Anticipating the Impact of COVID-19 Pandemic on Health Inequality in South Africa: Early Evidence on Direct and Indirect Influences

We examine the impact of COVID-19 on health and health inequality through both direct and indirect channels, including reviews of previous findings and of new quantitative analyses. This paper documents the early evidence that was available at the end of October 2020. We employ three large data sets that reflect social and health changes during the COVID-19 pandemic—a first and second wave of data from the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (hereafter, NIDS-CRAM) and a Maternal and Child Health (MatCH) SMS survey of mothers—and matched these data to information from the latest census and District Health Information Systems. We find little evidence of inequality in the direct health effects of COVID-19. Conversely, we discovered substantial evidence of indirect pathways of inequality. The severe restrictions on social and economic activity imposed by the government in March and April 2020 had dramatic short - and medium-term effects that disproportionately affected vulnerable groups such as women and the poor. The asymmetrical burden of these indirect effects will likely deepen health inequalities in a country that is already among the most unequal in the world. The ultimate impact of the pandemic on health inequality could not yet be assessed at the time of our study, but this paper serves as an early warning regarding vulnerabilities and risks that should be tracked closely over coming months. Particularly concerning is the decreased use of public-health services despite sustained drops in HIV testing in South Africa, where nearly 8,000,000 people—and one in every five adults—are living with HIV.