A single healthcare worker infected with COVID-19 cost the Kenyan economy over $33,000 – around 18 times the country’s per capita GDP.

This is according to a new report on the economic cost of COVID-19 infections among healthcare workers in Eswatini, Colombia, Kenya and South Africa (the provinces of KwaZulu-Natal and Western Cape) during the first year of the pandemic, which has been compiled by the World Bank and Resolve to Save Lives.

The estimated cost per health worker infection ranged from $10,105 in Colombia to $35,659 in Eswatini, with $34,226 in South Africa’s KwaZulu-Natal province and $33,781 in its Western Cape province.

These figures are based on three calculations: the direct cost of healthcare worker’s infection in terms of their healthcare costs and loss of productivity; the costs of infections transmitted by sick healthcare workers; and the disruptions to essential health services.  

The economic burden was highest in areas with the fewest health workers. In South Africa’s Western Cape, the total cost of health worker infections was equivalent to 8.38% of the total health budget. 

In Kenya, where maternal and child death rates were high before the pandemic, health care worker illness disrupted essential services for these vulnerable populations and caused a substantial increase in deaths. This was the biggest “expense” in that country’s calculations.

“Immunisation, chronic disease management, emergency services, and surgery were also severely disrupted, leading to increased non-Covid deaths,” according to the report.

No vaccines for African health workers

At a press conference on Wednesday to launch the report, Dr Keith Cloete, head of health in the Western Cape, South Africa, reminded the audience of the impact of vaccine inequity on health workers.

“Everybody knew that the most important thing was to vaccinate healthcare workers. Our delay in having access to vaccines meant that, in your study period from 1 March 2020 until 28 February 2021, we had vaccines for two weeks,” said Cloete. 

The first South African health worker was vaccinated on 17 February 2021; health workers only got access to vaccines via a clinical trial of Johnson and Johnson vaccines rather than as part of a vaccine rollout for the general population.

In the absence of vaccines, the Western Cape had to try to assuage health workers’ fear by ensuring that they had personal protective equipment (PPE), and by improving its occupational health and safety and employee wellbeing policies, added Cloete.

The province also invested in good data to enable it to predict COVID-19 waves and plan accordingly.

“At the height of the waves is when you have the most healthcare workers in quarantine and in isolation, so you’re going to have the lowest number of available staff. So that’s one of the first predictive models we did, and we then intentionally employed people on contract to cover these waves,” explained Cloete.

The COVID-19 incidence among HCWs was higher than in the general population in all study sites – almost 10 times higher in Kenya and seven to eight times higher in the two provinces of South Africa 

“The economic burden due to SARS-CoV-2 infection among HCWs makes a compelling investment case for pandemic preparedness, particularly the protection of HCWs, and resilient health systems going forward,” argues the report.

Juan Pablo Uribe, the World Bank’s Global Director for Health Nutrition and Population, warned that there was a projected shortage of 10 million health workers by the end of the decade and that health workers from low-income countries were moving to high-income countries, exacerbating shortages in poorer countries.

“Many of our health workers are still very much unsatisfied or frustrated in their workplaces. And more important, they’re facing incredible risks of infection, of disability and injuries and in many places, even of violence,” said Uribe.

Resolve CEO Dr Tom Frieden said that health workers needed to be protected during pandemics by policies, protective equipment, and data systems and information “to hold us all accountable for protecting people who protect and care for us so that they can be safer and healthier, and societies can be safer and healthier”. 

Image Credits: Western Cape government.