• Wednesday, Apr 14, 2021
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Covid-19 in Bangladesh: A cruel choice between hunger and disease

  • Published at 06:57 pm May 4th, 2020
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A true pandemic plan should go beyond the obvious things BIGSTOCK

Two recent studies show the underlying economic impact of the pandemic

In Bangladesh, Covid-19 began as a health crisis but has been simultaneously unfolding a grave socioeconomic crisis. 

The population that falls in the low-income bracket are disproportionately affected by the Covid-19 induced economic crisis. About 90% of the people in this country are involved in the informal economy and are dependent on their daily or monthly wage, with very little buffer of savings, assets, or social protection. They were among the first to lose income and/or employment because of social-distancing and lockdown. Without necessary support, this large section of the population are bound to fall in a dire situation.

Poor and vulnerable people are also the ones disproportionately exposed to the virus for a variety of reasons. They are at the frontline of providing the essential services or they have to go out to feed their families. They often live in conditions where social distancing is not feasible, in overcrowded slums or small houses shared with the extended family. Many of them have poor sanitation facilities. They are also likely to be less aware, compared to their educated, wealthier counterpart, about how to mitigate the risks of infection.

For devising effective policy response to this unprecedented crisis, the importance of real-time research evidence cannot be over-emphasized. Brac Institute of Governance and Development (BIGD),Brac University, has initiated aRapid Research Response (RRR) to Covid-19 to capture the fast-changing realities of the low-income population of Bangladesh during the crisis with a hope to provide rapid, reliable and relevant insights to policymakers as well as practitioners such as BRAC on how to control the pandemic effectively while minimizing its socioeconomic impact.

This feature draws from two RRR studies. The first one focusing on livlihood, coping and support during the pandemic is a joint initiative of Power and Participation Research Centre (PPRC) and BIGD. A quantitative phone survey on how the crisis is affective the livelihood of the vilnerable people, how they are coping and what support they need, the study aims to better inform the designing and targeting of support programs for the economically vulnerable population. The data collected between April 4-12, was acquired from surveying over 5 thousand households in urban slums in Dhaka, Chittagong, Khulna, Barisal, and Rangpur.

The second study titled ‘Trust, Institutions, and Collective Action: How are CommunitiesResponding to Covid-19 in Bangladesh?’ is a qualitative study to understand how government policies and statements are being received and acted upon by communities so that policies and measures can be adapted as necessary.

This study was led by Dr. Tariq Omar Ali, Georgetown University, Dr. Naomi Hossain, American University, Dr. Mirza Hasan, BIGD and Md. MamunUr-Rashid, Development Research Initiative (DRI).

A joint initiative of researchers from the Accountability Research Center at American University and Georgetown University in the USA and Development Research Initiative (dRi) and BIGD, the research, conducted between April 5-13, looks at case studies on community dynamics of Covid-19 response across 20 sites and with 123 key informants selected from different occupations and social groups. 

Findings:

Deep and widespread economic impact of the lockdown 

Figure 1: Impact on household income: Per capita dailiy household income in February vs early April (BDT)

•     The poorer segment of the population is taking the brunt of this economic shock  with relatively larger income shocks. Particularly for the extreme poor, the income has almost completely been wiped out.

•     But Covid-19 is not just affecting the poor. An alarming proportion of the nonpoor are also facing a very similar fate. In Bangladesh, only a small fraction of the workforce, even among the middle-class, have secure, formal employment. Therefore, it is not surprising that that as the country goes into largescale economic shutdown, their incomes also plummet.

“Lockdown is for the rich and those who can afford it, not for the poor.” – A study respondent

Extreme poor: People below the lower poverty line

Poor: People above the lower and below the upper poverty line

Vulnerable non-poor: People above the lower poverty line and national

median income

Non-poor: People above national median income 

  

 •     72% main income earners in urban slums and 54% in rural areas had no income during early April.

•     77% of vulnerable non-poor and 65% of the non-poor, on average, income has gone down far below the poverty line. They represent the ‘new poor’ created by Covid-19.

•     In urban areas, more the 80% have gone below the poverty line 

Food insecurity: An urgent national humanitarian issue 

Figure 3: Drop in per capita food expenditure by urban rural and poverty categories

•     Families across rural slums and urban areas have reduced their expenditure on food as well as the number of meals a day.

•     24% rural and 14% urban households also reduced their number of meals a day from 3 to 2 or fewer.

•     As the non-poor groups have also experienced drastic income shocks, the impact has been similar, though slightly smaller.

•     Reductions in the number of meals, combined with reductions in food consumption, indicate a decline in nutritional intake among these households.

•     For the extreme poor, who already spend very little on food, the decrease in expenditure on food can have a devastating impact.

•     Urban slum dwellers, most of whom live in rental housings and are unable cut down rental expenses, are most vulnerable

Figure 4: Estimated number of days respondents can feed their families without external support (as of 12 April)- % of households   

•     As of April, only three percent urban slum dwellers, and 11% rural households mentioned that they could feed their families without help for more than a month. More than half in urban slums and more than a third in rural areas said that they could go on for less than a week.

•     It is evident that by now food insecurity must have struck a large segment of the population, if a large-scale support program has not yet been implemented. 

How are they feeding their families? 

Figure 6: Coping mechanisms to meet food needs (% of households)

•     Most households are using a combination of sources to feed their families.

•     Only a fraction of the households can use their income in buying food as for majority, income has fallen to zero.

•     Majority, both in urban slums and rural areas, using up their savings.

•     Many are also meeting the food needs during the crisis by borrowing and by reducing food consumption.

•     None of the above are sustainable options, and without additional support, a hunger is likely to become a national crisis.

•     To date, there has been minimum support from the government, NGO support is virtually non-existent.

•     People are disregarding the lockdown to look for work and assistance.

•     There is a strong consensus that the lockdown will not hold if people cannot eat

“Hunger knows no lockdown. It demands food.” – A study respondent

“People say the old days are gone and now there is no shortage of food. But that is a false statement.” – A study respondent

“We are constantly told to maintain social distancing. But this rule is hard to follow when no relief is provided. If we do not receive any relief soon, the day is not far when we will die of hunger.” —Businessman, Bakalia, Chattogram

“People might still be living off of their savings. But when they run out of savings, they will die of hunger.” —Imam, Shariakandi, Bogura

•     Almost 80% of the urban slum households want food support, the rate is 70% in rural areas, which reemphasises our apprehension that food is going to be crisis if measures are not taken.

•     Majority also mentioned the needm for cash support.

•     Reported concerns about the increase in food price is a likely explanation of why many respondents are seeking food support.

•     The highest responses for food and cash support came from the extreme poor.

•     People on low incomes will need to depend on government assistance

“We are constantly told to maintain social distancing. But this rule is hard to follow when no relief is provided. If we do not receive any relief soon, the day is not far when we will die of hunger.” —Businessman, Bakalia, Chattogram

Experiences of the lockdown

The lockdown is generally accepted as necessary. All respondents, irrespective of location, gender, and occupation, are aware of what a lockdown and social distancing entails, and why these measures are necessary to prevent the spread of Covid-19. Urban slum-dwellers are particularly concerned about population density in their areas and the risks of communal toilets and washing facilities. However, fear is widespread, particularly after early April reports of Covid-19 deaths in Bangladesh. However, not everyone is adhering to the lockdown. This problem can be further unpacked to reveal many underlying issues that currently prevail in these communities. Some people lack awareness of the necessity of the lockdown but reportedly this is somewhat fewer now than before. There is also the presence of an enduring faith in God as a protection from Covid-19. Respondents across the sites state that poor people who rely on daily earnings to procure food are not able to follow lockdown rules. Respondents, without exception, feel that it is morally acceptable for the poor to break the lockdown. 

“The main road is only two minutes walking distance away from my home. Prior to this crisis, whereas hundreds of cars used to cross the road every minute, now you can hardly hear a single hunk throughout the day.” — NGO Worker, Kolapara, Patuakhali

“As long as the Army is there, nothing but dogs can be seen on the streets. But as soon as the Army leaves, swarm of people occupy the streets again.” —Day Labourer, Nalchity, Jhalokhati

“People have yet not seen others to die of the Coronavirus in front of their eyes, which is why they still roam about outside their home. When they will see death looming, they will not get out of the house again.” – A study respondent

“Interestingly enough, many people in our area gathered on building rooftops on the night of this Sab-e-Barat to say prayer. The truth is that no matter what rule the government enforces on us for our protection, some of the people simply do not want to comply.” —Teacher, Bakalia, Chattogram

“The government should increase Coronavirus testing capacity to find out how many people are infected with the virus. Law enforcement measures should be more strict in towns and villages to keep people at home. Healthcare system should also be improved by establishing more labs. And finally, the government should provide at least one month of food supply.” —Student, Narayanganj, Dhaka

Furthermore, due to overwhelmingly high rates of unemployment, young men leave their homes to look for food, work or some form of entertainment out of boredom.

Patrolling by police and army is, for the most part, effective in enforcing the lockdown. In most places, local authorities and officials are working hard, often with community leaders, for the implementation or restrictions. Measures have been taken to provide hand-washing facilities, establish community borders to keep out outsiders, arrange assistance and, persistently inform people of the importance of maintaining social distance and staying home in avoiding the possibility of contamination and spread.

Effect on healthcare

Healthcare is being adversely affected. People with illnesses unrelated to Covid-19 are reportedly either unable to find doctors or have been avoiding hospitals out of fear of contamination or quarantine. Some clinics and diagnostic centers have reportedly been closed with people advised to postpone appointments. Some government health facilities have also been treating patients through windows and at a distance, in an effort to protect frontline health workers. However, some workers are fearful of contracting the virus due to inadequate protections as many workers are not provided with personal protective equipment (PPE) from their employers and have been asked to procure for themselves.

Local government, overall, are playing a commendable role 

Local governments have been making serious efforts to protect citizens. It is perceived that elected local authorities (Pourashava or Union Parishad) chairmen, members, and commissioners, have been generally making sustained efforts to establish or maintain the lockdown, and to arrange relief. Local community leaders and members have been reportedly supporting the lockdown efforts in most areas. However, most NGOs have visibly done little to date in providing support, identifying community needs, assuring correct distribution, and raising awareness.

People’s hopes for surviving Covid-19 rest on promise of government relief, however, there is some lack of trust in the government and with good reason.

People are closely monitoring all public updates on government assistance programs and have highlighted concerns about what forms this assistance would take, who would receive it, and how it would be distributed. Yet to have actually received any said assistance in most cases, there is confusion and lost trust in the government’s ability to ensure the effective dissemination of assistance, especially to those who need it the most. 

“The government is failing to act the way it speaks of distributing relief and tackling this crisis. As a result, people are losing their trust in the government. The local people are not receiving any help or benefits offered by the Prime Minister, leading to distrust.” —Healthcare Officer, Shibchor, Madaripur

While there is some mention of the total government assistance package, there is very limited information about per capita government assistance. Additionally, there is also a general lack of trust on official information mostly as a result of prior government action, although the IEDCR is given some credit for regular timely and reliable information about Covid-19. People rely on the media and, in some cases, even Facebook to find information related to Covid-19.

“People often tend to be negative. When the Coronavirus pandemic in our country was in its primary stage, people wanted schools and colleges to shut down, they wanted a lockdown. Now that the government has declared a lockdown, people do not want to stay at home. They cannot yet quite trust the government.” —Family Planning Inspector, Maheshpur, Jhenaidah

This calls into question the validity of the information being disseminated since a significant amount of information received via such sources have proven to be false and unreliable in the past.

“The common people trust non-government institutions more than they trust government institutions. Which is why important announcements and information should be made on and disseminated through the non-government institutions.” —Farmer, Kolapara, Patuakhali

Policy Implications

COVID-19 is not only making the poor poorer but creating a vast gropu of“new poor”, hopefully temporarily. Food insecurity exists as a result of nutritional decline and reduced food consumption; crisis is projected to exacerbate by the end of April, if large scale support-system is not in place.

Because impact is broad-based, immediate safety net programs need to go beyond targeting, and prioritize self-targeting vehicles such as OMS. 

People are relying on government assistance: Lockdown success and trust in government policies depend on clear information and immediate relief. Messages are most effective when reinforced independently by multiple sources. Relief should be distributed accountably, with wide social involvement shared across television,news outlets, radio and social media.

Punitive measures will greatly demoralize people currently facing the greatest hardship, and are likely to prompt resistance, violating social distancing and lockdown rules.

Naureen Khan is Research Communications Manager, BIGD

Nusrat Jahan is Head of Business Development and Knowledge Management, BIGD


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