The South African government’s COVID-19 response: protecting lives and livelihoods

This chapter brings together aspects of the impact of COVID-19 on lives and livelihoods in South Africa. As at 15 August 2021, the epidemic is reported to have led to 77 141 deaths and been associated with 229 850 excess deaths. At the same time, the national economy has been severely affected with Gross Domestic Product decline of 7% in 2020/21, job losses exceeding 2 million, and sharp reductions in national revenue. The chapter takes a case study approach to provide an overview of the Government’s budgetary support to the health and income protection responses as well as the modelling that informed these. It also reviews some of the carry-through implications of the economic down-turn on public finances, including health budgets. The authors draw primarily on their experiences and subsequent reflection, with particular focus on the period 1 March 2021 to 28 February 2022. The budget provision for the health response to COVID-19 exceeded R20 billion, which was achieved through additional allocations and reprioritisation. Income protection measures exceeded R100 billion. However, suboptimal attention was given to how prolonged lockdowns would affect businesses, jobs, livelihoods and the economy over the medium and long term, with job losses initially exceeding 2.2 million and 1.4 million by the first quarter of 2021. As these effects fed through to public finances, growth and tax revenue declined substantially, resulting in reductions in virtually all government budgets. Over the 2021 Medium-term Expenditure Framework period, the economic effects of the epidemic and stringent lockdown measures have resulted in the reduction of provincial health budget projections by as much as R76 billion. The chapter emphasises the need to consider both lives and livelihoods in pandemic decision-making, ideally bringing together various dimensions of epidemiological and economic modelling in a multi-criteria decision framework.