahadjumpedby150%inMonrovia.The increasewas inflatedbytransportcosts,whichthesedaysmakeeverythingmoreexpensive.Liberiaimportsabout66%ofitsfood,andsoitsfoodsupplyisexpectedtoworsenbyyear-end.

GDPgrowthhasaveragedover8%since2011,puttingLiberiaamongAfrica’sfast-growingnations.Butithasalreadybeenforecasttoslowto5.9%in2014,givenslower growth in iron-oreproduction,weaktimberandrubberexportgrowth,andthegradualwindingdownoftheUnitedNationsforce(AfDB2014a).

SIERRA LEONEThe government, through the Ministry of Healthand Sanitation, declared an outbreak of EVD afterlaboratory confirmation of a suspected case fromKailahundistrict on25May2014. Thedistrict is inthe eastern region, sharing borders with GuineaandLiberia.Thisoutbreakwasa spillover fromtheongoingoutbreakinGuineaandLiberiasinceMarch2014.Theoutbreakeruptedatthebeginningoftherice and cocoa harvest season (July–August) whentradersareexpectedtoreachplots,toexchangefoodandotheritemsforcocoa.

One of the firstmeasures by the governmentwasto restrictmovements, which suddenly took downhouseholdincome.Theclosureofmarkets,internaltravel restrictions and fear of infection curtailedfood trade and caused supply shortages. Althoughprice data have been hard to come by or are notavailable,reportshavesuggestedfoodpricespikes.The country’s dependency on imported rice hasbeendecreasing,butitremainsanetimporter,withacerealimportdependencyratioofabout18%.

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The depreciation of the currency, which hasaccelerated since June, is expected to addinflationary pressure. Consumers were alreadycomplaining about the depreciation adding to thepricehike.Theclosureofborderswithneighbouringcountriesaggravatedfoodshortagesas itdisruptedcross-border trade. An FAO national study waslaunched in August–September 2014, and coveredthreeclustersofvillagesineachofthe13districtsinwhicha totalof702householdswere interviewed,aswell as351community leaders,39 ruralmarketsites, 26 district-headquarter town markets and8 agricultural commodity traders (FAO2014a). Theresults concluded that the outbreak had causeda shortage of labour on farms. Activities such asweeding, harvesting and other key activities werefallingbehindorhadbeenabandonedowingtothedeathofable-bodiedpersons.Familiesarereportedto have left their farms or to have been displacedto areas perceived as “safe” from thedisease. Thereportalsostatesthatthedisruptionandclosureofperiodic markets have raised commodity prices inplaceswheretheyareinheavydemand—pricesforimportedricehaverisenbyabout13%andforfishbyover 40%, for example—and reducedpriceswherelocalsupplyisexcesstodemand.

Thedecreaseinpricesofcommoditiesinsurplusareahashittheincomeoffarminghouseholds,especiallythose involved inproductionandagribusiness sub-sectors.This incomereductionhasdirectlyaffectedfoodsecurity.

TheimpactofEVDonagricultureacrossthecountryisbeingfeltbywomenfarmersandwomeninsmalltrade and small agribusiness activities, as they arethemainagentsatlowerlevelsofagriculture’svaluechain.Becausetheirbusinesseshavebeendisrupted,thatsendsfood-shortagewavesaroundthecountry,disruptingagriculturalmarketinfrastructure.

IMPACT ON AGRICULTURE IN THE THREE COUNTRIESThe impact has been tremendous. The threecountries are all net cereal importers, with Liberiathemostreliantonexternalsupplies.Theclosureofsomebordercrossingsandisolationofborderareas

wherethethreecountriesintersect—aswellaslowertradefromseaports,themainconduitforlarge-scalecommercialimports—areleadingtotightersuppliesandareincreasingfoodpricessharply.Atleast80%of incomeisspentonfoodcommoditiesacrossthethree,underliningthepovertylevel.ThedepreciationofnationalcurrenciesinSierraLeoneandLiberiainrecentmonths isexpected toexert furtherupwardpricepressureonimportedfoodcommodities.

SERVICESTransportservicedisruptionscausedbyair,seaandlandtravelbanswereineffectivewaystocontainEVD,as shownby results basedon theGlobal Epidemicand Mobility Model (Poletto and others 2014).Rather,suchbanslimitedthespeedoftransportingessential medical supplies and personnel, andseverelydisruptedlivelihoods.

Many airlines stopped going to the affectedcountries. One of the direct impacts of EVD is toreducetouristarrivals.TherearealsoindirecteffectsintheformofdecliningtouristarrivalstoAfricaasawhole,mainlyowingtogeneralfearassociatedwithair travel to and from the continent. Governmentsare therefore losing a lot of money from forgoneimmigrationrevenueandforeigntraveltickettaxes.In addition, hotels, bars and restaurants have lostincomefromforeigntouristsanddomesticresidents,whose movements are restricted, in turn hittingpotentialtaxincomeandemployment.Afterbansongatherings, Sierra Leone Brewery puts the numberofredundanciesat24,000fromitsoperationsacrossthe country (National Revenue Authority of SierraLeone2014).

TheEVDthreatishurtingAfricantravelandtourismincountriesbeyondthecountriesdirectlyaffected.Amajoronlinesafaribroker,SafariBookings,conducteda survey of 500 safari tour operators in October2014and found thathalfof the touroperatorshadsuffered 20–70% declines in their African safaribusiness because of EVD fears. “It is a heavy blowfortheindustryandthenumerouswildlifereservesthat rely on its revenue”, the company said. “TouroperatorsreportedthatmanytouristsviewAfricaasasinglecountrywhen itcomes to riskassessment.

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They don’t realize that East and Southern Africa,where most safaris are conducted, are just as farfromtheoutbreakareaasEuropeorSouthAmerica”.At Kenya Airways, which depends in part onWestAfricantravellers to feed itsNairobihub,salesmayslideasmuchas4%thisyearafter itpulledoutofLiberiaandSierraLeone.

There are specific impacts to countries near theaffected countries such as Gambia where manypeoplearepoorandmoreof themdependon the

tourism industry. The World Travel and TourismCouncil, which represents airlines, hotels andother travel companies, recently stated that earlyindicationssuggestadeclineof30%inbookingstoWest Africa. Gambia derives 16% of its GDP fromtourism.AtthestartoftheseasoninOctober,therewere steep reductions in tourist numbers relativeto previous years,with an expected 50–60% drop,accordingtothetourismminister.

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OrganizationAmount pledged

($ million)

Amount disbursed

(%)Source

World Bank 518 23.4http://www.worldbank.org/en/news/press-release/2014/10/30/world-bank-group-additional-100-million-new-health-workers-ebola-stricken-countries(updated 17Updated17November 2014)

European Union Institution 459.8 9.98 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-

ebola-response-data/ (Updated17November 2014)

IFC/World Bank Group 450 -

http://www.worldbank.org/en/news/press-release/2014/12/02/ebola-world-bank-report-growth-shrinking-economic-impact-guinea-liberia-sierra-leone (updated2December 2014) This is to enable trade, investment, and employment in Guinea, Liberia, and Sierra Leone

African Development Bank (AfDB)

220 20.62

One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17Updated17November 2014)

AfDB: http://www.afdb.org/en/news-and-events/article/kaberuka-makes-a-call-for-individual-contributions-in-fight-against-ebola-13744/ (updated 8Updated8November 2014)

IMF 130 immediate IMF Press release No 14/441, 26September 2014, <https://www.imf.org/external/np/sec/pr/2014/pr14441.htm>

Central Emergency Response Fund (CERF)

15.2 immediatehttp://www.unocha.org/cerf/resources/top-stories/cerf-response-ebola-outbreak (updated on Updated 16October2014)https://docs.unocha.org/sites/dms/CERF/CERF%20Ebola%20Response%203%20Oct%202014.pdf(Updated3October2014)

Regional Solidarity Funds to Fight Against the Ebola Virus (ECOWAS) 9

immediate

http://www.panapress.com/Ghana--Le-Fonds-de-solidarite-Ebola-de-la-CEDEAO-atteint-9-millions-de-dollars-us---12-630409874-143-lang1-index.html (updated 7Updated7November 2014)

including the West African Economic Monetary Union (UEMOA)contribution of $1.5 million

http://news.ecowas.int/presseshow.php?nb=207&lang=en&annee=2014(updated 6Updated 6November 2014)

Islamic Development Bank (IDB)

45 immediate

http://www.menara.ma/fr/2014/11/05/1441437-l%E2%80%99oci-et-la-bid-annoncent-une-aide-d%E2%80%99urgence-en-appui-aux-efforts-internationaux-de-lutte-contre-le-virus-ebola.html (updated onUpdated5November 2014) as follows:$10 millionfor fight against poverty, $28 million to support health system and $6 million to fight the Ebola Virus).

APPENDIX II - SOURCES FROM FIGURE 4

Table A1. Contributions of multilateral organizations

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Table A2. Contributions of bilateral partners

Organization/Country

Amount pledged

($ million)Amount disbursed

(%) Source

UK 359.8a 8.71

One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17(Updated17November 2014),

UK: https://www.gov.uk/government/topical-events/ebola-virus-government-response/about

US 344.6 24.64 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated (Updated17November 2014)

Japan 142 14.43

http://www.radiowave.com.na/news/dailynews/9639-japan-pledges-u-100-million-towards-ebola-fight

One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/US$10 million for fight against poverty,

Germany 133.5 20.15

http://www.worldbank.org/en/news/press-release/2014/10/30/world-bank-group-additional-100-million-new-health-workers-ebola-stricken-countriesOne: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated(Updated17November 2014)

France 124.4 37.81One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17(Updated17November 2014)

China 122.5 6.53 http://www.chinadaily.com.cn/world/2014-10/31/content_18837862.htm

Sweden 67.0 13.19 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated (Updated17November 2014)

Canada 58.1 88.12

One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated(Updated17November 2014)

http://www.cgdev.org/blog/how-much-actually-being-spent-ebola

(updatedUpdated27October 2014)

Netherlands 44.8 15.22One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17(Updated17November 2014)

Australia 36.1 38.18 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17(Updated17November 2014)

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Table A3 Contributions of international private sector and charity/foundations


($ million)Amount

disbursed (%) Source

Paul Allen Family Foundation

100 2.9 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17(Updated17November 2014)

http://www.cgdev.org/blog/how-much-actually-being-spent-ebola(updated(Updated27October 2014)

Bill & Melinda Gates Foundation


http://www.cgdev.org/blog/how-much-actually-being-spent-ebola

Mark Zuckerberg and Priscilla Chang

25 — ECA-EVD-Study-Consolidated (Final 10December2014).docxOne: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17(Updated17November 2014)

http://www.cgdev.org/blog/how-much-actually-being-spent-ebolaSilicon Valley Community Foundation


Google/Larry Page Family Foundation

25 — One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(updated 17(Updated17November 2014)

Children’s Investment Fund Foundation


— = data not available.

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Table A4 Contributions of the African private sector


($ million)

Amount disbursed

(%)Source

MTN Group 10 — http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson (updated 19Updated19November 2014)

Dangote 4.1 — http://allafrica.com/stories/201411121328.html(l(Updated11 November 2014)

Econet Wireless 2.5 — http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson (updated on 19Updated19November 2014)

The Motsepe Foundation

1 — http://www.themotsepefoundation.org/news_pg1.html (updated as of 28 October 2014)

http://www.themotsepefoundation.org/story50.html (Updated9November2014)

Kola Karim CEO of Nigerian conglomerate Shoreline Energy

1 — http://www.citypress.co.za/business/africas-super-rich-asked-step-fight-againstebola/ (Updated9 November 2014)

Tony Elumelu Foundation

0.6 — https://www.ubagroup.com/mc/newsandevents/newstopic?id=20141111122357db4ga5dk99 (updated 11November 2014)

The United Bank for Africa (UBA)

1 — http://allafrica.com/view/group/main/main/id/00033833.html(updated (Updated12November 2014)

Stenbeck Family 1 —

http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson (Updated19November 2014)

Afrixim Bank 1 —Coca Cola Eurasia and Africa

1 —

Vitol Group of Companies and Vivo Energy

1 —

— = data not available.

Table A5 Some African countries’ pledgesCountry Amount pledged

($ million)Amount

disbursed (%)Source

Botswana 0.2 — http://sa.au.int/en/content/press-conference-spread-ebola-virus-disease-evd-west-africa(updated 11(Updated11August 2014)

Côte d’Ivoire 1.0 — http://leconakryka.com/riposte-a-ebola-alhassa-ouattara-a-donne-1million-de-dollars-a-la-guinee-la-sierra-leone-et-le-liberia/(updated 13(Updated13September 2014)

Equatorial Guinea 2.0 — http://www.guineaecuatorialpress.com/noticia.php?id=5658&lang=fr (Updated16September 2014)

Ethiopia 0.5 — http://www.one.org/fr/blog/comment-fonctionne-loutil-interactif-de-suivi-des-engagements-dans-la-lutte-contre-ebola/(updated19Updated19November 2014)

Kenya 1.0 — http://www.the-star.co.ke/news/article-189009/kenya-pledges-sh87-million-fight-ebola-west-africa(Updated9September2014)

Namibia 1.0 — http://www.one.org/fr/blog/comment-fonctionne-loutil-interactif-de-suivi-des-engagements-dans-la-lutte-contre-ebola/(updated 19Updated19November 2014)

Nigeria 3.5 — http://sa.au.int/en/content/press-conference-spread-ebola-virus-disease-evd-west-africa(u(pdated 11August 2014)

South Africa 0.3 — http://fts.ocha.org (updated 8December2014)

http://fts.unocha.org/reports/daily/ocha_R10_E16506 as of 1412081424.pdf— = data not available.

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