AFRICAâ€™S FUTURE The questions for Africa are: How do we go on from here, how do we reconstruct and what kind of future do we want?
Investment prospects for Africa in a post Covid-19 era
New investments will give Africa the lead in agri-development
COVID-19: invention and remodelling key to business survival
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PRESENTING THE AFRICAN THINKER
he coronavirus pandemic has dominated political and economic conversations all year round and surely upended the global economy in ways no one thought possible at the turn of the year. The final bill is not close to being finalised yet and it is likely that COVID-19 will shape the geopolitical makeup of the world and its effects will be felt for generations to come. Some estimates put the cost to the global economy at $22 trillion while governments have so far spent about $10 trillion in funding to keep economies ticking over. Africa meanwhile, stands at the vanguard of the pandemic. As we point out in this initial edition, this crisis has severely tested Africa’s political, economic and social resilience. Its leaders must rethink strategies and adopt progressive industrial policies, ones that puts social and environmental consciousness firmly at the core of their decision-making to create an inclusive, prosperous and sustainable societies. As one of our contributors put it, AFRICA MUST THINK AHEAD. Here at African Thinker, we are using a variety of platforms and services, including magazines, electronic media and international events to deliver unparalleled commentary to shape developments in Africa. We believe that Africa must look for unique solutions that deal with the continent’s peculiar set of circumstances.
We aim to be Africa’s leading Thought Leader, providing critical analysis and leading the debate on issues that affect the motherland. African Thinker offers essential reading for those industries wanting to keep up with the latest global trends affecting African businesses across all industry as well as exclusive, engaging and sharable features and analysis. With demand for reliable and up-to-date information on economies of Africa and the various industry sectors on the rise for critical decision making, we aim to provide the necessary support to companies and individuals that are reshaping the future of the continent. Africa, we feel, needs to have access to its best minds to deal with uniquely African challenges or innovations that put it a step ahead. Yes, we will champion ideas that will shape generations to come.
ALFONCE MBIZWO firstname.lastname@example.org
Re-imagining and re-engineering Africaâ€™s future
Investment Prospects for Africa in a Post Covid-19
COVID19 changed our world in a matter of months. The world as we knew it is over, a new normal is upon us. A brave new world is shaping up opening audacious possibilities that never existed before.
BY SHAUN JAYARATNAM
The covid-19 pandemic has created an interesting conundrum for the investment world. As global economies attempt to go back to some normalcy following extended periods of economic inactivity, investors are also faced with critical decisions
BY JIM COLEMAN
No Recovery without debt relief
New investments will give Africa the lead in agridevelopment
COVID-19: invention and remodeling key to business survival
Breast cancer: Fighting every womanâ€™s nightmare
Barriers to malaria interventions in Ghana
At a time when the rest of the world is re-thinking its approach to commercial agriculture, Africa has a clear opportunity to refresh its approach to the sector and become an emerging force.
Companies need to reconfigure their business model, develop cohesive overarching strategies. They must build an-agile model around clients, suppliers and resources that responds to volatile unpredictable global events, allowing
I BEAT CANCER. Now I want to give back. I want to do more for the Breast Cancer cause and part of that is I have joined a charity called Zimbabwe Breast Care Trust. Our charity will also continue some of the work that I have started such as looking for ways to reduce the cost of Breast Cancer treatments
Malaria in pregnancy can have a devastating effect on pregnant women and their unborn children. Consequently, various intervention measures have been put in place to prevent and manage malaria among pregnant women in endemic countries such as Ghana.
BY SHAUN JAYARATNAM
BY TENDAYI GWATA
BY MATILDA ABERESE-AKO
The COVID-19 pandemic is a shared global challenge, and it demands a shared global response that addresses both the health and economic dimensions of the crisis. More extensive debt relief for Africa is an essential feature of any such response. BY MO IBRAHIM
BY SOLA DAIVID-BORHA AND LINDA MANDA
Contributors SHAUN JAYARATNAM is a sales and marketing, business development and operations management professional with over 25 years of experience in several industries He has worked in Russia, Ukraine, Africa and Asia. Connect with him on Linkedin.
JIM COLEMAN is a senior banker, treasurer and director with over 35 yearsâ€™ experience of financial markets in the UK and internationally, including NatWest Markets, Lloyds Bank and Abu Dhabi Commercial Bank and is a director of several businesses. He holds a degree in mathematics from the University of St Andrews, an MBA from Imperial College Business School and is a Fellow of the Association of Corporate Treasurers.
MO IBRAHIM is a Sudanese-British billionaire businessman. He worked for several telecommunications companies, before founding Celtel, which when sold had over 24 million mobile phone subscribers in 14 African countries.
XEBISO B. KAMUDYARIWA is a lecturer at the University of Witwatersrand. She focuses on Construction Procurement research.
LINDA MANDA is Sector Head Agribusiness, Corporate and Investment Banking at Standard Bank
MATILDA ABERESE-AKO is a medical and organizational anthropologist and a Research Fellow at the Institute of Health Research in the University of Health and Allied Sciences in Ghana. She previously worked with the Navrongo Health Research Centre as a research fellow. She has a BA hons degree in Integrated Development Studies from the University for Development Studies in Ghana.
Sola David-Borh is Chief Executive of Africa r egions at Standard Bank
TR A D E & IND USTRY
Investment Prospects for Africa in a Post Covid-19 Era B Y JIM C O L EM A N, C E O : D E C A R N YS C A P I TA L A N D D C C A F R I C A
he covid-19 pandemic has created an interesting conundrum for the investment world. As global economies attempt to go back to some normalcy following extended periods of economic inactivity, investors are also faced with critical decisions on the best markets and asset classes to invest their capital. In these uncertain times, what we do know for certain is that the pandemic has left even the world’s largest investors wary and even more risk averse. Navigating uncharted waters with the UK, now almost certain not to have an agreed trade deal with the EU by 31st December the UK’s official withdrawal from the European Union has created a unique set of challenges for its relations with its sovereign neighbours and the rest of the world. In the backdrop of negotiations by the EU and UK Parliaments to map out rules on trade, immigration, aviation, security and access to fishing waters, the covid-19 pandemic has weighed significantly on the UK economy. Unemployment, already rising rapidly, is projected to rise to over 3m by the end of 2020. New cases of Covid are running at over 2500 per day again causing the government to re-introduce social gathering restriction of only 6 people including children. The onset of winter is expected to cause a significant increase in new cases of Covid. Noting the dramatic hit on the economy, trends point towards consequences more severe than experienced during the 2008 global financial crisis and the odds seem to be increasing. With a steep decline in GDP figures not seen in over 40 years, the International Monetary Fund forecasts a general decline of 8% across the world’s advanced economies and 10.2% for the UK with slow recovery. It is therefore not surprising that most countries are preoccupied with national re-building projects geared to stimulate local economic investment and activity. As a result, investor appetite for risk has declined significantly over the crisis period. This has raised considerations around how this will impact Africa – home to some of the poorest, and some rapidly developing nations in the world – in particular. De-globalisation, according to the World Economic Forum is set to further marginalise the continent with funds tracking the currencies of the major trading nations. Therefore, with the entire continent’s GDP less than that of the UK, there is little to no tracking in this sphere. With the exception of the South African Rand, most funds have no knowledge of African currencies so don’t have interest in African economies. With UKAfrica trade at only 2% currently, it remains to be seen how far the former will be willing to invest in Africa; following its exit from the EU, the UK is likely to look towards crafting new approaches towards trade, aid and investment. To its advantage, Africa has a burgeoning human capital in its increasingly young population: The United Nations Economic Commission for Africa asserts that by 2050, the teeming numbers of young Africans will form over a quarter of the
world’s labour force. In theory, this is set to unlock great potential for the continent in the next decade and may afford the continent better bargaining power in future. However, without radical restructuring and policy reform, led by experienced leadership who have the continuous support of political overlords, even the expected increase of youth participation in economies may be fleeting. Despite low levels of Foreign Direct Investment into the continent, Africa has historically given better return on investment as compared to other regions in the world, and therein lies its investment case. However, with investors increasingly in survival mode and avoiding potential melt downs, the challenge rests on Africa to prepare itself as fertile ground for investment. To attract and sustain FDI, African countries need to demonstrate strong management and transparency, especially within its banking sector. Governments also need to play their part with clear plans to improve collection of taxes, employment, education, health services, water and waste processing. With the advance of technology, different commodities are becoming important. Core commodities will remain steady but still cyclical. There will be new commodities which will cause upheaval to the status quo. Some may have greater longevity than others as the advance in nanotechnology gains pace. Now, more than ever before food has become increasingly important and factors such as climate change and population growth have exacerbated the problems. That Africa holds great potential goes without saying. While the Covid-19 pandemic has undoubtedly dealt Africa several blows – including lower trade and investment as well as a continental supply shock affecting domestic and regional trade – there may be room for innovative investment opportunities in the future. These include live entertainment and related broadcasting; as well as hubs that provide links to trusted service providers such as private banking, lawyers, accountants, medical care, clothing, life- style, vehicle rental, entertainment. africa.com
Jim is a senior banker, treasurer and director with over 35 years’ experience of financial markets in the UK and internationally, including NatWest Markets, Lloyds Bank and Abu Dhabi Commercial Bank and is a director of several businesses. He holds a degree in mathematics from the University of St Andrews, an MBA from Imperial College Business School and is a Fellow of the Association of Corporate Treasurers.
BUSINESS & ECONOMY
No Recovery without debt relief M O IB R AHIM
he COVID-19 pandemic is a shared global challenge, and it demands a shared global response that addresses both the health and economic dimensions of the crisis. More extensive debt relief for Africa is an essential feature of any such response. In June, the African Union launched the Africa Medical Supplies Platform to facilitate the production and provision of vital medical equipment – the latest achievement in an already impressive response to the COVID-19 crisis. Yet, in the same week, it was revealed that most of Nigeria’s federal government revenue was going to debtservice payments, and the country would be cutting public-health spending by 40% – even as COVID-19 infections continue to climb. The contrast is as tragic as it is stark. The world’s youngest continent is itching not only to stand on its own two feet, but also to provide global leadership. And it remains hamstrung by an old foe: debt. If Africa is to achieve its potential, its creditors must set it free. Debt relief works. Fifteen years ago this week, the G8 issued the
Gleneagles declaration, relieving 18 “highly indebted poor countries” – Benin, Bolivia, Burkina Faso, Ethiopia, Ghana, Guyana, Honduras, Madagascar, Mali, Mauritania, Mozambique, Nicaragua, Niger, Rwanda, Senegal, Tanzania, Uganda, and Zambia – of debt totaling more than $40 billion. No longer saddled with massive debt-service costs, countries were able to invest more in their own economies and people. Many of the countries that had received debt relief, such as Ethiopia and Rwanda, subsequently experienced significant upticks in economic growth. Standards of health care, access to education, and employment opportunities improved markedly. And countries improved their governance and benefited from greater stability – crucial to sustaining long-term growth. This progress is now at risk of unraveling. Though Africa has so far recorded a relatively low number of COVID-19 infections, it faces a severe economic crisis, with potentially far-reaching social and political implications. External demand, oil prices, tourism and travel revenues, and remittances have all collapsed. Investors have pulled $100 billion from emerging markets since the beginning of the pandemic – the largest-ever capital outflow in such a short africanthinker.com
period This is contributing to a deepening – and highly dangerous – liquidity crisis. African governments urgently need capital to stabilize economies hit by cumulative external shocks and to finance an adequate publichealth response. Yet, unlike the eurozone or the United States, most African countries cannot print money to get them through the crisis. Moreover, their fiscal space remains limited, not least because they must continue to make large debt payments. This leaves their leaders with an impossible choice: cut spending on crucial services, as Nigeria has done, or default. Debt relief would save countries from this bleak scenario, freeing up the capital needed to fight the pandemic and stabilize the economy. World leaders already recognize this. In April, G20 leaders agreed to suspend some debt repayments for the world’s poorest countries for the rest of 2020. But it is nowhere near enough. Pledges must now be swiftly implemented and significantly expanded. Specifically, all creditors – bilateral, multilateral, and private – must implement an immediate debt-service standstill for all African countries until the end of 2021. As Vera Songwe, the Executive Secretary of the United Nations Economic Commission for Africa, has proposed, a special purpose vehicle (SPV) could also be created, modeled on the repurchase (“repo”) facilities that American and European central banks often use to support the smooth functioning of markets. This new lending vehicle, backed by the G20 central banks, would not only expand access to cheap liquidity; if designed well, it could also support the shift toward a more sustainable growth model. The International Monetary Fund also has an important role to play. The creative use of its reserve asset, Special Drawing Rights, could go a long way toward supporting fragile economies. The world’s wealthiest economies have responded to the COVID-19 crisis with unprecedented fiscal measures. African countries must do the same. Ensuring that they can is not charity; it is a matter of shared interest. If African governments lack the resources to respond effectively to the crisis, the hard-won gains of recent decades will be wiped out; poverty will skyrocket; the virus will become increasingly difficult to contain; and social unrest will grow, particularly in countries like Sudan that are already struggling to end decades-long conflicts. This would exact a massive human and economic toll, and leave all of us living in an increasingly insecure world. The COVID-19 pandemic is a shared global challenge, and it demands a shared global response that addresses both the health and economic dimensions of the crisis. Debt relief for Africa is an essential feature of any such response. – Project Syndicate 8
F O O D & AGR I C ULT UR E
New investments will give Africa the lead in agri-development SOLA DA I V I D -B O R H A A ND LI ND A MA ND A
t a time when the rest of the world is re-thinking its approach to commercial agriculture, Africa has a clear opportunity to refresh its approach to the sector and become an emerging force. Big shifts are already happening in food production, land and water use, and the integration of agri-tech and product tracing. If African firms take an early lead during this transition, they will be well placed to compete globally by building enduring assets and commercial advantages beyond primary production. The financing of new investments in agriculture has always relied on a healthy financial eco-system: active banks, sound insurers and lively futures markets. The next set of gains will come from new platforms that allow small and large firms to connect to each other and to their shared stakeholders. Reciprocal exchange of market data will make smaller, efficient players more visible to large buyers. “Without continued advances in agricultural productivity, the
whole project of African advancement is at risk,” according to Linda Manda, Sector Head Agribusiness, Corporate and Investment Banking at Stanbic Bank’s parent company, Standard Bank. “The stakes are high for all of us”, says Ms Manda, “because communities in Africa rely on the agriculture industry for much more than food: employment, investment and infrastructure development are all part of the deal.” Over half (52%) of all people in Sub-Saharan Africa are employed in agriculture (2019). THREE RECENT DEVELOPMENTS: HIGHER VALUE INCENTIVES
Three recent development milestones suggest that African firms are ready to move beyond low-margin primary production while remaining active in agriculture. According to Sola David-Borha, Chief Executive of Africa regions at Standard Bank, “‘higher-value economic activity is even more likely if finance, technology and trade
NEW I NVESTMENTS W I LL GI VE AFR I CA THE LEAD I N AG RI-DEVELO P MEN T
Multinationals are already active cross-border distributors, but we expect new African producers to be attracted to the intraAfrican produce-to-trade and value addition opportunity. Africa also needs to be ready for the next disruption in trade.
Linda Manda is Sector Head Agribusiness, Corporate and Investment Banking at Standard Bank
move deeper into African agriculture. Larger and more open markets, strong supplier networks and technology investments will drive Africa’s growth.” Trade data, and Standard Bank’s own long experience of trade finance, shows that Africa has been a net importer of food for almost two decades although the trade deficit has narrowed recently. Despite impressive export growth of certain key products, other food imports continue to rise. The covid-induced disruption to imports are a reminder that regional resilience in food supply is a practical imperative, not an intangible aspiration. A LARGER, MORE OPEN, INTERNAL MARKET IN SSA
Sola David-Borh is Chief Executive of Africa r egions at Standard Bank
First, the African Continental Free Trade Area (AfCFTA) should create a much larger internal market that gives producers access to a larger and more open market. Local production can better compete with the current import-and-distribute model. Large-scale production will arise when the returns are not stifled by trade friction. As an African bank, Standard Bank’s role is to put our strong balance sheet to work, lending to the new crop of agri-entrepreneurs. Multinationals are already active cross-border distributors, but we expect new African producers to be attracted to the intra-African produce-to-trade and value addition opportunity. Africa also needs to be ready for the next disruption in trade. Some global imports will always be required but it would be wise to ensure that key inputs can also be sourced regionally. FADING DISTINCTIONS BETWEEN SUPPLIERS
Second, the contrived distinction between the produce of small-holder farmers and very large commercial producers is beginning to fade. The new financial platforms being offered by Standard Bank will confirm the extent which large and small farming operations can complement one another. Out-grower programmes offered by large global firms allow smallholders to establish themselves as suppliers to the biggest and most profitable value chains. Tobacco, sugar and sorghum are all good case studies. Our banking platform is a place where buyers can meet producers, surrounded by market data on inputs, crop prices, volumes, regulations, trade advice and currency movements.
From the top of a tall grain silo, the neat polygons of monocrop plantations appear to be the only advanced outposts of progress. By contrast, small-holder farmland can seem rough and rudimentary remnants of a preindustrial age. Our own experience is quite different. Smallholder farmers that have access to the right platforms and better yields are also able to compete on quality and cost. Local knowledge of weather, grains, indigenous varieties, insects, and soil has accumulated over many years in Africa and is becoming a treasure of indigenous competence and resourcefulness. The huge expansion of biological patents attests to the large commercial value of small, local insights. ADOPTION OF TECHNOLOGY AND OPTIMISATION LOGISTICS
The third recent milestone is the broad acceptance across Africa that advances in technology are not peripheral to growth. Grudging acceptance has given way to enthusiastic adoption. Healthy livestock, fertile plantations, productive greenhouses and efficient cold chains all require technology partnerships to keep them productive and profitable. Two decades of smartphone penetration in rural communities has probably eased the transition from guesswork and speculation to datadriven decisions and GPS mapping. To make the most of this milestone, every hectare of land, every seedling and every bag of fertiliser must be used optimally. On-farm losses and unreliable methods are simply unaffordable during health pandemics and economic recessions. Private investment in telecoms, machinery and pipelines will eventually work alongside publicly funded infrastructure: roads, rail and bulk water supplies. Policy reforms need to support more publicprivate partnerships that have shown they can build and maintain high-quality infrastructure assets. Consumer demand for less waste and more conservation will support investments in new systems that supply micro-nutrients to digitally-mapped crops and livestock. Food-insecure communities in Africa can cheer this development as much as timestarved households in wealthy countries: a regular surplus of well-priced food is the best guarantee of the social stability in which economic growth can best be cultivated.
I NFR A STR UCTUR E
COVID-19 has ravaged South Africa’s construction industry, but it can recover XE B IS O B. K AM U DYAR IWA
he construction industry tends to be a major contributor to the economies of most countries. Early 2020 figures show construction contributing as much as 8% to the GDP of South Africa and 6% of the UK economic output. Any negative impact to this industry has national economic ramifications and brutal effects on households depending on construction workers. A year that dawned with promise for many around the world has descended into chaos with a pandemic whose effects have not experienced since the Spanish flu. The term “lockdown” has become synonymous with this pandemic. Globally countries shut their borders, implemented social distancing, put everyone on high alert and economies at risk in order to save lives. As countries came to grip with the pandemic, for some lockdown brought construction sites to a standstill, creating ghost towns and a crisis for the Construction Industry. Countries like the UK, Germany, Canada and Brazil, though hit by COVID-19, did not shut down their construction industries. These countries shared one important commonality: they declared construction an essential service and allowed work to continue albeit with stricter health and safety measures in place. Before all blame for the state of the South African construction Industry is laid at COVID-19’s feet, it should be noted that the industry was already in trouble. As Industry Insight reports, the sector was in trouble pre-COVID with the first quarter of 2020 showing a contraction of 4.7%, the 7th consecutive quarter decline since 2018, with further declines forecast for the year. Challenges faced by the industry included late or non-payment of various stakeholders, reduction in available work, project delays, cost overruns and corruption to mention a few. COVID-19 came with its own additional problems that made a dire situation worse. To understand the impact of a standstill construction industry in South Africa, one has to visualise the number of sites and workers affected. The impact spreads beyond just contractors, clients and professional consultants who are the internal stakeholders. Thousands of households and projects were put at risk economically because of the freeze, housing projects slated to ensure families were in homes by winter were left incomplete and many smaller construction companies went bankrupt as they could not endure such a long period of inactivity. While, government had to quickly adjust budgets and available funds to ensure industries and households could survive this period, it was not going to be enough. The CIDB Construction Monitor put formal employment in the sector at about 856 000 and informal employment at 483 000 for the 3rd quarter of 2019. This means hundreds of thousands of families are immediately affected when breadwinners are suddenly cut off
from jobs. Established, stable organisations were expected to stay afloat for only three months of lockdown before they would be unable to pay workers and maintain their businesses. In an economy already struggling with high unemployment rates, the pandemic came with alarming effects. This was an unexpected crisis, one no one could have planned or adequately mitigated for. While Stats SA gives a cautionary figure of 14 000 jobs lost in the industry, less conservative figures put the estimate at 100,000 affected jobs. Consider, thousands of projects were on ice for weeks or even months. Is it possible to compute the staggering amounts of monies lost through the lockdown measures? Can an accurate count be done of those households in dire straits because jobs have been lost? Honestly, the true cost of the pandemic can hardly be computed now, we can at best estimate. Just to give an idea of the possible numbers involved, these are the figures quoted by David Maynier, the Western Cape Provincial Minister of Finance and Economic Opportunities in arguments for reopening the private construction sector during level 4 restrictions: the construction industry was valued at about US$9.9 billion (R172 billion) in 2019, the Western Cape (a single province out of 9) was estimating loss of income figures at just under US$866 million (R15 billion) and nationally it was expected that about 40% of the workforce and businesses would be affected by the lockdown. These numbers show the extreme effects of a closed construction industry and invite an investigation into what exactly has been happening to cause such a grim outlook. During level five lockdown, only essential services were functioning. Sites literally had to shut down regardless of what stage they were on a project. Think about it, all these sites at different level of completion left to the elements. Besides these risks, no work means no milestones implying complications when payments need to be made. All construction companies, regardless of size or clout were affected. The move to level three opened some breathing room with especially contracting teams allowed back on site. The current move to level 2 will hopefully include fast tracked progress to provide the needed boost to the industry. The fact that lockdown is still in place means stricter health and safety measures have been put into place meaning more costs for contractors who need to ensure that workers are in a safe environment and are adequately equipped with Personal Protective Equipment (PPE). While there is talk of cost sharing with clients, this is dependent on the type of contract in place for a project. On the positive side though, it is expected that adhering to stricter H&S measures should be easier for the industry as they already had stringent measures in place. Extra measures would include better sanitation, social distancing, constant handwashing and taking temperatures of workers on site.
A DOUBLE-EDGED SWORD
XEBISO B. KAMUDYARIWA is a lecturer at the University of Witwatersrand. She focuses on Construction Procurement research
So, the construction site is made safer; does that mean everything is back to normal? Unfortunately, exacerbating the situation further is the fact that limited people are allowed on site implying fewer construction workers to enable social distancing. This can lead to delays in the construction process as there are fewer hands to do the necessary work. Others have touted this as an opportunity to bring technology into the industry to improve efficiency. This solution is unfortunately double edged as while machines can improve the construction process, they can also literally take jobs away. This is besides the fact that technology would not come cheap making it a solution for bigger projects (by implication higher grade contractors) that are able to handle the cost. Another touted solution is that of working round the clock; workers do the work in shifts to enable the work to move as quickly as required. This would obviously mean extra expenses such as lighting for working at night; but this cost could prove a small price to pay to ensure work progresses. Implementation of these solutions though is for work going forward and does not address current implications of delays. As early as February, construction material
shipments from China for example were already hit, with indefinite delays meaning contractors could not meet their obligations on time. In this case, again contracts play a major part in determining how the cost of delays will be shared between the contractor and the client. The crisis provides an avenue for standard contracts to be revised to prevent only one party, usually the contractor bearing the majority of risk. After this crisis, it is hoped that in the future such risks are anticipated, and adequate mitigation strategies determined. One issue that has come into focus in terms of import delays is that of local production. South Africa does have capacity to produce materials, it is hoped that local industry gets a boost as project materials are increasingly sourced locally. The industry has already been facing reduced infrastructure spending and major companies such as Stefanutti have seen their share prices crashing to an unprecedented degree. Insurance companies have also been battling with clients, refusing to pay out on business interruption policies. On one hand these are the sort of emergencies when such policies should prove helpful, on the other, pay-outs to the large number of affected businesses could possibly bankrupt insurers. Class action suits are in motion over these issues though insurers have compromised by promising to do case by case reviews instead of blanket rejections. africanthinker.com
C OV ID-1 9 H A S RAVAG ED S O U T H A F R I C A’ S C O NS T R UC T I O N I N D US T RY, BUT I T CA N R ECOVER
In the face of such calamity, how does the industry move forward? What measures can be implemented to rescue the various affected stakeholders? What can possibly help ensure the revival of the Construction Industry without compromising the needs of other industries and the nation at large. A look at what other countries are implementing gives some ideas on how to possibly proceed. Many countries have experienced a fallout from the pandemic, some with the same challenges the South African industry has faced. Examples are provided below of varied Covid effects and government strategies to improve the economy and the Industry from Fitch. Country
Limited impact as the government managed to control the spread
Acceleration of major PPP projects for existing economic recovery needs and spotlight on private developments
Restrictions resulted in affected manpower numbers and supply chain challenges
Government likely to channel funds to immediate concerns such as the labour market and households
Economic devastation from the pandemic and extensive quarantines
Implementation of Compromiso Por Colombia Plan which will focus on accelerating private initiative and public-private partnership projects. Government will focus spending on economic support to businesses and individuals while relying on private investment as the driver of economic recovery
Construction works were largely allowed to continue but faced supply chain disruptions, logistical challenges and a weakening of macroeconomic conditions Residential and non-residential building expected to be impacted as builders slow down the launch of new projects, but infrastructure development will face reduced impact
While new projects could be limited, government is looking at the use of PPPs to help improve the industry
Fitch also notes that developed markets and China will be at the forefront of infrastructure stimulus by increasing public infrastructure investment. This will be possible through the low borrowing rates afforded them. This prioritising of infrastructure development has
already been observed in countries like Germany and China. While the United States has the potential for stimulus measures, these may be put on hold due to elections and difficulties agreeing to terms of stimulus. Developing markets on the other hand have limited potential for increasing infrastructure spend as they struggle to re-establish preCOVID investments. Some governments like those of Kenya and the Philippines have already pulled back from major infrastructure spends. South Africa’s recovery approach borrows from both categories. The Construction COVID-19 Rapid Response Task Team (“CC19RRTT”) is one of the task teams established as a means of assisting government with interventions to prevent a complete collapse of the Construction Industry. Two key interventions they suggested were keeping to previously proposed infrastructure spend and also fast tracking independent public projects which have proven effective in other countries. Government has had to be circumspect in the manner they approach the current economic crisis as the Construction Industry is not the only affected party. For example, money has been redirected from the education infrastructure grant to schools needing water, sanitation and PPE. The revised budget also shows some R16bn from conditional grants redirected to provide Covid relief. Investment in residential and non-residential buildings has also shown a decrease of just over 10 percent. It should be noted though that government is also prioritising infrastructure development. It plans to expedite 50 infrastructure projects worth US$20,2 billion (R340bln) as part of its focus on the reconstruction and recovery of the South African economy. The Development Bank of South Africa is funding construction to the tune of US$259 million (R4.5bn) in the Johannesburg and Tshwane metros, the Cooperative Governance and Traditional Affairs Minister, Nkosazana Dlamini-Zuma confirms that US$32 million (R554 million) has also been set aside for creating jobs through municipal infrastructure projects. During the Sustainable Infrastructure Development Symposium South Africa (SIDSSA) in June, 276 projects worth a combined value of $150 billion (R2.6 trillion) were identified as being under evaluation by government; implementing even a fraction of these is expected to assist with boosting the industry and the economy. According to Fitch, South Africa has a strong domestic presence in construction and financing. This private financing is expected to help cushion the construction industry preventing it from collapsing. This outlook provides hope that not all is lost for the industry, and government’s commitment to the sector as an economic recovery vehicle is already a huge step towards its revival.
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BUSI NESS SENSE
COVID-19: invention and remodelling key to business survival “Never give in. Never give in. Never, never, never, never—in nothing, great or small, large or petty— never give in, except to convictions of honour and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy.” Winston Churchill B Y S HAU N JAYAR AT N AM
he world is in a great lockdown, facing the worst downturn since the Great Depression. The enemy – coronavirus. The coronavirus outbreak has evolved into a global pandemic with over 200 countries affected to date. With no vaccine in sight, the virus has caused nearly one million deaths and over 33 million people infected. VUCA – volatile, uncertain, complex and ambiguous, a term coined up by the United States War College in 1998 to train officers for the 21st century describes perfectly the world we’re living in. The virus has created utter chaos, disrupting every aspect of our life’s. The economic recovery will be a slow journey. Some of the challenges moving forward that businesses include uncertain consumer behaviour while demand patterns have been fundamentally altered. Another is that there is no clarity on the longterm financial state of the economy. Lastly how to define the way forward when economic recovery will differ from country to country. It certainly won’t be business as usual as that is what got us here in the first place. Instead it will be changes that we’ve had to make to adapt and survive that will define our future in this volatile environment. Organisations must be alert, nimble, and agile as they face long lasting demand and supply changes. It’s imperative they understand what customers value, their needs, their fears and their priorities, develop products and experiences based on those insights. Companies need to reconfigure their business model, develop cohesive overarching strategies. They must build an-agile model around clients, suppliers and resources that responds to volatile unpredictable global events, allowing quick decision making devoid of errors or early inaction. RESILIENCE AND ADAPTABILITY ARE ESSENTIAL.
Making this turnaround requires strong leadership with a clear and coherent vision, building a resilient cohesive team, as well as investments in innovation & digital transformation. This isn’t a normal economy, nor is it a normal world, certainly not a normal challenge.
To pull us through this VUCA world we need leaders with VUCA – Vision – charting a clear path, mission and strategy for the future ; Understanding of the changing circumstances, seeing the moves as they are happening, not when they are being revealed to the world ; Courage to step up and make tough bold decisions and moves ; Adaptability – adapting quickly to changing circumstances without altering strategic course. The company strategy, market footprint, assets, systems, processes, and its entire supply chain must be re-evaluated to formulate strategic action plans that are sturdy across multiple scenarios. With changing priorities, travel, tourism, retail and luxury purchases will be impacted. In the short term there will be decrease in consumption and demand for global consumer products, especially for luxury brands. At this point it’s impossible to define what’s a short-term duration, it can be 6 months, a year, 2 years or more. Panic buying, driven by fear and anxiety, on the other hand has led to an increase demand for staple packaged products, home care items and consumer health products. DEMAND FOR THESE MAY SUBSIDE SHARPLY POST CRISIS.
During these uncertain times people’s routine and purchasing habits are reshaped. However, this also creates an opportunity for businesses who can pivot operations and invest in new technologies to adapt to the changing environment. Businesses need to reprioritize their portfolio based on shifts in consumer and customer needs and a new supply chain. There will be a reconfiguration of the food industry business standards and the way supply chains operate. There may be more government regulations on consumer health and food security, along with more digital traceability to ensure safe production standards. Businesses need to keep their eyes and ears close to the ground, be in tune with the changing regulatory measures. As consumers desire to remain healthy and safe will be stronger than ever, businesses may need to focus more on innovative
sustainable products and services centred around immunity and safety. The push towards a healthier diet has led to increase sales for plantbased and cell-base protein manufacturers with more investments and innovation in the industry. Investors are leveraging on the consumer shifts towards sustainable and healthy choices. The crisis has impacted consumer mobility and retail footfall. As retailers try to cope during the lockdown they are also faced with a new challenge (and opportunity) of increase e-commerce demand. Globally online retailing has been the major beneficiary of coronavirus impact. The sector has experienced exponential growth since the virus outbreak. There has been a spike in app downloads for e-grocery and food delivery services. For many consumers the challenge with e-grocery is getting used to selecting and ordering a big basket of products. Normally, it will take a long time to adjust to this mode of purchase but forced lockdowns have accelerated that
process. The convenience may be too much for some consumers to revert to their old way of shopping, it could even lead to permanent adoption by some. Digital transformation will change consumer habits and demand. Retailers and supply chains that do not re-position and adapt fast will cease to exist. Regrettably many retailers will be wipe out during this crisis but those with both online and offline presence are capitalising on e-commerce to mitigate the losses from the closure of their physical stores during the lockdown. With online orders for primarily storebased retailers increasing these businesses will invest more in their e-commerce and digital marketing presence. NECESSITY IS THE MOTHER OF INVENTION
The upsurge of innovation is one of the positive outcomes of this crisis. Automation, immersive new technologies, digital platforms
C OV ID-19: I N V EN T I O N A N D R E M O D E L L I NG K E Y TO BUS I N E S S S URV I VA L
and networks will reshape our world, defining the way we work, live and socialise. Since the lockdown there’s been an increase telepresence surge in people using cloud platforms and SaaS providers to work from home. Robot manufacturers have seized the opportunity to showcase their bot’s abilities during this crisis, especially in hospitals or other facilities where patients are quarantined. The use of AI and robotics is accelerating. It holds a lot of promises but at the same time challenges as these technologies will replace many work activities currently done by humans. Fortunately, the transition will not be abrupt, but a gradual process, differing from industry to industry, country to country. Nonetheless, digital solutions need to be developed quickly, and organizations and stakeholders must get out of their comfort zone, reskill, adapt to new operating models. Digitization and automation need to be accelerated in areas of supply chain, back-office functions, procurement, and route to market. All of this will have a major impact on earnings. Because China is a major producer for various products, as well as a supplier of components and raw materials for multiple industries, when it went into a lockdown some 5 million companies globally were affected. This coupled with the US-China trade war has made companies and governments realise how overly dependent and vulnerable they were. Supply chain managers had traditionally focused on cost, quality and delivery. There are not wrong to do so. However equally important now is paying attention to resilience, re-configurability, and responsiveness. Moving forward businesses need to conduct a rigorous review of their supply chain, map it out – 1st, 2nd, 3rd tier, supplier’s own source, logistics etc. They must switch from an operational supply chain to building a resilient supply chain that is smart and flexible, reconfigure their supply chain exposure, plan for diversification. This may mean working less with traditional suppliers, a diminished negotiating power, increase shipping cost, etc. Unfortunately, in the short term this cost may be passed on to consumers in the form of higher prices but in the long run everyone benefits. Organizations need to analyse consumer demands in real time and deliver solutions. To win back client’s marketers must leverage analytics to design online marketing campaigns and communication channels that are immersive, engaging and social. Big data analyses are increasingly being used in decision making in the various sectors. Sales channels will be more digitalised, pricing, marketing and promotions adjusted based on data.
Life streaming will grow bigger and faster. A wide range of products are sold via this platform, from food, cloths, daily necessities to houses, cars and cosmetics to electronic devices, pets, construction services and events. It has help retailers broaden their sales channel. There will also be increased advertising spending via streaming and a decrease in outdoor ad spending. According to iiMedia Research, sales via China’s live streaming platforms is estimated to hit US$130 billion this year, accounting for 8.7 per cent of online retail sales, users of live streaming within China would reach 526 million. Many of our assumptions of in-person services with physical locations have been challenged during this pandemic. Digital medicine tools are showing their usefulness to patients and medical practitioners in this pandemic. Instead of booking an appointment with a doctor, patients now have multiple options at their disposal whether it’s to get advice via a chatbot or to message a nurse or doctor. From remote working, video conference calls, e-learning for children, telemedicine, esports, to sales and workouts via streaming, food and alcohol delivery, lots of things have changed and postpandemic some of these habits are likely to stay. Organizations grappling with integrating technology in their business need to adapt to the modern age. The future is now, not 6 months or a year or 2 away. The possibilities are infinite. According to an Econsultancy and Marketing Week’s “Covid-19 Business Impact Survey” - 60% of large global organisations (with annual revenues of over US$60 million) have identified new processes that they might use post-outbreak. Significant numbers of respondents said they had also observed new ways of working which could be used post-outbreak (82%), innovations in marketing messaging/branding (49%) and innovations in products and services (47%). Will this be a prolonged recession, or are we entering a depression? Will there be a second wave of the virus hitting our shores in fall? The unknowns are many, the economic recovery will surely be slow. But for sure consumer shopping habits will change, and businesses needs to adapt.
Shaun Jayaratnam is a sales and marketing, business development and operations management professional with over 25 years of experience in several industries He has worked in Russia, Ukraine, Africa and Asia. Connect with him on Linkedin.
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C O V E R S T O RY
B Y S HAU N JAYAR AT N AM
Re-imagining and re-engineering Africa’s future It is in your hands to create a better world for all who live in it. – Nelson Mandela
he covid19 changed our world in a matter of months. The world as we knew it is over, a new normal is upon us. A brave new world is shaping up opening audacious possibilities that never existed before. If you think about it in many ways we have been presented with a clean slate. We can choose our path, a freedom of choice that can make us or break us. The current decade would be decade of change. WHAT FUTURE DO WE WANT?
The question is – do we want to go back to where we were, do we recover, or do we reconstruct? What kind of economy we want? Covid-19 sends a powerful message to all leaders around the world: they need to adjust to a new normal. An economy is a tool designed by a government led by a leader; it facilitates a country to reach the goals it sets. No government
nor policy will ever be perfect; hence an economy must keep on designing and redesigning till it arrives at its goal, achieving collective happiness, and prosperity for its citizens and if ever it’s possible equality for all. The African Development Bank estimates that the pandemic has cost Sub-Saharan Africa between US$35 - $100 billion due to an output decline and a steep fall in commodity prices, especially the crash in oil prices. The World Economic Forum estimates that global losses for the continent will be in the order of $275 billion. Africa imports almost 100% of its pharmaceuticals, with India and China accounting for 70% of the imports. The pandemic has brutally exposed the fragility and weakness of Africa’s industrial capabilities and health and pharmaceutical sector, the two are complementary. Governments have an important role to play in the nature and direction of industrialization. Progressive governments throughout 20
C OV ER STORY
history understand that the faster the rate of growth in manufacturing, the faster the GDP growth. China transformed itself, and the world economy by being a manufacturing powerhouse, and selling abroad. So did Vietnam and Bangladesh. Bangladesh, a country far poorer than many African countries, can manufacture 97% of its pharmaceuticals, even though it’s just next door to India which together with China are the largest producers of API (active pharmaceutical ingredients). MANUFACTURING AND INDUSTRIALIZATION
The keywords are manufacturing and industrialization. The challenges facing the health services sector in Africa is numerous and severe. These include shortages of health care professionals, weak leadership, training and development, governance, infrastructure, resources and policy barriers. This crisis has severely tested Africa’s political, economic and social resilience. African leaders must rethink prior assumptions and ask themselves where they see their countries in 2030 and 2050 (when the population will be at 2.5 billion). Africa must adopt progressive industrial policies that puts social and environmental consciousness firmly at the core of its decision-making to create an inclusive, prosperous and sustainable societies. Africa must think ahead. It’s high time the old ideas and ways are thrown out, new forwardthinking innovative ideas and policies are designed and executed. What will the brave new world post covid-19 look like in Africa? Personally, I believe opportunities are emerging, it’s time to rise to the challenges. It’s time to turn adversity into opportunities. Africa cannot allow itself to be marginalize anymore. The valuable
resource in Africa isn’t oil, diamonds, cocoa etc, it’s African’s. Africa has 35 out of its 54 countries in the highly export-commodity-dependent category (referring to countries with 80% or higher dependency). This is an opportunity for Africans to rise, industrialize and add value to the continent’s vast raw materials. In 2001, African leaders pledged to invest around 15% of their budgets in health but fast forward today only five countries have fulfilled this promise. There’s no doubt today that the health sector in Africa will be strengthened by covid-19. Many African countries have already been deprived access to essential medical supplies during this pandemic -- surgical masks, PPE and so forth. Excessive global demand has relegated Africa to the back of the queue. This is an early warning and lesson for Africa. According to a 2019 McKinsey study, China and India supply 70 percent of Sub-Saharan Africa’s demand for medicine, worth $14 billion. China’s and India’s markets are worth $120 billion and $33 billion respectively. Just consider this – what if both India and China are unable or unwilling to supply the African market? Clearly, Africa will face a health hazard. The restrictions introduced by the US and European countries for exports of vital medicines, reagents, respiratory or personal protective equipment affect African countries heavily. It is a wake-up call to think about how the continent should deal with pharmaceutical regulation, health-related procurement and manufacture of medicines and products in areas that are critical for disease control and protect well-being. Billions of people today await a vaccine that ends this pandemic. Ideally the vaccine will be patent-free, rapidly produced and distributed, and free for all. No African country should be pushed to the back of the vaccine queue. The dependency syndrome Africa remains highly dependent on foreign funding and imports of pharmaceuticals. The production of health equipment and consumables follows a similar pattern. Covid19 has demonstrated a hidden capacity to produce masks, tests, and other essentials throughout Africa. This capacity should be nurtured. This must be a shifting point towards greater reliance on African-produced health products, coupled with investments in R&D. Industrialized countries became rich by manufacturing and exporting to others, including high-quality goods and services e.g China, Japan, Korea. Poor African countries remain poor because they continue to produce raw materials for rich countries. For example, 70% of global trade in agriculture is in semi-processed and processed products, cocoa, coffee, cashew, sesame, etc. Africa is largely absent in this market while the region only remains
RE-IMAG I N I N G A N D RE-EN G I NE E R I NG A F R I C A’ S F UT UR E
an exporter of raw materials. How did Vietnam, with a population of 95 million, emerge from a 20-year civil war to lift more than 40% of her population out of poverty between 2002 and 2018, developing a manufacturing base that spans textiles, agriculture, furniture, plastics, paper, tourism and telecommunications? It has emerged as a manufacturing powerhouse, becoming the world’s third-largest exporter of textiles and garments (after China and Bangladesh). Vietnam is also the second largest coffee producer and the top producer of Robusta coffee in the world. Since the onset of the US-China trade war and now the COVID-19 pandemic more manufacturers are moving their base to Vietnam. Vietnam currently exports over 10 million tonnes of rice, coming third after India and China. In 2016, exports to Ghana, at the time the second largest buyer of Vietnamese rice, surged nearly 40 percent to 350,000 tons. Shipments to Angola, another potential market, rose 4.6 times in volume and 3.6 times in value in the same year. Ghana’s demand for rice is around 1.6 million tons per year and the country depends on imports to cover more than half of that amount. In 2019, Ghana top trading partners for rice were Vietnam with a share of 71% (268 million US$); Thailand with a share of 16.1% (60 million US$); India with a share of 4.2% (15.7 million US$). To ensure national food security amid the covid-19 pandemic Vietnam stopped the export of rice on 24th March, resuming exports on 11th April 11. This affected a lot of importing countries, including several West African countries. Food security is quickly becoming an urgent issue as the world’s population is increasing and natural disasters are becoming more frequent. The pandemic has exposed Africa. African leaders need to reflect and think deeply to formulate long-term strategies to address the weaknesses that this pandemic has revealed. They must ask themselves where they want to position the continent in the next thirty years and beyond. WHAT THEN SHOULD BE DONE?
Africans need to move away from the commodity-driven model which has failed in creating prosperity. With a consumer base of 1.3 billion and $3.3 trillion market under the African Continental Free Trade Area (AfCFTA), the continent must bring together its fragmented markets. Be it feeding its own people or building industrial powerhouses led by African champions, the Africa of tomorrow must look inwards for its solutions. Perhaps this pandemic can herald structural transformation in the continent. It’s an opportune time for Africa to execute structurally trans
formative projects that generate positive outcomes for the country along with social returns. Africa needs to address its weaknesses, build on its strengths. It must build better private and public institutions, strengthen weak ones and set up new ones that are missing. Wake up Africa, cease the opportunity that this pandemic has presented. Logistics for transporting capital and consumer goods across the region need predictable structures. To achieve this private and public institutional challenges such as custom regulations need to be restructured and long-term regulations and agreements put in place so supply chains can be strengthened. Roman philosopher Seneca once said: “Luck is what happens when preparation meet opportunity.” ACTION is the part missing from this quote. Opportunity and preparation without action is pointless. Action is what you get when you avail yourself to the opportunity and do something. Luck isn’t just about being at the right place at the right time, but also about being open to, ready for, and taking advantage of the new opportunities. For African leader’s it’s about being skilled at creating and noticing chance opportunities and adopting a resilient attitude that transforms this pandemic into a good opportunity. Countries must pool all the knowledge, experience and resources at their disposal for the good of the continent. There is probably no better time to fast track change than now. This is a chance to accelerate transformation and even leapfrog. Calls for debt relief is just like placing a band-aid to a wound that requires surgery. Something much more ambitious and radical should be envisaged. This crisis allows Africa to think big. This is an ideal time for collective action within Africa and with the rest of the world to reimagine and re-engineer Africa’s future. It only seems impossible until it’s done, said the late Nelson Mandela, a very apt statement for Africa.
Shaun Jayaratnam is a sales and marketing, business development and operations management professional with over 25 years of experience in several industries He has worked in Russia, Ukraine, Africa and Asia. Connect with him on Linkedin.
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HE ALT H & M E DICIN E
Breast cancer: Fighting every woman’s nightmare B Y T E N DAYI G WATA
was diagnosed with Stage 3 Her2 positive breast cancer. This is a type of breast cancer occurs in 20% of those diagnosed with the disease. Being Her2 +ve means that there is a protein in your system that drives the cancer to grow. Some breast cancers are Estrogen positive and Progesterone positive which means their growth is hormone driven and some are Triple-negative breast cancer, which means they are negative for estrogen and progesterone, and the protein HER2. Triple negative breast cancer it is one of the most aggressive types of breast cancer and most difficult to treat. I first discovered the lump in breast one morning, because it actually hurt. It was a kind of throbbing pain and I could feel a lump. I remember not being too sure and thinking it could just be one of those monthly menstrual lumps you sometimes get. I had no reference point because I hadn’t been very good about doing my monthly self-checks and my annual mammogram and scan. So I went to the trauma center, where they sent me on for a scan. They confirmed the diagnosis doing a number of things, firstly I had an ultrasound scan, and then from the scan they did a mammogram, which gave a clearer indication, that is could be cancer. So from there I needed to have a biopsy. At that point, I was informed that because it was in the breast area and also because it was quite a large lump, I would need a plastic surgeon to remove the lump. That’s when I discovered that we have 2 plastic surgeons servicing the whole country and that both at the time were not in the country and both not due back within the next couple of weeks. Panic ensued. My family and I sat down to weigh the options and we decided that I would seek medical assistance in South Africa. Which turns out to have been a very good decision, because at the initial scan my tumour was 4cm wide and 1cm high and 3 weeks later at my last scan before starting treatment it had grown to 4x5cm in size. The cancer had also spread to my armpit. The biopsy was done with local anesthetic, so I was awake which was scary. The radiologist who did the scan was a no nonsense, straight talking type of doctor, I remember asking her how bad she though it was and her exact words were “My dear you in for a very rough time ahead of you”. They did both a core needle and fine
needle biopsy, both are basically a needle that is pushed through your skin and flesh to the area in question and a sample is retrieved for testing. The difference between the two is that; a fine needle biopsy uses a fine needle and syringe to take a sample of cells and a core needle biopsy uses a hollow needle to get a sample of breast tissue and because tissue is taken rather than cells, it gives more detailed information. These samples were then tested and this where they were able to confirm that it was indeed breast cancer. I then had to wait a couple of days while they did the tests on the samples they had taken. Eventually on Friday morning, I went to meet my surgeon who sat me down gave me the confirmation. I remember my vision going blurry and then black. For a few seconds I couldn’t see or hear anything. I didn’t cry then, I just remember asking what happens next and being told that I would need to make an appointment to meet an oncologist the next week to discuss treatment options. I remember the surgeon giving me a book on breast cancer and suggesting I read through it before my next appointment. Turned out to be a great book and it got me to start doing more research about my situation so that at my next appointment I would be prepared with questions. The following week after my diagnosis, I had my first appointment with my oncologist. I had never met her before; she is part of a team that would work with my surgeon during my cancer journey. Wow, what an amazing woman! I liked her immediately because she was also a no nonsense person (It seemed that I would be meeting more people like this as I went along which is great because I really appreciate people who tell you like it is especially at a time like that), she sat me down, immediately told me that my diagnosis was not a death sentence and that breast cancer treatment has come a long way with very decent survival rates. She explained that I would need to have a few more tests, before starting treatment, as they needed to confirm the type of breast cancer, and the stage. The tests included; blood tests and a CT scan, which confirmed that I had Her2 positive, Stage 3 Breast cancer. There are 5 stages of breast cancer from Stage 0 to Stage 4. By the time you get to Stage 4, it usually means that the cancer has spread to other organs, such as the bones, lungs, brain, liver, lymph nodes or
B R EAST CA NCER : FI GH TI NG EVERY WO MAN ’ S N IG HTMARE
chest wall and they usually refer to this as metastasized breast cancer. Interestingly enough, people can still survive Stage 4 breast cancer, but if you are going to have breast cancer, you want to catch it as early as possible, while its still in Stage 0 up to Stage 1 or 2, your chances of survival will be much higher. When the doctors talk about survival, its not just a case of surviving the treatment and going into remission, it covers a period of 5 years from the time your were diagnosed. I was then given a treatment plan which basically maps out what my treatment is going to look like, what to expect and when. For me this was 8 sessions of chemotherapy, the first 4 sessions would happen every 2 weeks and the second 4 sessions would be every 3 weeks. After finishing the chemo, I would then have surgery. The idea was to shrink the tumour as much as possible so that by the time we got to surgery it would be much easier to take out the tumour. I noticed that their approach was to conserve the breast as much as possible. Then after surgery, I would then have to do 30 sessions of radiotherapy. I also needed to have an injection called Herceptin every 3 weeks for 12 months. So that’s 17 injections in a year, one every 3 weeks directly into my thigh. This injection is specifically for Her2 positive patients and has been shown to help make sure the breast cancer doesn’t come back. Imagine, after all that, you get treated, you beat it and there is still a chance your breast cancer could still come back!!! I remember thinking “Ok great so there is a plan and it looks doable, its only 8 sessions of chemo, I can do this!!” Ha!! There are no words that will ever prepare anyone for chemo and its many many side effects. My first chemo session, my sister came with me. I remember they had told me to make sure I had had a decent breakfast and a good nights sleep. Me? Sleep zero! Breakfast failed. I was just far too nervous. I kept having to take deep breaths and the words that were going round and round in my head were all jumbled up and didn’t make much sense. When I got to the oncologist, they sat me in a very comfy chair, in a large room full of comfy chairs. Most of the chairs had people of all ages; I think the youngest person I saw was about 15 years old and the oldest must have been about 80. Chemo for me was basically an IV in my hand. It wasn’t painful at all, it just took forever, 3 hours and was very very cold. I am so glad they told me to bring a blanket, something to read and some snacks. If you are lucky, you wont get nauseas and can munch on stuff. During that first session, someone got up from their chair and went to the nurse’s station and started ringing a bell. Then the whole room erupted and people were cheering. I was so baffled and couldn’t understand what was going on and why did the guy ringing the bell have such a huge smile on his face. Someone then explained that when you get to the end of your chemo you get to ring the bell. I remember thinking that I couldn’t wait to ring the bell. I didn’t at the time realize how much meaning this would have. Chemo is not easy, with each session of chemo it gets harder and harder to get up keep going. After each session I would be laid up in bed for 5 days. In those 5 days, I could barely eat, food did not taste like food, the texture was no longer the same and water was so hard to swallow. I would be in pain throughout my entire body, and the pain was different depending on which part of the body. The worst for me 25
was bone pain, its exactly as the name says, pain in the bone. I still don’t have words to describe this pain; it would come unexpectedly and leave unexpectedly. I never knew when it would hit and how long it would last. I just knew that when it came there was no position I could get into, nothing I could take to make it feel better. I would just have to ride out the pain. I remember having moments when it was even difficult to breathe, those were the moments I would ask myself if I would be alive the next day. I remember having mouth ulcers, which is also another side effect, these were so bad, it became difficult to put anything in my mouth and talking became very difficult. I did get pain medication to help with these side effects but always found it only worked for a couple of hours and then I would have to ride it out until I was able to get the next dose. My hair fell out 10 days after the first session of chemo. I noticed it in the shower; my hand just came away with a clump of hair. I was expecting it but it still broke me. I remember my son and I sitting outside in the sun, both of us pulling out clumps of my hair. He was 4yrs old at the time and thankfully this was just a fascinating thing happening to his mom. He asked lost of questions including “when will my hair start to fall out?” The way chemo works, it attacks the cancer cells in your body but it also attacks the healthy cells. So your immunity becomes very very low, to the extent that a common cold can be something that could land you in hospital fighting for your life. By the time we got to the end of session 8 of chemo, I rang that bell and it was the best moment of 2019 for me. I felt like I just come out of a war and survived. In fact on that day, I remember feeling weak but when it came to ringing the bell I got a surge of energy I didn’t even know I had. After that, I got to have a break, as it was December. I got to have Christmas at home and my birthday in the first week of January. I wasn’t really keen to celebrate. I kept thinking about the surgery I had to go through the next week, as that is when we would find out how well the chemo worked. Thankfully the chemo worked so well that surgeon said that the tumour had completely gone and all he had to do was clean out the flesh that had been affected by the tumour. They call this are the margins. They also removed 10 lymph nodes from my armpit; little did I know that this part of the surgery is what would take the longest to recover from. After the surgery, I had to move around with a drain hanging out of my side. This was basically a tube coming out of my skin with a bag at the end. With this kind of surgery, for a while after, the area around the surgery will produce liquid that needs to be drained out. I would have to empty the drain myself, twice a day and measure the amount of liquid that came out. Only at a certain point would they then remove the drain. It was gross!! I remember going to shops one day because I was fed up of being indoors only to have my drain banging into things which was super painful. I also had to do physiotherapy after surgery. I managed to do 2 months worth and then had to stop when I started radiotherapy. The physio is very important as it helps stop that fluid build up which continues even after the drain is removed and because the surgery had included removing lymph nodes from my armpit, I needed to learn to use my arm again. At the beginning I wasn’t even able to raise africanthinker.com
BREAST C A N C ER: FI G H T I N G E V E RY W OM A N ’ S NI GH T M A R E
my left arm above my waist and they say if you don’t do the exercises, you risk your arm staying stuck with that minimal movement. I would say the radiotherapy was probably the easiest part of the whole treatment plan. You basically get to lie down on a bed under a machine that then beams rays to the area where your cancer was, the whole thing takes about 20mins and you need to do it 5 days a week. The reason why I needed radiotherapy was because although the chemo got rid of the tumor and the surgery of the affected flesh, there was still a risk that I had cancer cells floating around and the radiotherapy is needed to kill them off. Radiotherapy is still a bit of a wild ride. Around the 10th session my skin started changing colour, a few days later the whole area was completely black and a few days after that I started getting blisters. Radiotherapy burns your skin. It’s painful and the only way to get through it is to be naked as long as possible in between sessions and if you have to wear clothes, only very loose 100% cotton. It also made me feel tired, a tired that I actually have never felt before, especially just after each session. I would get home and just pass out. There was nothing I could do to stay awake, my eyes would be so heavy, so would my arms and legs, infact my entire body would feel like it weighed a tonne and I just needed to get into bed. Through out all this, I had quite a few tests done. I would have a blood test before each chemo to check my white blood cell count; I would have a cardiologist check my heart every 3 months because the chemo drugs could destroy your heart. During radiotherapy I would also occasionally have blood tests done to also check my white blood cells. These tests are so important but also very tense times because if at any point the results are not what they should be, it could mean stopping treatment for a while until things get back to an acceptable level. To me this always scared me because I didn’t know if I would be able to keep up the momentum if I had to stop at any point and also what would it mean for the I encountered a few challenges throughout this journey. Some of them were as simple as keeping my cool. Some of the medication seems to result in you having a very short temper and there is nothing worse than losing your temper with the people who love you and are trying to help you through such a difficult journey. Some challenges were trying to keep a positive head space. They say that your survival of something like this is largely dependent on your attitude. If you are positive, you take positive actions, you have positive thoughts it somehow energizes you especially during that dark days when things don’t look so bright. So to do this at the beginning was easy, first few weeks? No problem. I had my family and friends cheering for me, I felt strong, yeah the side effects were bad but I was still standing. Yeah I am going to beat this cancer.
But as the weeks went by it became harder and harder as I became weaker and weaker. Then I realized being strong and positive doesn’t mean having to be smiley and cheery all the time. Some days were so bad and being positive to me was saying to myself, “Tendayi, this pain is temporary. Remember that it only lasts for 5 days, just get through the 5 days and things will be different.” My favourite mantra became “One day at a time, and sometimes; One hour at a time” Some of the challenges were things that made me sit up and start asking questions about the fairness of cancer treatment. For example, the drug Herceptin that I needed to have every 3 weeks for 12 months, the drug that increases your changes in making sure that the cancer never comes back. That crucial drug was for sale in Zim at USD2100 per vial, that means someone with my kind of breast cancer would need to pay USD35700 to be able to stand a chance of not getting the same cancer again. Meanwhile this very same drug was available in South Africa at USD600 per vial. For anyone, both prices are expensive but why was Zim so much more? I liked this kind of challenge though. It distracted me from my own aches and pains and got me to focus on finding out why and what could be done. There is something about refocusing your pain that really helps you get through days at a time. Thankfully all this rechanneling, chasing up and asking people why and pushing for change eventually resulted in the drug pricing being changed for Zim so now people can get the drug at the same price as across the border. This is quite a big deal because Herceptin is not one of those drugs you can just send a runner to get for you. It has to be kept in a specific temperature, between 2 and 8 degrees Celsius and if the temperature goes anywhere out of that range the drug stops working. So the only option to get the drug at the SA price, was for you would to fly to SA, pick the drug, fly back and get it stored properly straight away as the packaging for travel was only good for a short period of time. The other big challenge I encountered was when the only working radiotherapy machine in Harare broke down in the middle of my treatment in the middle of the first lockdown. Because I had not got to the end of my treatment we couldn’t be sure that if there were any cancer cells left after the surgery and chemo had been completely destroyed. The options going forward for me included a possible mastectomy. The only other machine working was in Bulawayo and at that time the Covid infection rates were rising in that area and it just wasn’t an option. I remember thinking to myself that I needed to understand what could be done as I had learned that there were 3 other radiotherapy machines in Harare that had been broken for over a year. So many
B R EAST CA NCER : FI GH TI NG EVERY W OMAN’S NI GH TMARE (CO N TIN U ED)
things didn’t make sense to me. As I started asking questions and doing my investigations, I then learned that there were over 500 of us waiting for treatment and no working machine. This really upset me because I remembered the people who would come to radiotherapy who arrived in ambulances and wheel chairs, people who had tumors, people who by not having treatment meant their tumors would start growing and grow aggressively. And that’s when I started campaigning for the broken machines to be fixed. I was relentless. I phoned everyday (social distancing and the risk to me didn’t allow me to go anywhere) but it didn’t stop me. I went to twitter and I went to the media and finally arrangements were finalized and the machines were fixed. One of the interesting things I found during this time was that when I googled “broken radiotherapy machines” the results I found included reports of the same situation in other African countries. It became apparent that this was not a situation unique to us in Zimbabwe and although it’s a story for a another day, its definitely food for thought. It was so great to move my focus from my fears and pain and to work on something that would not only help me but would help so many people. That gave me strength and purpose and most importantly it felt good. Today I can proudly say that I have met many challenges in the last 15 months and I have managed to overcome them. It’s taken
a lot out of me and I wont lie, I feel exhausted but it’s a satisfying kind of tired. And the best news of all? I am now officially in remission!! Yeah I BEAT CANCER!!!!!! Now I want to give back. I want to do more for the Breast Cancer cause and part of that is I have joined a charity called Zimbabwe Breast Care Trust. The charity, started by Dr Noleen Mbuwayesango who, I met when she was doing a heart Echo for me (checking out to see if my heart was doing well during treatment) opened its doors just as the Breast Cancer Awareness month began. During our first meeting, it turned out that Dr Mbuyawesango was also going through treatment for breast cancer and this impressed me greatly! I was barely able to do much physically and here was this woman still treating other people despite the challenges she was facing. We are currently working very hard to raise awareness, remind everyone to do their monthly breast self checks and go for their annual mammograms and scans. We have designed a poster that helps people keep track of their monthly checks by enabling the to note down the self check findings and have a comparison for the next one. Our charity will also continue some of the work that I have started such as looking for ways to reduce the cost of Breast Cancer treatments, raising money to help those who cant afford mammograms and treatment. I hope you can all support us. Please like our page on Facebook, Zimbabwe Breast Care Trust and visit our website www.zbct.co.zw.
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HE ALT H & M E DICIN E
Barriers to malaria interventions in Ghana BY M AT IL DA AB E R E S E -AKO
alaria in pregnancy can have a devastating effect on pregnant women and their unborn children. Consequently, various intervention measures have been put in place to prevent and manage malaria among pregnant women in endemic countries such as Ghana. However, malaria continues to afflict some pregnant women. THE PROBLEM
Although malaria is preventable, it remains a leading cause of illness and death in sub-Saharan Africa (SSA), which suffered 92% of malaria cases and 93% of malaria deaths worldwide in 2017. The most at-risk populations include children and pregnant women. Malaria in pregnancy (MiP) is associated with negative outcomes such as illness requiring hospitalization, anemia, aborted pregnancy, low birth weight and still births, especially in first time pregnancies. In SSA, an estimated 25 million pregnant women are at risk of infection by Plasmodium falciparum annually. The World Health Organization (WHO) recommends that malaria in pregnancy interventions be included as a component of maternal health care. Ghana adopted the following interventions in 2003: regular use of long-lasting insecticide-treated bed nets; directly observed administration of intermittent preventive treatment (DOT) with sulphadoxine-pyrimethamine â€” a full therapeutic course of antimalarial medicine given to pregnant women at routine antenatal care visits regardless of whether the recipient is infected with malaria. A study in eight health facilities and eight communities with high incidence of malaria in pregnancy in two administrative regions of Ghana suggested that socio-cultural, household, individual and health system factors influenced knowledge, attitudes and utilization of malaria interventions in pregnancy. Negative pregnancy outcomes such as miscarriage and still birth from malaria and other biomedical causes were sometimes interpreted as spiritual attacks from enemies. So pregnant women were encouraged to seek physical and spiritual protection, which resulted in women visiting prayer centres, herbalists and selfmedicating using herbs. This practice contributed to delay in seeking maternal and MiP care in health facilities and compliance with treatment. However, the belief that pregnant women should not be abused and should not be starved contributed positively to the protection of pregnant women from violence and encouraged them to develop regular eating habits. Healthcare managers reported that sometimes the National Malaria Control Programme failed to
supply them with antimalarial drugs and supplies and the National Health Insurance Scheme delayed in reimbursing them for services provided. Multiple factors such as the nature of the healthcare system, sociocultural and individual influences impact the uptake of malaria in pregnancy interventions. THE LESSONS
To ensure seamless delivery of services in order to achieve the goal of controlling malaria during pregnancy in Ghana, authorities must provide a regular supply of antimalarial drugs and medical supplies and products, as well as prompt reimbursement of funds to public, faith-based and private health facilities. The same factors influence the uptake of some drugs. Consequently, interventions must focus on three levels: regular and sufficient supply of essential drugs in health facilities; provision of appropriate and adequate information, education and communication to antenatal clients to motivate them to complete required dosages, and community outreach programs to encourage early and regular antenatal care visits. Intensive and regular education must be provided by health providers to pregnant women to improve their knowledge of the effects of malaria in pregnancy and MiP interventions to facilitate prompt utilization of preventive and treatment services. Distributors of long-lasting insecticide bed nets in health facilities and communities must also provide comprehensive, culturallyappropriate information. Facility managers must ensure that antenatal care managers have access to transport to reliably distribute drugs to health facilities in order to ensure that all pregnant women who seek antenatal care for the first time receive them for onward use. Positive socio-cultural beliefs should be further studied and encouraged among communities to promote healthy habits among pregnant women, while negative practices should be discouraged through extensive community education.
Matilda Aberese-Ako is a medical and organizational anthropologist and a Research Fellow at the Institute of Health Research in the University of Health and Allied Sciences in Ghana. She previously worked with the Navrongo Health Research Centre as a research fellow. She has a BA hons degree in Integrated Development Studies from the University for Development Studies in Ghana.