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January 2015

SOCIO-ECONOMIC IMPACTS OF EBOLA ON AFRICA

R E V I S E D E D I T I O N

January 2015



The current outbreak of the Ebola virus disease in West Africa is the most devastating Ebola epidemic that the world has seen since the disease was identified in 1976. Beyond the considerable death toll, the disease has had a noticeable socioeconomic impact, not only in the countries directly affected by the outbreak but also further afield.

The present study assesses the socioeconomic impact of the disease on the affected countries and Africa as a whole, both in terms of real costs and in terms of growth and development prospects. Based on primary data and information collected during missions of the Economic Commission for Africa to the affected countries, the study puts forward policy options that could accompany mitigation efforts.

The study highlights the fact that alarming downward revisions of economic growth rates for affected countries and the West African subregion were carried out using scattered data and amid uncertainty about the future epidemiological path of the disease. In addition, such revisions did not take proper account of the magnitude of the international response. While the affected countries are feeling economic and social impacts, there is a stimulus effect as a result of the ongoing international response to the outbreak. This, coupled with the weight of the affected economies, has meant that the effect of Ebola on West Africa and the continent as a whole has been minimal.

Despite encouraging trends in the epidemiological situation in some of the affected countries, there is still a long way to go before the crisis can be declared over. Some of the most-affected countries were just emerging from years of conflict and already had structural vulnerabilities. Thanks to socioeconomic reforms, in recent years these countries had managed to achieve sustained economic growth, but the Ebola outbreak reversed the positive trend and pushed the countries to the limit by widening their fiscal deficits.

It is against this backdrop that the Economic Commission for Africa calls for, among other things, external debt cancellation for the most-affected countries. This would give the countries the breathing space they need to better address the short-term socioeconomic challenges posed by the Ebola outbreak and to plan for their long-term recovery on a solid footing. While the cancellation of debts does not automatically lead to the availability of funds, the financial resources earmarked for debt repayments could instead be invested into the countries’ health-care systems, including training health professionals, equipping health centres and ensuring the fair distribution of health personnel between rural and urban areas. These funds could also be used to benefit other strategic sectors of the economy that have been hit hard by Ebola, including education, agriculture and food security, and services.

9 789994 461493

ISBN: 978-99944-61-49-3

Printed in Addis Ababa, Ethiopia by the ECA Documents Publishing and Distribution Unit. ISO 14001:2004 certified.January 2015

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Economic Commission for Africa

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© United Nations Economic Commission for Africa, 2015Addis Ababa, EthiopiaAll rights reservedFirst printing December 2014Second printing January 2015

Language: English

ISBN: 978-99944-61-49-3 eISBN: 978-99944-62-49-0

Material in this publication may be freely quoted or reprinted. Acknowledgement is requested, together with a copy of the publication.

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 .............................................................................................. viAcronyms and abbreviations ........................................................................................viiiAcknowledgements ....................................................................................................... ix

FOREWORD .................................................................................................................................................... X

EXECUTIVE SUMMARY ............................................................................................................................ XII

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

2. CONCEPTUAL FRAMEWORK AND METHODS FOR ANALYSING IMPACTS ............................ 4Conceptual framework ................................................................................................... 4

Economic effects .............................................................................................................. 4Social effects .................................................................................................................... 5Intangible effects .............................................................................................................. 7

Methods for analysing impacts ...................................................................................... 9Descriptive quantitative and qualitative analysis ............................................................ 9Survey on non-affected countries’ preparedness and on indirect effects of EBOLA ......... 9International transmission of the EBOLA effect ............................................................. 10Perceptions analysis by statistical text mining ............................................................... 10

3. RECENT DOCUMENTS ON EBOLA IMPACTS IN GUINEA, LIBERIA AND SIERRA LEONE ..11Guinea ......................................................................................................................... 11Liberia .......................................................................................................................... 12Sierra Leone ................................................................................................................. 13Key conclusion—more than EBOLA at work .................................................................. 14

4. EBOLA EPIDEMIOLOGICAL SITUATION AND RESPONSE IN THE THREE COUNTRIES—AND OTHER GLOBAL KILLERS ..........................................................................................................................16

Epidemiological situation ............................................................................................. 16Scale of the response ................................................................................................... 20How the EBOLA toll compares ...................................................................................... 24

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5. MACROECONOMIC IMPACTS OF EBOLA VIRUS DISEASE ..................................................................................................................... 25

GDP ............................................................................................................................. 25Investment, savings and private consumption .............................................................. 25Inflation, money and exchange rates ............................................................................ 26Public finance .............................................................................................................. 26

Public revenue ................................................................................................................ 26Public spending .............................................................................................................. 28Fiscal deficits .................................................................................................................. 28Debt burden and debt alleviation .................................................................................. 28Labour supply and productivity ...................................................................................... 29

Poverty and inequality ................................................................................................. 30Contingency and recovery plans ................................................................................... 30Survey on non-affected countries’ preparedness and on indirect effects of EBOLA ....... 30

Economic effects ............................................................................................................ 30Social effects .................................................................................................................. 31Special measures ............................................................................................................ 31

Economic effects of EBOLA on West Africa and the continent ....................................... 31

6. GENDER AND HEALTH SYSTEMS ANALYSIS OF EBOLA’S IMPACTS .................................... 34Gender dimensions—women bear the brunt ............................................................... 34

Cross-Border trade ......................................................................................................... 34Mining ............................................................................................................................ 35Agriculture ..................................................................................................................... 36Unpaid care work ........................................................................................................... 36

Vulnerability of African health systems ........................................................................ 36Under-infrastructured .................................................................................................... 36Under-Staffed ................................................................................................................. 37Under-Resourced ............................................................................................................ 39Under-Integrated ........................................................................................................... 40Inefficient ....................................................................................................................... 40

7. PERCEPTIONS ANALYSIS ....................................................................................................................42Sentiment analysis ....................................................................................................... 42Recurrent topics ........................................................................................................... 43

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8. POLICY RECOMMENDATIONS .......................................................................................................... 48Epidemiological ............................................................................................................ 48Economic ..................................................................................................................... 50Social ........................................................................................................................... 52Intangible..................................................................................................................... 54

APPENDIX I. SECTORAL ANALYSIS OF ECONOMIC AND SOCIAL IMPACTS .......................... 56Trade and mining ......................................................................................................... 56

Guinea ............................................................................................................................ 57Liberia ............................................................................................................................ 59Sierra Leone ................................................................................................................... 60Potential impact of a sustained reduction in trade ........................................................ 61

Agriculture ................................................................................................................... 62Challenges for agriculture and food security ................................................................. 63Guinea ............................................................................................................................ 63Liberia ............................................................................................................................ 64Sierra Leone ................................................................................................................... 65Impact on agriculture in the three countries .................................................................. 65

Services ....................................................................................................................... 66

APPENDIX II - SOURCES FROM FIGURE 5 .........................................................................................67

APPENDIX III - EXTERNAL DEBT CANCELLATION FOR EBOLA-AFFECTED COUNTRIES ......73External debt situation of the EBOLA-affected countries and the case for debt cancellation ................................................................................................................. 73Recommendations for post-debt cancellation measures ............................................... 75

REFERENCES .................................................................................................................................................77

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FIGURES, TABLES AND BOXESBOXES

Box 1. Stopping EBOLA in its tracks: Nigeria’s experience .............................................................3

Box 2. Stigma after recovering from EBOLA ..................................................................................7

Box 3. Royal Air Maroc continues flying to EBOLA-affected countries ...........................................8

Box 4. Life with Ebola: Equatorial Guinea and Niger to host the Africa Cup of Nations Competitions ....................................................................................................................9

Box 5. Mali’s experience in addressing the EBOLA virus disease ................................................18

Box 6. Brussels Airlines serving the three countries ....................................................................44

FIGURESFigure 1. Analytical framework for the EBOLA outbreak ...............................................................6

Figure 2. EBOLA cases in Guinea, Liberia and Sierra Leone .........................................................17

Figure 3. EBOLA infections among health-care workers .............................................................19

Figure 4. In-kind contributions....................................................................................................20

Figure 5. Some pledges and disbursements to contain the EBOLA outbreak .............................22

Figure 6. External debt and debt service for the three countries, 2013.......................................29

Figure 7. Simulated growth for West Africa and Africa ...............................................................32

Figure 8. Number of hospitals per 100,000 inhabitants 2013 .....................................................37

Figure 9. Number of medical doctors per 10,000 inhabitants, 2006–2013 .................................37

Figure 10. The main host countries of the drain of medical skills from Africa (excluding North Africa) .............................................................................................................38

Figure 11. Share of health spending in national budgets, 2011 (%) ............................................39

Figure 12. Sentiment scores and scores of other topics in articles about EBOLA —published between March 2014 and 15 November 2014— ....................................................43

Figure 13. Sentiment scores computed on articles published inside and outside EBOLA-affected countries ............................................................................................................44

Figure 14. World cloud of news on EBOLA ..................................................................................45

Figure 15. Scores of economic, social and medical topics in the sample of articles ....................47

Figure A1. Sectoral interconnections ...........................................................................................58

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TABLESTable 1. GDP projections, Guinea (%) ..........................................................................................27

Table 2. GDP projections, Liberia (%) ...........................................................................................27

Table 3. GDP projections, Sierra Leone (%) ..................................................................................27

Table A1. Some contributions of multilateral organizations .......................................................67

Table A2. Some contributions of bilateral partners .....................................................................68

Table A3. Some contributions of international private sector and charity/foundations ..............69

Table A4. Some contributions of the African private sector ........................................................70

Table A5. Some African countries’ contributions .........................................................................70

Table B1: External debt and debt ratios for the three countries hardest hit by EBOLA, 2013 .....75

Table B2: Recent economic, social development & policy performance indicators (2014) ..........77

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ACRONYMS AND ABBREVIATIONSAfDB African Development Bank

ASM Artisanalandsmall-scalemining

AUC AfricanUnionCommission

ECA EconomicCommissionforAfrica

ECOWAS EconomicCommunityofWestAfricanStates

EBOLA Ebolavirusdisease

FAO FoodandAgricultureOrganizationoftheUnitedNations

GDP Grossdomesticproduct

GNI Grossnationalincome

HIPC HeavilyIndebtedPoorCountries

IFPRI InternationalFoodPolicyResearchInstitute

IMF InternationalMonetaryFund

OCHA OfficefortheCoordinationofHumanitarianAffairs

OECD OrganizationforEconomicCooperationandDevelopment

SMEs Smallandmedium-sizedenterprises

SARS SevereAcuteRespiratorySyndrome

UNCT UnitedNationsCountryTeam

UNDP UnitedNationsDevelopmentProgramme

DESA UnitedNationsDepartmentofEconomicandSocialAffairs

UNMEER UnitedNationsMissionforEbolaEmergencyResponse

UN-Women UnitedNationsEntityforGenderEqualityandtheEmpowermentofWomen

WAMA WestAfricanMonetaryAgency

WEFM WorldEconomicForecastingModel

WHO WorldHealthOrganization

AlldollaramountsareUSdollarsunlessotherwiseindicated.

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ACKNOWLEDGEMENTSThisstudybytheUnitedNationsEconomicCommissionforAfrica(ECA)waspreparedundertheleadershipofCarlosLopes,ECA’sExecutiveSecretary,withthecloseinvolvementofAbdallaHamdok,DeputyExecutiveSecretaryofECA.TheECAEBOLATaskTeam,setupinSeptember2014bytheExecutiveSecretarytopreparethestudy,benefitedfromtheguidance,supervisionandcoordinationofDimitriSanga,DirectoroftheECASubregionalOfficeforWestAfrica.

TheECAcore teamcomprisedAbbiKedir,Aboubacry Lom,AmadouDiouf,CarlosAcosta,CarolineNgonze,FrancisIkome,IssoufouSeidouSanda,JackJonesZulu,Jean-LucMastakiNamegabe,JosephFoumbi,KatalinBokor,MamaKeita,MedhatEl-Helepi,NassirouBa,RajMitra,XiaoningGongandZachariasZiegelhöfer.

AnECAsurveyonnon-affectedcountries’preparednessandonindirecteffectsofEBOLAwasconductedthroughtheAfricanCentreforStatisticsandadministeredthroughtheSubregionalDataCentresoftheECASubregionalOfficesundertheleadershipoftheirrespectivechiefs:NassimOulmane(NorthAfrica),SizoMhlanga(SouthernAfrica),GuillermoMangue(CentralAfrica),AndrewMold(EastAfrica)andAboubacryLom(WestAfrica).

UsefulcommentsandsuggestionswerereceivedfromselectedmembersoftheECASeniorManagementTeamandstaffinvariousdivisionsandSubregionalofficesofECA.

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

ThereportwouldnothavebeenpossiblewithoutthecontributionofAliouBarry,BruceRoss-Larson,CarolinaRodriguez,CharlesNdungu,CollenKelapile,DembaDiarra,Dr.FodeBangalySako,JimOcitti,MarcelNgoma-Mouaya,PaulineStockins,TeshomeYohannes,andthewholeECAPublicationsSection.

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Beyond the death toll of the current outbreakof Ebola virus disease (EBOLA), 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 tremendous impacts on socioeconomicconditionsnotonly in the three countries but alsointheirneighbours,WestAfrica,thecontinent—andeventheworldatlarge.

Earlier studies of this outbreak which was firstofficially acknowledged in March 2014 have threedrawbacks: they offer little insight into effects onWest Africa and virtually nothing continent-wide;their projections can draw only on very few andspottydata;and(inviewofwhentheywerewritten)theymakethestrongassumptionthattheepidemicislikelytospread,heavilyunderestimatingresponsesfromGovernmentsanddevelopmentpartners,andthewaveofremittancessentbythediasporatotheirfamiliesbackhome.

To widen and update these findings, ECA hasconductedastudyonEBOLA’sactualsocioeconomiccosts and their effect on growth and developmentprospects.Theaimwastopresentanevidencebasefromwhich to devise policy options to accompanytheaboveresponses.

Based on primary data and information collectedduring ECA EBOLA Task Team missions in October2014(LiberiaandSierraLeone)andNovember2014(Guinea) andmyown tour inOctober 2014of the

three countries, this study shows that althoughEBOLAhashighmortalityandcausesuntoldsufferingamong thosedirectly affected, it isnot thebiggestkilleramongcurrent (orpast)diseases.Throughaneconomics lens, italsorevealstheeffectofcurrentresponses,andtheminimalimpactofEBOLAonWestAfricaandthecontinent(giventhesmallweightsofthethreeeconomies,actualEBOLAprevalenceandencouragingnationalandinternationalresponses).

Despite encouraging trend in the epidemiologicalsituationinsomeofthemostaffectedcountries,thestrugglehasalongwaytogobeforewecandeclarethe crisis over: losses in productivity and adversechanges to social constructs and behaviour needto be remedied while the vulnerability of healthsystems across Africa is a crucial problem as veryfewcountriesarewellplaced toabsorbanEBOLA-inducedshock.

Guinea, Liberia and Sierra Leone already hadstructural vulnerabilities and limited potential tosustaingrowthandtheEBOLAoutbreakhaspushedthem to the limit by widening their fiscal deficits.If the countries have to continue making debtrepayments in the absence of significant financialinflows, they will not be able to fulfill their fiscaland balance-of-payment needs. With the presentoutbreakseverelyaffectingexports,currentaccountdeficits, accumulation of debt service arrears andthe external financing gap are projected to widenin all three countries. External debt cancellationwould give the three countries breathing space tobetter address the short-termeconomic and socialchallengesoftheEBOLAoutbreakandtoplantheirlong-term recovery on a solid footing. While thecancellation of debt does not automatically leadto the availability of funds, the financial resourcesearmarked for debt repayments could instead be

FOREWORD

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invested into the countries’ health-care systems,includingtrainingofhealthprofessionals,equippinghealth centresandensuring the fairdistributionofhealth personnel between rural and urban areas.These funds could also be used to benefit otherstrategicsectorsoftheireconomiesthathavebeenhithardbyEBOLA, includingeducation,agricultureandfoodsecurity,andservices.

Thisoutbreakunderlinestheneedforcountriesandtheirpartnerstoreconsiderthedevelopmentprocess,includingdecentralizingdevelopmenteffortsandnotjust structures. Nigeria’s success in tackling EBOLAshowed 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 (EBOLA) outbreak inWest Africa has the worst death toll sincethe disease was diagnosed in 1976. It also

has far-reaching socioeconomic consequences.Althoughthediseaseisstillunfolding,severalstudieson those impacts have been conducted since thediseasebrokeoutinWestAfrica,includingthosebythe World Bank, the International Monetary Fund(IMF), theWorld Food Programme (WFP) and theFood and Agriculture Organization of the UnitedNations(FAO).CountryReportshavebeenpreparedby United Nations Country Teams (UNCT) underthe leadership of theUnitedNationsDevelopmentProgramme (UNDP) country offices and theWorldHealthOrganization(WHO).

ButfewerreportshavefocusedonWestAfrica,andvirtually none on the African continent.Moreover,most early prospects and projections on EBOLA’ssocioeconomic impactswerebasedonpatchydataandreflecteduncertaintyaboutthedisease’sfutureepidemiologicalpath.

ItisagainstthisbackgroundthatECAbeganthisstudy.Theoverallobjectiveistoassessthesocioeconomicimpacts on countries, the region, and Africa as awhole,both intermsof therealcostsentailedandgrowthanddevelopmentprospects,soastodevisepolicy recommendations to accompany mitigationefforts. The findings and conclusions of the studywillbeadjustedandupdateduntilthecrisisisover,culminating in a fully fledged evaluation of theimpactsoncetheoutbreakiscontained.

EPIDEMIOLOGICAL SITUATIONAccording to theWHO SituationReport (7 January2015),20,712caseshadbeenidentifiedinthethreecountrieswithwidespreadandintensetransmission(13,191 laboratory confirmed), and 8,220 deathsreported. The mortality rates vary by country—Guinea, 64% (1,781 out of 2,775); Liberia, 43%(3,496outof8,157);andSierraLeone,30%(2,943outof9,780)—withanaveragemortalityrateinthethreecountriesof40%.Thesethreecountrieshavecommoncharacteristicssuchaspoliticalfragilityandarecenthistorymarkedbycivilwarandweakenedinstitutional capacity. Eight cases, including sixdeaths, have been reported in Mali. Outbreaks inSenegal,NigeriaandtheDemocraticRepublicoftheCongoweredeclaredoveron17October,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 COUNTRIESReflectingalarmismowingtothedisease,aswellasEBOLA-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, EBOLA is puttingthebudgetunderheavypressure, substantiallywideningthefiscaldeficit.

• Investment, savings and private consumption. In the face of lowered public revenue andincreased outlays, the crisis may divert publicspending from investments in physical andhuman capital to health and other socialexpenditure. Foreign and domestic privateinvestment is also declining in the short term,oftenoutofalarmismpromptedbythedisease.Authorities inall threecountrieshavereportedpostponed or suspended investment in majorprojects.

• Labour supply and productivity. The crisis hascut the labour supply (including expatriates),potentially loweringthequantityandqualityofgoods and services, especially public services.EBOLA-related mortality and morbidity havecut thenumberof farmersavailabletowork inagricultureandtakenanextremelyheavytollonhealthworkers.

• Inflation, money and exchange rates.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 also

beenhit.

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SOCIAL IMPACTS ON THE THREE COUNTRIESEBOLAriskscausingariseinmorbidityandmortalityfrom diseases not related directly to EBOLA itself,given the following combined effects on regularhealth-careprovision:

• Fewer people are seeking formal medicalattentionbecauseoffearorthestigmaofbeingexposedtothedisease.

• Weakening health services can allow theincidence of other diseases to rise, includingmalaria,denguefeverandyellowfever,andpushup the risks linked to fewer vaccinations and tolesspervasiveantenatalandchildhealthcare,allofwhichcanraisematernalandinfantmortalityrates.

• A significant share of the deaths reported havebeen of medical personnel and specializeddoctors, hampering countries’ capacity torecuperatefromthiscrisis.

The EBOLA outbreak has curtailed educationalservices.Theimplicationsforeducationaloutcomesarenotyetclear.Therelatedeconomiclossesbornebythenationalbudgetarehighaswagestoteachersstillneedtobepaidandfacilitiesmaintained.Evenworsemay be future productivity losses, reflectingthe lower education of those who do not returnto school, which will also require heavy additionalinvestment in an attempt to bring educationaloutcomesbacktopre-outbreaklevels.

Unemploymentandcommercialclosureshaverisen.Many businesses or branches have shut, and eventhose that remain open have had to make staffredundantorreducetheirworkinghours.Thelargestproportion of the population exposed consists ofrural familieswho depend on subsistence farming.Suchpeopleseldomhavemuchstocktofallbackonandhaveseenmostoftheirsavingseroded.Andasmarketshaveclosedforweeksandeconomicactivityhas contracted, producers of perishable products

cannot sell their produce, affecting householdsecurity,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,thereisnoneedtoworryaboutAfrica’sgrowthanddevelopmentprospectsbecauseofEBOLA.

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POLICY RECOMMENDATIONSPolicyrecommendationsandresponsestotheEBOLAemanatingfromtheanalysisarepresentedbelowinverybroadstrokesandunderfourmajorheadings.

EPIDEMIOLOGICAL

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

• 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 forcollectinganddisseminatingsolidsocioeconomic data. Urgent steps should betaken to strengthen the statistical systems ofthethreeaffectedcountries,includingtheircivilregistration systems. Other African countriesshouldalso strengthen their statistical andcivilregistrations systems to better manage anyEBOLAorotherdiseaseoutbreaksinthefuture.

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

• AffectedcountriesshouldstepuptheresilienceoftheirhealthsystemstodealwithEBOLAandnon-EBOLA diseases such as malaria, HIV/AIDSand tuberculosis (these three have claimed farmorelivesthanEBOLA).

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

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.

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• Thethreecountries’Governmentsshouldprovidespecial incentive packages to their farmers tohelprelaunchtheiragriculturalsectors.

• ThethreeGovernmentsshoulddeviserecoverycontingency 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 anotherEBOLAepidemicbutonenhancingthecapacitytoaddresspublichealthissuesofanykind.HenceEBOLA 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 andinmonitoringtheriseinthenumberoforphansowingtoEBOLA.

• Stepsmustbe taken toensure that theEBOLAoutbreakdoesnot igniteafoodandnutritionalcrisis.

• Governments and local authorities shouldensure that children return to school and that

the educational outcomes hurt by EBOLA arebroughtbacktopriorlevels.

• 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 acton opportunities, and by challenging harmfulsocial and cultural norms thatplacewomenatelevatedriskofinfection.

INTANGIBLE

Tooffset stigmaat home and improveperceptionsabroad,thestudyrecommendsthat:

Pan-African institutions,particularlyAUC,AfDBandECA, need tomakemore effort to “set the recordstraight” on EBOLA. This requires them to presentmoreaccuratedataandinformationonthediseaseanditsimpact.

ThesethreeinstitutionsneedtodevelopamediaandcommunicationsstrategytoputoutanobjectivebutconstructivenarrativeonEBOLA.Mediapresenceofthethreeinstitutions’leadersshouldbespotlighted,includingjointappearancesinhigh-profileAfricanandnon-Africanmedia.Sucheffortsshouldbereplicatedsub regionally by heads of regional economiccommunitiesandotherAfricaninstitutions.

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

AUC, AfDB, ECA and other African bodies shouldconsider a joint, more detailed analysis of thesocioeconomic, political and cultural impacts of

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EBOLA when the crisis is contained. Such a study,based on primary data generated by Africaninstitutions, will enable the continent to tell theEBOLA story in an objective and nuancedmanner,putting Africa’s interests first and steering clear ofthedistortionsandmisperceptionsthathavegrownuparoundthedisease.

African leaders should ensure effectiveimplementationof the decisions of the emergencysession of the Executive Council of the AfricanUnioninAddisAbabaon8September2014,ontheEBOLAoutbreak(Ext/EX.CL/Dec.1(XVI)).Thisrelatesespeciallytotheneedtoactinsolidaritywithaffectedcountries, including breaking the three countries’stigmatizationandisolation,andstrengtheningtheirresilience(andthatofthecontinentmorebroadly).

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1


BACKGROUND

Africa is experiencing its worst outbreakof Ebola virus disease (EBOLA) since thediseaseappearedin1976.1WestAfrica—the

epicentre—is experiencing its first outbreak,whichbeganinMarch2014.CaseshavebeenreportedinGuinea, Liberia, Mali, Nigeria, Senegal and SierraLeone,withfewfurthercasesinnorthernDemocraticRepublicoftheCongo.

The first reported case in West Africa dates backto December 2013, in Guéckédou, a forested areaof Guinea near the border with Liberia and SierraLeone. By March 2014, Liberia had reported 8suspected casesandSierra Leone6;by theendofJune,759peoplehadbeeninfectedand467peoplehaddiedfromthedisease,makingittheworsteverEBOLAoutbreak.Health services inGuinea, LiberiaandSierraLeonewerenotwellequippedtofightthedisease. Doctors were unfamiliar with the disease,andbecauseitssymptomsresemblethoseofotherailments, early diagnosis and effective preventionwere slow to begin with. Common practices,includingcommunalhandwashing, thetraditionofcaringforsickrelatives,andthewashinganddressingofdeadbodiesinpreparationforburial,contributedtothespreadofthevirus.Lackofmedicalpersonneland beds in Ebola treatment units, the complexityof identifying active cases and contacts, and theslowness of the response also contributed to theseriousnessofthehealthcrisis(UNDP,2014).

1 The Ebola virus outbreak was first reported in 1976 in Yam-buku, a village in the Democratic Republic of the Congo, near the River Ebola, hence the name. Since then, there have been more than 20 EBOLA outbreaks mainly in East and Cen-tral Africa.

The 2014 outbreak in West Africa has taken ahorriblehumantoll.Themortalityrateofthediseaseis estimated at 60 to 70%. Although originating inrural Guinea, the outbreak has hit hardest Liberiaand Sierra Leone, in part because it has reachedurban areas in these two countries, a factor thatdistinguishes this outbreak from previous episodesthat were short and mainly rural. In accord withreportsfromtheWorldHealthOrganization(WHO),affected countries are classified into three: thosewithwidespreadand intense transmission (Guinea,LiberiaandSierraLeone);thosewithaninitialcaseorcases,orwithlocalizedtransmission(theDemocraticRepublicoftheCongo,Mali,NigeriaandSenegal);andthosewithneighbouringareasofactivetransmission(Benin, Burkina Faso, Côte d’Ivoire, Guinea-BissauandSenegal)(WHO2014,18September).

Beyond the terrible toll on lives and suffering, theepidemic is already having measurable economicimpacts, as seen in forgone output, higher fiscaldeficits and lower real household incomes. GDPand investment are predicted to decline. Prices ofstaplegoodsarealreadygoingup,foodsuppliesaredwindlingandjobsarebeinglostassomecountriesclose border posts (WFP, 2014), airlines suspendflights and people’s free movement is banned inattempts to prevent the propagation of the virus.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,likeEBOLA,tendtoprovokeoverreactionseveniftheriskoftransmissionislow.

1. INTRODUCTION

2


Panicandconfusion relating to theEbolaoutbreakin the three most affected countries were alsotriggered by the early projections and attitudes.Mostof theearlyprojectionsofEBOLA’seconomicimpacts depend on patchy data and so are highlyuncertain about the disease’s epidemiological path(GovernmentofSierraLeone:MinistryofHealthandSanitation2014).TheymakeabasicassumptionthattheepidemicislikelytospreadfastanddonotgivefulljusticetotheswiftpolicyreactionortothehealthandhumanitarianresponsesfromGovernmentsanddevelopmentpartners.

For example, the World Bank in October 2014estimated the two-year (2014–2015) regionalfinancial impact to be $32 billion if the viruscontinuedsurginginGuinea,LiberiaandSierraLeoneand spreading to neighbouring countries (WorldBank,2014a).However,thisestimateturnedouttobe unrealistic given the actual EBOLA prevalence.The World Bank study also underestimated thepotential impact of containment measures bythe countries—especially after Nigeria’s state ofemergency declaration in August (see box 1)—andofinternationalinterventions.InearlyDecembertheWorldBankupdatedthisanalysis, implyingforgoneincomeacrossthethreecountriesoverthetwoyearsofmorethan$2billion(WorldBank,2014b).

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.

Specific features in some of the affected countrieshave made the outbreak particularly difficult tocontrol. Fear has compounded the crisis whileeroding social ties and exacerbating the impact

of the epidemic, leading to the closure of schools,businesses and borders, reducing trade, haltinginvestment, and therefore reducing the prospectsforgrowthinfutureyears(UNDP,2014).Moreover,the EBOLA epidemic has affected key cash/exportcommodities, contributing to the reduction ofhousehold incomes and ultimately of purchasingpowerandfoodaccessofpopulations(WFP,2014).

It isagainstthisbackgroundthatECApreparedthisstudy,whichbuildsonthefindingsoftheECAEBOLATaskTeammissionstoLiberiaandSierraLeone(6–15October)andGuinea(12–15November),andontheExecutive Secretary’s visit (22–25 October) to thethreecountries.

OBJECTIVES AND SCOPE OF THE STUDYTheoverallobjectiveistoassessthesocioeconomicimpacts of EBOLA not only on the countries withwidespread and intense transmission, but also onWest Africa more widely and the continent as awhole—in terms of both the real costs as well asgrowthanddevelopmentprospects.

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 usefulfor policymakers (of affected and non-affectedcountries) to better understand the impacts of anEBOLA outbreak on socioeconomic developmentandperformance,allowingthemtoplanaheadanddevisestrategies formoreresiliencetoEBOLA.Thestudy’s findings and conclusions will be updateduntilthecrisis isover,culminatinginafullyfledgedevaluationoncetheoutbreakiscontained.

3


STRUCTURE OF THE REPORTThereportisstructuredineightchapters,includingthis introduction.Chapter2reviewstheconceptualframework andmethodology, and chapter 3 someliterature on EBOLA in Guinea, Liberia and SierraLeonesincethebeginningoftheoutbreak.Chapter4outlinestheepidemiologicalsituationandscaleoftheresponse,while chapter 5 offers amacroeconomicanalysis of EBOLA’s impacts. Chapter 6 looks atgender dimensions and the vulnerability of Africanhealth systems, chapter 7 presents a perceptionanalysis of the outbreak, and chapter 8 rounds offwithpolicyrecommendations.

BOX 1. STOPPING EVD IN ITS TRACKS: NIGERIA’S EXPERIENCE

Nigeria has been lauded as one of the success stories in containing the current spread of EBOLA within its borders relative to Guinea, Liberia and Sierra Leone. This is attributed, among others, to brave and decisive Nigerian leadership from the presidency to the lowest echelons of power. The leadership took hard and sometimes unpopular decisions, e.g. putting school activities on hold, discouraging handshakes and restricting movement of dead bodies from affected to non-affected regions—the total aggregate effects of these measures having helped to bring EBOLA under effective control.

By its sheer economic size and a well decentralized governance structure, the country also was able at short notice—particularly in the affected regions—to mobilize and deploy various resources including human and financial resources. These interventions were underpinned by a relatively functional health system that aided in providing an effective multi-sectoral response to the disease. In addition, various stakeholders, including the private sector, played a critical role in arresting the spread of EBOLA by joining hands working with the Government to provide a coordinated response in terms of financial resources and equipment necessary for a combative action against Ebola.

Source: Nwuke 2014

4


CONCEPTUAL FRAMEWORK

TheEBOLAemergencyislikelytogenerateastringofsecondaryeffectsthatthreatenprogressonsocialoutcomesandhindertheeconomiesof

affected countries for years to come.Although theimmediate concern during the outbreak is to savelivesand tocontain thespreadof thedisease, it isimportanttounderstandhowthediseaseisaffectinghouseholds and social interactions, and thus theirlivelihoods. A comprehensive response to theepidemicwillrequireimmediateemergencyactionscombinedwithmid-tolong-termperspectivestohelpthecountriestogetbackontracktoachievingtheirdevelopmentgoals. Figure1presentsa conceptualframeworkwithwhichtoanalysesomeofthemainpotentialsocialandeconomicimpactsofEBOLAonaffectedcountriesandonAfrica.

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.RegulartradepartnersmaybedivertedfromdealingwithEBOLA-affectedcountries,intheimmediateperhapsbecauseofnewpreventiveregulationsandchanges in logisticalservices.Somecountries have already announced possible visarestrictionsforvisitorsfromaffectedregions.Planes,trainsandtrucks,carryingcargoorpeople,mayseetheiractivitiesreducedorsuspendedaltogether.

The alteredbusiness environment is not limited toany particular sector, though it affects somemorethan others, varying by country and reflecting theeconomic structure. Effects are emerging in theprimary sector, such as agriculture, mining andforestry; in the secondary sector inmanufacturingandconstruction;and inthetertiarysector,usuallytourism,financialservicesandtrade.Theripplesofeconomic downturn are likely to cross-cut a range ofsectors.

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

Fromacontinentalperspective,EBOLAcanalsoaffectregional integration: suspension of trade in goodsandservicescanforcetraditionalpartnerstolookforalternativesourcestomaintainsupply—undermining

2. CONCEPTUAL FRAMEWORK AND METHODS FOR ANALYSING IMPACTS

5


integration and setting back economies’ movestowardstransformationandgreaterproductivity.

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 medicallyexpected that victims of EBOLA show symptoms2–21daysaftercontactwiththevirus,but inmostcases symptoms appear 8–10 days after exposure.Giventhehighmortalityrateofaround37%2(thoughvarying sharply by country), the outbreak causesmajorlossoflife.

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 EBOLA. These cases, however, would not beregistered as related to EBOLA. 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 both

2 According to WHO, the average EBOLA case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks. Up to 2 November 2014, the fatality rate of the current epidemic was 36.9%, a figure that might be underestimated owing to underreporting of cases (WHO 2014, 5 November).

operationallyandfromanoutcomeperspective.Theinterruptionofdelivery—owingtoshiftedresourcesor lack of capacity to respond to emerging healthneeds—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: theimmediate budget losses are not yet known—because teachers’ and others’ wages still need tobe paid and facilities maintained. Many of theserecurring operational costs are still borne by theGovernment. Nor are the immediate impacts oneducationaloutcomesknown.

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.

TheEBOLAoutbreakthereforehaspotentialindirectimpacts 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.

6


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

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

AgricultureIndustryMiningKnowledge transferMeetingsNot tending to regular

pathologies, malaria, vaccination, etc.

Ebola Virus Disease Outbreak

SOCI

AL

EFFE

CTS

ECON

OM

IC EFFECTS

INTANGIBLE EFFECTS

Gender

7


INTANGIBLE EFFECTS

GiventhecomplexityandevolvingnatureofEBOLA,thediseasegenerates“intangibleeffects” forsocialcohesion, stigmatization, governance and security,andriskperceptions.Whenevaluatedwiththesocialand economic impacts of EBOLA, the intangibleeffects couldworsen thehumanitarian crisis in theimmediatelyaffectedregion.

Socialcohesion:SincetheoutbreakofEBOLAinearly2014, 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:TheECATaskTeamthatwentonafact-findingmission (October and November 2014) to Guinea,Liberia and Sierra Leone noted that stigma wasaffectingmedicalprofessionalsaswellasrecoveredpatients. For instance,medical personnel (doctors,nurses and clinical officers) can be stigmatized by

communities as they are perceived to be vectorsof the disease and hence people do not wantanythingtodowiththem.ThisprejudicecouldwellaggravatethespreadofEBOLAaspeopleshunhealthfacilities for fearofcoming intodirectcontactwith medicalstaff.

At an institutional level, quarantining patients andsuspected victims of EBOLA—though necessaryfor containing the spreadof thedisease—can leadto violation of fundamental human rights throughimposed restrictions on movement of people andrestrictionsontheireconomicactivities.Forexample,in September2014, Sierra Leone imposeda three-day lockdown that heavily restricted movementsin and out of affected areas as part of a nationalresponsetocontainthedisease’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 (seebox2).

BOX 2. STIGMA AFTER RECOVERING FROM EVD

High school teacher Fanta Oulen Camara spent two weeks in March fighting for her life against the deadly Ebola virus but her darkest days came after she was cured of the disease and returned to her home.

“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: Nichols and Giahyue 2014.

8


AsintheearlydaysofHIV/AIDS,thedriversofstigmalinkedtoEBOLAhavetobeidentifiedifthebattleistobewononallfronts.Interventionshavetoeliminatethefearoftransmission,whichusuallydrivesstigma.Communities and individuals should be given theright information on the modes of transmissionand the supporting mechanisms for those alreadyinfected.

Governance and security: Given that most of thehealth services in the affected countries have tobe accessed locally, EBOLA has overstretched localauthorities’ capacity to respond well. The threecountrieshaveweakdecentralizationstructuresandincreasinglyrelyoncentraladministrationtoprovidemostof the servicesneeded fora response,whichcentralizationhasthepotentialtounderminetheseauthorities’abilitytodeployresources.

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

Apart from such governance challenges, EBOLAhas security implications. For instance, at the subregional level, immigration laws and regulationshavebeentightenedtocontroltheinfluxofpeoplefromaffectedcountries.Theseareforcingpeopletouseunconventional routes to crossbackand forth,posing heightened risk to areas that are currentlyfreefromEBOLA.YetcountriesinWestAfrica,asin

manypartsofAfrica,havelongandporousbordersthat are hard to police for illegal movement ofpeople and goods, increasing the risk of spreadingthevirus.Unrestrictedmovementofpeoplemayalsocompromisebordersecurity.

Risk perceptions: EBOLA is distorting businessperceptions of Africa in general and of thethree countries in particular, affecting long-terminvestmentdecisions.Forinstance,WHOnotesthatsome African airlines such as Kenya Airways havesuspended flights to affected countries because ofperceived transmission risks—unlike, say, Royal AirMaroc(seebox3).Manycountriesacrosstheglobehave put tough screening measures at their portsof entry for all people they regard at higher risk,particularlythosecomingfromEBOLAregions.

Thesemeasuresdemonstratetheadverseeffectsofnegative perceptions and ignorance on economicactivities, and the losses associatedwith cancelledor delayed investment, for example, may well beimmense.TheyarealsotarnishingAfrica’simageasaregionwithhugepotentialforgrowthandbusiness,whichcouldbehurtpermanentlyifnocountervailingmessagesareputoutbyAfricanleadersandtheirownpeople.ItisworthmentioningsomegoodpracticesinthisregardnamelythehostingoftheAfricaCupofNationsbyEquatorialGuineaandNiger(seebox4).

BOX 3. ROYAL AIR MAROC CONTINUES FLYING TO EVD-AFFECTED COUNTRIES

Royal Air Maroc has maintained its flights to Guinea, Liberia and Sierra Leone the three most affected countries by EBOLA. The airline took this decision at a time when they were hard hit by a health crisis and risked becoming more isolated. Its commitment has allowed international assistance to reach affected zones. Halting flights would undoubtedly have aggravated an already alarming situation.

The decision has been saluted by many organizations and high-level decision makers.

Source: Royal Air Maroc

9


BOX 4. LIFE WITH EBOLA: EQUATORIAL GUINEA AND NIGER TO HOST THE AFRICA CUP OF NATIONS COMPETITIONS

The most important football competition on the continent, the Africa Cup of Nations (CAN), and related celebrations will take place on the African continent from 17 January to 08 February 2015. This competition will take place thanks to the determination of the Government and people of Equatorial Guinea who have accepted to host it despite the concerns around the EBOLA virus disease outbreak. Africa as a whole has saluted this move by the Government and people of Equatorial Guinea. The Country has set up measures to minimize the associated risks. In an interview to the BBC, Mr. Lucas Nguema Esono Mbang, Second Vice-Premier in charge of Social Affairs and Minister of Education and Sciences, affirmed that “the Country has secured 2 million dollars to procure health equipments and has set up two quarantine and isolation zones with specially equipped rooms in Malabo and Bata.” In addition to usual airports checks, the country has also set up checkpoints in the four stadiums that will host the games to detect and isolate suspected cases. On the other side of the continent, preparations are underway to host the U17 CAN in Niamey, Niger from 15 February to 01 March 2015.

Source: Confédération Africaine de Football (CAF)

METHODS FOR ANALYSING IMPACTSSo, how are all the above effects measured orotherwiseanalysed?VariouspartsofthisECAstudydraw on different methods. Underlying all themethodsisdataavailability,whichlargelydeterminesthe typeofmodelor approach tobeadopted in agivenanalysis.Becausearaftofeconomicvariablesand sectors are affected by EBOLA, there is atemptationtouseeconomy-widemodelstocapturetheessentialcomplexchangesandinterrelationshipsoftheoutbreak.

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 bynationalministries,departmentsandagencies,withdatafromUnitedNationsagenciesinthefieldaswell

asothersources.For futureversionsof thereport,secondaryinformationwillberegularlycompiledonkeyindicators3viafocalpointsestablishedduringtheEBOLATaskTeammissions.

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

Some neighbouring countries closed their borderstoEBOLA-affectedregions.Othersintroducedhealthscreeningsatairportsorevenregularcheck-upsviagovernment-providedmobilephones,likeMorocco.One element of the study is an ongoing surveyamongAfricancountriestoassessthepreparednessofnon-affectedand“mildlyaffected”countries(Mali,NigeriaandSenegal)toapossibleEBOLAoutbreak,aswell as theperceived indirecteffectsemanatingfromtheirlinkstothethreeaffectedcountries.ThesurveyisbeingconductedbyECASubregionaloffices

3 Number of cases, fatality rates, incremental costs of health centres, number of medical staff, demand and supply for non-EBOLA–related health care, school attendance, public spending on health care and other areas, domestic economic indicators including sectoral production and inflation, trade flows, and investment flows.

10


and touches on issues such as the socioeconomicsectorsaffected,specialmeasuresintroducedbytheGovernment, direct costs of measures introducedand indirect effects of EBOLA. Preliminary surveyresultsreceivedasof10January2015arediscussedin the section ‘Survey on non-affected countries’preparednessandonindirecteffectsofEBOLA.’

INTERNATIONAL TRANSMISSION OF THE EBOLA EFFECT

ThenegativeeconomicshockoriginatingfromGuinea,Liberia and Sierra Leone has been transmitted tocountrieswithwhichtheyhavestrongeconomicties(analysed further in the section entitled EconomiceffectsofEBOLAonWestAfricaandthecontinent).To assess the size of the effect on growth inWestAfricaandthecontinent,weusetheWorldEconomicForecastingModel (WEFM). TheWEFM consists of150-pluslinkedcountrymodelsandisregularlyusedbytheUnitedNationsDepartmentofEconomicandSocialAffairs(DESA)andtheUnitedNationsregionalcommissions to develop economic projectionsat global, regional and country levels. The model

includes a detailed structure of international linksthatprovidesaframeworktostudytheinternationaltransmission of economic shocks originating fromoneormorecountries.

PERCEPTIONS ANALYSIS BY STATISTICAL TEXT MINING

Statistical text mining (as used in Chapter 7,Perceptions analysis) contributes to a betterunderstanding of the perception of EBOLA, andthe image of Africa, around the world. Takinga large sample of articles on EBOLA, ECA ran astandard statistical text analysis tool (available intheRstatisticaltext-miningpackage)andcomputedstatisticsonthemostusedwords,recurrenttopics,frequenciesandproximities,etc.TheresultsprovidesomeperceptionsofEBOLAbyregionandhowthoseperceptionsevolved.

11


The following non-comprehensive review ofrecent publications—mainly from WFP, FAO,UNICEF,UNDP,OCHA,IFPRI,PlanInternational,

IMF and theWorld Bank—looks at socioeconomicimpactsinthethreemostaffectedcounties.

GUINEAEconomic impact. The economic situation in theEBOLA-affected countries deteriorated because ofthecombinedeffectsofthediseaseandofprevalentstructuralproblems.Guinea isacase inpoint,withits structural problems of low energy availabilityandslowexecutionofstructuralreformstoimprovegrowthandreducepoverty.

InAugust2014,the IMFreviseddownGDPgrowthforGuineafrom4.5%to3.5%for2014(IMF,2014a).In October, EBOLA led to a downward revision bythe IMF to 2.4%, and theWorld Bank’s 2014 GDPforecastfrom4.5%to2.4%,with2%forecastedfor2015(WorldBank,2014a),downfrom4.3%forecastbeforetheoutbreak.InDecembertheWorldBankcutthe2014growthprojection further to0.5%(WorldBank, 2014b), while the Government of Guinea’sforecast stands at 1.3% in November 2014 for thesame year. This official national revision suggestsan income loss of $662million compared to initialprojectionsfor2014.

UNDP estimates a loss in GDP growth of 2.3%.The UNDP simulation using a computable generalequilibriummodel indicates a loss of 6.1% in GDPgrowthfor2014.Accordingtotheestimates,evenif

theEBOLAoutbreakisbroughtundercontrolinearly2015,thelossinGDPfor2015mayrangebetween$230to$300million(UNDP,2014b).

Theindirectknock-oneffectsnotonlyhitinvestmentin the country but are also seen in lost jobs,underemployment and lower household andindividualincomes.WithinsixmonthsofthestartoftheoutbreakinMarch2014,householdincomelosswasat13%(UNDP,2014).Thisismainlybecausethehouseholdmembersdisproportionatelyaffectedareintheeconomicallyactiveagegroup(15–49years).Wherelifeexpectancyislow,thisgroupiscrucialforhouseholdincome.

In October 2014 the fiscal impact of the outbreakwas estimated at $120 million—$50 millionattributed to revenue shortfalls and $70million toincreased spendingaspartof the response (WorldBank,2014a).DirectEBOLA-relatedspendingin2014todatehasbeen$90million, including$10millionfromownresourcesandtherest fromdonors.Thefiscal impact of the outbreak has been heavy, atover$200million, taking together falling revenues,increasedspendingand forgone investment (WorldBank,2014b).

Social impact. The social effects include behaviourchanges—sometimesviolent—drivenbyfear.Inthemountainouspartofthecountrywheretheoutbreakbegan,villageshiddenbydenseforesthavebeencutofffromtheoutsideworld.InSeptember2014,eightofficials and local journalists—part of a delegationsent to warn of EBOLA’s dangers—was killed by a

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

12


mobinthevillageofWomey,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.

Education remains temporarily suspended andvaccinationcampaignsdisrupted.Thesocialdivideintheforestedregionislessseverebutremainsvisible.Some village communities are excluded from theweeklymarkets.About230,000peopleareseverelyfoodinsecureduetotheimpactofEbola;byMarch2015,thatnumberisexpectedtorisetoover470,000.ThetotalproductionoffoodcropsinGuineafor2014maybedownbyabout3%comparedtothepreviousyear (FAO/WFP,2014a).According to investigationsconducted remotely by WFP, Ebola constitutes ashock to analreadyprecarious situationof chronicfood insecurity and malnutrition (OCHA, 2014),especially in Forest Guinea. IFPRI (2014) estimatesat15%thecountry’sproportionofundernourishedpopulationbetween2011and2013,with18.2%ofunder-fivesunderweight.

EBOLA carries a strong gender dimension in allthe affected countries. In Guinea, women accountfor the highest share of Ebola cases inGueckédou(62%) and Télémilé (74%). The epidemic hasdisrupted important sources of employment forwomen, particularly informal sector activities suchastheproductionandexchangeofagriculturalandhandicraftproducts(UNDP,2014b).

LIBERIAEconomic impact. Some multilateral organizationsevenbefore theoutbreakexpectedgrowthtoslowinLiberia. IMF,forexample,forecastedaslowdownfrom8.75% (in 2013) to 6% (in 2014) even beforeEBOLA.However,becauseEBOLAcurtailedactivityinmining, agriculture and services in the secondhalfof the year, it subsequently revised down its 2014real GDP growth forecast for Liberia to 2.5% (IMF,2014c). In October, the World Bank revised down

its2014GDPgrowthforecastfrom5.9%beforethecrisis to 2.5% (World Bank, 2014a) and later 2.2%inDecember(WorldBank,2014b).However,astheepidemic may be abating in the country and withsomesignsof activitypickingup, theWorldBank’s2015 forecast projects a slight uptick in growth to3.0% compared with 2014. Though this is still farbelowits6.8%GDPgrowthforecastfrombeforetheoutbreak,itishigherthanits1.0%forecastfor2015madeinOctober(WorldBank,2014b).

Inflation increased to about11% in June2014andisexpectedtoriseto13.1%bytheendoftheyear,accordingtoIMF(2014c).Importswere$200millionlowerthan in itspreviouspre-EBOLAprojectionforthesameperiod.Privatecreditexpansionfellto14%inJunefromayearearlier.

TheeffectsofEBOLAonthefiscalbalanceareharsh.Fiscal revenue is projected to decline by about$46million in 2015 and by $49.9million in 2016,for a fiscal deficit in 2015 of at least $93 million(11.8%ofGDP).DirectEBOLA-relatedspending(forhealth, quarantine security and food imports) isputat$67million (IMF,2014c).As inSierraLeone,pressure on the financial sector is increasing thevolumeofnon-performingloansthreateningbanks’financialstability.AccordingtoUNDP,totalrevenuemaydecreaseby7%andtaxrevenueby18%,whileborrowingcouldriseby171%(UNDP,2014b)in2015.

Socialimpact.TwodenselypopulatedneighbourhoodsofthecapitalsawriotsinAugustduetogovernmentquarantinemeasures (IMF, 2014c).More generally,inflationhashitthepoorandvulnerableveryhard,underlining the need for a strong social protectioneffort as part of the recovery. For instance, somecommunitiesarereportingthatthepriceofricehasincreasedbyaround50%(PlanInternational,2014)sincethebeginningoftheoutbreak.

In the area of education, to date, students haveremained at home after the Government decidedinAugust 2014 to close schools toprevent furtherspread of the disease. There is a concern thatgirls are at greater risk of sexual abuse and early

13


pregnancyandmarriageduetothelossofeducationandcareeropportunities,andgreaterpoverty(PlanInternational,2014).

Regarding theagricultural sectorand foodsecurity,about 170,000 people are severely food insecureduetotheimpactofEbola,andbyMarch2015thatnumberisexpectedtorisetoover300,000.Therapidspreadofthevirusinthecountrycoincidedwiththeperiodofcropgrowthandharvest,andagriculturallabourshortageshaveledtoadeclineof8%ofthetotal production of food crops (FAO/WFP, 2014b).Thiswillexacerbatefoodinsecurityandmalnutritionforacountrywhere,between2011and2013,28.6%of thepopulationwasalreadyundernourishedandalmost15%ofchildrenunderfivewereunderweight(IFPRI,2014).

AccordingtoUNICEF(2014),childrenareaffectedbythisepidemicintwoways.First,manyhavelostoneorbothparentsandbeenleftorphaned.Second,theepidemichashadacatastrophic impactonalreadyfragilehealthsystems.Somehospitalshad toclosetheir doors, forcing women to give birth at homeand depriving children of immunization and basicmedicalcare.

SIERRA LEONETheWorldBankreviseddownits2014GDPgrowthforecastforSierraLeonefrom11.3%beforethecrisisto8.9%inOctober(WorldBank,2014a)andto4.0%inDecember(WorldBank,2014b).UNDP’sestimatesareinlinewiththeWorldBank’smoderatescenario.In fact they are forecasting a loss of 4% using acomputable general equilibriummodel. Given thatthisscenarioisthemostlikely,GDPgrowthcouldbe7.4%in2014(UNDP,2014b).

Theeconomic impacts includefallinggrowth,risingpricesandslippingbusinessandpersonalincomes.

The general message of the Government’spreliminaryassessment,publishedinOctober,isthatthecountrywillseereversals ingainsmadeontheMillenniumDevelopmentGoalsandothereconomicmetrics (Government of Sierra Leone, 2014). The

Governmentestimatesagrowthdeclinefrom11.3%to6.6%in2014mainlyowingtothedisruptionsofeconomicactivitiesinkeysectorssuchasagriculture,mining,construction,manufacturing,trade,tourismand transport (GovernmentofSierraLeone,2014).The IMF country report of September indicates abroadlysimilargrowthdeclinefor2014,from11.3%to8% (IMF, 2014b). Its forecast for 2015 is a 2.0%contraction, contrasting starkly both with its own8.9%forecastfrombeforetheEBOLAoutbreakandwiththe7.7%forecastinOctoberbytheWorldBank(2014b).

According to government officials (Government ofSierraLeone,2014),panicbuying,supplyreductions,area quarantines and border closures pushed upthe inflation forecast for 2014 from 6.7% in Juneto7.5% inAugust2014.TheSeptember IMFfigureputtherisehigher,at10%attheendof2014,andpredicted elevated inflation in 2015 (IMF, 2014b).Fortunately, inflation appears to be easing slightly.FromSeptembertoOctober2014,nationalinflationfellfrom8.5%to8.3%,whileinFreetownitfellfrom12.6%to11.8%.Thisdecreaseinpricelevelsisdueto the advent of the harvest season, in which thesupplyoffoodonthemarketincreasessignificantly(UNDP,2014b).

Containing the EBOLA outbreak led to rises ingovernment spending and capital spendingreallocated from other projects (such as thoseearmarkedforlong-termgrowth),wideningthefiscaldeficit,evenifriskstodebtorfiscalsustainabilityarebelievedtobemoderate.AsinLiberia,thereissomefinancial sector fragility stemming from increasingnon-performingloans.

The balance of payments is suffering becauseof increased food and health-related imports(Government of Sierra Leone, 2014). IMF (2014b)projects the balance of payments shifting from aprogrammedsurplusof$38millionbeforethecrisistoadeficitof$72.4millionin2014.

Althoughtheclosingofoperationsbyminesandothercompaniesrunbymultinationalshasledtoadeclinein foreign direct investment, the offsetting role of

14


voluntarydonationsandsupportfromdevelopmentpartnersshouldberecognized.Nationalrestrictionsonair,seaandroadtransport,andborderclosures,have also severely hit trade with neighbours andothercountries.Thecurrencydepreciatedrelativetointernationalcurrencies,whichare inhighdemanddomestically. Another obvious impact of EBOLA isthe increase in unemployment (National RevenueAuthorityofSierraLeone,2014).

ExceptforGDPandinflation,therearenoindicativenumbersonmostofthenegativeeconomicimpactsof the disease. Other studies indicate the revenueimplications of EBOLA on Sierra Leone and haveidentified transmission channels. According tosomepreliminarycountryestimates, revenue issetto decline by 14.9%by end-2014, largely owing toEBOLA(NationalRevenueAuthorityofSierraLeone,2014).InmonetarytermstheEBOLA-relatedrevenuelosswillbe$45.7millionin2014and$91.3millionin2015,or1%and1.6%ofnon-ironGDP(IMF,2014b).

Social impact.Negative effects includemortality ofkeyhealthpersonnel,stretchedhealthinfrastructureand reversal of health gains as non-EBOLA healthdelivery is compromised. The education sectorsuffers because of school closures and delays toor diversions from water and sanitation projects.According toUNICEF, some5million childrenaged3to17areoutofschoolasaresultofEbolainthethreeaffectedcountries.

EBOLAisathreattosocialcohesion,especiallyamongvulnerablegroupssuchaswomenandchildren.Morewomen thanmen are infected (51% against 49%),includingmorewomeninagricultureandtradethanmen(GovernmentofSierraLeone,2014).

AccordingtotheMinistryofHealth,thenumberofchildrendying of curable diseases such asmalaria,pneumoniaanddiarrhoeacouldexceedthenumberdying of Ebola by three or four times, becauseof people’s fear of seeking treatment in medicalfacilities. While 50% of deaths in the country arenot Ebola related, many are due to Ebola-relatedbehaviour,includinganaversiontoandfearofgoing

to health-care facilities when infected with othertreatable diseases (Sierra Leone Health FacilitySurvey,2014).

Essential social services, such as child healthprotection programmes, nutrition, water andsanitation, and HIV prevention and treatment, willneed special attention so that already vulnerablefamiliescanbebetterprotected.

The FAO/WFP’s (2014c) November 2014 estimateindicates that 120,000 people are severely foodinsecureduetotheimpactofEbolainSierraLeone.InMarch 2015, this number could reach 280,000.The country already had a high proportion ofundernourished people (29.4%) and underweightchildrenunderfive(19.9%)between2011and2013(IFPRI, 2014, IFPRI; Welt Hunger Hilfe, ConcernWorldwide,2014).

Itisestimatedthatthetotalproductionoffoodcropsfor 2014 will be less than 5% compared to 2013.However, rice production is expected to decreaseby 17% in one of the most infected areas of thecountry(Kailahun),whichisusuallyoneofthemostproductiveagriculturalregions.

Womenmake up 60% of cross-border traders andrely heavily on sales in community markets, andbothactivitieshavebeenseverelydisruptedbytheepidemic(UNDP,2014).

KEY CONCLUSION—MORE THAN EBOLA AT WORKThe three economies had structural problems—atthe root of most of their socioeconomic issues—exacerbatedbytheoutbreak.Forinstance,Guinea’sstructural troubles include a chronic electricityshortageandlackofstructuralreform.In2013,itsawasharpslowdowninminingactivity,mainlyowingtolowerbauxiteanddiamondproduction.

Yet these countries’ prospects (and those of otherAfricancountries)willbelargelysetbyotherfactorsnot related to EBOLA.Generally declining prices ininternational commodity prices, for example, will

15


challengemanyofthecontinent’scountries.Norisitpossible(fromimpactstudies)tosingleoutEBOLA’simpact and project socioeconomic trends on thatbasis. For instance, elections—planned for 2015 inEthiopia, Guinea, Nigeria and Burkina Faso amongother countries—often throw up uncertainties,affectinginvestmentandgrowthprospects,reflectingmainlydelayedinvestments.

16


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

imported fromGuinea)and, later,Mali.The largestanddeadliestEBOLAepidemicinhistory,itcantearapart the social fabric of a country. It has claimedthe lives of thousandsof people (figure2presentsthelatestdataforGuinea,LiberiaandSierraLeone),andpatientsstillflowintocentresofcare,whichareoverwhelmed.

It began with an isolated outbreak of level 2,upgraded to level 3 (the highest) by the Director-General ofWHO on 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 personnelfordiagnosis, treatment, logisticsmanagementandcontacttracing—allofthemcompoundingthehealthcrisis.

Thesethreecountries,membersoftheManoRiverUnion, have other common characteristics suchaspolitical fragility anda recenthistorymarkedby

civil war, loosening of ties between governmentand society, a “governance deficit,” and weakinstitutional capacity. A decade after the end ofregionalconflicts,ManoRiverUnioncountrieshavemadeprogresstowardsreconciliation,althoughtoomanypeoplearestillmarginalizedowingtopovertyand unemployment. Their lack of jobs—especiallyforwomen—weakinstitutionalcapacityandpaucityof resources to provide basic services (water,health care, education and electricity) arouse theirpopulations’discontent.Centralizedgovernmentandcitizens’distrustof thestateandpublic institutionscreatemistrustinsomecommunities,makingithardtoisolatepatientsandmonitortheircontacts.

EPIDEMIOLOGICAL SITUATIONGuineawasthefirstaffectedcountryintheManoRiverUnioninDecember2013.Theearliestreportedcasescame from Guéckédou, Macenta and Kissidougouin theForestedRegionand later fromConakry, thecapital.On21March2014,theGovernmentdeclaredanepidemicaftertheInstitutPasteurinLyon,France,confirmedthecasesonsamplesithadreceived.

According to WHO, despite stabilizing in somedistricts, the virus still shows intense transmissioninGuinea,withthenumberofcasesfluctuatingbutstayinghigh.TransmissionishighinMacentainthesouthwestneartheLiberianborder.Transmission ispersistent in theneighbouringdistrictofKérouané,N’Zérékoré, Beyla, Faranah and Coyah. Conakryrequiressustainedeffortstofightthedisease.Siguiridistrict,ontheborderwithMali,hasreportednew

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

17


confirmedcases.Ahighlevelofvigilanceisneededthere,particularlybecauseof itsproximity toMali,whichhasreportedseveralEBOLAcases.

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

SierraLeonewashitby theoutbreak inMay2014,andhassinceseenitspreadquicklyinthethreemaintownsalongtheeasternborderregionnearKailahun.

According to WHO, transmission of the disease ishigh.Manyofthenewconfirmedcasesarerelatedto intense transmission in the west and north.Transmission also remains intense in the capital,Freetown, and high levels of activity persist in theneighbourhoods of Bombali and the rural West,PortLokoandTonkolili.KoinaduguandKambiahavereported some cases. The neighbouring regions ofKenema and Kailahun are seeing a sharp declinein incidence, reflecting the response efforts there,includingisolationofpatients,screeningandcontactmonitoring, and robust prevention and controlmeasures.

Total20,712 cases

3,118

287

1,891

7,602

282

Con�rmed Probable Suspected Con�rmed Probable Suspected

158

Lib eria8,157 cases 3,496 deaths

2,943 deaths

1,781 deaths

70 cases confirmed in the past 21 days

Sierra Leo n e9,780 cases

1,816

3,223

Cumulative cases Cumulative deaths

2,577208

22

2,471

Con�rmed Probable Suspected Con�rmed Probable Suspected

1,499282

Total8,220 deaths



1,314 cases confirmed in the past 21 days

Guinea2,775 cases

FIGURE 2. EBOLA CASES IN GUINEA, LIBERIA AND SIERRA LEONE

Source: WHO, 7 January 2015

18


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.Thisdeclinehasleveledoff since then. Efforts to fight the disease are stillcritical,especiallyinthecapitalMonrovia.Incidenceis declining in theneighbouringdistrict ofMarigibi

but high transmission persists.Other areas of hightransmissionincludeBomiandBongcounties.Lofa,however, has seen a steady decline in new casesper week (Sharma and others, 2014). The latestnewsfromLiberiaisencouraging,asthenumberofnewcasesisdeclining.Infact,13outof15countieshavenot registerednewcases in thepast40days,with theexceptionofMonrovia.Even inMonrovia,the number of new cases is around 2 per day, as

BOX 5. MALI’S EXPERIENCE IN ADDRESSING THE EBOLA VIRUS DISEASE

Mali registered two independent Ebola cases, both coming from bordering Guinea, at the end of October 2014. The first case was a two-year-old girl infected by family members in Guinea. None of her identified contacts in Mali were infected. The second one was a Grand Imam who travelled to Bamako for treatment and died, presumably of EBOLA. The two cases revealed the country’s weakness in spotting EBOLA cases at its borders, as both cases were already showing symptoms when they entered Mali. The fact that the second patient was not diagnosed with EBOLA when he was hospitalized led to further transmissions and raised issues over the preparedness of medical staff. As of 31 December 2014, a total of 8 people had been infected in Mali, of which 6 died. Since 16 December, there have been no EBOLA new cases in the country. Following the initial two EBOLA cases, over 850 people who might have come into contact with the victims were identified and put under medical surveillance.

The EBOLA cases triggered a change in public attitudes, and the authorities strengthened border controls (road and airport checkpoints), launched public awareness campaigns via posters, radio and television, and reinforced health controls and sanitary measures in public places such as schools, hotels and restaurants. As part of the strategy, Ebola centers were established in Bamako and Kayes. All of these measures have been coordinated by the Ministère de la santé et de l’hygiène publique and the Ministère de l’action humanitaire, de la solidarité et des personnes âgées, with significant support from development partners including UNICEF, UNMEER, WHO, Germany and the United States. The ongoing Ebola virus disease related measures have overridden other public health awareness campaigns, especially those targeting HIV prevention.

Contrary to most of the countries in the affected zone, Mali did not close its borders, but it did decide to reinforce control measures, with a clear focus on its porous 850 km border with Guinea.

On the socioeconomic side, day-to-day economic activities (street vendors, local markets, public transport) have reportedly fallen in Bamako. This is mostly due to fear and anxiety among the population. It is difficult, however, to capture the global magnitude of the drop in the economic sector due to the lack of data on informal sector activities.

Source: ECA Mission to Mali (December 2014)

19


compared to 50 per day in October 20144. Thisdevelopment is an indication that the situation isbeingstabilizedandthatongoingeffortsarepointingintherightdirection.

Forthethreecountries,figure2shows20,712casesidentified(13,191laboratoryconfirmed),and8,220deaths reported. In addition, 8 cases, including 6deaths,havebeenreportedinMali(seebox5).

Atotalof838health-careworkers(ofwhich820inthethreemostaffectedcountries)areknowntohavebeeninfectedwithEbolaasof4January2015(see

4 UN-wide mission (12-15 January 2015) to Guinea, Liberia and Sierra Leone to prepare for Ebola recovery assessments as the basis for the preparation of countries’ recovery plans.

figure3).Thetotalcasecountincludes2health-careworkersinMali,11inNigeria,1inSpain(whobecameinfected while treating an Ebola-positive patient),1 in theUnited Kingdom (who became infected inSierraLeone),and3intheUnitedStates(1infectedinGuinea,and2infectedduringthecareofapatientinTexas). Investigationsareunderwaytodeterminethesourceofexposureineachcase.Earlyindicationsappeartoshowthatasignificantproportionof theinfections occurred away from Ebola treatmentcentres and other care facilities, which underlinesthe need to adhere to infection prevention andcontrolmeasures in all health institutions, not justEBOLA-relatedfacilities.

FIGURE 3. EBOLA INFECTIONS AMONG HEALTH-CARE WORKERS

CASES

CASES

CASES

DEATHS

DEATHS

DEATHSGuinea 154 89

Liberia 370

CASES820

178

DEATHS488

Sierra Leone 296 22175%

58%

48%

Source: WHO, 7 January 2015.Source: WHO, 7 January 2015

20


SCALE OF THE RESPONSEInviewofthespeedyandgeographicalspreadoftheepidemic,theinternationalcommunityhassteppedup efforts to contain the outbreak, even as moreneedstobedone.AccordingtotheOCHAmonitoringreportontheneedsandrequirementsforEBOLAasof 8 December 2014, the Inter-Agency ResponsePlan forEbolaVirusOutbreakstipulatedafinancialrequirementof$1.5billionforGuinea,Liberia,SierraLeoneandtheregionforSeptember2014–February2015. As of 13 January 2015, 1.16 billion (78%) ofthisamounthadbeenfound,throughresponseplanfunding.

Figures 4 and 5 do not include an exhaustive listof pledges which are coming in continuously. Forexample,on8November2014theAfricanbusinesscommunitypledged$32.6millionduringanAfricanBusiness Roundtable held by ECA, AfDB and AUC.Other leading African businesses may follow suitsoonafterconsultingtheirboards.Multilaterally,theUnitedNationshassetuptheUnitedNationsMissionfor Ebola Emergency Response (UNMEER), whichaimstotreattheinfected,ensureessentialservices,preserve stability andprevent furtheroutbreaks. Ithas also established the Ebola Multi-Partner TrustFundtooverseeacoherent,UN-wideresponse.

FIGURE 4. SOME IN-KIND CONTRIBUTIONS

Source: ECA compilations from websites of organizations/countries.

Cuba

European Commission (EC) andEuropean Union Member States (EUMS)

Ghana

Japan

Netherlands

South Africa

Sweden

United Kingdom

United States of America

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

More than 256 health professional including doctors and nurses to Guinea, Liberia and Sierra Leone

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

Mobile laboratories, training for health workers, food security support, water and sanitation, the EU Civil Protection Mechanism facilitating rapid deployment of emergency supplies and experts, monitoring of the situation through the Emergen-cy Response Coordination Centre (ERCC), The Dutch naval vessel, the Karel Doorman, used to deliver 5,000 tons of assistance from nine Member States – including ambulances, trucks, mobile hospitals and protective with the support of the Emergency Response Coordination Centre (ERCC), an air bridge for personnel and equipment deployment, three relief �ights (one to each of the three a�ected countries) has helped deploy three European mobile laboratories, and has had humanitarian medical experts on the ground since April 2014, the EU has put in place a medical evacuation (Medevac) system for all international relief workers. The European Centre for Disease Control and Prevention (ECDC) has also provided experts in the a�ected countries

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

Building six Ebola Treatment Centres (ETCs) to be sta�ed by UK and international volunteers (currently including Cuba, Denmark, Norway, Australia, New Zealand and Republic of Korea); Supporting 1000 treatment and isolation beds, providing care to up to 8,800 patients over 6 months; Training 800 sta� per week, including 240 health workers, and 100 safe burial teams; Building, equipping and running three new laboratories to improve diagnosis rates;Creating 200 Community Care Centres (CCCs) to promote early diagnosis, isolation and treatment; Deploying RFA Argus and three Merlin helicopters to support medical teams and aid experts; Supporting development and clinical trials of a possible vaccine. Providing 150 vehicles, including 42 ambulances, and over 1800 tonnes of aid via air freight to Sierra Leone

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

Italy Two mobile laboratories equipped for diagnostics currently operating within the European Response in Liberia and in Guinea Conakry and operated by medical teams, each of them composed by 4 Units (medical and technical sta�). Italian Development Assistance has also deployed a Medical Doctor and a logistician in Freetown (Sierra Leone).

Denmark Experts/medical sta�/training, FMTs residential facilities

21


Cuba

European Commission (EC) andEuropean Union Member States (EUMS)

Ghana

Japan

Netherlands

South Africa

Sweden

United Kingdom

United States of America

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

More than 256 health professional including doctors and nurses to Guinea, Liberia and Sierra Leone

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

Mobile laboratories, training for health workers, food security support, water and sanitation, the EU Civil Protection Mechanism facilitating rapid deployment of emergency supplies and experts, monitoring of the situation through the Emergen-cy Response Coordination Centre (ERCC), The Dutch naval vessel, the Karel Doorman, used to deliver 5,000 tons of assistance from nine Member States – including ambulances, trucks, mobile hospitals and protective with the support of the Emergency Response Coordination Centre (ERCC), an air bridge for personnel and equipment deployment, three relief �ights (one to each of the three a�ected countries) has helped deploy three European mobile laboratories, and has had humanitarian medical experts on the ground since April 2014, the EU has put in place a medical evacuation (Medevac) system for all international relief workers. The European Centre for Disease Control and Prevention (ECDC) has also provided experts in the a�ected countries

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

Building six Ebola Treatment Centres (ETCs) to be sta�ed by UK and international volunteers (currently including Cuba, Denmark, Norway, Australia, New Zealand and Republic of Korea); Supporting 1000 treatment and isolation beds, providing care to up to 8,800 patients over 6 months; Training 800 sta� per week, including 240 health workers, and 100 safe burial teams; Building, equipping and running three new laboratories to improve diagnosis rates;Creating 200 Community Care Centres (CCCs) to promote early diagnosis, isolation and treatment; Deploying RFA Argus and three Merlin helicopters to support medical teams and aid experts; Supporting development and clinical trials of a possible vaccine. Providing 150 vehicles, including 42 ambulances, and over 1800 tonnes of aid via air freight to Sierra Leone

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

Italy Two mobile laboratories equipped for diagnostics currently operating within the European Response in Liberia and in Guinea Conakry and operated by medical teams, each of them composed by 4 Units (medical and technical sta�). Italian Development Assistance has also deployed a Medical Doctor and a logistician in Freetown (Sierra Leone).

Denmark Experts/medical sta�/training, FMTs residential facilities

22


2.0

1.00

1.0

1.0

1.00

0.5

0.5

0.40

0.33

0.2

Nigeria

Equatorial Guinea

Namibia

Kenya

Senegal

Cote d'Ivoire

1.0

Algeria

Ethiopia

Gambia

Mauritania

South Af rica

Botswana

2.5

1.0

1.0

1.0

1.0

1.0

1.0

1.0

0.5

0.5

0.50

0.50

0.35

0.31

0.23

0.15

0.1

0.08

0.06

0.05

0.03

0.02

0.02

MTN Group

Dangote

Econet Wireless

Afrixim Bank

Coca Cola Eurasia and Africa

Kola Karim CEO of Nigerian conglomerate Shoreline Energy

Stenbeck Family

The Motsepe Foundation

The United Bank for Africa (UBA)

Vitol Group of Companies

and Vivo Energy

Barclays Africa Group Limited

Nedbank Group

Old MutualGroup

Quality Group of Tanzania

Sygenta

Seplat Petroleum Development Company

National Oi l Companyof Liberia

The National Oi l Company of Liberia (NOCAL)

AUC sta� members

Liberia Petroleum Company

Mercury International

Ecobank

The Association of Sierra Leone Commercial Banks

Sierra Ruti le

Wireless Application Services Providers Association of Ghana

0.01

SocFin AgriculturalCompany

1.0

Tony Elumelu Foundation

4.1

Save the Children

51841.1%

World Bank

100%

80.7%

450

144

45

17.2

9.0

1.6

1.0

0.5

0.5

6

5.0

4.3

4

3.3

2.0

1.6

1.5

1.35

1

20

100%

100%

100%

88.6%

79%

12.5

11

96.6%

10.7

10

9.5

100% 8.7

94%

5.0

1,20040.4%

220 20.6%

130

390 100%

100

70.8

50

35

25

25

25

20

81%

15

86194.7%

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

N/A

N/A

N/A

N/A

N/A

N/A

100%

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

96%

100%

100%

N/A

N/A

N/A

35080%

202

16.8%

32.7%

137

100%

100%

100%

100%

100%

41.8%

100%

100%

55%

55%

123

8.3%

77.799.4%

36.7

36.134.9

31.7

9.7

10

Multilateral Partners African Private Sector

Bilateral Partners

International Private Sector and Charity/Foundations

United States

IFC/World Bank Group

Bil l Gates-Backed Group

GAVI

United Kingdom

AfricanDevelopment

Bank

Germany

Japan

France

IMF

China

101

51%Canada

Paul Al len Family Foundation

Sweden

Bil l & Melinda Gates Foundation

Islamic Development Bank

Norway

Australia

King Abdallah of Saudi

Arabia

Switzerland

Denmark

Google/Larry Page Family Foundation

Mark Zuckerbergand Prisci l la Chang

Sil icon Valley Community Foundation

Children’s Investment Fund Foundation

Russian Federation

Central Emergency Response Fund (CERF)

Larry Page's Family Foundation

Brazil

Finland

India

Spain

Italy

Belgium

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

Israel

IKEA Foundation

Will iam and Flora Hewlett Foundation

Médecins du Monde

Open Society Foundation

Bayer

GeneralElectric

Common Humanitarian Fund

Comic Relief

Volvo

ArcelorMittalFoundation

AUC

Bridgestone

OPEC Fund for International Development

FIFA

European Commission (EC) + European Union

Member States (EUMS)

100%

60.1

Netherlands

89%

African countries’

--

-

-

-

-

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

US$100 millions= US$1 million=

100%

100%

FIGURE 5. SOME PLEDGES AND DISBURSEMENTS TO CONTAIN THE EBOLA OUTBREAK

23


2.0

1.00

1.0

1.0

1.00

0.5

0.5

0.40

0.33

0.2

Nigeria

Equatorial Guinea

Namibia

Kenya

Senegal

Cote d'Ivoire

1.0

Algeria

Ethiopia

Gambia

Mauritania

South Af rica

Botswana

2.5

1.0

1.0

1.0

1.0

1.0

1.0

1.0

0.5

0.5

0.50

0.50

0.35

0.31

0.23

0.15

0.1

0.08

0.06

0.05

0.03

0.02

0.02

MTN Group

Dangote

Econet Wireless

Afrixim Bank



Stenbeck Family

The Motsepe Foundation


Vitol Group of Companies

and Vivo Energy


Nedbank Group

Old MutualGroup


Sygenta


National Oi l Companyof Liberia

The National Oi l Company of Liberia (NOCAL)

AUC sta� members


Mercury International

Ecobank


Sierra Ruti le


0.01

SocFin AgriculturalCompany

1.0


4.1

Save the Children

51841.1%

World Bank

100%

80.7%

450

144

45

17.2

9.0

1.6

1.0

0.5

0.5

6

5.0

4.3

4

3.3

2.0

1.6

1.5

1.35

1

20

100%

100%

100%

88.6%

79%

12.5

11

96.6%

10.7

10

9.5

100% 8.7

94%

5.0

1,20040.4%

220 20.6%

130

390 100%

100

70.8

50

35

25

25

25

20

81%

15

86194.7%

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

N/A

N/A

N/A

N/A

N/A

N/A

100%

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

96%

100%

100%

N/A

N/A

N/A

35080%

202

16.8%

32.7%

137

100%

100%

100%

100%

100%

41.8%

100%

100%

55%

55%

123

8.3%

77.799.4%

36.7

36.134.9

31.7

9.7

10

Multilateral Partners African Private Sector

Bilateral Partners

International Private Sector and Charity/Foundations

United States

IFC/World Bank Group

Bil l Gates-Backed Group

GAVI

United Kingdom

AfricanDevelopment

Bank

Germany

Japan

France

IMF

China

101

51%Canada

Paul Al len Family Foundation

Sweden

Bil l & Melinda Gates Foundation

Islamic Development Bank

Norway

Australia

King Abdallah of Saudi

Arabia

Switzerland

Denmark


Mark Zuckerbergand Prisci l la Chang

Sil icon Valley Community Foundation


Russian Federation


Larry Page's Family Foundation

Brazil

Finland

India

Spain

Italy

Belgium


Israel

IKEA Foundation

Will iam and Flora Hewlett Foundation

Médecins du Monde

Open Society Foundation

Bayer

GeneralElectric


Comic Relief

Volvo

ArcelorMittalFoundation

AUC

Bridgestone


FIFA

European Commission (EC) + European Union

Member States (EUMS)

100%

60.1

Netherlands

89%

African countries’

--

-

-

-

-

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

US$100 millions= US$1 million=

100%

100%

Source: See Appendix II.

Note: N/A is ‘not available’

24


How the EBOLA toll comparesTheworld has beenshakenbythecontagionofEbola,whichisbecominga question of global public health, claiming morethan8,000 lives. Yet for all the grief thedisease iscausing,itstotalmortalityandmorbidityare,sofaratleast,lowinaglobalandhistoricalcontext.

For example: the 1918–1919 influenza outbreak,also called “Spanish flu,” became a pandemic andclaimed about 30 million lives according to theInstitutPasteur,andup to100millionaccording tocertainrevisionistanalysts.Itmaybethemostlethalpandemicofalltime,certainlyinsuchashorttime.Over a longer period, the Black Death caused anestimated50milliondeathsduringthe14thcentury(WHO,2014).

Morerecently,thecholeraepidemicthatemergedin1994intheDemocraticRepublicoftheCongo,aftertheRwandan crisis, raged among refugees.Amongthe 500,000–800,000 who crossed the borderseekingasyluminthesuburbsofGoma,50,000diedwithin amonth of arriving, owing to a generalizedoutbreakofcholeraanddysentery.

AccordingtoWHO,contagiousdiseasesindevelopingcountries still account for seven of the 10 maincausesofchildren’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(WHO,2013).

WHO puts at 8.6 million the number of newtuberculosis cases across the globe in 2012 and at1.3millionthenumberofpeoplewhodiedfromthediseasethatyear.Some3.3billionpeopleworldwideare vulnerable to malaria5:in2012,thediseasekilled

5 http://www.who.int/topics/millennium_development_goals/diseases/fr/

about627,000people,mostofthemagedunderfiveand living in Africa (WHO, 2013). Measles caused145,700deathsworldwide in2013.ThenumberofdeathsowingtoSARSduringthatepidemic,despiteitswidefootprint,wasamodest774(WHO,2013).

At the end of 2012, 35.3million people were HIVpositive,includingabout2.3millionnewinfections.6

Some1.7millionpeople,including230,000children,died from AIDS.More than two thirds of newHIVinfections are in Africa excluding North Africa,accordingtoWHO.

Tobacco, too, is a big killer: tobacco consumptionand smokeexposure (passive smoking) claimmorethan 700,000 lives in the European Union, andthis in an area with strong anti-tobacco legislation (WHO,2013).

Finally, more than 20 million people are killed orseriously injured by road accidents every yearacross the world, with economic costs of around$518 billion—$65 billion in developing countries (WHO,2013).

5. 6 http://www.who.int/topics/millennium_development_

goals/diseases/fr/

25


MACROECONOMIC IMPACTS OF EBOLA VIRUS DISEASE

The first observations from Guinea, Liberiaand Sierra Leone suggest that EBOLA canaffect the economy in multiple ways and to

varyingdegrees.7

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 tollcomesfromforeigncompaniesreducingoperations,as they cut staff to a minimum and expatriates(including nonessential diplomatic staff) leave,curtailing their demand for services. The EBOLA-induced shocks to the labour force, publicfinance,investmentandsavingsmaycauseasharpfallinGDP, retardingdevelopment.

The impacts of the epidemic on GDP growth asestimatedbythethreecountries’nationalauthoritiesareintherangeof2to58percentagepointsfor2014(i.e.lowerthanwhatGDPgrowthwouldhavebeenwithout EBOLA). At purchasing power parity, thisGDPlosscomestoaround$716millionforthethreeeconomies.9 Since the outbreak and subsequent

7 The appendix offers further discussion of the economic and social impacts by sector.

8 2.2%2.1% for Guinea, 4.7% for Sierra Leone and 4.9% for Li-beria.

9 ECA calculation based on GDP at purchasing power parity for 2013 from AfDB, OECD and UNDP 2014 for the three countries, to which pre-EBOLA and post EBOLA growth rates for 2014 from national sources are applied.

slowing economic activity, all three countries haverevisedoneormoretimestheirGDPprojectionsfor2014(seetables1–3):GuineareviseditsGDPgrowthfrom4.5% to3.5%and then to1.3%; Sierra Leonefrom 11.3% to 8% and then to 6.6%; Liberia from5.9%to2.5%andthento1%.

INVESTMENT, SAVINGS AND PRIVATE CONSUMPTIONInthefaceofloweredpublicrevenueandincreasedneed for a sound response, the EBOLA crisis isdiverting public spending from investment inphysicalandhumancapitaltohealthandothersocialspending.Foreignanddomesticprivateinvestments,too,aredeclining,largelyoutofpanic.Thedecreaseindomesticinvestmentislikelytocontinueoverthemediumtermifinvestorsdonotgetfinancialsupporttoresumeactivities.

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 andMatotoka–Kono roads; reconstructionof the Makeni–Kabala road, Hillside Bypass road,and Lumley–Tokeh road; and work on city andtown streets in the provinces and the WesternArea have been suspended (Government of Sierra Leone,2014).

26


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

More widely, families’ consumption and savingshavebeenhitbythedisease,thoughmicrodataarehardtocomeby,owingtomortalityandmorbidity,and reduced economic activity, working hours andincome.

INFLATION, MONEY AND EXCHANGE RATESAffectedcountriesfaceinflationarypressuresastheEBOLA 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(IMF,2014c).

AlsoinLiberia,inflationisrising,pushedbyastrongpressure on food prices. Year-end 2014 inflation isnowprojectedat14.7%andtoremainhighatabout10%in2015.Thecountry’sgrossofficialreservesareforecast to fall from 2.8 to 2.6months of imports(IMF,2014c).

The nominal exchange rate of the leone againstothercurrencieshasdepreciated,withanincreased

parallel 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-Guinée,2014).

PUBLIC FINANCEAs seen, one impact of EBOLA is to lower publicrevenueandraiseexpenditure,especiallyinhealth,putting further pressureon thefiscal balance. Thisfurtherweakens the state’s capacity to contain thedisease or to buttress the economy against widerimpacts (primarily via fiscal stimulus). Ultimately,countries face dependence on external support tobridgethegap.

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 EBOLA is estimated at about$46millionand$91millionfor2014and2015,or1%and1.6%ofnon-ironoreGDP(IMF,2014b).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(IMF,2014a).TheNationalRevenueAuthorityofSierraLeone (2014) reporteda15% shortfall in tax collectionagainst the targetsset for July and August 2014; the Liberia Revenue

27


Table 1. GDP projections, Guinea (%)

2014 2015Source of data Initial projection Projection after

outbreakInitial projection Projection after

outbreak

Guinean authorities 4.5 1.3 6.3 1.9ECAa 4.5 1.3 6.3 1.9World Bankb 4.5 2.4/0.5 4.3 2.0/-0.2IMF 4.5 2.4 4.3 4.1African Economic Outlook 4.2 — 4.3 —

— 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 EBOLA. 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 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 (%)



outbreak

Liberian authorities 5.9 1.0 6.8 0.0

ECAa 7.3 1.0 7.0 0.0

World Bankb 5.9 2.5/2.2 6.8 1.0/3.0

IMF 5.9 2.5 6.8 4.5

African Economic Outlook 6.8 — 8.2 —


a See note a,Table 1

b See note b,Table 1

Table 3. GDP projections, Sierra Leone (%)



outbreak

Sierra Leonean authorities 11.3 6.6 8.9 —

ECAa 11.9 6.6 11.6 —

World Bankb 11.3 8.0/4.0 8.9 7.7/-2.0

IMF 14.0 8.0 8.9 9.9c

African Economic Outlook 13.8 — 11.6 —


a See note a,Table 1

b See note b,Table 1

c This takes into account the sudden and quick catch-up of mining output, which was dormant in 2014.

28


Administrationexpectsprojectedrevenuesfor2014todeclineby19%(GovernmentofLiberia,2014).

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, for instance, EBOLA-related spending for2014isputat$36million(72%directdisease-relatedhealth response and28% social spending), and for2015 at $40.9million (100% social spending) (IMF,2014b). In Liberia the authorities estimate directEBOLAspendingat$79.7million,besides$20millionin cash transfers and $30 million in agriculturalstimulus(GovernmentofLiberia,2014).TheGuineanGovernment puts the EBOLA-related bill at $134million through to February 2015 (Government ofSierra Leone, 2014; Government of Liberia, 2014;GouvernementdelaGuinée,2014).

FISCAL DEFICITS

Through theaboveeffectsongovernment revenueandspending,EBOLAputsthebudgetunderpressureandwidens 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(IMF,2014b;IMF,2014c).

DEBT BURDEN AND DEBT ALLEVIATION

Pledgesandcontributionsarekeytobridgingthefiscalgapsgeneratedby theEBOLAcrisis— forexampleIMF’s $300 million pledge made during the G20meeting of November 2014 in Brisbane, Australia.Similarly,inapressreleasedated2December2014(WorldBank,2014c), theWorldBankGroupstatedthatitismobilizingnearly$1billioninfinancingforthehardest-hitcountries.Thisincludes$518millionforepidemicresponse,andatleast$450millionfromtheInternationalFinanceCorporation—amemberoftheWorldBankGroup—tobuttresstrade,investmentandemploymentinthethreecountries.

Such assistance from the international communityis laudable and much needed to bridge financinggaps.However,withpartoftheassistanceasloans,theEBOLAcrisiscouldpossiblyaggravatethethreecountries’ debt burdens. The World Bank, forexample, provided credit support of $40million toGuinea (World Bank, 2014d) and of $20million toLiberia(WorldBank,2014e).SimilarlyinSeptember2014, IMF approved EBOLA-related credits to thethreecountriesof$41millionforGuinea,$49millionfor Liberia and $39 million for Sierra Leone (IMF,2014d)anditsadditionalpledgeof$300millionmadeinBrisbaneforthethreecountriesisacombinationofconcessionalloans,debtreliefandgrants.

AllthreecountrieshavebenefitedfromtheHeavilyIndebted Poor Countries (HIPC) initiative and theMultilateral Debt Relief Initiative over the past 10years. For example, owing to its eligibility for theHIPCinitiativein2012,Guineacuttheinterestpaidon its external debt from 3.7% of Gross nationalincome (GNI) in2011 to2.8% in2012and1.1% in2013.Itiscrucialthatthecrisisdoesnotsparkdebtdistress nor offset any of the fiscal gains (mainlyreduceddebtservicingandthushigherdevelopmentspending) generated by these initiatives, becausethese gains are crucial to poverty reduction andeconomictransformation.

Figure 6 provides some indicators of the debtburdenforthethreecountriesbeforetheoutbreak,

29


showingapre-EBOLA(2013)externaldebtburdeninthe range of 20.8% to 31.1%ofGNI, for a total ofsome$3.1billion.Evenaftertheimplementationoftheabove-mentioned initiatives, theburdenof theexternaldebtservicestillconstrainsthefiscalspaceofthethreecountries. In2013,theGovernmentofGuinea allocated $60.4 million of public resourcestowardstheservicingofthedebt–thiscorrespondsto1.1%of itsGNI.During thesameperiod,Liberiaspent$5.8million,or0.3%ofGNI,toserviceexternaldebt,andSierraLeonepaid$27.3millionor0.6%ofGNItoexternalcreditors.

ItisinthiscontextthatECAappealstoallstakeholdersformore debt cancellation for the three countries(seeappendixIII).

LABOUR SUPPLY AND PRODUCTIVITY

EBOLA may decrease labour supply, potentiallyhurting the quantity and quality of goods and

services,especially inthepublicdomain.Toreduceclosecontactinworkplaces,somepublicandprivateinstitutions have asked some non-essential staff tostayathome;othershavereducedworkinghoursforallstaff,leadingtoafallinproductivity.

InSierraLeone,forexample,bankscuttheirworkinghoursandthustheirdailyservices.Andinlinewiththerestrictions imposedbythestateofemergencyinJuly2014,dailymarketswereclosedearlierthanusual.Thesemeasureshadrepercussionsonworkers’productivity from all sectors as they had to leaveworkearliertocarryoutfinancialtransactionsbeforethe banks and markets closed. Some expatriateshave left, as seen, undermining labour supply andproductivityastheseworkersmaybehardtoreplaceintheshortterm.

EBOLA-related mortality and morbidity have hitthenumberoffarmerswhocanworkinagriculture(whether directly or through looking after loved

FIGURE 6. EXTERNAL DEBT AND DEBT SERVICE FOR THE THREE COUNTRIES, 2013

21%Guinea

Liberia

Sierra Leone

External debt stocks (USD million)

0 200 400 600 800 1000 1200 1400

1,197

541

1,395

External debt stocks (% of GNI)

31%

31%

60.4 1.10%

5.8 0.30%

27.3 0.60%

Debt service on external debt (USD million)

Debt service (% of GNI)

Source: World Development Indicators Database of the World Bank, accessed 13/1/2014.

30


ones). 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.

POVERTY AND INEQUALITYIn the short term, the epidemic is likely to widenincome inequality and increase poverty in thethree countries by impoverishing directly affectedindividualsandfamilies,andbyreducingconsumptionandaccesstobasicsocialservices,especiallyamongthe poor. In the longer term, the disease’s effectonGDPgrowthmaywellbefeltonGDPpercapita.Andgiventhatincomedistributionisalreadyhighlyunequal, it is extremely likely that the poor willbe hit hardest—undermining the socioeconomicdevelopmentgainsofrecentyears.

CONTINGENCY AND RECOVERY PLANSIn 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(IMF,2014e).TheUnitedNationssystem,inpartnershipwithotherorganizations,10 is preparinganEbolaRecoveryAssessmentthatwillsupportandcomplementnationaleffortsintheelaborationoftherecoveryplans.ThefirstversionoftheAssessmentisexpectedtobereadybyMarch2015.

10 Including the African Union, the Mano River Union, the Af-rican Development Bank, the World Bank and the European Union.

SURVEY ON NON-AFFECTED COUNTRIES’ PREPAREDNESS AND ON INDIRECT EFFECTS OF EBOLAThe analysis in this subsection is based on an ECAsurvey of countries’ preparedness for an EBOLAoutbreakandontheindirecteffectsofEBOLA,whichwas launched inNovember2014 (and is still beingconducted)amongnearlyallAfricancountriesotherthanthosedirectlyaffectedbyEBOLA;18responded.

Itaimstoinquireabouthowandtheextenttowhichthe non-affected countries have been hit by thediseaseandhaveorganizedthemselvesforprotectionagainstitsspreadandsocioeconomicconsequences.

Theresultsarebasedonthe18replies,11pendingamore exhaustive response.12While awaiting repliesfromtheremainingcountries,theanalysisispartial.

ECONOMIC EFFECTS

Somecountriesmaynothaverecentdataonmanyof the economic indicators that could help themto conclude with certainty the economic impactof EBOLA. Even if they have them, any economicworsening may not stem directly from EBOLA—causality has to be established. West Africancountries neighbouring Guinea, Liberia and SierraLeonemayhavefeltalargerimpactgivetheirclosereconomicinteraction.Thesurveythereforefocusedon perception of the authorities whether a givenindicatorhasbeenorislikelytobeaffectedbyEBOLAinthefuture.

AlthoughallthoserespondingarenotveryclosetotheEBOLA-effected countries, those inWestAfricareported negative impacts on economic indicatorssuch as GDP growth, inflation and trade. Theyperceive tourism and transport as directly affectedsectors.Amongtherespondents, theauthoritiesof

11 Angola, Burkina Faso, Burundi, Cameroon, Cabo Verde, the Central African Republic, Chad, the Republic of the Congo, the Democratic Republic of the Congo, Equatorial Guinea, Gabon, Ghana, Gambia, Guinea-Bissau, Madagascar, Niger, Rwanda and Sao Tome and Principe.

12 Details on the questionnaire can be found at http://www.un-eca.org/sro-wa/pages/Ebola-web-appendix.

31


non-WestAfrican countries think that thenegativeimpactofEBOLAislessthanearlierexpected,evenif they feel that EBOLA has contributed to slowerexportandimportgrowth.

SOCIAL EFFECTS

The impact on the social sector owing to EBOLAis likely to be less visible, particularly in countriesfar from the three affected countries. However,countries highlighted some issues thatmaynot beapparentthroughaggregateddata.

In response to questions on the impact of theoutbreak on routinehealth delivery systems,morethan half of respondents stated that they hadintroduced special precautionary measures (laserthermometers, protection material) at medicalcentres.Thesemeasures,however,donotseemtohavetakenawaysubstantialresourcesfromregularhealth-care provision. Furthermore, around a thirdofcountriesreportedthattheywererestrictingthemovementofpeoplebyclosingbordersorstoppingdirectflightstotheaffectedcountries.Someofthemhave already lifted thesemeasures. None of themreportedintroducingvisabans.

SPECIAL MEASURES

All respondent countries reported taking specialmeasures for economic and health preparedness.Almost all countries have set up high-level,multi-governmental committees that monitorpreparedness for a possible outbreak. Almost allthe respondents have designed a contingency oran EBOLA prevention plan. These strategies werereported to cost$1.5million in theCentralAfricanRepublic,$3.1millionintheDemocraticRepublicoftheCongoand$0.8millioninSaoTomeandPrincipe.

Most have also introduced some sort of specialhealthprogrammetoprepareforapossibleEBOLAoutbreak and identified treatment and isolationcentres. Almost all countries have launchedawareness campaigns: the Democratic Republic oftheCongohasestablishedanEBOLAtollfreenumberthatpeoplecancallforinformationonthedisease;

theCentralAfricanRepublicdeclared26Augustasaday for intensifiedcommunicationonEBOLA;Chadinvolvespolitical,religiousandtraditionalleadersinactivitiesaimedatraisingpreventionawareness;andGhanahastrained10,000healthworkersand50,000volunteerstocarryoutadoor-to-doorcampaign.

All countries reported having received some sortof assistance from United Nations agencies andbilateral development partners. Five countries(the Democratic Republic of the Congo, EquatorialGuinea,Gambia,GhanaandSaoTomeandPrincipe)pledged financial support directly for theworst-hitcountriesordidsoviaWHO,while theDemocraticRepublicoftheCongo,Guinea-BissauandtheNigeralso provided non-financial support by deployinghealthworkersandsendingmedicalequipment.

ECONOMIC EFFECTS OF EBOLA 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 regionaccounts 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%(ECA,2014f).

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 fromemergingcountries)andconsumptionboostedbyanewlyemergingmiddleclass.IftheEBOLAoutbreak

32


is 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 as framework for analysing internationaltransmissionofeconomicshocks.

Because all three EBOLA-affected countries havebeenrevisingdownwardtheprojectionsfortheirGDPgrowthratefor2014and2015,thesimulationlooksat a benchmark scenariowhere all three countriesregister a growth rate of 0% in 2014 and 2015;projected growth for the other African countriesremainsunchangedfortheseyears.

Inthesimulation,thedisruptiveeffectsofEBOLAontheeconomiesofGuinea, Liberia andSierra Leoneare mirrored by negative shocks to investment,

consumption,unemployment,inflationandpotentialoutput. The shocks are calibrated such that theymatchanegativeeffectonGDPgrowthinthethreecountries,whichresultsinazerogrowthscenario.13 Weassumethatthenon-affectedcountriesareonlyaffected through the international transmission ofthenegative economic shocks originating from thethreecountriesandthatthereisnocontagion.14

ThissimulationyieldsforGDPgrowthasmalleffectinWestAfrica(-0.19percentagepointsin2014and

13 TheWEFM includes countrymodels for Guinea and SierraLeonebutnotforLiberia.Forthisreason,theshockoriginat-ing fromLiberiawasdirectly introducedto itsAfricantradepartnerswith a strength corresponding to the reduction inLiberianimportsandexports.

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

FIGURE 7. SIMULATED GROWTH FOR WEST AFRICA AND AFRICA

Source: ECA simulations as of 17 January 2015

Reduction in GDP Growth rates from Pre-EVD projections

Sierra LeoneGuinea Liberia West Africa Africa

20142015

-4.5

-5.9

-11.3

-0.19 -0.05

-6.3 -6.8

-8.9

-0.15 -0.04

-11.5

-9.5

-7.5

-5.5

-3.5

-1.5

Per

cen

t

33


-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 theEBOLAcrisis.

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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 EBOLA(WHO,2011).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 EBOLA outbreak poses anunprecedentedchallengeintheoverallachievementof gender equality and women’s empowerment.Theunpaidcareworkathouseholdandcommunitylevelsaswellasthegendereddivisionoflabourhaveledtowomenbearingthebruntoftheoutbreak(asevidencedbyUN-Women,2014),whichreportsthatasmanyas75%ofEBOLAfatalitiesinLiberiaand59%ofthose inSierraLeoneareamongwomen.Acrossthe three countries, 55% to 60% of the dead arewomen(WashingtonPost,2014).

Further,sharpretrogressionhasbeenexperiencedbywomenandtheirhealthindicators,suchasmaternalmortality. With medical facilities overwhelmed,expectantmothers are often leftwithout pre-natalcare,obstetricservicesandnew-borncare,reversingthe earlier progress towards the Millennium

DevelopmentGoalonmaternalmortalityinallthreecountries.

Compounding this, an increased risk of gender-based violence and exploitation of girls and youngwomenhasbeen reported in thecountries,due inparttoisolationbyquarantineortoorphanhoodbyEBOLA.Womenhavealsofeltreversalsineconomicempowerment, owing to the shutting of bordersaffectingcross-border trade (where themajorityoftraders arewomen), and in agriculture andmining(whichhavesignificantfemaleworkforces).

CROSS-BORDER TRADE

Informalcross-bordertradeinAfricaisestimatedat43%ofofficialGDP,placingitalmostatparwithformaltrade (Lesser andMoisé-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,AUandAfDB,2010).

Womendominatecross-bordertradeinWestAfrica(70% in theManoRiver region),even though theireconomic contribution is hardly given due value.TheircontributiontonationalGDPamountedto64%of value added in trade in Benin, 46% inMali and41%inChad.ItisreportedthatinWestAfrica,femaleinformalcross-border tradersemploy1.2people intheirhomebusinesses,andonaveragesupport3.2childrenand3.1dependantswhoarenotchildrenorspouses.

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

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Of the 2,000women informal cross-border traderssurveyed by UN-Women between 2007 and 2009in Cameroon, Liberia, Mali, Swaziland, the UnitedRepublic of Tanzania and Zimbabwe, the vastmajoritystatedthatrevenuefromtheirtradingisthemainsourceofincomeforthefamily;womentradersuseittobuyfoodandotheritemsforthehousehold,pay for school fees, health-care services and rent,savein“susu”clubsandbanks,andreinvestintheirbusinesses.

In short, the official closures of themajor bordersbetweenGuinea,SierraLeone,Liberia,Côted’Ivoire,SenegalandGuinea-Bissauhavedevastatingimpactsonhouseholdincomes.15

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 countries16 with more than 100,000 ASMoperatorswithestimateddependants ranging from600,000to9millionforeachofthesecountries(ECAandAUC,2011).

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, more

15 Recentdataindicatethat30%ofhouseholdsinLiberiawereheadedbyawomanin2009,22%inSierraLeonein2008and17% in Guinea in 2012. Source: World Development Indi-cators, World Bank, http://data.worldbank.org/indicator/SP.HOU.FEMA.ZS,accessed25November2014.

16 Angola, Burkina Faso, the Central African Republic, Chad,Côted’Ivoire,theDemocraticRepublicoftheCongo,Eritrea,Ethiopia,Ghana,Guinea,Liberia,Madagascar,Mali,Mozam-bique, theNiger,Nigeria, Sierra Leone, the Sudan,Uganda,theUnitedRepublicofTanzaniaandZimbabwe.

than$13.5millionwas projected as being injectedinto 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 (ECAandAUC,2011).Additionally,ofthe582,000caratsof diamonds officially exported from Sierra Leonein 2006, 84% originated from ASM operators(GovernmentofSierraLeone,2011).

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 EBOLA has forced many ASM operators—particularlywomen—toabandonartisanaldiamondandgoldminingaltogetherbecauseoftightbordercontrolsaimedatcurbingthespreadofthedisease,andrestrictionsonpeople’smovements.Beforethecrisis, artisanal gold mining—a female-dominatedactivity—provideda steadyand reliable income forwomen(Maconachie,2014).

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

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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 andconsumptionwithinaneconomybuttheyhaveoftenbeen overlooked in times of emergencies (Spence,2012).KailahunandKenemadistrictsinSierraLeone,forinstance,havewomenmasterfarmersandheadsof household whose agricultural bases have beenseverely eroded and, in some cases, completelywipedoutbyEBOLAdeaths(AfDB,2014b).

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 EBOLAwidows 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-Africa,2014). InGuinea, it isestimatedthataworkloadof15–17 hours per day is borne bywomen in familyandprofessionalactivities.SimilarworkhourshavebeenreportedforLiberiaandSierraLeone.

Aswomenarepulledoutoftheirdailyworktocarefor sick family members or children orphaned bythedisease,theyhavelesstimetoearnmoneyand

growandsellfood,whichcanleadtoincreasedfoodinsecurityandperpetuationofthepovertycycle.

VULNERABILITY OF AFRICAN HEALTH SYSTEMSThe rapid expansion of EBOLA revealed the lowcapacitytoreactandmanagean infectiousdiseaseoutbreak among most African countries’ healthsystems, exposing few means, even more limitedknowledgeamonghealthpersonnelandthesystems’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 efficiency ofthe essential components of health systems.WHOconsiders six elements essential for a functionalhealth system: provision of services; healthpersonnel;systemsofinformationandknowledgeonhealth;medicalproducts,vaccinesandtechnologies;healthfinancing;andleadershipandgovernance.

UNDER-INFRASTRUCTURED

Withthesupportofpartners,Africancountrieshavebuiltahealth infrastructureofsorts,butat0.8theAfricanaveragedoesnotevenreachonehospitalper100,000inhabitants(WHO,2014).Only13countriesexceed this standard, with Gabon having the bestoutcome; Guinea and Liberia are way below theAfrican average (see figure 8). Worse, this metrichasdeclinedinAfrica,downfrom0.9in2013(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 scarcely

37


workingowingtoalackofmaintenance.Onereasonisthatpayrollconsumesaheavyshareofthebudget(60–80%ofmostministries of health), leaving fewresources for spending elsewhere (Gobbers andPichard, 2000). The upshot is a heavy percentageof temporary staff, sometimes paid on piece ratewithoutfixed-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.

UNDER-STAFFED

TheAfricanaverage fordoctors is reasonable,with2.6 doctors per 10,000 inhabitants, but not so fornursesandmidwives,asthesedoctorssuperviseon

FIGURE 8. NUMBER OF HOSPITALS PER 100,000 INHABITANTS 2013

FIGURE 9. NUMBER OF MEDICAL DOCTORS PER 10,000 INHABITANTS, 2006–2013

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

WHO standard 1.0

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 average1.0 WHO standard

Source: WHO 2014.

Source : WHO 2014.

38


average12.0nursesandmidwives.WHO’sstandardsare for one doctor per 10,000 inhabitants, onenurseper300inhabitantsandonemidwifeper300womenofreproductiveage.Supportstaffsinhealthunits (plumbers for drinking water and sanitation,electricians anddrivers, experts inhigh technologyforequipment)areinextremelyshortsupply.

Among countries affected by EBOLA, the ratios fordoctors are far below that average: Guinea (1.0),Sierra Leone (0.2) and Liberia (0.1) (see figure 9).Indicatorsfornursesandmidwivesarealsoworrying:2.7 in Liberia and 1.7 in Sierra Leone, not even a

quarteroftheAfricanaverage.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 public

FIGURE 10. THE MAIN HOST COUNTRIES OF THE DRAIN OF MEDICAL SKILLS FROM AFRICA (EXCLUDING NORTH AFRICA)

Source: Performance Management Consulting,www.performancesconsulting.com

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)






39


serviceobligations). 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, draining the continent’smedical base (seefigure10).Still,theremaybehugefinancialbenefitstosendingcountries(atleastintheshortterm):themassive recruitment of Ghanaian doctors by theUnited Kingdom between 1998 and 2002 made itpossibleforthecountrytosavenearly$172million(PerformanceManagementConsulting,2010).

Yettheoverallpictureisnotencouraging:Africahas1.3% of the planet’s health workers but its globaldisease burden is 25% (PerformanceManagementConsulting, 2010). The human resource deficitis a pressing burden with, at times, devastatingconsequences.

UNDER-RESOURCED

Lackof funding isoneof themain reasons for theaboveunimpressivedataoninfrastructureandstaffperformance. States are themain funders of their

healthsystems.Incountriesthathavedecentralizedmorethanothers,localcommunitiesalsocontributeto thehealth effort (although community health isfarfromapriorityinAfrica,despitethediscourse).

WHO calls on countries to devote at least 9% ofpublicspendingtohealth—andtotheircredit,manycountries do so (see figure 11).Other bodies haveotherspendingtargets: 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(AU,2007).

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

at least 9.0%WHO Standard

FIGURE 11. SHARE OF HEALTH SPENDING IN NATIONAL BUDGETS, 2011 (%)

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

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Healthcareisalsofinancedbytheprivatesectorandreligiousentities.Owingtolowsalariesinthepublicsector,theprivatesectorhasbenefitedfromhumanresourcesmovingfromtheothersector(and,asseen,some of these personnel use public infrastructurewhen practising privately). These practices,which can increase the costs of health care, mayreduce the credibility of formal health in favour of traditionalpractitioners.

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

TheswiftadvanceoftheEBOLAepidemicisexplainednotonlybystrugglinghealthsystemsbutalsobythefailureofothersectoralpolicies.

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.Suchdensityallowedthevirustodisseminatefastinternationally: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.

INEFFICIENT

A principal components analysis was conductedbasedonWHOdata. It covers36Africancountriesaccording to the availability of data on healthindicators, covering the period 2006–2013. Fourmajorfeaturesemergefromtheanalysis:

• Financial resources allocated to health, mainlyfromtheState,arespentonhospitalequipmentsratherthanhumanresources;

• Despite the emergence of a more dynamicprivatesectorandthepriorityaccordedtoit,thequalityof services in thepublic sector remainsbetter;

• Thesocialsecuritysystemisasimportantasthelevelofhealthexpenditurepercapita;and

• Good-quality health services require not onlygood hospital equipment but also adequatehumanresources.

The analysis shows the importance of humanresourcesintheefficiencyofthehealthsystem.Forinstance,althoughLiberiahasmobilizedsubstantialfinancialresourcesforitshealthsystem,weakhumanresources proved to be its Achilles heel, unlikeNigeria, Egypt, Côte d’Ivoire and Senegal, whichhavearelativelyhighnumberofdoctorsper10,000inhabitants. Liberia’s total expenditure on healthis equivalent to 15.6%of itsGDP,with a ratioof 8bedsper10,000inhabitants.OtherAfricancountriesspendlessthan7%oftheirGDP,withanaverageof5.5bedsper10,000inhabitants,buthaveagreaternumberofdoctorsthanLiberia.

41


InSierraLeone,thehealthsystemisprimarilybasedon the private sector, which accounts for around83.5% of the total expenditure. This is in contrastto Mali, Benin, Djibouti, Eritrea, Gambia, Lesotho,Malawi, Mauritania, the Democratic Republic ofthe Congo, Rwanda, Togo and Zambia, where thecontributionoftheprivatesectorisestimatedtobebetween22.5%(minimum)and56.2%(maximum).

InGuinea,themainfeatureofthehealthsystemisthe importanceofsocialsecuritybutwithvery lowhealth expenditure per capita. Indeed Guinea, likeGhana,Guinea-Bissau,Kenya,Lesotho,Mozambique,Niger and Togo, spends on average 13.4% of itspublic health expenditure on social security, whiletotal health expenditure per capita is on average$35. At the opposite end of the scale, Nigeria,EquatorialGuineaandNamibiaspendonly0.6%ofpublic health budgets on social security but havehigherhealthexpenditurespercapita(rangingfrom $85to$1,051).

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It is important to knowwhat the world is sayingabouttheEBOLAoutbreak—its“perceptions.”Arethese opinions, expressed at different times and

places,optimisticorpessimistic?

Tofindout,“sentimentanalysis”wasused.Thisisadataminingtechniquethathasreceivedrecognition,particularlyafterPangandLee’s (2008)paper.Alsocalled “opinionmining”, this uses natural-languageprocessingtechniquestodeterminetheattitudeofaspeakertowardsatopicviamethodssuchasdetectionof 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 andWeiss, 2004), which canautomaticallyfindrecurrentphrasesinalistoftextsandclassifythetextsbytopicsbasedonsuchphrases.

SENTIMENT ANALYSISBasedon2,502newsarticlespublished inaffectedcountriesbetweenMarch2014andNovember2014and729newsarticlespublishedinvariouscountriesaroundtheworld,asentimentscorewascomputedusing the R text mining package and R sentimentanalysisplug-in.

Apreliminaryanalysisofawiderangeofinformationincludingnewsitems,reportsandstudiesabouttheoutbreak illustrates general sentiment in differentpartsoftheworld(seefigure12).AhighscoremeansthatpeoplearegloballymorepositivewhentalkingaboutEBOLAandalowopinionscoretheopposite.Theopinionscore iscomputed fromthe frequencyof positive and negative words using text mining(Meyer,HornikandFeinerer,2008)intheRstatisticalpackage(RDevelopmentCoreTeam,2012).Thegraphalso shows scores of economic, social andmedicaltopics computed using a similarmethodology. Thescoreshavebeennormalizedsothatthesumofthescores 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-affectedAfrican 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 (see box 6). Communication about thediseaseisthereforeparticularlyimportant.

7. PERCEPTIONS ANALYSIS

43


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

Sentiment scores

Africa Latin America

Asia Oceania North America

Europe

25

2015

105

0

Economic topic scores25

2015

105

0

Medical topic scores25

2015

105

0

Social topic scores

Africa Latin America


Europe Africa Latin America


Europe

FIGURE 12. SENTIMENT SCORES AND SCORES OF OTHER TOPICS IN ARTICLES ABOUT EBOLA —PUBLISHED BETWEEN MARCH 2014 AND 15 NOVEMBER 2014—

Source: ECA computations based on sample of articles.

Sentimentintheaffectedandnon-affectedcountrieshas followed similar trends (see figure 13), butinternational sentiment has always been morepessimistic (and it went down more sharply thanits EBOLA-country counterpart in September 2014,when the first case was diagnosed in a majorWesterncountry).Itmeansthatthereisunnecessarypessimism in non-affected countries. But the twosentimentsareconverging,whichsuggeststhatthepessimism is dissipating as theworld learns to livewiththeepidemic.

RECURRENT TOPICSTheperceptionofthecrisiscanalsobeillustratedbya“worldcloud”(seefigure14).Thehighfrequencyof words like “said” shows that people aremostlyreportingwhat they heard from others. The cloudalso shows that people tend to focus on healthaspects,ratherthaneconomicorsocialfactors.

Based on the same methodology as for thesentiment analysis, scores have been computed,instead of using a list ofwords expressing positiveornegativesentiments,onsetsofwordsexpressingeconomic, medical and social concerns about theEBOLA. Figure 15 illustrates the differences in thepreoccupationsexpressedinthearticlesdepending

44


BOX 6: BRUSSELS AIRLINES SERVING THE THREE COUNTRIES

Brussels Airlines is still flying to Conakry, Monrovia and Freetown. Its twice-weekly flight from Monrovia to Brussels—now the only air link from the city to Europe—is a real humanitarian air bridge. While serving the affected countries and the sub region, the airline has taken the threat of EBOLA seriously and maintained a continuous risk assessment and communication with organizations tackling the outbreak, including Belgium’s own Ministry of Health and Médecins Sans Frontières (Doctors without Borders). The airline also works closely with local governments in the three countries on strict precautionary measures.

As of 4 November, Brussels Airlines had temporarily suspended the reservations of 77 “suspicious” passengers trying to fly from the three countries but all 77 passengers were later allowed to take their seats as none had contracted EBOLA, but had been infected with more common, but less lethal, diseases such as malaria.

Brussels Airlines relies on its crew volunteering to operate the flights, and to date has always found enough of them to maintain a full schedule. Recently under pressure from staff concerned over safety, it has not envisaged cancelling flights but adjusted its schedule to avoid staff members spending the night in affected areas. Brussels Airlines has redirected the crews which had to staying near Monrovia, for example, to hotels in other West African countries, such as Gambia, Senegal or Côte d’Ivoire, leading to a technical stopover and adding an hour to its flight back to Brussels.

Such decisions have set an example not only of humanitarian responsibility but also a good practice for corporate social responsibility, especially against the backdrop of a complex, humanitarian emergency.

Source: ECA

0

5

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20

25

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35

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


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onwhethertheywerewrittenbypeoplelivingintheEBOLA-affected countries (“local news”) or peoplelivingoutsidethem(“internationalnews”).

As EBOLA is first a medical issue, medical topicsdominate, in local and international news;international news shows more focus on medicalaspects thannationalnews.The scoresonmedicaltopics are high at the beginning of the outbreak,because at that time most news articles includeda long description of the disease, its history, itshigh lethality and propagation mechanisms. Forexample, a security message released in March2014by theUSembassy inConakryconfirmedthepresenceof theEbolavirus in theForestRegionofGuinea. Themessage continuedwith a descriptionof the symptoms of the disease, indications ofmortalityratesandthewaythediseasespreads,and

recommendations toavoid contactwith individualsshowingsymptomsuntilfurtherinformationbecameavailable.17

Inthesamemonth,thefirstconcernsaboutthevirusgetting to theWest were expressed with the caseof a doctorwhowent back home afterworking inEBOLA-affectedregionsandwasshowingsymptoms (RTNews,2014).

Medical concerns showed slight decrease in May,September and November, but the scores were

17 “Security Message for U.S. Citizens: Ebola Hemorrhagic Fe-ver”, US Embassy, Conakry, http://searchabout.wc.lt/look/Conakry_Guinea_Ebola/Security_Message_For_U_S_Citi-zens_Ebola_Hemorrhagic__/aHR0cDovL2NvbmFrcnkudX-NlbWJhc3N5Lmdvdi9lYm9sYWhlbW9ycmhhZ2ljZmZ2ZXI-uaHRtbA==_blog.

FIGURE 14. WORLD CLOUD OF NEWS ON EBOLA


GOVERNMENTCARE

QUARANTINEISOLATION

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consistentlyhigh. It isaround June that thephrase“out of control” started to be used consistently(MSF Canada, 2014). This marks a period whenthe medical concerns started rising again in bothlocal and international news. In July 2014 the firstcaseof EBOLAwas confirmed inNigeria, validatingthe declaration and increasing international alarm.However, the Nigerian case was well handled,proving to the international community that itwasindeed possible to control the spread of the virusinacountry ifadequatemeasureswere taken (seebox1).InAugust2014acasewasreportedinSenegal,whichwasalsowellhandledusingcontainmentandtreatmentmeasures.

These two cases probably explain the decrease inthe concerns in international news for September,October andNovember, even thoughonly thefirsttrueEBOLAcaseintheUS,confirmedinSeptember,really caught the attention of Western citizens. InOctober2014,anarticlewaspublishedinaRwandan

newspaper entitled “What’s WrongWith How theWestTalkAboutEbola?”(AllAfrica,2014).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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FIGURE 15. SCORES OF ECONOMIC, SOCIAL AND MEDICAL TOPICS IN THE SAMPLE OF ARTICLES

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Local news International news

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The socioeconomic and intangible impactsof EBOLA differ by country, by segment ofsociety and by economic sector. Responses

should, ideally, be tailored, but as the crisis is stillevolvingandgiventhescarcityofreliabledata,suchcustomized recommendations are infeasible. Thisreportthereforepresentsitspolicyrecommendationsusing broad brushstrokes under the following fourheadings.

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

Detailed stock-taking should identify the actors in the three countries, to establish what the actors are doing, howtheyaredoingitandtheirinterventions’impact.Thisneedstobeprecededbyawell-structuredanddetailedsocioeconomicneedsassessmentoftheaffectedcountriestoestablishtheirshort-,medium-andlong-termpriorityneeds,whichwillthenserveasaguide for interventionbyvariousstakeholders.Thesetwoprocessesaimatcoordination,toensurethat interventions are structured around priorityneedsofaffectedcommunities.Thisstepisneededbecausetheoutbreakhasattractedmultipleactors,particularly to the three affected countries. As inother crises, this presents coordination challengeswhich,unlessmanagedwell,couldaggravateratherthanalleviateEBOLAimpacts.

Strategies are needed to collect and disseminate reliable data. The actual epidemiological scale ofEBOLA cannot be measured with precision, nor

the 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.Thereisanacuteshortageofreliabledataonsocioeconomicsectorsinthethreecountries,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 socioeconomicimpacts.Continuousdatacollectionisrequired,particularlyinensuringthenumberofreported,confirmedandprobablecases,alongwithcloseattention to compiling EBOLA-relatedmortalityfor a correct understandingof the scaleof theproblem.Inaddition,household-andindividual-surveys need to continue for better policyinterventionsbasedonevidencefromthefield.Analytical studies on household and individualwelfare assessments/challenges in relation toEBOLA are best tackled only if survey data areavailable.

8. POLICY RECOMMENDATIONS

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• 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 EBOLA 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. Similar measuresshouldbetakeninnon-affectedAfricancountrieswith weak statistical and civil registrationsystems.

The drivers of EBOLA should be isolated from other diseases to avoid prescribing solutions to the wrong problems.StatisticalmodellingusingarangeofscenarioscanascertainthebeforeandaftereffectsofEBOLAinthethreecountries.Relatedtothisistheneed to bolster the resilience of these countries’healthsystems,forEBOLAandnon-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 matchcurrentEBOLA-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 EBOLA. Based on existing institutional frameworkssuch as public––private partnerships, the AfricaChief Executive Officer Forum and philanthropicbodies(e.g.,theMoIbrahimFoundation),theprivatesectorandwealthyAfricanindividualcitizensshouldcontinuetoleverresources,astheydidinNovember2014 when representatives of the African privatesector,undertheaegisoftheAfricanUnion,gatheredin Ethiopia as part of the international effort tomobilizeresourceswithinAfricaandtodiscusshowtoredressthethreecountries’economicdecline.AsofNovember2014,theprivatesector inAfricahadpledgedfinancialresourcestotheAfricanUnion–ledPrivateSectorEbolaFund18of$32.6million.

18 MTN Group and (AfDB ($10 million each), The);Dangote Group and Trust ($3 million); Econet Wireless ($2.5 million); Motsepe Family Trust, Stenbeck Family, Afrexim Bank, Coca Cola Eurasia and Africa, Vitol Group of Companies and Vivo Energy ($1 million); Quality Group of Tanzania, Old Mutu-al Group, Nedbank Group USD),and Barclays Africa Group Limited ($500,000); and United Bank for Africa ($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 EBOLA to households in rural areas.Beyondoffering jobstothousands,thishasthepotentialtohelppreventoutbreaksofinfectiousdiseasesinthefuture.

ECONOMICWest Africa and the broader African continent should not panic over declines in GDP growth owing to EBOLA.Whilethethreeaffectedcountrieswill suffer steep GDP losses, the effects on bothWestAfricaandthecontinentwillbeminimal:-0.19percentage points in 2014 and -0.15 percentagepoints, respectively, in 2015; and -0.05 percentagepoints in 2014 and -0.04 percentage points,respectively,in2015.

To boost the economy and counteract the damaging alarm-driven indirect effects, the best government measure is to build confidence. Economic recovery in theaffected countrieswill startonce theEBOLAoutbreakiscontainedanditsfulleconomicimpactsaredetermined.Aidalone isnotenough.Providingconsistent and regular—and when true, upbeat—messagesaboutEBOLAisextremelyhelpful.

Lessons from successful past recovery programmes should be levered in crafting workable responses to the EBOLA epidemic.ForLiberiaandSierraLeonein 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,fromEBOLA.ItisalsorealisticthattheywillbeonthesamerobustgrowthtrajectoryafterEBOLAiscontained.

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

who lostoneparentandwomengivingcareathuge risk to themselves. Other social groupshave also lost employment owing to EBOLAand its effects on businesses and production.Support should therefore provide robust socialprotection to facilitate the socioeconomicrecovery of deeply affected communitieswhose economic livelihood is threatened. Theinternational aid effort and domestic resourcemobilizationwithincountriescanbeearmarkedtosuchinterventions.

• Countries not directly affected need to make budgetary reallocation for better preparedness and containment against an EBOLA outbreak. This is not easy when most of them facecompetingdemandstotheirstretchedbudgets,butitisbettertoactpreventively.Internationalsupport helps fill some of the spending gapscreatedbythecrisis.

• 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. Even with the crisis and lowertrade, large financial inflows are supporting thecurrencies (e.g., the US $450 million from theInternationalFinanceCorporation—seefigure6).

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Modest depreciation can also promote exportcompetitiveness.

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 EBOLA-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 reinforceborderhealthchecks insteadofclosingallborders,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 tostrengthenresilienceandresponsecapacityagainstfuture similar shocks, which may require supportfrominstitutionslikeECA.

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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: EBOLA is not necessarily a socioeconomic crisis in itself—it only becomes one when health systems are unable to contain it. ThecapacityofcountrieslikeNigeriaandSenegal 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. Strongsystemsarecrucialforreducingrisksfromtheepidemicandtodealwithitwhenpeopleareexposed.Underpinned bywell-trained health personnel andappropriateinfrastructure,particularlyinruralareas,suchsystemsarehallmarksofaneffectiveresponsetothecurrentoutbreak,andfutureoutbreaksofanydisease.

Stakeholders should ensure that EBOLA is not tackled in isolation from other killer diseases such as HIV/AIDS, malaria, pneumonia and diarrhoea, especially among children and women. Health-systems strengthening should not focus narrowlyon preventing another EBOLA epidemic, but on

enhancing sub-national, national and regionalcapacitiesinpublichealth.Verticalfunds,suchastheGlobalFundtoFightAIDS,TuberculosisandMalaria,havehelpedreducetheprevalenceofthesediseases,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 EBOLA. 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);and ensuring that policies and programmesestablishcommensurateresponsestominimizethe

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social impact of an outbreak. The study suggests thefollowing:

• For the directly affected, policies should ensure a household rather than individual approach. OnceamemberofafamilyislosttoEBOLA,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 EBOLAneeds 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 EBOLA 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 EBOLA 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 EBOLA outbreak has had a disproportionate social impact on women, mainly because of their direct role in looking after the sick. EBOLA hasdisempowered women and this must be rectifiedby,forexample,puttingthematthecentreofpost-crisis recovery plans. The study recommends thatGovernments:

• 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 includebuilding women’s abilities to identify and actoneconomic,socialandpoliticalopportunities;challengingsocioculturalnormsthatplacethemathigherriskofinfectionandthatimpedetheircapacity to benefit from economic growth;and using gender-sensitive awareness-raisingmechanisms for preventing and responding to)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” have been revived. Although the outbreakhasbeenlargelyconcentratedinthreeWestAfricancountries, some media (and Governments) lumpAfrica together asoneEBOLA-infested region,withthepotentialtoeraseAfrica’srecentsocioeconomicprogress.

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 much threatfrom EBOLA itself, but more from misinformationand ensuing misperceptions. And so the studyrecommendsthefollowing:

• Pan-African institutions, particularly AUC, AfDB and ECA, need to make more effort to “set the record straight” on EBOLA.This requires themtopresentmoreaccuratedataand informationonthediseaseanditsimpact.

• These three institutions need to develop a media and communications strategy to put out an objective but constructive narrative on EBOLA. Mediapresenceofthethreeinstitutions’leaders should be spotlighted, including jointappearances in high-profile African and non-Africanmedia.Sucheffortsshouldbereplicatedsubregionally by heads of regional economic

communitiesandotherAfricaninstitutions.

• African media and communication houses—print and audio-visual—should be encouraged to provide accurate and fact-based accounts on EBOLA. Theyshouldcoverprogressmadetoreverseitsspreadandimpact.

• AUC, AfDB, ECA and other African bodies should consider a joint, more detailed analysis of the socioeconomic, political and cultural impacts of EBOLA when the crisis is contained. Suchastudy,basedonprimarydatageneratedbyAfricaninstitutions,willenablethecontinentto tell the EBOLA story in an objective andnuanced manner, putting Africa’s interestsfirst and steering clear of the distortions andmisperceptionsthathavegrownuparoundthedisease.

• 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 EBOLA outbreak (Ext/EX.CL/Dec.1(XVI)).This relatesespecially to theneedtoactinsolidaritywithaffectedcountries,including breaking the three countries’stigmatization and isolation, and strengtheningtheirresilience(andthatofthecontinentmorebroadly).

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The socioeconomic impacts of EBOLA are feltmainly by key economic sectors in Guinea,Liberia,andSierraLeoneandtheirneighbours.

Thekeysectorsdiscussedinthisappendix(ingreatercountry-leveldetailthaninthemaintext)aretradeandmining,agricultureandservices.Thenextfigureshowssomeoftheinter-sectoralrelationships.

TRADE AND MININGThissection looksat the impactofEBOLAontradeactivitiesof the three countries. It exploresaswellpossible effects on services and mining given theinterconnections, although the full extent of theimpactofEBOLAontradecannotbefullyassesseduntilthecrisisstabilizes.

Evidencesuggeststhattradehasbeenseverelyhitinall threecountries.Thereduction inexportsduringthesecondhalfof2014forLiberiawasestimatedat16.5%,whiletheannualizedgrowthrateofexportsandimportsforGuineaforthesameperiodstoodat-2.2%and-4.6%respectively.InLiberiainternaltradeinvolvingcommercialtrucksdeclineddramaticallyby80%,whiletherehasbeena27%dropinfuelsalessinceMay2014inSierraLeone.Agriculturalexportsalso fell, including commodities such as rubber(-20%inLiberia),cocoa(-24%),coffee(-58%),palmoil (-75%)andrice(-10%) inGuinea. Informalcrossbordertradingactivitieswerealsoadverselyaffectedtothetuneof50%inGuineaand70%inLiberia.19

19 These figures are quoted from IMF data (IMF Country Re-ports for the three countries – Guinea IMF Country Report No. 14/244 (August 2014); Liberia IMF Country Report No. 14/299 (September 2014); and Sierra Leone IMF Country Re-port No. 14/300 (September 2014)), and the World Bank’s

In addition, many businesses have had to close.Even those that have managed to stay open haveseen steep drops in activity owing to reducedworking hours and lower staff numbers. Scarcityof commodities, food in particular, has pushed upinflation,reducingcompetitiveness,hurtingexportsand cutting the surplus available for export.Manyofficialbordercrossingsbetweenthethreecountrieshave closed, disrupting intra-country trade, drivingdomestic prices up, limiting the supply of goodsand hurting vendors’ incomes. These closures areexpected to worsen food insecurity in the threecountriesgiventhehighlevelofcross-bordertradeinagriculturalcommodities,includingstaplessuchasriceandpalmoil.Transportactivityhasfallenowingto tight restrictions on movement and a reducedlabour force, thereby raising the cost of movingcommoditiesandreducingtheavailabilityofgoods.Depreciating domestic currencies (stemming frommounting demand for foreign currency) have hadmixed impacts on trade, as although they boostexports,atthesametimetheyhurtimports.

The contributionof themining sector to the threecountries’ economies is not negligible. As of 2014,the contribution of this sector is estimated to be15%, 14% and 20% in Guinea, Liberia and SierraLeonerespectively.Theminingsectorisasignificantcontributor to exports. For instance, the share ofmining as a proportion of Liberia’s total exports isestimated to be 56% in 2014. However, asminingcompanies have ceasedmany of their activities inthesub region,miningexportshavedeclinedsince

Economic Impact of 2014 Ebola Epidemic: Short- and Medi-um-Term Estimates for West Africa (2 December 2014).

APPENDIX I. SECTORAL ANALYSIS OF ECONOMIC AND SOCIAL IMPACTS

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the outbreak began. In Sierra Leone, for example,in thesecondhalfof2014, thecontributionof thenon-ironore sub-sector tooverallGDPdeclinedby1% and exports of diamonds fell by $29.1 million(IMFcountryreportsandWorldBank,2014),whileinLiberiaminingexportsdroppedby30%in2014.

GUINEA

Agricultural exports are declining. EBOLA has hithard rural areas including Gueckédou, Macenta,Nzérékoré, Boffa and Télémélé—the food basketnot only for Guinea but for neighbouring regionstoo.Agriculturalproductionintheseareashasbeenstronglyunderminedbymarket closures,deathsoflocal people, and the departure of expatriates andlocalworkers. Keyexports suchas cocoaandpalmoilhavetumbledowingtoreducedproduction.Datasuggestproductiondecreasesforthemajornationalexport commodities of coffee, palmoil and rice of50%,75%and10%,respectively.Potatooutputhasalsoshrunk,hittingexportstoSenegal,traditionallythedestinationofhalfofGuinea’spotatoproduction.Because exports drawmainly on surpluses as wellas existing stocks, the drop in exports of thesecommoditiesisprobablyevenhigherthanthefallinoutput.

Asevidenceofthesharpdropinagriculturalexports,traders in southern Senegal claim a 50% drop inmarket activities since early August owing to theborder closure with Guinea. They also report thatfruitandpalmoilfromGuineaarenolongeravailableinbordermarkets.Further,theclosureof16weeklymarketsinsouthernSenegal(alongtheborderwithGuinea) is expected to further disrupt trading andslow regional economic activity, affecting not onlyGuinea and Senegal, but alsoGambia andGuinea-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,amajormining

company,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(IMF,2014c).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.

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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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Thehard-hitminingandagriculturalsectorswilllikelysee far lower export receipt sowing to the drop ininvestment.Fallsinminingandagriculturalexportswilllikelywidenthemerchandisetradedeficitandreducethe revenue of the international trade tax in 2014(whichcontributesaround18%oftotalrevenue).

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.

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 on

hold. 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%previously.ThenumberofweeklycommercialflightstoLiberiahasdroppedfrom27beforeAugusttoonlysixatthestartofSeptember.

Farmershaveabandonedtheirfarmsandharvest,inmostcasesaffectingagriculturalexports.Accordingto field observations by FAO in Lofa County—once Liberia’s bread basket—EBOLA has heavilyaffected income, livelihoods and agriculture owingto enforced termination of farming activities. Theobservationsevenindicatethatsavingsaccumulatedoverseveralyearsarefullyerodedforlackofincome-generating opportunities. This has directly affectedfoodsecurityandthelocaleconomy,asthesesavingswere essential for micro trade, food procurement,agricultural input purchases, agro-processing andsmallbusiness.

AccordingtoarecentreportbyMercyCorps(2014),EBOLAcontainmentmeasuresareevenaggravatingfood 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,inadditiontotheclosureofweekly

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markets.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 supplyof goodshasbeen restrainedby transport challenges within the transportationservices. Given restrictions on movements, withmultiplecheckpointstocontainthespreadofEBOLA,trucks may now take two to three days to travelbetweenNimbaandMonrovia; itused to takeoneday.Thisiscausinglossofperishablegoodsowingtospoilage.Thenumberofcommercialtrucksoperatingatthemomenthastumbled,byperhaps80%.

Estimatesofimpactsonagriculturalproduction,andthus exports, caused by disruptions to movementof the labour force, difficulties inmoving productsto ports and closure of cross-border markets, donot exist. However, IMF has recently provided areductionestimateofaround20%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 thetwodominantfirmsshuttingdown

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

According to IMF, the mining sector is projectedtocontractby1.3%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(IMF,2014b).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 pricesfor 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 around 27%since May 2014. Agricultural production has beenmassivelydisrupted,particularly inthetwoeasterndistricts—Kailahun and Kenema—where EBOLAemerged, 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-

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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.Thericepriceisreportedtohaveincreasedbyabout30%intheEBOLA-affectedareas.

Mining,whichaccountsfor17–20%ofthenationaleconomy, is dominated by the iron-ore sector thatcontributesaround16%ofGDP.(Miningoperationsalsoincluderetile,limonite,bauxiteanddiamonds.)GovernmentreportsindicatelittleeffectofEBOLAonminingproduction,andthemainminingcompaniesindicate businesses as intending to maintain theirplannedproductionlevels.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 bymajor airlines serving the region havemadeitdifficultfordiamondcompaniestoshiptheirexportsabroad.Thetaxrevenuedeclinefor2014toSierraLeoneintheformofreducedminingroyaltiesandlicencesisprojectedtobe$15.1millionandthatforexportsofdiamondsandofironoreforthesameperiod,$29.1million and $291.1million. In August2014 the EBOLA-related revenue shortfall wasestimatedat1%ofnon-ironoreGDPinthesecondhalfof2014andwillincreaseto1.6%in2015(IMF,2014a).

Services, which account for 30% of the economy,havebeenhardhitbyEBOLA.Thenumberofweeklycommercialflightshasdescendedfrom31tosixwith

a severe dampening effect on the hospitality sub-sector. Reports indicate a steep drop in the hoteloccupancyrateto13%,fromtheyear-roundaverage

of70%.

POTENTIAL IMPACT OF A SUSTAINED REDUCTION IN TRADE

Sustained reduced trade could potentially affectlivelihoods in the three countries. Some of thepotentialimpactsincludeworseningfoodsecurity,20

rising inflation and a widening budget deficit.Reserves of rice, the major staple in all threecountries, are worryingly depleted. Impaired tradeof rice—particularly cross-border—could well leadto food crises. Reduced imports and domesticproduction would result in a limited supply of abroad array of commodities, pushing up prices.Reducedtradeandmarketactivitieswouldhittrade-related commercial operations, further worseningunemployment, especially as the informal sectoris the major source of jobs. The budget deficit isexpectedtowidenasaresultofprojecteddeclinesinminingandagriculturalexportsandroyaltyrevenues,owingtothehaltinminingproduction.Evenifmixedimpacts are expected for the merchandise tradebalance,economicgrowthwilldecelerate.

Overall, the impacts of EBOLA are expected tobe considerable in the three countries, owing tothe compounded effect of three region-specificfactors. Much of the trade in the three countriesis still conducted through personal meetings andindividuals approaching markets and purchasingproducts,thenreturningbackhomeandtradingtheirpurchases.Quarantine and restrictions on people’smovementsareexpectedtohittradeharshly,withinandacrossEBOLA-affectedcountries.Thus,asalargepart of the recent growth in these three countriesis driven by trade across borders, which are now

20 About 200,000 people are experiencing limited food access as revealed recently by the World Food Programme. The analysis indicates that if the disease continues to spread at the average rate observed since mid-September, around 750,000 people could lose access to affordable food by March 2015. This would be mainly from disruption to the food transport system, as well as from closed cross-border trade.

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closed, the economic impact of EBOLA is probablygreaterthanexpertsmaythink.Theimpactoffallingtrade is probably underestimated as official tradestatistics do not capture informal trade, includingcross-bordertrade,whichisestimatedtocontribute20–72% of GDP inWest African countries (Sy andCopley, 2014). GDP growth in the three countriesis fuelled largely by exports of agriculture, miningand oil. Thus a blocked trade sectorwill stall theireconomicgrowth.Althoughmobilityrestrictionsarevitaltobreakthechainoftransmission,theyshouldbeappliedprudently—otherwisetheymaydomoreharm than good, for instance by blocking trade inessentialgoods,suchasfoodandmedicine.

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

Foodpricesareontherisewhilelabourshortagesareputtingtheupcomingharvestseasonatseriousrisk(FAO,2014a).Theoutbreakisreducinghouseholds’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.

Border closures adopted by some neighbouringcountriesmayaffectfoodmarketsupplyasallthreecountriesarenetcerealimportersandcross-bordertradeisimportantforfood.Theseclosures,alongsideimposition of quarantine zones and restrictions onpeople’s movements, have seriously curtailed themovementandmarketingoffood,promptingpanic

buying,foodshortagesandsteepfoodpricehikesforsomecommodities,especiallyinurbancentres(FAO,2014b).

TheagriculturalsectorhasbeenhithardbyEBOLAin all the three countries. In Liberia, agricultureaccountsfornearly25%ofGDP,andemploysalmost50% of the workforce. Falling workforce mobilityand rising migration of people to safe zones, andforeign companies postponing investments owingto theevacuationofexpatriates,havehurtexportsanddomesticagriculture.Asaresult,theWorldBankreviseditsgrowthexpectationsfrom5.9%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 forabouthalfoftheeconomy.AccordingtotheMinistryofAgriculture, 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 theWorld Bank, the three countries’budgetdeficitsareexpectedtoincreaseby1.8%ofGDP in Sierra Leone and Guinea and by 4.7% inLiberia.Contractionof themajor economic sectorscoupledwith a sharp decrease in exportswill hurtGDP growth. The World Bank has, for example,revisedthe2014GDPgrowthprojectionfrom4.5%to2.4%

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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-producingareaswerecoincidentallythehardest-hitareas,especiallyinSierraLeoneandLiberia;lackoftransportforfood-surplusareastoshipoutsupply;and innutritionandhealth,unavailabilityofhealthclinics to diagnose diseases unrelated to nutritionproblems caused by EBOLA, 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.

Riceproductiondeclinedby8.5% inbadly affectedregions such as N’Zerekore. Cereal importrequirements could not be satisfied due to thedecline in export earnings. More people than notwillbefoodinsecurebyMarch2015,andtheEbolaoutbreakhascontributedsignificantlytothat(FAO/WFP,2014a).

WiththeEBOLAshock,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. EBOLAhas therefore entered an alreadyshakeneconomy.

Themaineconomic impactsofEBOLA inGuineatodatehavebeenonagricultureandservices.Becauseof the impact of EBOLA on farm activities, theWorldBankhasprojectedGDPgrowth for2014 todecrease from4.5% to2.4%.Projectedagriculturalgrowth for 2014 has also been cut from 5.7% to3.3%. Agriculture in EBOLA-affected areas hasbeenhitbyanexodusofpeoplefromthesezones,affectingkeyexportcommoditiessuchascocoaandpalm oil. Coffee production has also fallen by half,from5,736tonsto2,671tonsbetweenthefirstsixmonths of 2013 and the first six months of 2014(WorldBank,2014a);cocoaproductionhasdeclinedbya third (from3,511 tons to2,296 tonsover thesameperiod).Palmoilproductionhasfallenby75%.In someareasof thecountry, cropshavenotbeen

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harvestedbecauseofthelackoflabourers.Inothers,excesssupplyofproducewithoutavailabletransporthas caused losses to farmers. The situation is direandcompoundedsometimesbypanicandfear.

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 agricultureexcept for limited commodity trading that haspersisted over the years. Agriculture contributes42% of GDP. Rice and cassava, the main crops,contribute 22% and 23% of agricultural GDP; treecrops,e.g. rubber, coffeeandcocoa,makeup34%ofagriculturalGDP;livestock,14%;andfisheries,3%.Forestry contributes around 19% of national GDP(MinistryofAgricultureofLiberia,2013).

As in theotherhardhitcountries, foodproductionin Liberia declined, and the EBOLA outbreakexacerbatedthesituation.In2014aggregatenationalfood production was about 12% lower than in2013.InMarch2015,outofthetotalfood-insecurepopulation,40%ofthemwillbefoodinsecuremainlyduetoEBOLA(FAO/WFP,2014b).

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(MinistryofAgricultureofLiberia,2013).

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.TheFAOMonrovialocalofficereportedthatEBOLAeffectspreventedwomenfarmers’associationsfromrepayingtheirloans,especiallyinFoyadistrict(LofaCounty)wherethefirstcaseofEBOLAwasdiagnosedinthecountry,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 recentEBOLAcases inKakata in thecentreof the rubber-productionregioncouldslowproductiondrastically.Timberoutput,whichhasdroppedsince2013owingto governance issues and transport bottlenecks, isbased in the largely unaffected southeast and hasavoidedanymajorimpactssofar.

Governmentreportshaveindicatedthatdistributionof imported food fromMonrovia’s seaport to ruralmarketshasbeencutsharply.Astheportisthekeysource of rice supplies for rural areas, this createdshortagesthatcontributedtofoodpricerisesaroundthe country. A rapid market assessment by FAO(FAO, 2014a) indicated that prices of some fooditemslikecassavahadjumpedby150%inMonrovia.

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The increasewas inflatedbytransportcosts,whichthesedaysmakeeverythingmoreexpensive.Liberiaimportsabout66%ofitsfood,andsoitsfoodsupplyisexpectedtoworsenbyyear-end.

GDPgrowthhasaveragedover8%since2011,puttingLiberiaamongAfrica’sfast-growingnations.Butithasalreadybeenforecasttoslowto5.9%in2014,givenslower growth in iron-oreproduction,weaktimberandrubberexportgrowth,andthegradualwindingdownoftheUnitedNationsforce(AfDB,2014a).

SIERRA LEONE

The Government, through the Ministry of HealthandSanitation,declaredanoutbreakofEBOLAafterlaboratory 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.OneofthefirstmeasuresbytheGovernmentwastorestrictmovements,whichsuddenlytookdownhouseholdincome.Theclosureof markets, internal travel restrictions and fear ofinfection curtailed food trade and caused supplyshortages. Although price data have been hard tocomebyorarenotavailable,reportshavesuggestedfood price spikes. The country’s dependency onimportedricehasbeendecreasing,butitremainsanetimporter,withacerealimportdependencyratioofabout18%.

In 2014, the national aggregate level of foodproduction declined by 5% compared to 2013.However, this aggregate figure hides considerablenational disparities. For instance, milled riceproductiondeclinedby8%nationally,butincertainprovincesthedeclinewasashighas17%.ByMarch2015,46%ofindividualswhoarefoodinsecurewillbesolelyduetoEBOLA(FAO/WFP,2014c).

The depreciation of the currency, which hasaccelerated since June, is expected to add

inflationary 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 and8agriculturalcommoditytraders(FAO,2014a).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%andforfishbyover40%, for example—and reducedpriceswherelocalsupplyisexcesstodemand.

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

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

IMPACT ON AGRICULTURE IN THE THREE COUNTRIES

The impact has been tremendous. The threecountries are all net cereal importers, with Liberiathemostreliantonexternalsupplies.Theclosureofsomebordercrossingsandisolationofborderareas

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

SERVICESTransportservicedisruptionscausedbyair,seaandland travel bans were ineffective ways to containthe outbreak, as shown by results based on theGlobal Epidemic and Mobility Model (Poletto andothers,2014). Instead,suchbanslimitedthespeedof transporting essential medical supplies andpersonnel, and severely disrupted livelihoods. InLiberia, thenumberof commercial flights fell from27perweekinAugust2014tojust6perweekfromSeptember 2014. The situation is similar in SierraLeone,whichexperiencedadeclinefrom31flightsto6fightsperweek.MeanwhileinGuineaairporttraffichasfallenby60%sinceMarch2014,inadditiontoadeclineofcontainerservicesby32%andofshipsinportsby9.4%(WorldBank,2014).

Many airlines stopped flying to the affectedcountries.Oneofthedirect impactsofEBOLAistoreducetouristarrivals.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 SierraLeone,2014).

The EBOLA threat is hurting African travel andtourism in countries beyond the countries directlyaffected. A major online safari broker, SafariBookings, conducted a survey of 500 safari touroperatorsinOctober2014andfoundthathalfofthetouroperatorshadsuffered20–70%declinesintheirAfrican safari business because of EBOLA fears. “Itisaheavyblowfor the industryandthenumerouswildlife reserves that rely on its revenue”, thecompanysaid. “Touroperators reported thatmanytouristsviewAfricaasasinglecountrywhenitcomestoriskassessment.Theydon’trealizethatEastandSouthernAfrica,wheremostsafarisareconducted,arejustasfarfromtheoutbreakareaasEuropeorSouthAmerica”.AtKenyaAirways,whichdependsinpartonWestAfricantravelerstofeeditsNairobihub,salesmayslideasmuchas4%thisyearafteritpulledoutofLiberiaandSierraLeone.

There are specific impacts to countries near theaffected countries such as Gambia where manypeoplearepoorandmoreof themdependon thetourism 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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APPENDIX II - SOURCES FROM FIGURE 5Table A1. Some contributions of multilateral organizations

Partner Funding USD (million)

Amount disbursed (%)

Source as of date

European Commission (EC) + European Union Member States (EUMS).

1,200.0 40.4 http://europa.eu/newsroom/highlights/special-coverage/ebola/index_fr.htm and European Union Delegation to the African Union, Addis Ababa

15/01/2015

World Bank 518.0 41.1 http://www.worldbank.org/en/news/press-release/2014/10/30/world-bank-group-additional-100-million-new-health-workers-ebola-stricken-countries

1/9/2014

IFC/World Bank Group 450.0 - http://www.worldbank.org/en/news/press-release/2014/12/02/ebola-world-bank-report-growth-shrinking-economic-impact-guinea-liberia-sierra-leone

12/2/2014

African Development Bank 220.0 20.6 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/, AfDB: http://www.afdb.org/en/news-and-events/article/kaberuka-makes-a-call-for-individual-contributions-in-fight-against-ebola-13744/

1/9/2015

IMF 130.0 100 IMF Press release No 14/441, 26 September 2014, <http://www.imf.org/external/ np/ sec/pr/2014/pr14441.htm>

Islamic Development Bank 45.0 100 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

11/5/2014


17.2 100 http://www.unocha.org/cerf/resources/top-stories/cerf-response-ebola-outbreak7 https://docs.unocha.org/sites/dms/CERF/CERF%20Ebola%20Response%203%20Oct%202014.pdf

1/9/2015


9.0 100 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, http://news.ecowas.int/presseshow.php?nb=207&lang=en&annee=2014


1.6 100 http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16506

1/9/2015

AUC 1.0 100 http://pages.au.int/ebola/documents/fact-sheet-african-union-response-ebola-epidemic-west-africa

12/26/2014

FIFA 0.5 N/A http://www.un.org/wcm/content/site/sport/home/sport/template/news_item.jsp?cid=41937

9/29/2014


0.5 100 http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16507

1/9/2015

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Table A2. Some contributions of bilateral partners

Partner Funding in Million

USD

Commited pledges

in Million USD

Amount disboursed

(%)

Source

United States 861.41 816.41 94.77% http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16506

United Kingdom

350.00 280.00 80.00% UK embassy in Addis Ababa as of 12 January 2015

Germany 202.00 33.90 16.78% One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(Updated 2 January 2015),

Japan 143.88 47.11 32.74% One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/(Updated 2 January 2015),

France 136.58 136.58 100.00% France Embassy in Addis Ababa as of 15 January 2015China 122.50 10.27 8.38% One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-

gaps-in-ebola-response-data/(Updated 2 January 2015),Canada 101.10 51.70 51.14% One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-

gaps-in-ebola-response-data/(Updated 2 January 2015),Sweden 77.74 77.29 99.42% http://fts.unocha.org/pageloader.aspx?page=emerg-

emergencyDetails&emergID=16510Netherlands 60.07 53.91 89.74% http://fts.unocha.org/pageloader.aspx?page=emerg-

emergencyDetails&emergID=16511Norway 36.68 36.68 100.00% http://fts.unocha.org/pageloader.aspx?page=emerg-

emergencyDetails&emergID=16515Australia 36.10 15.07 41.75% One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-

gaps-in-ebola-response-data/(Updated 2 January 2015),Switzerland 34.85 34.85 100.00% http://fts.unocha.org/pageloader.aspx?page=emerg-

emergencyDetails&emergID=16516Denmark 31.70 28.10 88.64% Danish Emassy in Addis Ababa as of 15 January 2015Russian Federation

20.00 20.00 100.00% http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16518

Brazil 12.50 12.50 100.00% Joint Press statement of the Ministry of External Relations and of Health-Brazilian Contribution to the International Efforts to Combat the Ebola Outbreak

Finland 11.00 10.63 96.60% http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16520

India 10.66 8.61 80.76% http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16521

Spain 10.14 10.14 100.00% http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16522

Italy 9.73 7.66 78.73% Italy Embassy in Addis Ababa as of 12 January 2015Belgium 9.48 9.48 100.00% http://fts.unocha.org/pageloader.aspx?page=emerg-

emergencyDetails&emergID=16524Israel 8.77 8.27 94.30% http://fts.unocha.org/pageloader.aspx?page=emerg-

emergencyDetails&emergID=16525

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Table A3. Some contributions of international private sector and charity/foundations

Organization Amount pledged

($ million)

Amount disbursed

(%)

Source as of date

Bill Gates-Backed Group - GAVI

390 100 http://www.swissinfo.ch/eng/bloomberg/bill-gates-backed-group-commits--390-million-to-ebola-vaccines/41164126

12/11/2104

Paul Allen Family Foundation 100 55 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/

1/9/2015

Save the Children 70.84 N/A http://www.theguardian.com/global-development/2014/oct/09/ebola-outbreak-response-breakdown-key-funding-pledges

10/9/2014

Bill & Melinda Gates Foundation

50 55 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/

12/24/2014

King Abdallah of Saudi Arabia 35 N/A http://www.one.org/us/ebola_tracker/king-abdallah-of-saudi-arabia/

1/9/2015


25 N/A One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/

12/5/2014

Mark Zuckerberg and Priscilla Chang


12/24/2014

Silicon Valley Community Foundation


12/5/2014


20 81 One: http://www.one.org/us/shareworthy/new-one-analysis-shows-major-gaps-in-ebola-response-data/

12/5/2014

Larry Page’s Family Foundation

15 N/A http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16506

1/9/2015

IKEA Foundation 6 N/A http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

12/5/2014

William and Flora Hewlett Foundation

5 N/A http://www.theguardian.com/global-development/2014/oct/09/ebola-outbreak-response-breakdown-key-funding-pledges

10/9/2014

Médecins du Monde 4.30 N/A http://www.theguardian.com/global-development/2014/oct/09/ebola-outbreak-response-breakdown-key-funding-pledges

10/9/2014

Open Society Foundation 4 N/A http://www.theguardian.com/global-development/2014/oct/09/ebola-outbreak-response-breakdown-key-funding-pledges

12/5/2014

Bayer 3.30 N/A http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16506

1/9/2015

General Electric 2 100 http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

12/5/2014

Comic Relief 1.60 N/A http://www.theguardian.com/global-development/2014/oct/09/ebola-outbreak-response-breakdown-key-funding-pledges

10/9/2014

Volvo 1.50 100 http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

12/5/2014

ArcelorMittal Foundation 1.35 96 http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16506

1/9/2015

Bridgestone 1 N/A http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

12/5/2014


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Table A4. Contributions from some members of the African private sector

Organization Funding in Million USD

Commited pledges in

Million USD

Amount disboursed

(%)

Source as of date

MTN Group 10.00 N/A N/A http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson

9-Oct-14

Dangote 4.10 N/A N/A http://allafrica.com/stories/201411121328.html (Last updated as of November 11, 2014)

11-Nov-14

Econet Wireless 2.50 N/A N/A http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson

9-Oct-14

Afrixim Bank 1.00 N/A N/A http://www.citypress.co.za/news/ebola-new-report-gives-bad-news-good/

17-Dec-14


1.00 N/A N/A http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson


1.00 N/A N/A http://www.citypress.co.za/business/africas-super-rich-asked-step-fight-againstebola/

9-Oct-14

Stenbeck Family 1.00 N/A N/AThe Motsepe Foundation

1.00 N/A N/A http://www.themotsepefoundation.org/news_pg1.html (updated as of October 28, 2014)

28-Oct-14


1.00 N/A N/A http://allafrica.com/view/group/main/main/id/00033833.html

9-Oct-14


1.00 N/A N/A http://www.tonyelumelufoundation.org/pressreleases/tony-elumelu-foundation-donates-n100-million-towards-ebola-containment-relief-across-west-africa/

9-Oct-14

Vitol Group of Companies and Vivo Energy

1.00 N/A N/A



Nedbank Group 0.50 N/A N/A http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson

Old Mutual Group 0.50 N/A N/A http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson



Sygenta 0.35 N/A N/A http://www.peaceau.org/en/article/message-dr-nkosazana-dlamini-zuma-african-union-commission-chairperson

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Organization Funding in Million USD

Commited pledges in

Million USD

Amount disboursed

(%)

Source as of date


0.31 0.31 100% http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

1/9/2015

National Oil Company of Liberia

0.23 0.23 100% http://fts.unocha.org/pageloader.aspx?page=emerg-emergencyDetails&emergID=16506

1/9/2015

The National Oil Company of Liberia (NOCAL)


12/5/2014

AUC staff members 0.10 0.10 100% http://pages.au.int/ebola/documents/fact-sheet-african-union-response-ebola-epidemic-west-africa

9/5/2014



12/5/2014

Mercury International 0.06 0.06 100% http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

12/5/2014

Ecobank 0.05 0.05 100% http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

12/5/2014



12/5/2014

Sierra Rutile 0.02 0.02 100% http://www.uschamberfoundation.org/ebola-outbreak-corporate-aid-tracker

12/5/2014



12/5/2014

SocFin Agricultural Company


12/5/2014


72


Table A5. Some African countries’ pledges

Country Funding in Million USD

Commited pledges in

Million USD

Amount disboursed

(%)

Source

Algeria 1.0 N/A N/A Algeria Embassy in Addis Ababa as of 16 January 2015

South Africa 0.33 0.33 100% http://fts.unocha.org/pageloader.aspx?page=emerg-emergen-cyDetails&emergID=16543

Ethiopia 0.50 N/A N/A One: http://www.one.org/us/shareworthy/new-one-analysis-shows-ma-jor-gaps-in-ebola-response-data/(Updated 2 January 2015),

Gambia 0.50 N/A N/A http://allafrica.com/stories/201408280987.html, Aout 2014

Equatorial Guinea

2.00 N/A N/A http://www.guineaecuatorialpress.com/noticia.php?id=5658&lang=fr (Updated16September 2014)

Botswana 0.20 N/A N/A http://sa.au.int/en/content/press-conference-spread-ebola-virus-dis-ease-evd-west-africa(updated 11(Updated11August 2014)

Mauritania 0.40 N/A N/A http://www.guineetv1.com/le-president-mauritanien-apporte-400-000-dollars-a-la-guinee/, décembre 2014

Namibia 1.00 N/A N/A http://fts.unocha.org/pageloader.aspx?page=emerg-emergen-cyDetails&emergID=16569

Nigeria 5.00 N/A N/A http://fts.unocha.org/pageloader.aspx?page=emerg-emergen-cyDetails&emergID=16570

Kenya 1.00 N/A N/A http://fts.unocha.org/pageloader.aspx?page=emerg-emergen-cyDetails&emergID=16571

Senegal 1.00 N/A N/A http://fts.unocha.org/pageloader.aspx?page=emerg-emergen-cyDetails&emergID=16573

Cote d’Ivoire 1.00 N/A N/A http://fts.unocha.org/pageloader.aspx?page=emerg-emergen-cyDetails&emergID=16577


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CancellingtheexternaldebtofGuinea,LiberiaandSierraLeone,thethreecountrieshardesthit by the EBOLA outbreak, will give these

countriesthebreathingspacetheyneedtoaddressthe complex social and economic developmentchallengestheynowface.Inadditiontomeetingthechallenges of the EBOLAoutbreak, these countriesneedtopromotepositiveeconomicgrowth,improvepublic service delivery, meet regular debt servicepayments and plan their long-term social andeconomicdevelopment.ThesetbackinducedbytheEBOLA outbreak complicates these challenges andreinforcesthecompellingcasefordebtcancellation.Basedonavailabledata,thisappendixpresentstheexternaldebtsituationofGuinea,LiberiaandSierraLeone, makes the case for debt cancellation, andputs forward recommendationsonhow touse theresultingfreed-upfunds.

Itiscommontocallforthecancellationofdebtsofcountriesthathavebeenseverelyaffectedbysuddenshocks such as natural disasters or outbreaks ofdisease.Haiti,forexample,hadthedebtsitowedtomajorcreditorscancelledafterthe2010earthquake.Guinea, LiberiaandSierra Leonealreadyhadweakinitialconditions,structuralvulnerabilitiesandlimitedpotentialtosustaingrowthandtheEBOLAoutbreakhaspushedthemtothelimitbywideningtheirfiscaldeficits.Ifthecountrieshavetocontinuemakingdebtrepayments in the absence of significant financialinflows, they will not be able to fulfill their fiscaland balance-of-payment needs. With the presentoutbreakseverelyaffectingexports,currentaccountdeficits,accumulationofdebtservicearrearsandtheexternalfinancinggapareprojectedtowiden inall

threecountries(ECA,2014;UNDP,201421).Thethreecountriesalreadyhavehighpovertyrates,averylowhumandevelopmentindexranking,andweakpolicyandinstitutionalenvironments(seetableB2).Theiroverall development outlook is deteriorating day-by-dayandtheEBOLAoutbreakisstillclaiminglives,severely limiting economic activities and recoveryefforts.Ourcallisnotforintermittentdebtrelief,butfortotaldebtcancellation.

EXTERNAL DEBT SITUATION OF THE EBOLA-AFFECTED COUNTRIES AND THE CASE FOR DEBT CANCELLATIONSince the outbreak, there has been an influx ofdonor support, both financial and in-kind. Supportfrominternationalfinancialinstitutionstothethreecountries through, for instance, the Rapid CreditFacility for better emergency response planningand execution, is commendable (IMF, 2014).22

In November 2014, the World Bank proposed adevelopment policy credit for Guinea amountingto $40 million (Emergency Macroeconomic andFiscalSupportGrant).However,thisisaloanwithamaturityof38yearsanda6-yeargraceperiod,alongwithagrantof$10millionfromtheCrisisResponseWindowof the Bank.Guinea’s overall risk rating is“Substantial”,suggestingapotentialriseintheriskofdebtdistressanddebtoverhang.

21 UNDP (2014). UNDP Africa Policy Note, Vol. 1, No. 3, 24 (Oc-tober).

22 IMF (2014). Third Review Under the Extended Credit Facility Arrangement and Request for Waiver of Nonobservance of Performance Criteria and Modification of Performance Cri-terion, IMF Country Report for Liberia, No. 14/197, Washing-ton, D.C. These measures include the Heavily Indebted Poor Countries (HIPC) initiative and the Multilateral Debt Relief Initiative (MDRI).

APPENDIX III - EXTERNAL DEBT CANCELLATION FOR EBOLA-AFFECTED COUNTRIES

74


The 2013 external debt of Guinea, Liberia andSierra Leone in currentdollars is $1.2billion, $542million and $1.4 billion respectively, for a total of$3.1billion.Theexternaldebtburdenof the threecountries is high relative to their GNI and exports,assummarizedintableB1.Atbetween21%to31%,the external debt burden of the three countries isnotanegligibleproportionoftheirGNI,withexportsfallingfarbelowtheirdebtobligations.Inthewakeoftheoutbreak,bothexportsandthecapacitytoraiserevenueviataxeshavebeenseverelyaffectedduetothe significant slump in economic activities, EBOLAleading to debt distress and strained governmentbudgets.

The above debt ratios clearly indicate the limitedcapacityofthethreecountriestorepaytheirdebts,resulting in a debt overhang problem (Moses andOladeji,201423;Nissanke,201324).Thedebtburdenandmacroeconomicsituationofthethreecountriesmeanthattheyremainvulnerabletoexternalshocks.ThedeclineinexportsfollowingtheEBOLAoutbreakislikelytobedeepenedbytherecentsharpdeclineincommodityprices,becauseoftheheavyrelianceofthethreeonresourceexports.Inthisregard,majorcreditorssuchastheWorldBankandIMFrecognizethatthecountries,particularlyGuinea,facevarying

23 Moses, E. and S. Oladeji (2014). External Debt, Servicing and Debt Relief Transmissions in Nigeria, Journal of Economics and Sustainable Development, Vol. 5(20):11-33.

24 Nissanke, M. (2013). Managing Sovereign Debt for Produc-tive Investment and Development in Africa: A critical apprais-al of the Joint Bank-Fund Debt Sustainability Framework and Its Implications for Sovereign Debt Management, mimeo, School of Oriental and African Studies.

butintensifyingrisksofdebtdistress.25Inconjunctionwith declining growth, exports and governmentrevenue, thesedistress levelsare likely to risewithcontinuousdebtservicingandthepressuretosettlepreviousdebtservicearrears.

External debt cancellation26 would give the threecountries breathing space to better address theshort-term economic and social challenges of theEBOLAoutbreakandtoplantheirlong-termrecoveryonasolid footing. It shouldberecognizedthat thecancellation of debt does not automatically leadto the availability of funds. However, the financialresources earmarked for debt repayments couldinstead be invested into the countries’ health-caresystems, including training of health professionals,equipping health centres and ensuring the fairdistributionofhealthpersonnelbetween rural andurban areas. These funds could also be used tobenefit other strategic sectors of their economiesthat have been hit hard by EBOLA, includingeducation, agriculture and food security, andservices.27The impactofEBOLAonagricultureandfood security has been particularly serious giventhat theoutbreakstarted inruralagriculturalareasjust as farmers were preparing to start sowing. In

25 IMF (2012). Joint Debt Sustainability Analysis under the Debt Sustainability Framework for low-income countries, pre-pared by the staff of the World Bank and IMF, Washington D.C. IMF (2014) Requests for Disbursement under the Rapid Credit Facility (RCF) and for modification of performance cri-teria under Extended Credit Facility Arrangement, IMF Coun-try Report No. 14/298.

26 Lenders to the three countries include all bilateral and mul-tilateral lenders such as the World Bank, IMF and AfDB.

27 ECA (2014). Socioeconomic Impacts of the Ebola Virus Dis-ease on Africa, Addis Ababa.

Table B1: External debt and debt ratios for the three countries hardest hit by EBOLA, 2013

Source: IMF and World Bank database accessed in January 2015. Note that debt to exports ratio is not available for 2013 due to lack of data on exports. Hence, the table includes the five-yearly averages prior to 2013 for Guinea and Sierra Leone but the same average can only be computed prior to 2012 for Liberia.

Variable Guinea Liberia Sierra LeoneDebt (Current US$) 1.2 billion 541.5 million 1.4 billionDebt/GNI (%) 20.9 30.9 31.1Debt/Exports (%) 190 320 180

75


this regard, financial resources freed up by debtcancellation could be channeled into short-termemergencyfoodreliefprogrammes. Inthemediumterm,thethreecountrieswillneedfoodimportsfromneighbouringcountries,asthefoodcurrentlybeingprovidedbyWFPisnotnecessarilythesameasthecustomarydietofpeople in theaffectedcountries.Inthelongterm,thefundsfromdebtreliefcouldbedirected towards agricultural policies that supportfarmersthroughmicrofinancingandthemarketingof agricultural produce. Debt cancellation wouldundoubtedlyprovidemorefiscalspaceforthethreecountriestoachievetheirsocialdevelopmentgoalsinthecontextofthepost-2015developmentagenda,boostingtheirgrowthandrecoveryprospects.

Until the outbreak of EBOLA, the countries weremaking encouraging economic and social progressand notable post-conflict recovery. However, if thecurrent level of fiscal distress continues into 2015,growth will suffer even more, which in turn willdeepenpovertyandweakentheirrecovery.Indeed,theinvestmentpotentialofthethreecountrieshasalreadybeenweakenedandgrowthcontinuestobereviseddownwardsbyforecasters(ECA,2014;WorldBank, 201428). Continued high external debt anddebtservicingburdensarelikelytodiscouragefutureinvestment inkeysocialsectorssuchashealthandeducation.

RECOMMENDATIONS FOR POST-DEBT CANCELLATION MEASURESThe three countries need to make effective useof the funds that would be freed up to containthe Ebola outbreak and to finance long-termsocial and economic development initiatives. TheEBOLA outbreak is a public health crisis aswell asahumanitarianone.EvidenceshowsthatpastdebtreliefthroughtheHIPCinitiativedidhelpmanyAfricancountriestoimprovespendingonsocialsectorssuchashealth,supportingthecallforcancellingthedebtsofthethreemostEBOLA-affectedcountries(Temah,

28 WorldBank(2014)TheEconomicImpactofthe2014EbolaEpidem-ic,Short-andMedium-termEstimates forWestAfrica,WashingtonD.C.

200929).Anyfundsfromthedebtcancellationshouldbetargetedatstrengtheningtheweaknationalhealthsystemsofthethreecountries,improvingsanitation,establishing social protection programmes,improving education, and securing access to foodfor those living in rural areas,manyofwhomhavebeenbadlyaffectedbytheoutbreak.Creditorscouldestablishmechanismsfortheeffectivemonitoringoftheuseoffundsafterdebtcancellation.

Budget reallocations need to focus on upgradingexisting social services and health systems tothe level required by international protocols (forinstance, WHO standards) and to purchase andstockEbolavirusdiseasevaccineswhendeveloped.The immediate priority is to use the fiscal spacecreatedbystoppingdebtrepaymentstomitigatetheadverseeffectsofEBOLA,includingasignificantrisein theallocationof funds for long-neglectedhealthinfrastructure, training of health personnel at alllevelsandtimelypaymentofthesalariesofhealth-caresectorworkers.

Ascountriesemergingfromconflict,Guinea,Liberiaand Sierra Leone continue to suffer from weakinstitutional capacities for policy implementationand public sector management (see their CPIAindex, table B2). This calls for additional supportfrom donors for the three countries to effectivelyuse thepolicy spaceprovidedbydebt cancellationtostrengthenpublicfinancialmanagementsystemsto ensure sound macroeconomic management,prudentfiscalpoliciesanddebtmanagement.

It should be noted that debt cancellation shouldnot lead to lack of confidence about the viabilityand credit worthiness of the three countries forfuture lendingby creditors.Development partners,especiallyinternationalfinancialinstitutions,shouldpromote special lending initiatives and support forthe threecountries toaccessexternal loanswithasignificant grant element (for instance, 100% grantfor$60millionbyAfDB),longgraceperiodsandverylowornearzerointerestontheamountborrowed.

29 Temah,C. (2009)DoesDebtRelief IncreasePublicHealthExpen-diture?EvidencefromSub-SaharanAfricanCountries,mimeo,AddisAbaba,Ethiopia.

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AsinthecaseofHaiti,post-catastrophedebtreliefintheformofdebtcancellationmustbeprovidedforthesethreeWestAfricancountries,whichcontinue

tofeeltheeffectsofacatastrophicdisasterthatisyettobecontained.

Table B2: Recent economic, social development & policy performance indicators (2014)

Variable Guinea Liberia Sierra Leone

Population (in mill.) 12.0 4.4 6.2

Per capita income (US$) 460.0 454.0 679.0

Poverty rate (head count rate) 55.2% 64.0% 52.9%

HDI ranking[1] 179/187 175/187 183/187

CPIA score 3.1 3.0 3.3

[1] All of the three countries are in the bottom of the list of countries classified by UNDP as countries with HDI characterized by ‘low human development’ (UNDP, 2014).

Source: Except for the HDI figures which came from UNDP, all data is obtained from the World Bank.

All figures are for 2014 except CPIA that are for 2013.

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January 2015



The current outbreak of the Ebola virus disease in West Africa is the most devastating Ebola epidemic that the world has seen since the disease was identified in 1976. Beyond the considerable death toll, the disease has had a noticeable socioeconomic impact, not only in the countries directly affected by the outbreak but also further afield.

The present study assesses the socioeconomic impact of the disease on the affected countries and Africa as a whole, both in terms of real costs and in terms of growth and development prospects. Based on primary data and information collected during missions of the Economic Commission for Africa to the affected countries, the study puts forward policy options that could accompany mitigation efforts.

The study highlights the fact that alarming downward revisions of economic growth rates for affected countries and the West African subregion were carried out using scattered data and amid uncertainty about the future epidemiological path of the disease. In addition, such revisions did not take proper account of the magnitude of the international response. While the affected countries are feeling economic and social impacts, there is a stimulus effect as a result of the ongoing international response to the outbreak. This, coupled with the weight of the affected economies, has meant that the effect of Ebola on West Africa and the continent as a whole has been minimal.

Despite encouraging trends in the epidemiological situation in some of the affected countries, there is still a long way to go before the crisis can be declared over. Some of the most-affected countries were just emerging from years of conflict and already had structural vulnerabilities. Thanks to socioeconomic reforms, in recent years these countries had managed to achieve sustained economic growth, but the Ebola outbreak reversed the positive trend and pushed the countries to the limit by widening their fiscal deficits.

It is against this backdrop that the Economic Commission for Africa calls for, among other things, external debt cancellation for the most-affected countries. This would give the countries the breathing space they need to better address the short-term socioeconomic challenges posed by the Ebola outbreak and to plan for their long-term recovery on a solid footing. While the cancellation of debts does not automatically lead to the availability of funds, the financial resources earmarked for debt repayments could instead be invested into the countries’ health-care systems, including training health professionals, equipping health centres and ensuring the fair distribution of health personnel between rural and urban areas. These funds could also be used to benefit other strategic sectors of the economy that have been hit hard by Ebola, including education, agriculture and food security, and services.

9 789994 461493

ISBN: 978-99944-61-49-3

Printed in Addis Ababa, Ethiopia by the ECA Documents Publishing and Distribution Unit. ISO 14001:2004 certified.January 2015