HARNESSING THE THUNDER - Civil society’s care and creativity in South Africa’s Covid storm

HARNESSING THE THUNDER

HARNESSING THE THUNDER Civil society’s care and creativity in South Africa’s Covid storm

David Harrison

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner and the publisher. Š David Harrison, 2020 Published and distributed by Porcupine Press in 2020 P O Box 2756 Pinegowrie, 2123 Gauteng, South Africa info@porcupinepress.co.za www.porcupinepress.co.za ISBN: 978-1-9284-5566-0 Cover design artwork by DGMT Cover design by Wim Rheeder: wim@wimrheeder.co.za Typesetting by Porcupine Press Set in 11 on 16 point, Minion Pro Printed by Imaging Solutions, Cape Town

CONTENTS

Preface

8

Chapter 1: Gearing up for a storm

13

Chapter 2: Taking to the airwaves

38

Chapter 3: Quick into the lifeboats, poor children first 51 Chapter 4: A flash of hope for hungry families

68

Chapter 5: A nation sobers up

89

Chapter 6: Human spirits

111

DEDICATION

This book is dedicated to the people who work in civil society organisations, who mobilised to protect and support families in distress during the Covid-19 crisis. But they did more than that – they used the crisis to promote change. The DG Murray Trust team and its investment partners simply helped unlock their creative power – harnessing the thunder while providing shelter from the storm.

SUMMARY

This story highlights the critical role of civil society organisations in protecting the whole of society and innovating in times of uncertainty. As we try to rebuild and transform our society, organised civil society must be recognised as equals with government, trade unions and the private sector.

Our nation is one body, and civil society is its neuro-electric system that can sense and signal changes in every cell. Without it, government becomes less and less responsive to need, and communities more and more alienated. The whole body suffers, as does the physical environment around it – because people no longer care.

Just look at the litter smothering our townships and villages.

Its meaning is there for all to see, but we choose not to see it.

In the same way, the seismic tremors of our divided society are always there, but we choose not to feel them. Somehow Covid-19 caused us to see deeper into the fissures and to hear louder the rumblings from the ground. They became part of the thunder of the storm.

7

PREFACE

IT TOOK ITALY to focus the mind. In February 2020 we had watched the rapid rise of the epidemic in Hubei province in China, but took some comfort in its spectacular decline by the end of that month. Our quarterly DGMT board pack prepared in the first week of March made scant reference to Covid-19.

Then Italy’s numbers started to climb and, by mid-March, pictures of overwhelmed hospitals and devastated communities in Lombardy rattled world leaders and set Twitter alight. By the time of our board meeting on Monday, 16th of March 2020, contingency plans for staff were already in place. Even then, they centred on mitigating the likely disruptions to our core work over the next few months. The full impact of Covid, and of the lockdown measures that would be put in place, had not yet hit home.

It soon did, however, as rumblings of the gathering storm grew louder by the day. The board meeting ended on Tuesday.

By the weekend, I was on the phone to DGMT chairperson, John Volmink, and his deputy, Mvuyo Tom, seeking approval for DGMT to swivel most of its work towards Covid-19 – helping to prevent transmission and limit its impact. Their response was unequivocal: “Go for it.” If we didn’t, all our other work would be at risk.

We quickly decided on national responses we felt might not be on other people’s radars. “When the storm really hits,” we 8

asked ourselves, “who would most likely be at the back of the queue?” The answer was obvious – the same people who always get to be at the back of the queue, including community care workers (CCWs) who provide health care and social services for lower salaries than many of us pay for medical aid, people in rural areas and informal settlements who still rely mainly on radio for outside information, and children in those same communities who have no access to Wi-Fi or smartphones.

These injustices were bound to be aggravated by Covid and we saw that coming. Prompted by a call from writer and activist Elinor Sisulu, we agreed to coordinate the procurement and distribution of personal protective equipment (PPE) and support to tens of thousands of CCWs across the country. A WhatsApp message to the head of communications in the National Department of Health initiated a massive effort to produce almost 2 000 daily 10-minute radio inserts – in 12 different languages – that were broadcast on 65 public and community radio stations. Seizing on the disaster regulations promulgated by the government in response to the pandemic, DGMT facilitated the zero-rating of the websites of 39 public benefit organisations (PBOs) providing educational support for children without access to online learning.

What we didn’t see coming was the precipitous plunge in the availability of food due to the stringent lockdown regulations. Families shut indoors without access to the ‘piece jobs’ that supplement government grants simply ran out of food and had no way of replenishing it before the end of each month.

For those foreign nationals excluded from any form of social security, there was no relief. Within a few weeks, community care workers were no longer asking for PPE; they were asking for food.

9

The lockdown effects were not all bad. The intention was to contain the spread of coronavirus long enough to give health services time to prepare and to flatten the incidence curve.

Much has been written about its effectiveness, or not, in this regard. Suffice to say that without the window period for health services to prepare after the first confirmed infections in early March, things would have been a lot messier.

Certainly, emergency rooms at hospitals and clinics were less messy during the stricter phases of lockdown, without the usual number of motor vehicle accidents, stabbings, and gunshots. Actually, while the restrictions on movement played a part, it was the ban on alcohol sales that had the biggest effect.

As lockdown limitations were gradually lifted, the unbanning of liquor sales coincided with the spike in trauma cases. The unequivocal link between alcohol excesses, injuries and violence was exposed for all to see, despite the attempts of the liquor industry to divert the public gaze elsewhere.

While much of the media focus was on the ban itself, we were more interested in the longer-term changes that government could put in place to even out the social costs and benefits of the alcohol industry in South Africa. If its costs were fully disclosed on the income statement of SA Inc., every shareholder would be demanding immediate action. The World Health Organisation (WHO) advocates for a number of costeffective regulatory measures to curb heavy drinking, without unduly inconveniencing modest drinkers. With the support of the South African Medical Research Council and the University of Cape Town’s School of Public Health, DGMT mobilised over 160 researchers, academics and community activists to petition government to introduce these measures as a matter of urgency.

The response, coordinated by the Speaker of Parliament, was 10

prompt and encouraging, and seems to be gathering momentum.

This is the story of the response of the DG Murray Trust (DGMT) and its close partners to Covid-19 – not to puff up our role, but to describe the experience, because we think there is much to be learnt from it, both in responding to future disasters and in transforming our society. Some of that experience has given us hope – glimpses of what could be possible if government, civil society and business really worked together. Other aspects were profoundly discouraging – failures of government and the selfishness and profiteering of certain companies and individuals.

Even if the pandemic burns itself out – just like the Spanish flu – life will not be quite the same, not only for people who lost loved ones but for the rest of us as well. The acute crisis has exposed the chronic decay of our society – where black South Africans continue to live shorter, harsher lives; where we happily drop off our children on their first day of school with the knowledge that half of them will fail to complete their basic education; where many social grant recipients wish the lockdown would never end because, after the initial crunch, the child support grant brings in a bit of extra cash. And where fully 10% of the South African population scramble for the paltry sum of R350 as a special Covid relief grant. That’s about the cost of one plate of food in a swanky restaurant.

What Covid has also shown us is that innovation can happen in a hurry; that there are some answers to South Africa’s seemingly insoluble problems. You can get food to families in distress at 70% of the current cost to the state. You can also get PPE to health workers for half of what government paid for it – and that’s authorised and legitimate state expenditure, not the corruption which blew billions more. You can get digital content 11

into children’s homes and poorer schools, without any party losing out financially. You can reduce the harmful effects of alcohol. Within the next year. You can. Whether we will or not, however, depends on us. Covid-19 has created new precedents and platforms for change. We must now use them to greatest effect.

12

CHAPTER 1

GEARING UP FOR A STORM

THAT FIRST CALL from Elinor Sisulu in mid-March drained me completely. She felt that community health workers were likely to be at the bottom of the pile in the scrum for personal protective equipment (PPE). Her view was that DGMT was wellplaced to coordinate a national effort to secure and distribute PPE to them. She would help and requested the rubber-tyre recycling company REDISA to assist with logistics management.

Elinor was right. DGMT was well-placed to approach funders and mobilise local community organisations. The thought had already crossed my mind, but I was reluctant to let it linger there.

It would be a huge undertaking. Her Friday call precipitated the weekend conversations with John Volmink and Mvuyo Tom as leaders of the DGMT board. If I were secretly hoping they’d say no, those hopes would have been dashed. “Go for it,” they said.

The first place I went was to bed. Perhaps I had picked up some bug or other, but I felt utterly exhausted by the prospect of gearing up to confront another virus. It reminded me too much of the first few years of loveLife, South Africa’s national HIVprevention campaign for young people, which I led from 2000 – 2009. We had spent much of that time warning government and the corporate sector of the ‘impending catastrophe’ (as one of our first publications was titled) – even as we ramped up a massive media and community campaign for young people.

13

Over 300 000 people are estimated to have died unnecessarily as the government, led by AIDS-denialist President Thabo Mbeki, ignored pleas to provide antiretroviral treatment.1 That’s at least ten times the likely Covid-19 deaths in South Africa. This time round, government was highly responsive – some said overzealous – in its reaction. An entire economy was shut down trying to save ten or twenty thousand lives.

Bed is sometimes a good place to think, and later the following week, I submitted two proposals to the nascent Solidarity Fund – one for PPE for over one hundred thousand community care workers and the other for radio inserts on all public radio stations. The PPE proposal argued that, as rationing kicked in, hospital and clinic staff would inevitably be prioritised over community health workers caring for people in their homes. Further, PPE would not only be needed for health workers, but for social and relief workers as well, working in both the public and non-profit private sectors. It was impossible to predict how many community care workers (CCWs) would need protection and support. There was no central database of CCWs, and the demand would depend on the intensity and duration of the Covid storm, and whether PPE could be sourced elsewhere.

We canvassed provincial health and social development departments, professional councils and non-government organisations to derive an estimate of 120 000 people requiring PPE for three months. The actual number would probably be lower, but then the storm might last longer than that, or there might be a series of storm surges. Who knew, back in March 2020? In any event, our calculations were based on providing the minimum 1 Nattrass, N. (2008). AIDS and the scientific governance of medicine in post-apartheid South Africa, African Affairs, Vol 107/427: p157-176.

14

amount that would be required by community care workers. If there was excess stock, that would be even better.

Estimating the total budget was just as unpredictable, with PPE prices going through the roof in late March and early April.

Based on first quotations, our budget had worked out at R1 000 per person – or R120 million in total. Yet, within two weeks of submission, the projected costs of procurement already exceeded R160 million. We swallowed hard and put on a brave face. An amount of R120 million was already a big ask; going back for more might just be too much for foundation boards to consider, especially if they were not privy to the rollercoaster price ride as demand and supply see-sawed. In the last week of April, the newly-established Solidarity Fund and the ELMA South Africa Foundation jointly agreed to foot a R120 million bill.

While the ELMA Foundation was a long-time friend and co-funder with DGMT, the Solidarity Fund was set up in March 2020 as a rapid response to Covid-19, providing a platform to channel donations from individuals, companies and foundations to augment government’s efforts. As CEO of a foundation, and knowing the mechanics of such an operation, I was hugely impressed. My admiration grew as I watched the growing political pressures on the fledgling organisation.

It would prove very hard to resist expectations from some official quarters that it should serve as ‘government’s ATM’. The Solidarity Fund quickly took flak for lack of transparency, for tardiness of decision-making, and for the myriad of operational issues that inevitably accompany the rapid deployment of resources. In time, one decision of the Fund would leave a sour taste in the mouth (see Chapter 2), but in my book, their overall performance has been excellent.

Not that they got it all right. When the pandemic hit, 15

President Ramaphosa turned first to business for help, and not to civil society organisations. The obvious reason is that the corporate sector has far deeper pockets, and without two massive individual contributions from captains of industry, the Solidarity Fund wouldn’t have had much punch. But the reasons go deeper than that. An implicit premise is that it is the commercial sector that has the expertise to manage a crisis – and there’s a lot of truth in that. Corporates quickly organised themselves as Business4South Africa (B4SA) and brought in skills by seconding staff to the Solidarity Fund and its operations.

But their knowledge of communities and the realities of service delivery in rural areas and informal settlements was limited. To its credit, the Solidarity Fund quickly set up advisory groups to assist in its thinking and harnessed the delivery capabilities of non-government organisations.

More crippling was its tethering to government processes and directives. PPE procurement for the National Department of Health was consolidated under the operations of B4SA, which protected it from much of the corruption and plunder that happened in other national departments and in many of the provinces. However, it meant adherence to tender practices and black economic empowerment codes of the Department of Trade, Industry and Competition. These aim to achieve broadbased redistribution of wealth, but when crudely implemented, tend to inflate prices and encourage rent-seeking behaviour.

As the nation found out a few months later, in the PPE feeding frenzy, you couldn’t see the trough for the snouts. Everyone blamed the piglets, but it was the farmer who had put out all that food. The system lent itself to corruption.

Even seemingly benign bureaucratic processes like a PPE price list issued by National Treasury incentivised price 16

gouging. The one issued in late April allowed for the purchase of surgical masks at almost four times the price that DGMT eventually procured them from China, while on the other hand, the quotes we received couldn’t match the allowable unit price for nitrile gloves, which were in increasingly short supply during April and May. Swings and roundabouts, you might say, but an unscrupulous trader could take advantage of these supplydemand mismatches to gouge deep holes in the public fiscus. As we now know, they did and, not content with the excess profits facilitated by a static and outdated price list, were somehow paid amounts twice or three times the official rate card.

This tethering to government processes damaged our cause too. It had been agreed that the PPE paid for by the Solidarity Fund would be sourced through the central procurement mechanism coordinated by B4SA. In early May, we submitted the first requisition for PPE. It included a request for 2.75 million patient and health worker masks, six million nitrile gloves, 30 000 gowns, 60 000 goggles or face shields, and 80 000 plastic aprons. Two months later, we took delivery of all that B4SA had managed to obtain – a paltry 550 000 patient masks, for which we paid twice the price of the high-quality Type II masks we eventually imported directly from China.

Fortunately, both DGMT and the Solidarity Fund had anticipated the possibility that our requisitions might not be filled and had made provision in the contract for independent procurement in such an event. Not that my original reason for an opt-out clause proved correct. I had been concerned that an over-stressed government might claim all PPE as its own and decide to whom it should be allocated. I hadn’t foreseen that B4SA would be unable to secure the PPE in reasonable time.

The real reasons for these delays were never fully divulged to 17

us by B4SA and the Solidarity Fund, but I was exposed to some of the inner workings of the procurement team and sensed the frustrations they themselves faced.

While the invitation to tender was extended to all and sundry, the Department of Trade, Industry and Competition stated that black-owned companies were to be given preference when pricing was comparable. The intent was good, but the consequence was to slow down and further distort efficient procurement. To be clear, there is a strong imperative for policies that promote black entrepreneurship and ownership.

But when an extraordinary disaster strikes, the focus must shift from making things better for the long term to preventing things from getting worse in the present. In this case, a national health disaster was making things worse now – causing even greater inequality, and the singular priority should have been to tackle it, now.

Government realised that it needed to speed things up and relaxed its standard controls on procurement of PPE. However, it should have adopted a more specific and targeted approach.

When there are no local manufacturers of crucial items like nitrile gloves, and where local stocks of other forms of PPE are so small that massive importation is required, then an undifferentiated call for quotations simply attracts hundreds of ‘tenderpreneurs’ with no experience or knowledge of PPE procurement. It promotes hustling, not enterprise. On acceptance of their quotes, these middlemen sourced goods of variable quality from Chinese middlemen, who were themselves jostling for a place in the factory supply queues. Large dollar- and euro-denominated orders took precedence, and small-time dealers were forced to find PPE through back channels and side deals. Small wonder that some of the imports were of dubious quality.

18

Unlike the products sourced by many provincial departments, all goods procured by B4SA were ultimately subject to quality review by the South African Bureau of Standards (SABS). Here, numerous consignments were rejected, at huge cost to somebody. To whom I don’t know, but it’s sure to have been the hapless taxpayer.

By the beginning of June, we were increasingly uneasy about the little progress being made in securing PPE. The country’s infection rate was starting to escalate, and we had hoped to be able to distribute a first consignment to hot spots by the middle of the month. There now seemed to be little prospect of that. With agreement from the Solidarity Fund, we decided to exercise our contractual right to procure all PPE independently, though still hoping that our first order through B4SA would materialise. Fortunately, the ELMA Foundation had also agreed from the start that DGMT could source PPE on its own, which created the space for an ingenious local solution.

The Stellenbosch Nanofiber Company (SNC) is a materials science company that develops and manufactures nanofiber materials using its patented SNC BEST® Ball Electrospinning Technology. Nanofibers are extremely fine fibres used in a wide range of applications, including cosmetics and medicines. They are woven together to create a diaphanous film that can be applied to the skin or, as we were about to discover, as a medicalgrade filter in reusable face masks. Once the stringent lockdown was lifted, I visited the factory to see the technology in action.

Coated head to foot in protective gear – to prevent me from introducing any germs into the process – I was allowed into the laboratory. Here, a viscous polymer was being siphoned from bottles on the ground into shallow baths. Plastic spheres the size of table tennis balls slowly rotated in the treacle. But the 19

syrup glazing the spheres was not smooth – it was spiky, and the spikes flew upwards like a child’s sparkler until they spun onto a sheet of polyester fabric to form the delicate nanofilter layer. The unseen magic was an electromagnetic field between the spheres and the fabric, which attracted the liquid polymer like fine hair to the static of a woollen cardigan.

The polymer-coated fabric was then cut and tailored to insert into the middle pouch of a specially manufactured cloth mask. These mask filters can be sterilised with boiling hot water and reused up to nine times, while the durable cloth masks are washable by hand or machine. The economic and environmental benefits are huge. For instance, assuming the cloth mask lasts three months, the daily cost works out at just one-third of the expense of daily disposable masks; and the waste needing to be dumped at the local landfill or incinerator reduced by 90%. The orders SNC received from DGMT alone saved the importation and disposal of over 10 million single-use masks. “We’d never made nanofiber mask filters before,” said SNC CEO, Dr Eugene Smit, “but sitting at home in the first week of lockdown we decided to see if we could contribute to combating the shortage of PPE.” Quite serendipitously, I was introduced to him just at that time.

SNC’s offering was compelling, but there was a problem.

This was a brand-new product manufactured in an emergency; it had yet to go through all the quality checks required for use in health care – even if only in people’s homes. The South African Health Products Regulatory Authority (SAHPRA) had temporarily lifted the requirement for licensing of Type II surgical masks, which would have slowed the process down further, and the product’s particle filtration efficiency (≥95%) had already been verified by South Africa’s only laboratory 20

authorised to do so, Protechnik Laboratories. Its breathability had also been confirmed (differential pressure, Pa/cm2 < 29.4).

But in order to meet both national and international standards, the product also needed to be tested to establish its bacterial filtration efficiency (BFE), which is defined as ‘the amount of an infective agent retained within the surgical mask and not released into the air of a surgical theatre’. In other words, its main purpose is to protect the patient from the doctor, and not the other way around. Still, we needed an official stamp of approval.

The problem was that the best verifying laboratories happened to be in Lombardy, Italy – one of the regions worst hit by coronavirus in Europe – and so were firmly shut. Even as they started to open, the backlog of tests could have meant that it would take months to get verified. Fortunately, SNC found a highly reputable laboratory in Bologna and joined the back of the testing queue. We faced a dilemma: if we waited until the results came through to start production, we could lose several months; but if production commenced and the product subsequently failed the test, a lot of money would be wasted.

Eventually, we guaranteed funding for the first 300 000 masks, but could opt out of additional payments if the tests failed. At worst, the money spent on the filters would be lost, but we could still distribute the cloth masks. This dilemma brought home the fact that while innovation can flourish in times of uncertainty, it is not without risk – and space needs to be made for it. Success would be applauded, but it would have taken some explaining to this project’s funders if R3 million had gone down the drain.

Given that the particle filtration test is more stringent than the BFE in terms of particle size – bacteria are bigger than viruses – an adverse finding was unlikely. Still, the test reports from Biochem Laboratories in Bologna were a great relief – bacterial 21

filtration efficiencies of ≥98% – meeting the international standards for a Type II surgical mask.

The reusable face mask project was an exciting demonstration of how scientific innovation and local manufacturing could be stimulated in times of crisis. It also showed how true broadbased black economic empowerment (B-BBEE) could happen: SNC teamed up with a Level 1 B-BBEE company to manufacture the cloth mask component, creating over 70 jobs for people from Khayelitsha and Delft in the process. If the masks had been imported, that money would have been creamed off into the pockets of just one middleman.

Of course, the estimated 120 000 community care workers didn’t only need masks; they needed gloves, gowns and plastic aprons as well. The aprons could be sourced locally, but the rest would need to be imported. We had estimated the quantities that would be required, including over ten million pairs of nitrile gloves and 50 000 spray-proof gowns. The question was how to source them from China without paying a premium to an intermediary. Fortunately, my sister-in-law Dr Yan Yang grew up in Shanghai and is still well-connected in China. She volunteered to help.

The deputy director of the Chinese Pharmaceutical Manufacturers’ Association, Dr Cheng Junpai, guided us, especially in terms of quality assurance – although, of course, she could not direct us to specific suppliers. We opted to stay close to the state-owned enterprise, Sinopharm, which serviced the local market and was a flag-bearer for Chinese pharmaceutical exports. We knew its reputation was its currency for international trade, and it staked that reputation on the quality of its products.

At the same time, we sought quotes from other suppliers whose credentials and product certificates were independently verified 22

by Chinese customs and excise authorities. Once the quotes were obtained, the products were viewed by trusted colleagues of Dr Yan and the exporters were requested to visit the source factories to gauge the product quality. While these processes would not entirely eliminate the risk of inferior imports, they gave us strong confidence that we had procured quality products.

This approach paid off: when they eventually arrived, we found that they were far more robust than those generally available on the South African market.

Ideally, we would have liked the endorsement of the South African Bureau of Standards (SABS) as well, which vetted all imports coordinated by B4SA. But the SABS itself had been closed for Covid cases, and there was such a backlog that it would have been weeks before they were assessed. In the meantime, we were receiving desperate reports of ambulance personnel going into homes to pick up Covid patients, wearing scarves around their faces and plastic refuse bags over their clothing. We had to make a call. We obviously did not have the capacity to assess quality at a microscopic level, but then again, it seemed that the real purpose of the PPE was being lost in the micro-scrutiny.

Letâ&#x20AC;&#x2122;s assume that, without a mask, the risk of transmission between a Covid patient and an emergency services worker is 20%. Mathematically, a Type II mask with â&#x2030;Ľ95% particle filtration efficiency would reduce that risk to 1% or less. Even if that mask only achieved 90% filtration efficiency in a test, the risk to the health worker would still be just one-tenth of having no protection at all. The dynamics of mask protection are actually more complicated, but dwelling on them will simply fall into the same trap â&#x20AC;&#x201C; focusing on the minutiae of the mask instead of the people who needed as much protection as could be provided, right now.

23

Given this reality, the main issue was to be sure that the PPE was not fake or poorly manufactured, and the best way to do that was to find reliable suppliers. Much of the PPE debacle in South Africa happened because some national and provincial departments paid scant attention to the quality of the supplier. The frequent result was importation of inferior products that were either distributed or dumped if they were subject to SABS testing and failed.

By the end of June, DGMT had ordered nine million pairs of gloves, four million disposable masks, 600 000 re-usable cloth masks and nearly two million nanofilters, 50 000 gowns, 150 000 face shields, 280 000 plastic aprons and almost 3½ million litres of alcohol-based sanitiser. We were delighted that the funding we had received would more or less cover the costs, even though we had to pay a huge amount to fly in the first consignment of PPE from China to get the show on the road. Subsequent orders were staggered according to distribution needs and would arrive by ship over the next three months.

Our delight turned to dismay when we received the bills from the clearing agents, which included excise duties of R15 million â&#x20AC;&#x201C; 20% of the value of the imports. We were under the impression that when government declared the national disaster, it had waived import duties on PPE. It turned out that they had, but only until the end of May when they were reinstated, apparently after complaints by local manufacturers. It was a bitter pill to swallow. Here we were importing PPE to make up for government shortfalls and to reach as many community care workers as we could, and we were being taxed for the effort!

The fact that the funding came largely from donations to the Solidarity Fund made it seem even more obscene. Once again, 24

it spoke to the lack of a concerted procurement strategy that should have been facilitated by national government.

GETTING THE PPE is one thing; distributing it to tens of thousands of community care workers across South Africa is another. It was beyond me, and so I made it the problem of Sinazo Nkwelo, innovation director at DGMT, and the REDISA team members assigned to this project, Stacey Jansen and Sharon Bender.

Sinazo joined DGMT on the 1st of March, three weeks before the lockdown. An assertive and articulate young woman from Maclear in the Eastern Cape, she has a business background and interest in broad-based black economic development. She was appointed to integrate different DGMT-supported initiatives in specific subdistricts. Her logic is that we will only break intergenerational cycles of poverty and marginalisation if we nurture children through each stage of their development to adulthood. While Sinazo has a longterm perspective on human development, Covid-19 demanded action in double-quick time. By the end of the third week of March, Sinazo was reassigned to convene the national initiative to protect and support over 100 000 community care workers â&#x20AC;&#x201C; and to do it fast.

REDISA is a non-profit company established in 2010 to coordinate rubber-tyre recycling in South Africa. It is led by Hermann Erdman, who instantly saw how its capacity could be harnessed in response to Covid. The company has developed a sophisticated two-way IT system for managing both deliveries and collections. They take logistics management seriously. Every transaction is geo-tagged and directly recorded in exhaustive detail. Over the past few months, I have come to realise that 25

they’re an auditor’s dream – able to demonstrate a paper trail for every piece of PPE, every step of the way. Unfortunately, they are still struggling with the reputational fallout of legal action in 2017, when the former Minister of Environmental Affairs, Edna Molewa, successfully applied for its liquidation in the High Court. The issue at stake was control over the operations, which had proved it could generate significant revenue. It was the Minister’s view that the non-profit company was benefiting excessively.

Elinor Sisulu is a non-executive director and provided me with the majority ruling of the Supreme Court of Appeals, which had overturned the lower court’s decision with costs, and put REDISA back in business. I appreciated the risk of reputational contagion, which could surface at inconvenient times in the rollout of such a public initiative. PPE procurement and distribution were bound to get messy and be picked up by the media at some point along the line – and we were keen to ensure that we kept our noses squeaky clean. But I also have an aversion to corporate and political leaders who make decisions based on whispers in the wind. The REDISA issue had been subject to judicial processes, and we felt that if we second-guessed the courts, what recourse would there have been for slander or fake news? REDISA was in – and as they had offered, entirely without remuneration. Looking back, we could not have done it without them.

The first task was to find local distribution partners, and one of South Africa’s great strengths is its rich network of thousands of non-government organisations (NGOs). Many sprang up in response to the privations of apartheid and continue to support local communities to this day. Not only do they fill the service gaps either on behalf of government or when it fails, but they 26

also generate innovative ideas for bettering their communities.

And true to their history, many are quite assertive in demanding the rights of the people they serve. As a result, their relationship with government is often conflicted. The sector’s reputation was badly tarnished by the Life Healthcare Esidimeni tragedy in 2015, where the Gauteng Department of Health transferred mentally ill patients to ill-equipped NGOs. Some of these were start-ups that had been set up at the whiff of public money that might flow to them, facilitated by their political cronies. One hundred and forty-three patients died – some coincidentally; many as a result of gross neglect.

While it was the system that lent itself to corruption and government officials who perpetrated it, it was the genuine NGO sector that took a knock. Particularly galling was to sit in meetings where departmental officials cited Life Esidimeni as evidence of the incompetence of the non-profit service sector, arguing for social services currently rendered by NGOs to be brought back into the public service. Once again, the capricious system had lent itself to corruption, and negotiating a new social contract between government and civil society – that fully articulates their respective roles – remains unfinished business in the transition to democracy.

But right now, our priority was to harness the distributed network of NGOs as local nodes to protect and support community care workers (CCWs). We invited them to partner with us in identifying CCWs – community health workers, emergency services workers, social and social auxiliary workers, relief- and child and youth care workers – who would need PPE either immediately or as the lockdown was lifted and they resumed their work. Our concern was for care workers who would be going into people’s homes because we suspected that 27

they would be last in line for PPE when the storm really hit.

In a time of rationing, they could become both the victims and the vectors of community infection. We were also concerned about their psychological wellbeing. Even in normal times, community-level workers tend to feel unsupported at the bottom of the pile. Now, they were being asked to be at the frontline – going door-to-door screening for Covid-19 infection and ultimately, if epidemiological projections were realised, caring for sick or dying grandparents as the children looked on.

We had seen it all before with HIV/AIDS – only that time it was the children’s own parents who were dying. While we set up a national call centre and tapped into a network of over 400 counsellors, much of the support would need to be provided locally. Anxiety and grief are best shared face-to-face.

Eventually over 350 NGOs and community-based organisations volunteered to participate, identifying CCWs and mobilising support for them in a national initiative branded Masked Heroes. Inevitably, there were a few shysters who tried their luck, hoping to profit from the venture or score some petty political point. There were not many though, and after some teething problems, most of the rest became enthusiastic participants, mobilising local support, managing the distribution of PPE and offering psychological ‘first-aid’ to community care workers who needed it. Many of these organisations were themselves under financial and emotional stress, having been cut off from community contributions – in cash or kind – that previously sustained them. Even if they continued to pay their staff the meagre salaries that community-based organisations can typically afford, they couldn’t substitute for the abrupt loss of income that their employees’ wider families experienced.

Instead of topping up household incomes, their staff now 28

found themselves the sole breadwinners. In a snap survey of 352 community care workers conducted by the project’s psychosocial support team to assess their needs, almost every person reported a calamitous loss in family income. Many said they were hungry. Although there was no way that DGMT could fully meet the need for food and other psychosocial support, substantial funding from the Johnson & Johnson Foundation, the Charlize Theron Africa Outreach Project, Maitri Trust, and the Horace W. Goldsmith Foundation provided the fuel for local distribution, food vouchers and the means for regular communication and psychological referral. Other concerned citizens were mobilised locally to just ‘be there’ for a community care worker in need, in whatever way possible.

Just ‘being there’, however, is not without personal risk in many communities across South Africa. In Khayelitsha, near Cape Town, one of our psychological first-aid training sessions being held in a youth centre was stormed by gun-toting gangsters who roughed up the participants and stole their cellphones, as well as the facilitator’s laptop. The trauma counsellors were themselves traumatised and needed counselling.

Despite these harsh setbacks, the machinery and human resources for a national distribution and support network started to come together. But there was one little snag. Some of the PPE would be on its way from China, while the rest would be locally produced. Trouble was we needed to get the PPE – all 300 tonnes of it – from the ports or local factory to small towns and villages across every part of the country. The quote we received from the B4SA logistics partner was bone-jarring, even though we were assured there was no mark-up on the transport costs.

If we had to pay, it would scoop another R10 million out of our already dwindling pot of funding that we were trying hard to 29

protect for the actual protective gear.

At the end of April, I shot an email to Asyia Sheik, head of public affairs, communications & sustainability at Coca-Cola Africa. I had briefly met her on a Zoom call a couple of weeks earlier. Coca-Cola’s logistics capacity is legendary and the source of envy of public health managers struggling with last-mile distribution. The joke goes that anthropologists searching for ‘undiscovered’ tribes will always find a Coca-Cola sign in their villages. Back home, there was no time for gentle courtship with the company, and I proposed an urgent marriage of necessity.

We needed to transport tens of thousands of boxes of PPE countrywide, at no cost to us.

Just five weeks into the lockdown, I was already jaded by the tepid response of those in the corporate sector that should have been right up front, securing the nation’s nutrition and enabling access to information and learning (see Chapters 3 and 4). The call to Coca-Cola was a long shot and I expected to be turned down. However, Asyia’s response was warm and assuring: she would need to consult with the bottlers – Coca-Cola Bottlers SA and PenBev – but was pretty sure they would agree. Without hesitation, they did, and their logistics teams and ours were soon planning the nitty-gritty of a national roll-out plan. Their professionalism and support were amazing and tempered my broad-brush cynicism of the corporate response. Provided they were given just 48 hours’ notice, their trucks would pick up consignments of imported PPE from Imperial Health Sciences warehouse in Midrand and take it to their depot in Bedfordview, where it would be repackaged and distributed to 11 regional depots. From there, it would be sent to the 350 NGOs serving as local nodes for distribution. Given the extraordinary nature of this work, and apart from a few glitches and tensions with 30

driver-owners of trucks, the system worked well.

There was, however, one wobble in late July, as the media exposed the extent of the corruption and mismanagement of public funds for PPE procurement. Inevitably, brand publicity and recognition was part of what attracted Coca-Cola to the partnership. Now they risked being tarnished by association, and our relationship suddenly seemed to go off the boil just as the first distribution was rolling out. We assumed that back in Coca-Cola’s head office in Parktown, Johannesburg, a rapid review of risk was underway. Given the stories of greed and plunder perpetrated by conniving officials of the governing party, the company’s response was entirely appropriate. But with growing frustration, we watched the numbers of Covid cases start to climb in KwaZulu-Natal, and shocking scenes of poorly managed and overwhelmed hospitals and clinics in the Eastern Cape – all the while hundreds of boxes of ‘our’ PPE sat in warehouses in Durban and Port Elizabeth.

It was a great relief when Asyia convened a meeting with the bottlers. After probing our procurement processes carefully, they concluded that their only residual concern was the possible reputational risk associated with the relationship with REDISA. Not that they had significant cause, having read the Supreme Court of Appeal judgement, but they did not want to take on any unnecessary reputational exposure. In their book, the partnership was a two-way one between Coca-Cola and DGMT. My sanctimonious aversion to spineless leadership was about to be tested and, if adherence to principle is the stuff spines are made of, mine proved a little gelatinous. We agreed that REDISA would not feature in the partnership agreements with Coca-Cola, although on the ground, nothing would change.

From a pragmatic point of view, it was not difficult to rationalise 31

this decision: community care workers needed PPE now, and it didnâ&#x20AC;&#x2122;t really matter whose names were on the paperwork.

Not surprisingly though, REDISA felt hurt and offended by the decision, after all the energy and resources they had put in to make things work. To their credit, the issue was behind us by the next morning.

The duration of this delay was small in the bigger scheme of things, but it demonstrated the challenge of trying to keep a distribution pipeline flowing. Much like the dynamics of traffic jams, any brakes applied to the system caused unanticipated bottlenecks and back-ups; we were already six weeks behind as a result of the inability of the B4SA to deliver the goods ordered in early May. The timing of distributions was contingent on the arrival of freight on ships, which then needed to be cleared through customs and excise. Some of the consignments were subject to checks by the SA Police Services, causing further hold-ups. On the other end, NGOs were getting exasperated by what seemed like empty promises, and it was a great relief to be able to prove eventually that we would deliver, albeit rather late.

From an epidemiological point of view, our original rationale was that high levels of PPE coverage among community care workers would help to flatten the curve by reducing transmission in high-risk settings. That meant getting the PPE out before the exponential rise in infections in each province â&#x20AC;&#x201C; or at least well before the peak. To our dismay, the first deliveries in the Western Cape happened just after the peak and as it spiked in Gauteng.

We just caught the wave in the Eastern Cape and KwaZuluNatal, the other two high-incidence provinces.

Eventually our first consignment went out in late July and early August, and we hoped that it would be plain sailing thereafter. But it was not to be. We got some insight into the 32

challenges of logistics and distributions across South Africa, as delivery plans were disrupted by Covid cases at the warehouses and truck arson on the Durban-to-Joburg highway. The Solidarity Fund’s logistics partner, Imperial, struggled to stay on top of the comings and goings of the various consignments from different donors for different purposes, and eventually gave us friendly notice of eviction of all remaining stock from the end of October. At short notice, we had to scramble to find 225m2 of warehouse space for seven million nitrile gloves, which we did, thanks to the Old Mutual Property Group.

The second large consignment eventually went out in mid-October. It was deeply frustrating, but we also realised that providing PPE at a time when the economy re-opened and normal health and social services resumed might be instrumental in preventing secondary outbreaks and spikes in infection.

While we experienced numerous setbacks with national procurement and distributions, the local NGO network was incredibly efficient. Sharon Bender, operations manager for REDISA, noted that “the NGOS were much more mobilised, on the ball, and able to keep their word than the distributors”.

Her comment was aimed less at Imperial’s occasionally frayed management and more at the amazing work done by community organisations that were often themselves under huge financial and operational strain.

Eventually, the PPE found its way to those for whom it was intended, like Phina Seefane, a community health worker in Limpopo, who has been working at Daspoort Clinic for the past eight years. It is best if she tells her own story: “I’ve come to realise that I am good at helping my community with their lives.

Mostly we find that people don’t have food and clothes and so we 33

try to help them with this. After that, they are happier, and they keep asking me to assist them with their needs. I believe it is my responsibility to share what I have with those who need it. Even if it’s just a small piece of bread. If I have it, I will give it to them.

My family always support me, particularly my husband who I stay with. I am happy I am assisting my community. I am so proud of that.

Sometimes people come to my home and ask for masks. I struggle on days when I don’t have masks to give to people who need them. Sometimes I barely have enough masks for myself, but I need to give them away and I am left with only one. I’m concerned about my health during this pandemic because I don’t earn much money and we don’t have medical aid. I am scared that if I get sick, I will go to the clinic and then to the hospital where I will need to spend lots of money for treatment. It’s money that I don’t have. My dream is to have a big house and a nice car.

But it’s also to have medical aid.”2 And paramedic Joseph Tuson, whose experience is retold here by journalist Natasha Joseph: “On an icy Thursday morning, as a cold front blew into Johannesburg and anybody who could huddled deeper into their duvets, Joseph pulled into his driveway, climbed out of his car – and undressed in the driveway. Just off a 15-hour shift, he placed his uniform into a bucket of hot soapy water his mother had set out. He walked straight into the house, all of its exterior and interleading doors left open so he wouldn’t have to touch any handles, and climbed into a shower. For the rest of the day, as he does now whenever he’s off shift, Joseph kept to himself. It’s not that he doesn’t want to see his mother or sister; he’s just doing whatever he can to keep them safe from exposure to the 2 Phina Sefane, as told to Jade Jacobsohn. ‘I’m concerned about my health during this pandemic because I don’t earn much money and we don’t have medical aid’. Masked Heroes, June 2020. Available at: https://maskedheroes.org.za/phina-seefane/

34

coronavirus. It hasn’t been an easy adjustment.

“I’ve had to train myself out of things like just walking through to the kitchen and making a cup of tea,” he explains later that afternoon. “I’m scared for my family. My mom is immunocompromised; my gran lives nearby. If I get (Covid-19) chances are I’m going to be fine, but them…”

Being a paramedic is gruelling, highly physical work. It’s also dangerous. There have been instances of ambulance personnel being attacked while responding to calls; EMS personnel won’t enter some areas without a police escort. Joseph is used to the “daily dangers” of high crime spaces, where he and his colleagues must attend to victims of those crimes. None of this has vanished just because of Covid-19. As Joseph puts it: “Work goes on. Life goes on… People are in car crashes, they get sick for other reasons besides Covid.”

But, of course, the virus has brought some significant changes.

Before, paramedics wore gloves when treating patients; now they’ve added aprons, masks, and visors. Joseph, like anyone who wears glasses, is trying to adjust to life on the job with misted-up spectacles. As the senior staffer on his shift, what stresses him out far more than occasionally foggy vision is ensuring that his colleagues have the necessary PPE to protect themselves from exposure to the virus. It’s a responsibility he takes seriously, and one that’s landed hard on his young shoulders. This time last year he was wrapping up his Bachelor of Health Sciences in Emergency Medical Care at the University of Johannesburg. Now he’s shielding himself, his colleagues and his family from a pandemic that’s ripped through the world.”3 3 Joseph, N. (2020). ‘We got into this job to help people, and we have an opportunity to do that in a time of crisis… Society needs us’. Masked Heroes, July 2020. Available at: https://maskedheroes.org.za/we-got-into-this-job-to-help-people-and-we-havean-opportunity-to-do-that-in-a-time-of-crisis-society-needs-us/

35

What can South Africa learn from this experience of a pandemic that’s ripping through the world? How can we improve our general responsiveness to national disasters and our specific response in the event of another Covid flare-up?

The main takeaway is that systems for procurement in extraordinary circumstances should be fit for purpose, within pre-approved principles and parameters. If there is no space for tailor-made design in times of crisis, the only way of doing things in a hurry is to relax the controls – and that is manna for the vultures. The obvious starting point should have been central procurement of all PPE purchased with taxpayers’ money. Then, three questions should have been asked: and how can be ramp up its supply?

supported to stimulate new product production locally?

If those questions had been asked, then fair and transparent tender processes could have been put in place for locally manufactured products, while bilateral negotiations could have secured quality PPE from countries like China without the cost of intermediaries.

In a disaster situation, there should be recognition that commissions on imported goods simply do not qualify as genuine broad-based black economic empowerment (B-BBEE).

Instead, the Trade and Industry Department should be proactive in identifying and accelerating the innovation that emerges in times of crisis, and promoting B-BBEE through pioneering partnerships.

If we are to combat corruption in South Africa, we must improve the state’s investigative and prosecuting capacity, and 36

insist that politicians on the take are held to account. But we must do more than that. If the system design lends itself to corruption, there will always be connivers lining up to take advantage of it.

Probably the most important aspect of design is transparency in what is procured, from whom and at what price. To quote Justice Louis Brandeis, sunlight is the best disinfectant.

Unfortunately, scant attention was paid to that systemssanitiser until it was too late â&#x20AC;&#x201C; we were all too busy trying to wash our hands of the problem with the spirits-based kind.

37

CHAPTER 2

TAKING TO THE AIRWAVES

MY WHATSAPP FEED shows that at 11h26 on the 26th of March – the first day of national lockdown – the director of Innovation Edge, Sonja Giese, sent me a message: “Anything I can help you with?” She received an instant reply from me: “Yes. Will call.” Judging by her WhatsApp note just one day later, the commission was daunting: “Bloody hell,” it read. “What have I got myself into?”

Sonja’s shocked realisation was that she had got herself into directing the production of 10-minute inserts for 15 public radio stations, in 12 different languages, every weekday for the next three months. I toyed with a flippant answer before discretion kicked in, and texted back that she had got herself into ‘personal development’: “By the end of it you will be an authority on radio broadcasting.” With remarkable intuition, I concluded that part of her anxiety stemmed from the fact that she’d never in her life produced a radio show and had no clue where to start. I reassured her with a smiley emoji, hoping it would serve as a digital Tranqipam of sorts.

Sonja’s timing had been impeccable. Just three minutes earlier, I had received confirmation from the National Department of Health’s Media Liaison Officer, Popo Maja, that they would “truly appreciate the support” for the radio initiative outlined above. It was an offer I had made to him earlier that 38

morning to keep radio audiences informed and engaged as the pandemic unfolded. We could raise the funds for production costs I said, but the South African Broadcasting Corporation (SABC) would need to agree to air the radio slots for free, which could be billed as: ‘Brought to you by the National Department of Health and the SABC’. DGMT was “happy to make it happen behind the scenes” – but I had just spent the last 180 seconds wondering how on earth to do that.

Radio still plays a big role in public communication in South Africa. While most people now have access to television, radio is the primary means of engaging with audiences in their home language. For that reason, it holds much power of persuasion, which would be needed if people were to take personal action to prevent Covid transmission. In the first weeks of lockdown, the main means of communication was via the government’s Covid website and social media, which were inaccessible to more than half of the population who don’t have smartphones and can’t afford mobile data.

I had seen the power of radio in the loveLife HIV-prevention campaign and knew that this medium was crucial for Covid communication too. Hence the offer to Popo Maja. It was a leap of faith – one that could lead the DGMT’s trustees to seriously question my sense of judgement if things didn’t work out. They knew that my instinct to ‘keep going forward’ had landed me in hot water before. On one occasion it was cold water, as I’d managed to sink a Toyota 4x4 in a crocodile-infested river in Botswana. Still, my family and I had come out on top in that situation – perching on the roof of the submerged pick-up until we were rescued.

This time, that instinct propelled me to ‘keep going forward’ without any certainty of how the R14 million production cost 39

would be covered. On its own, that kind of money wouldn’t break the bank, but DGMT’s other contingent liabilities related to Covid-related projects were swiftly growing as we tried to make things happen fast, hoping that our appeals for co-funding would eventually pay off. If all the proposals failed, DGMT would face an extraordinarily large bill that would hobble our continued support for smaller civil society organisations over the next year.

Finances aside, it may not even have been technically possible to pull off such a massive daily undertaking with the stringent lockdown restrictions in place – but that thought never crossed my mind. For a decade, loveLife had produced weekly radio shows in all official languages. Similarly, DGMT’s partner for early childhood development, Ilifa Labantwana, produces weekly shows for the Department of Health’s Side-bySide campaign, which is focused on the health and wellbeing of young children. I convinced myself that if it could be done weekly, why not daily?

About that time Sonja phoned to ask whether “everyday radio slots” meant weekends too. I said it did. Thankfully, her good sense and that of SABC radio management prevailed, and the inserts were aired during primetime on weekdays only. In my defence, my confidence rests in the great faith I have in the DGMT team and key partners like Innovation Edge. It may be a bit inflated, but it is not misplaced.

The next port of call was the SABC, which has a public communication mandate but is also severely cash-strapped. Our existing relationship with the SABC stood us in good stead, as they knew we were reliable creditors and could deliver. There was already tacit acceptance of what we, as DGMT, would and would not fund in our relationship with the SABC. We drew 40

the line at paying for airtime as we are not a commercial entity, and viewed our contribution as furthering the broadcaster’s public mandate, but we were willing to offset some of the 15 radio stations’ broadcast studio costs. I wrote to the head of radio, Nada Wotshela and to Che Che Mazoka, head of funding and partnerships. Within the hour, Che Che had written back welcoming the news and initiating joint planning.

The lockdown meant limited access to the SABC studios, so the inserts would have to be packaged in an external studio and transmitted electronically for broadcasting. It sounds like a simple matter to get right, but it’s not. There is a visceral resistance by most of the public radio stations to pre-packaged audio material. They take great pride in their role as custodians of African languages and wince at any adulteration whatsoever.

Regional dialects and the accents of second-language speakers are discouraged. Even the radio programme’s Nguni title, Sikhaba iCovid-19 – ‘Let’s kick out Covid together’ – subsequently proved contentious for some of the Sesotho stations, despite having originally agreed to it.

Linguists may disagree with the pedantic approach of the stations, but there can be no doubt that regional radio plays an important part in protecting these languages. Having said that, this attitude seemed impossibly doctrinaire when looking for a SiSwati medical doctor late at night to comment on the latest Covid figures – and you still have to find another ten medics who can speak other languages as well.

‘Finding one another’ would take several weeks and resulted in a first abortive launch of the radio series. Inevitably, contract negotiations were slow, and the agreement had yet to be signed by the Friday before go-live Monday. The draft contract was sitting with SABC legal but SABC finance would not give the go41

ahead to air unless the contract was signed and the 50% upfront payment firmly in its bank account. Eventually DGMT paid the money, on assurance that the agreement would be forthcoming.

No doubt there will be displeasure when our eagle-eyed auditors pick that one up.

However, the compressed timeframes were too tight to produce a polished performance on that first Monday, the 20th of April – exactly three weeks after my initial email to Nada and Che Che. Discomfort with format and dialect resulted in at least one station refusing to air, while mix-ups in segment sequencing on several of the other stations left their expectant listeners thoroughly perplexed. It was rather embarrassing to report the debacle back to the Department of Health, and I was relieved to get an airy response from the ever-pragmatic Deputy Director-General Yogan Pillay saying, no worries, he was sure we would sort things out. And Sonja and her team did: Sikhaba iCovid-19 relaunched a week later, almost without a hitch.

Crucial to resolving the relationship issues were two former SABC insiders, Buhle Mabaso and Lettie Dube. Buhle now works for Ilifa Labantwana, and is positioned within the Department of Health’s Side-by-Side campaign. Lettie is a freelance producer for Radio 2000 and had been part of the loveLife radio team. Both knew many of the SABC staffers and could negotiate the systemic obstacles and personality politics that bedevil big bureaucracies. The outside production was led by Koketso Sachane of 76 Media, who also had experience of working with the SABC. Ultimately, a team of close to 60 people was commissioned – researchers, translators, producers, presenters, voice-over artists – as well as dozens of volunteers who offered their time to critique the daily shows.

A crucial element of the programme was its finger on the 42

pulse of issues and events across the country. About 150 people wrote daily diaries online, in their mother tongue, sharing their experiences, views, questions and concerns. This input was collated by a dedicated team and fed into the content planning cycle. In that way, the Sikhaba team got a good sense of the public response and top-of-mind concerns as the Covid storm blew in.

While audiences were undoubtedly concerned about the risk of infection, the other realities of their lives kept surfacing as well. Callers spoke of their loss of jobs and their inability to feed their families. Statistically, half of the young people calling in were likely to be unemployed. When you’re living hand-tomouth and your risk of dying from coronavirus infection is actually very small, being asked to wear a mask, keep a social distance and wash your hands seems almost trite. Covid-19 must be placed in the context of their lives – recognising their other pressures and realities – if they are to be motivated to adopt these protective behaviours. Sikhaba’s format was split into three: the first segment was a daily update of the course of infection in South Africa, aimed at helping listeners to see through the epidemic and know we would come out on the other side; the second was a focus on preventive behaviours, made real; while the third featured an inspiring story of positive community or individual action in the face of Covid.

Both listeners and guests who were invited to share their experience of the show appreciated its warmth and groundedness.

“The most beautiful thing about this show,” commented one of the guests, “is that it was presented in our home language, which made it easier for us to learn and understand everything well.” Inevitably, the team had to counter fake news as well, especially on Facebook and Twitter. “Covid-19 is an imaginary 43

virus,” texted one user, adding that “the media is fooling the community.” Another wrote, “Government has the answers [to Covid], but they are playing us and instilling fear so they can rule even more.”

Mistrust of government’s motive was a common refrain, not only on Sikhaba’s social media platforms, but in the findings of the Ask Africa Covid-19 surveys as well. Over three-fifths of respondents stated that they had lost significant income during lockdown and vented their frustration at government. The initial jackboot approach of some members of the security forces didn’t help either. To cap it all, it then transpired that members of the ruling elite had benefited from the procurement of PPE and other emergency supplies, while families locked away were going hungry. Small wonder there was limited compliance when the official communication shifted away from commandand-control type communiqués to appeals for individual and collective responsibility. As one of the ministerial advisory sub-committees put it, the required shift was from ‘anxiety to agency’ – but it was very difficult to feel empowered when the little food and economic security you have is being ripped from under your feet.

Although it is difficult to measure the impact of Sikhaba – or even to gauge how many of the public radio stations’ combined listenership of more than 20 million listened to the shows – the feedback was encouraging. “The truth is I have learnt the power of knowledge and how this empowers people to feel less anxious in responding to the virus,” said one listener. “It helps people to feel more in control of their lives and their families.”

The demand for Sikhaba content grew steadily over the months, with over 11 000 Facebook followers by July. The content was repurposed and eventually syndicated to over 55 44

community radio stations, some of which aired the inserts three or four times a day. Marlyn Ntsele and her bright young team at iSupport handled community radio and social media in real time, responding to every single inbox question – in whatever language – within an hour.

Their one-on-one reach was small compared to the total number of listeners, but it illustrates both the efficiency and the spirit of care that rippled through the whole Sikhaba team.

Although we had initially agreed to a 13-week series, it became clear that the show needed to be extended for another three months. Sonja Giese stepped out to resume her normal life as mother and director of Innovation Edge. She had been a quick learner, both of the skills of radio production and the art of co-option. A couple of people wryly remarked that they’d reached out to Sonja to find out if she needed any help – only to find themselves neck-deep in the project a few days later. I issued her and the Innovation Edge team with a ‘certificate of great appreciation in producing nearly 1 000 Sikhaba iCovid-19 daily radio inserts on 15 public radio and 25 community radio stations from April to July 2020’. The certificate included magnified screenshots of our WhatsApp exchange on the 26th of March, when she innocently asked whether there was anything she could help me with.

With Sonja’s departure, DGMT’s Deputy CEO (and mom of one-year-old Zazi), Janet Jobson, stepped into the role of Project Lead. She was already leading the DGMT team’s input into the shows and so knew the ropes. By this time anyway, the daily process was a well-oiled machine, aided by health communications specialist Angela Stewart-Buchanan and other expert freelancers like Nikki Froneman, whose job was to find content specialists in every language every day. Nikki is an 45

independent producer and arts manager whose work dried up overnight with lockdown. She is also a talented arm-twister and shifted those skills to scouring the country and roping in experts for the radio shows. Her official title was Expert Wrangler.

Together with her team-mate, Caitlin Hanley, she managed to persuade over a thousand people to contribute to the show. In the process, an extensive network of experts was built up – many of whom then offered to give of their time and knowledge every week.

Each expert was briefed on the topic of the day and given a translated script of questions to answer, which were recorded as voice notes and sent through to Lettie Dube and other team members to do quality checks. Often there was need for several retakes which could take up several hours of an expert’s time. They all gave it freely and generously. Sometimes, local circumstances proved particularly trying, such as the show on community transmission in informal settlements, which required unusual inventiveness. The experts, drawn from local community groups, battled to record their inputs with the high levels of noise – babies crying, dogs barking and music pumping.

Eventually, the recordings worked, with everyone ensconced under heavy blankets.

A number of DGMT’s staff moonlighted on the radio production team from April to October. Each daily planning meeting was followed by a burst of coordinated action – research to be done for the following week’s programmes, scripts to be written, facts checked, expert opinions identified, translations completed, motivating stories found, producers briefed, and inserts recorded. The process might have been down pat, but the content had to be fresh every single day. Daily statistics released by the Ministry of Health between 19h00 and 21h00 every 46

night needed to be packaged as content for broadcast the next morning – and that meant getting scripts signed off, translated overnight and delivered to the stations by 10am. This team also played crucial roles in the sourcing of experts and quality assurance, as well as managing the finances of an initiative with many moving parts. It was astounding that this entire venture happened remotely – by Zoom and MS teams and WhatsApp. Most of the team members had never met each other in person.

It was this extraordinary dedication and hard work, well outside of job description, that made me indignant at the Solidarity Fund’s conditions for agreeing to finance the radio initiative. The Solidarity Fund had contributed substantially to the provision of personal protective equipment for community care workers – R90 million. For reasons described in Chapter 1, most of this funding had come to DGMT to reimburse it for its direct procurement of PPE from China. Not a cent of the money went to DGMT’s own operations, which it funded itself.

Nonetheless, on the Solidarity Fund’s books, DGMT would have been listed as the beneficiary of such significant funding.

At the same time, the Fund was under pressure to demonstrate its even-handedness and counter the suggestion that it was favouring particular NGOs or sectors of society.

Right at the beginning and within days of its establishment, I had put in the proposal to the Solidarity Fund on behalf of DGMT and our partner organisations, Ilifa Labantwana and Innovation Edge, to co-fund the radio initiative. The Millennium Trust had been quick to make a commitment of R2 million and the ELMA South Africa Foundation followed suit with another R5 million. By mid-April, we were halfway there. The Solidarity Fund’s ‘war room’ was keen, but wanted the funds to go to one of the parties other than DGMT. Given that Sonja Giese would 47

lead the project, we had no problem agreeing to this party being Innovation Edge, as we could use the Millennium Trust and ELMA funds for contracts already entered into by DGMT. We were happy to work as a consortium, so long as the organisation contractually responsible for managing specific aspects of the funding had direct control over its use. We could not agree to a situation where one organisation incurred the costs, while another organisation received the funds to pay for them. The auditors would not have been amused.

Another minor sticking point was the Solidarity Fund’s requirement to be credited on radio, despite only contributing half the funds. We understood their rationale: they needed to show that the donations they received were being well spent. We felt that this ask was fair enough, and the project’s co-investors magnanimously accepted the Fund’s singular recognition in the radio stings.

Things became complicated when Sikhaba iCovid-19 was extended by three months, and DGMT assumed project management for all aspects of the show. This time, the ELMA South Africa Foundation and the Zenex Foundation contributed just under half the new costs, while the Solidarity Fund provided the rest. But for reasons not fully explained, the Fund did not wish to channel any further funding through DGMT and insisted on paying the production invoices directly. It may seem a small issue in the greater scheme of things, but it placed an unnecessary administrative burden on an already overstretched team. Dozens of freelance contracts needed amending, and parallel processes had to be put in place for DGMT to manage the freelancers while the Solidarity Fund managed the money.

Inevitably, there were initial administrative delays that blocked cash flow and caused dissatisfaction in the freelance team, who 48

were working around the clock to meet the daily deadlines.

The Solidarity Fund’s leadership must have really felt pressurised – by politics or public perception – that such convoluted arrangements were preferred. It was left to the decidedly uncomfortable Siven Maslomoney, who coordinated the Fund’s communications portfolio, to convey this decision to us. Rightly, he guarded the internal deliberations of the Fund.

Still, he was the nearest lightning rod and I vented my ire at him and later, at the Fund’s highly pragmatic disbursements manager, Nicola Galombik – even though I knew the decision must have been made higher up. No doubt trade-offs were being made to try and placate different interest groups, or at least to show that there was no favouritism in the divvying up of the funds.

I was really irritated. It felt to me like window-dressing until, in a rare flash of insight, I realised I had done exactly the same thing by touting the radio shows as ‘brought to you by the National Department of Health and the SABC’. No mention of all the work done by Innovation Edge, Ilifa Labantwana or DGMT teams; no mention of the hundreds of voluntary contributors to the programmes; no mention of civil society.

In biblical terms, I had sold our birthrights. Of course, I had done this with the best intentions to get the show on the road as quickly as possible, for there was an epidemic to fight; and anyway, it is in the nature of many civil society organisations to stay out of the limelight. But sometimes, we do our sector a disservice by avoiding recognition of our efforts. It hides our light and can be disempowering.

This incident also served as a reminder for us to tread lightly as funders. It is too easy to slip into the role of social engineer – instead of social innovator. The NGO space is a delicate one – 49

comprised of a mix of volunteers, activists and employees – and it can be damaged through clumsy manipulation by government or funders. The Life Esidimeni tragedy is a case in point where, in the name of transformation, government officials incentivised new entrants into the sector whose main motivation appears to have been money. Over-engineering of social change can drive transactional costs higher and divert scarce resources from programme implementation, ultimately disadvantaging those whose interests it claims to promote.

The special role of civil society organisations is to be social innovators – challenging old ways of thinking and doing that hold our nation back, while building social cohesion at the same time. True social innovators instinctively value diversity of ideas and participation, because it facilitates the ‘creative destruction’ that rejuvenates societies and generates new social capital. The Sikhaba Covid-19 radio programme is a great example of how a groundswell of community voices – in every local language – was channelled and broadcast across the country, helping to shape norms and actions and build social solidarity. Without it, the voices from the ground could just have been experienced as peals of ominous thunder.

Civil society is not a vassal of government, nor of funders.

It provides a way of enabling ordinary people to be heard, and must be allowed the space to contribute to fundamental socioeconomic transformation on its own terms and in its own way.

Otherwise it simply becomes an amplifier of His Master’s Voice.

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CHAPTER 3

QUICK INTO THE LIFEBOATS, POOR CHILDREN FIRST

ON THE 13th of February 2018, I received an email from Stephen van Coller, then one of the vice presidents at mobile giant, MTN. He confirmed that both the Group CEO, Rob Shuter, and his South African counterpart, Godfrey Motsa, had agreed to zero-rate the digital content of all public benefit organisations (PBOs). Motsa had delegated responsibility for making it happen to Jacqui O’Sullivan, the corporate affairs executive.

Fast-forward nearly 2½ years.

On the 16th of July, Ms O’Sullivan publicly responded to a DGMT court application compelling MTN to comply with the disaster regulations and prioritise the zero-rating of approved PBO websites providing local educational content to poor children. DGMT, she contended, was acting in “extraordinarily bad faith”. After more than two years of inaction by MTN, we couldn’t help but feel that she’d stolen our line.

It was an acrimonious end to a courtship that had promised great hope to families living in informal settlements and rural areas. The General Household Survey of 2018 had found that while 65% of the population had some form of internet access, only 10% had access at home.4 Data usage had steadily increased Statistics South Africa. (2019). General Household Survey 2018, Report no. PO318.

Available at: http://www.statssa.gov.za/publications/P0318/P03182018.pdf

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over the previous five years, but 47% of South Africans still didn’t use the internet and reported unaffordability of devices and data services as the main barrier.5 In short, any online solution using smartphones (interactive websites, mobile apps or videostreaming) was inaccessible to half of the population.

DGMT has become acutely aware of the polarising impact of data costs over the past decade. While digital circuitry brought exponentially more information to wealthier children, poorer children remained completely out of the loop. Sometimes, when provincial education departments failed to deliver, they didn’t even get access to the schoolbooks they required. It is now clear that a powerful way to improve educational outcomes is to provide every child with access to mobile data. No, it is not a quick-fix, but it can begin to break cycles of intergenerational poverty by exposing eager learners to new worlds that previously they could only dream of.

The cost of data is coming down, but commercial rates will never be low enough for the poorest children and their parents to use digital content for nutrition and health advice, early learning, education or job-seeking. For this reason, DGMT has pushed hard for the zero-rating of mobile data for PBOs. There are at least 100 PBOs whose life’s work is to provide the poorest children with learning resources, books, stories, language and maths. Most children in informal settlements and rural areas have access to a feature phone. If they are lucky enough to have a ‘smart’ feature phone, they can access the internet through a browser, but cannot access any apps that are not preloaded onto the phone. If they have a ‘dumb phone’ they have no internet access whatsoever. But it is still possible

_____________________________________________________________________ 5 Research ICT Africa. (2018). Dominant operators’ data prices remain static while SA struggles to get and stay online. Policy Brief 1, June 2018.

Available at: https://researchictafrica.net/wp/wp-content/uploads/2018/06/2018_ Policy-brief-1_Data-prices-remain-static_South-Africa-.pdf

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to reach them by compressing information into tight bite-size chunks that can be transmitted together with questions or reading prompts; and then using an SMS or a chat function to talk with them. This work has been pioneered by initiatives such as the SmartStart early learning franchise, Nal’ibali reading-forjoy campaign, FunDza reading for teenagers and more recently, Acorn Education. Acorn has shown that it is possible to educate children on 25 to 50 megabytes per child per day.5 Since 2013, DGMT has punted the idea of a national social innovation registry to manage and monitor the zero-rating of digital content provided by public benefit organisations. Just for clarity, zero-rating of data means that the mobile user can access free digital content, with the costs borne by the network operator or a third party. In this case, the costs to the network operators could be reimbursed from that tiny sliver of net profit after tax that they have to contribute to a universal service and access fund (USAF).

It’s an elegant solution, which attracted the interest of the Competition Commission’s Data Services Market Inquiry. The idea was presented as a firm recommendation in the provisional report in mid-2019, noting that all network operators agreed with it. In the final report, the recommendation had been watered down somewhat and by the time the horse-trading over the rest of the Commission’s recommendations was completed in early 2020, the proposal had disappeared entirely. I spoke to its chief economist, James Hodge, to try and understand what had happened. “In the final analysis,” he said, “it made sense for the telcos to pick and choose which PBOs they wanted to support. That’s what competition is about.” We beg to differ.

This recommendation was a response to a market failure that 6

Personal Communication, Anco Booysen, CEO of Acorn Education, 23 August 2020.

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prevented children and young people from navigating their way from one fascinating website to the next in a process of learning.

Their routes of exploration would continue to be dictated not by their curiosity, but by the brand colour of their SIM cards.

Then came the thunder of the approaching Covid storm.

If ever there were a time to capitalise on the cellphone in almost every South African home, it was in March 2020.

Within days, schools, preschools, reading circles, health clubs, antenatal classes, job skills and a wide variety of community support programmes just stopped. The pipeline of learning and teaching to millions of children was abruptly cut off and would not start flowing again for several months. President Ramaphosa announced the closure of schools from the 18th of March. That same day, we wrote to the CEOs of all four network operators with substantial national coverage. “As you are aware,” we said, “schools and preschools have closed and are unlikely to open again for a while. It is realistic to assume that these restrictions will be in place for at least two months. This means that young children and learners will be sitting at home, most of them without access to any form of continuing education and interaction.” We urged the CEOs to implement the original recommendations of the Competition Commission and zerorate the websites of PBOs without delay as an immediate and proactive response to the looming crisis.

To sweeten the deal, we stated that we would pay for the services of BiNu, a commercial platform integrator that would allow for a single portal to zero-rate and track the usage of all public benefit organisations. BiNu already worked with the big two, MTN and Vodacom, and was sure it could complete the technical link-up within a day. Vodacom and Telkom responded within a few days, with a hint of encouragement, saying they 54

would investigate the option and revert. There was radio silence from MTN. I wrote again to its CEO, Rob Shuter, two weeks later, urging him to “please treat this as a matter of urgency.

Every day counts.”

A day later, MTN’s Jacqui O’Sullivan connected me to her colleague, Megan Vercueil, to “assess and respond to your request”. A week later, Ms Vercueil responded that we were welcome to apply to the Open Time platform, but “please note this is still under development with a targeted date towards the end of April”. She included a template for me to fill in the billing address for platform costs. I nearly choked.

By this time, the initial interest of Vodacom had fizzled.

I approached DGMT board member and struggle veteran, Murphy Morobe, to try and organise meetings with the respective chairpersons of MTN and Vodacom, Mcebisi Jonas and Jabu Moleketi. Both were gracious enough to meet us and agreed that the request was both reasonable and doable. One of them even noted the unexpected financial windfall to telcos generated by the lockdown. Both undertook to engage with the relevant executives, which they did, and a flurry of correspondence followed – with the same disillusioning effects. Both companies submitted a long letter detailing the noble extent of their efforts and community involvement, but regretting that they were “unfortunately not able to provide the zero-rating of all of these sites”.

In the meantime, the Department of Communications and Digital Technologies (DCDT) had issued a directive in terms of the disaster regulations requiring network operators to zerorate the local educational and Covid-related health content of websites, to be approved by a project management office.

This office was comprised of officials from DCDT, as well as 55

the Departments of Health and Basic and Higher Education.

Applicants were required to submit their motivations for zerorating, together with the technical specifications – uniform resource locators or URLS – of their websites. All the telcos already had the systems of zero-rating and reverse-billing of commercial customers. The banks in particular wanted their customers to log onto their mobi-sites at no cost, while they picked up the tab at the back end. But these systems were not designed to respond to the big ask by government, which ultimately required them to zero-rate over 1 000 sites.

At a meeting of the telcos in late March, proprietary interests outweighed common sense, and they each opted to build their own systems for zero-rating, instead of using an aggregator service that could have made everyone’s lives a lot easier. Clearly, they saw some competitive advantage in offering a suite of educational and health services to their subscriber base – and despite their avowals of overwork over the next six weeks, both MTN and Vodacom quickly developed their own branded bouquets of complimentary services for subscribers, while they chipped away at the growing mandatory list of URLs to be zero-rated.

Veteran of the struggle for digital freedom, Dominic Cull of Ellipsis, advised us to abandon our appeals to the largesse of the telcos and gun for the break in the clouds created by the disaster regulations. We did, and submitted a list of 60 public benefit organisations to the project management office on the 9th of April. We did so again a week later. We requested DGMT’s chairperson, John Volmink, to use his considerable influence to keep the pressure on, which he did, to the annoyance of some of the department’s officials. It may have been irritating for them, but these were extraordinary circumstances and every day counted.

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On the 5th of May, a list of 39 of the domains for which we had applied were included on the official list of approved websites. For a while, we wrangled over those that related to basic education but had been rejected, but eventually conceded that they did not have sufficient packaged resource material that could have been immediately available to learners. The rest of the websites we submitted served young people neither in education, employment nor training – in other words, precisely those young people who needed free and urgent access to digital content. Clearly they had not been on the radar of the drafters of the regulations, whose focus was on learners in school and students in college or university. No zero-rating provision had been made for them. We kept nagging the Department of Higher Education until September, but really didn’t have a legal leg to stand on. Digital innovation just itches to reach everyone, and this was yet another missed opportunity to show how universal services could be provided.

Regrettably too, the submission to the Department of Health got lost in transition as the approachable Yogan Pillay left his position as Deputy-Director General. Subsequent applications to zero-rating@health.gov.za and zero-rating@dhet.gov.za have gone unheeded, even as our efforts to get to the real people behind them have failed. Nonetheless, official approval of 39 websites was a great victory, and we were determined to make the most of it by working with many of the PBOs to optimise their digital content for data-light transmission. We understood that these concessions could be abused and that it was only reasonable for the telcos to impose caps on individual usage.

Our goal was to prove that a child’s education experience could be significantly enriched on just 500MB a month – about a fifth of the data used to stream a full-length movie on Netflix. We 57

eagerly awaited confirmation that the network operators had completed the technical processes of zero-rating the sites.

However, we were no longer ahead of the pack in terms of our submissions for zero-rating, as universities and colleges that had been slower off the mark now started to pile in. The tables had turned, and the network operators were no longer deciding what could or couldn’t be zero-rated. Government prioritised higher education institutions and for the next few weeks, the telcos were bogged down with overly-ambitious asks for unlimited streaming of lectures and tutorials. The list of the 39 PBO URLs languished at the bottom of the pile.

Although Section 28 of the Constitution states that in all matters pertaining to children their interests should be put first, we understood the urgent dilemmas facing universities and TVET colleges. Consequently, we held our fire. But once they had been zero-rated, we expected the network operators to start zero-rating the rest of the sites in order of their date of approval.

Telkom was the first to do so, but neither Vodacom nor MTN showed any movement on the PBO list.

On the 26th of June, exactly two months into lockdown, I wrote again to them, asking when the zero-rating of the approved PBO websites would be activated. Ten days later I got a polite letter from Ms O’Sullivan apologising for the delay but indicating that, as of the end of June, the government working group wanted them to prioritise schools on the list of the 938 URLs they had so far been instructed to zero-rate. That meant she couldn’t tell me when PBOs would be attended to. We were outraged. A quick scan of the schools on the approved list showed that almost all were Quintile 5 schools – the wealthiest public schools – with access to online learning platforms. Their children were deserving of education, but no more than poorer 58

children who can only access the digital content provided by PBOs. In our view, agreeing to action that has the effect of pushing poor children to the back of the queue is just plain wrong – even if government tells you to do it.

I quickly caucused with our board of trustees, and they were unanimous. The DG Murray Trust would approach the High Court to compel Vodacom and MTN to zero-rate the websites of those officially approved PBOs. The application was prepared by Dunsters Attorneys and their senior counsel, Adam Brink, but just as we were about to submit it to the High Court, the Internet Services Providers’ Association issued an update showing that Vodacom had started to comply. We promptly removed it as the second respondent in the application, which was then issued by the High Court on Thursday, 16th of July.

We had little doubt that government officials on the working group had instructed the telcos to prioritise schools ahead of the PBOs. Education officials often conflate learning with schooling, and no doubt they had their noses down trying to cope with all the uncertainty and hadn’t properly thought through the consequences. It was a poorly considered directive, but one they would be unlikely to defend in court, because it is patently unfair and unconstitutional. Just to be sure, we included the Departments of Basic Education and Communications and Digital Technologies as respondents as well. If they opposed the application, we would apply for that decision to be set aside too.

MTN’s initial public response was indignation: It was only following the directives of government, it said, and DGMT was acting in extraordinarily bad faith. “In time,” it said, the websites of PBOs would also be zero-rated. These statements were followed up by a lawyer’s letter confirming their intention to oppose the application. But by the following Wednesday, 22nd 59

of July, Dunsters Attorneys had received a letter confirming that MTN would comply and requesting withdrawal of the application, with each party paying its own costs. We withdrew and they complied within a week. I suspect that the MTN chairperson, Mcebisi Jonas, had got on the phone and read them the riot act. It happened to coincide with an article he wrote, declaring this “the moment that civil society, the private sector and the citizenry at large need to awaken and demand an alternative future”.6 The official spin was that MTN had chosen not to oppose the application because it distracted from the things that really mattered. We were just glad that poorer children were now included among those who really mattered.

In that same week, the remaining PBO URLs on Vodacom’s list of things-to-do were zero-rated, and the other operator, Cell C, followed suit. Parents of children could now download Shine Literacy’s stories or Siyavula’s learning adventures in Science and Technology or Olico’s online maths, as well as the educational content of the 36 other PBO websites – all for free, regardless of their mobile service provider.

Once some technical snags on the operators’ side had been ironed out, user traffic started to grow on most of the zero-rated sites. For example, Book Dash publishes free children’s books. Its name reflects its way of working, as their volunteers dash about designing, laying out and printing books in a single day! Visits to their site increased by 25% in the first month of being zerorated.7 Nal’ibali’s reading-for-joy website saw a 50% increase in traffic, with the average visitor staying on the site much longer Jonas, M. (2020). SA has a lot of plans but who is in charge? Sunday Times, 19 July 2020. Available at: https://www.timeslive.co.za/sunday-times/opinion-andanalysis/2020-07-19-this-is-the-moment-that-we-need-to-awaken-and-demandan-alternative-future/ 8 Personal communication, Julia Norrish, director of Book Dash, 15 October 2020.

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than before.8 The benefits to early childhood development were also tangible and swift as the number of visits to SmartStart’s early learning website increased from 5 000 a month to 29 000 by the end of the first month of zero-rating. Similarly, daily active users on BiNu’s Moya platform increased by 50% from 1.2 million to 1.8 million between July and September 2020.9 Moya provides free access to a suite of websites and messenger services, aimed mainly at young people. The timing of its growth spurt coincided with the implementation of zero-rating. Trophy of the month went to WordWorks’ Home Literacy Site, which provides information and resources to parents. In terms of the percentage growth of its user base, traffic shot through the roof, increasing 23-fold between July and August – from 3 553 to 80 995 unique visits.10 There were also glimpses of the ripple effects if health and educational content and job-seeking opportunities were to become part of everyday cellphone life for young South Africans.

No-fee public schools supported by DGMT and other funders in the Western Cape demonstrated the immediate benefits of access to digital learning. While many other poor schools experienced significant dropout as a result of the lockdown, very few children failed to return to these ‘Collaboration Schools’. Cellphone access to their teachers had kept them engaged and learning. These insights suggest that new social innovations could rapidly unfold if the barriers to digital access were overcome, with far-reaching consequences for national development. It is exasperating to think of the opportunity that Personal communication, Ben Rycroft, head of communications, Nal’ibali, 15 October 2020.

9 Personal communication, Gour Lentell, CEO of BiNu, 28 September 2020.

10 Personal communication, Andrea George, communications officer, WordWorks, 15 October 2020.

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we continue to waste as a country, fretting over our problems when some of the answers keep staring us in the face.

We put that frustration aside for a few hours to celebrate this partial breakthrough, which had been seven years in the making. At the same time, we knew that the obligations on network operators would only last as long as the declaration of a state of disaster. As part of their settlement agreements with the Competition Commission, the telcos had agreed to zero-rate a certain number of PBOs going forward. MTN had actually been boldest in this regard, making space for 500 zero-rated websites on their Open Time platform. Similarly, Vodacom had expedited the development of its ConnectU basket.

It would be churlish to suggest that their only concern was commercial, in that these platforms provide added value to their subscribers only. But the fundamental problem remains: a userâ&#x20AC;&#x2122;s choice of website is limited to those zero-rated by their specific cellphone company â&#x20AC;&#x201C; making the user experience more a maze of dead ends than a seamless pathway for personal growth and development.

Clearly, this cannot be the problem of the network operators only, and government must be part of the solution. There is already a statutory obligation on mobile network operators to meet universal service obligations as part of their licence conditions. In terms of the Electronic Communications Act, telcos are required to contribute up to 1% of their net profit after tax to a universal service and access fund (USAF), administered by a Universal Service and Access Agency (USAASA). The exact percentage is set by the relevant minister and is subject to change. It currently sits at a miserly 0.2%.

Even this measly provision has been roundly squandered by government and network operators alike. The USAASA has 62

been hamstrung by allegations of corruption, and instead of capitalising on the competitive advantage of wireless mobile, mobile operators were press-ganged into bringing fixedline infrastructure into schools. Unfortunately, there is little to show for the billions that were spent: hardware was stolen and software became obsolete with no maintenance systems in place. Until very recently, the universal access obligations of Telkom still included the installation of those green public payphones familiar to any South African alive in the eighties – although no-one outside of prison uses them anymore. The Act also made provision for a special e-rate discount of at least 50% for connectivity in public schools, but that provision also failed to be implemented.

The USAASA’s raison d’être is to ensure universal services and access to digital communication; education and training for those most excluded must surely rank as one of its priorities.

Unfortunately, the organisation is moribund and in January 2020, the Minister of Communications and Digital Technologies appointed an administrator, Basil Ford, to resuscitate it. When Rwanda’s lockdown happened, it was quick to capitalise on its declaration of 2020 as the year to ‘Make Time for Reading’.

Even if schools had to close, its leaders reasoned, stories could be brought into people’s homes, and programmes for reading provision were quickly put in place.11 In South Africa, the equivalent response would have been for the USAASA to accelerate the zero-rating of services for those communities cut off from any form of educational content during the lockdown.

If Ford were looking for a defibrillator for the USAASA, the Education Development Trust. (2020). Supporting home learning in Rwanda during Covid-19 lockdown. Available at: https://www.educationdevelopmenttrust. com/our-research-and-insights/commentary/supporting-home-learning-inrwanda-during-covid-19

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closure of schools on the 18th of March surely provided it. Here was the opportunity to show that this critical public entity was worth saving, but if there were a flicker of life deep in the bowels of the organisation, it didn’t register a blip on any external monitor. Nonetheless, we hoped that we could spark some action, and so did the numbers. Let’s assume that one million users needed free mobile content – capped monthly at 500MB per person. That would require network operators to zero-rate a total 500 terabytes a month. Thanks to inside sources, we had a sense of the true cost of sales to network operators – an upper estimate was R50 per gigabyte. That brought the total monthly cost for a million users to R25 million, which was a pittance compared to its potential impact.

Of course, the real need for free data was a lot bigger. Possibly about ten million learners had no access to online content, but there was unlikely to be an avalanche of demand. Connectivity is still an issue in rural areas and many poor families either have no cellphones or only the most basic ones. It was unrealistic to imagine that all children would be able to grab the opportunity to use digital information for self-learning; most parents are also not accustomed to reading to their children, even if stories are freely available. Over time, demand would grow, but it seemed reasonable to estimate the demand-on-tap at about a million.

On the advice of Rezah Atcha, the director in National Treasury responsible for the budget for telecoms and digital technology, I contacted Basil Ford, just before 7pm on Friday, the 3rd of April. Ford confirmed he had to submit a plan to use R200 million of unspent funds, or it would be returned to Treasury. I said that would work perfectly for zero-rating the mobile content of PBOs for the next eight months. He said that he didn’t work over weekends, but would review any proposal 64

the following Monday. Fortunately, I did work over weekends and submitted the documents to him by Saturday evening.

The submission argued that the Covid-19 epidemic had intensified the need for greater access to mobile services for the poorest 40% of the population: million children living in informal settlements and rural areas had access to facilitated online programmes. communication was directed through websites and social media. strained; we could use this time to prepare young people not in education, formal employment nor training for postlockdown work. regional and national systems of distribution and were reliant on mobile data for logistics.

It seemed such a logical fit. The USAASA had funds that had to be spent. Schools were closed and parents and children were desperate. Mobile content was the way to reach them. Access to the PBOs could go through a single portal and BiNu could aggregate the data so that the operators could reverse-bill the Universal Service & Access Fund. What was not to like?

Well, everything apparently. There was complete silence from Mr Ford. No acknowledgement. Nothing. I wrote again and again. Eventually I got wind that he had received the proposal, but no response. Nothing.

We found ourselves in the bizarre position of trying to secure public funds from an uninterested public agency for indifferent network operators who were in any case now compelled to zero65

rate approved sites. We had had our eyes on the long-term and had wanted to establish a precedent of USAASA-managed funding for PBO content, but eventually gave up to focus fully on the immediate opportunities for zero-rating created by the disaster regulations. Looking back, I suspect that the radio silence has more to do with embarrassment than disdain. National Treasury will only consider reassignment of rollover funds by departments or public agencies if their financial affairs are in order. Given that the USAASA was placed under administration, it was unlikely that it would have had a clean set of books to accompany any requests to retain and reallocate unused funds. Perhaps the vitals of this organ of state were so compromised that any form of stimulus was doomed from the start.

Hopefully, the network operators will have the public spiritedness to retain the zero-rating of PBOs even after the end of the declared disaster period, and begin to understand how important it is for a poor child or unemployed adult to be able to surf from one public benefit website to the next, without getting dumped at a paywall. If they don’t, it is the obligation of government to intervene, and the simplest solution is to make the zero-rating of PBO websites a condition of licence. The auction of new spectrum licences planned for 2021 is the ideal time to do that, and DGMT has made the necessary submissions to the Independent Communications Authority of South Africa (ICASA). If that doesn’t work, it will be back to the harder slog of trying to revitalise the USAASA. For my own closure more than anything else, I wrote one last – admittedly caustic – email to Mr Ford at the end of April: “In the spirit of collaboration, which the President has urged, I would request you to provide us with an update, so that we can know how to proceed. It is very difficult in the context of silence.

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Inevitably, oneâ&#x20AC;&#x2122;s tendency is to interpret such silence as indifference or hubris, but we must believe that it is merely an oversight in an extremely busy time where we are all seeking to ensure that the poorest are not left out.â&#x20AC;?

I was not holding my breath that I would receive a response.

Good thing that â&#x20AC;&#x201C; otherwise both parties would have been rendered lifeless in this futile attempt to engage with the public agency responsible for ensuring that poor communities are included in the digital revolution.

Perhaps there is a reasonable explanation, but there is still no word from the elusive Mr Ford.

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CHAPTER 4

A FLASH OF HOPE FOR HUNGRY FAMILIES

In early September, food retail giant Shopriteâ&#x20AC;&#x2122;s market value shot up by a massive R15 billion in just two days. The reason was the release of its end-of-year results, which saw sales in its South African supermarkets grow by almost 9%, while its trading profit jumped 13% to more than R18 billion. Its food stores for rich and poor both did well, with sales growth of 13.5% and 6.7% respectively. Only its revenue from alcohol showed a slight decline of 3.3%, notwithstanding the national lockdown and ban on sales for a full quarter of its trading year.12 More generally, food prices for milk, eggs, cheese and a number of other staples soared up to 30% in the first weeks of lockdown before coming down to less elevated levels. Still, the Pietermaritzburg Economic Justice & Dignity Group found that the price of a basket of food increased by 11% between March and May 2020, just as many people were losing their jobs. While prices came off their highs in June and July, by August the yearon-year increase in the household food basket they measure was 13.2%.13 The NIDS-CRAM survey, designed to gauge the social Shoprite Holdings. (2020). Financial Results for year ending 28 June 2020. Available at: https://www.shopriteholdings.co.za/shareholders-investors.html 13 Pietermaritzburg Economic Justice & Dignity Group. (2020). Food prices up again in August (Research Report, 26 August 2020). Available at: https://pmbejd.org.za/wpcontent/uploads/2020/08/PMBEJD-Research-Report-26082020.pdf 12

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impact of Covid-19 in South Africa, found that one in three people who had an income prior to lockdown had lost it within a month. Over that same period of time, half of households reported running out of money to buy food. With schools closed, learners lost their free school meals until the High Court in Pretoria ordered the Department of Basic Education to reopen the Primary School Nutrition Programme in July. By that time, one in seven households were reporting that their children had gone hungry in the previous week.14 In normal times, civil society activists don’t often find themselves in the top floor suites of major corporations or the offices of senior bureaucrats. Business and government leaders mingle at Davos, NEDLAC or social events; the invite lists rarely include the slightly scruffier leaders of civil society. But all of that changed in the first week of panic after the announcement of lockdown. Company CEOs, civil society activists and government officials all found themselves on the same calls, being introduced to one another – and to Zoom and MS Teams at the same time.

An almost euphoric “whatever it takes” attitude permeated the discussions. Previously, overly ambitious requests for corporate support were gently snuffed out with “sure, we’ll consider it.” This time around the response was “yes, absolutely”.

It was heady stuff, and some caught up in this fear-induced elation proclaimed a new era of cooperation across all sectors of society.

It lasted all of two weeks. Unsurprisingly, given the timeframes, President Ramaphosa’s sombre announcements and call National Income Dynamics Study (NIDS) – Covid Rapid Mobile Survey (CRAM).

(2020). Overview and Findings NIDS-CRAM Synthesis Report Wave 1, July 2020.

Available at: https://cramsurvey.org/wp-content/uploads/2020/07/Spaull-et-al.NIDS-CRAM-Wave-1-Synthesis-Report-Overview-and-Findings-1.pdf

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for united action was followed by an official flurry of conflicting commands and a hiatus of action. The utter lockdown instantly put millions out of work, without any clear plan to deal with the consequences. As with everyone else, business did not like it. Some business leaders withdrew quickly to lay off staff and salvage what they could. Behind the scenes, some were more petulant, averring that they wouldnâ&#x20AC;&#x2122;t go the extra mile until government did the same. After several weeks of uncertainty, the President announced a social and economic support package of R500 billion, roughly equivalent to 10% of GDP. But by that time, most of the corporate generals had retreated back into their trenches.

Certainly, some wealthy individuals acted promptly and generously. Johann Rupert and Nicky Oppenheimer each contributed R1 billion to establish separate funds to support small businesses through the crisis, while Mary Oppenheimer donated a similar amount directly to the Solidarity Fund. Patrice Motsepe pledged R1 billion to assist with the Covid-19 pandemic and its related challenges through his own foundation. Dozens of stories emerged of real generosity by local store owners, many of whom were under financial strain; others gave anonymously and without fanfare.

Big business organised itself too: Business Unity South Africa and the Black Business Council had merged efforts in B4SA, among other things, seconding employees to assist with PPE procurement and the legal and auditing sides of the Solidarity Fund; and the banking sector joined government in extending credit facilities to struggling companies. However, these measures did little to assist the informal sector or freelance enterprises in which probably most young black professionals work â&#x20AC;&#x201C; and that part of the corporate sector that could have had 70

the biggest impact in protecting poor and vulnerable families seemed unwilling to go the extra mile. The follow-my-leader response of mobile network operators was described in Chapter 3, and now national food retailers showed the same indolence.

They will point to food hampers donated by themselves and their generous shoppers, and it would be good to be proven wrong, but there is little to suggest that they actually gave till it hurt. Certainly, Shoprite’s end-of-year results give no indication that they did. Of course, it could be argued that with the economy under such stress, the greatest contribution of the retail sector was to continue to provide jobs and pay taxes.

But when you’re a major food seller in a time of food scarcity, your greatest contribution is to make less money and provide more food. If there was a national conference of food producers, manufacturers and retailers convened to address an acute food security crisis not seen in South Africa since the amaXhosa cattle killing in 1856-7, no-one else knew about it. Instead, each retailer chose to do its own thing, while the country cried out for national leadership from every sector. It was left largely to civil society and small businesses to mobilise support for communities across the country.

In times of economic stress, poorer households eat even less protein and more carbohydrates, because protein is more expensive. Where the families’ nutritional status is already marginal, this substitution pushes them over the edge and triggers acute malnutrition. A good measure of the proportion of children on the brink is the prevalence of nutritional stunting (short-for-age). Among children under five in South Africa, that number – preceding the lockdown – was already 27%.15 National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC) & ICF. (2017). South African Demographic and Health Survey 2016: Key indicators report. Pretoria, South Africa, and Rockville, Maryland, USA.

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Grow Great, the national campaign to stop stunting by 2030, identified a basket of ten highly nutritious foods that could protect families from nutritional crisis during the lockdown and beyond. They include eggs, tinned pilchards, beans and other legumes and fortified maize meal (micronutrients are also important). This basket doesn’t provide an entirely balanced diet as it excludes fresh fruit and vegetables, but it would largely secure a child’s nutrition for about R600 a month. This amount is roughly equal to the child support grant augmented from June to October – the normal R440 per child plus R500 per caregiver (who might have several children). Of course, families cannot use their entire income on food, which also needs to be cooked, and there are travel, funeral, clothing, airtime and health care costs too. Making these highly nutritious foods more affordable would stretch that money further.

Grant recipients were in fact the lucky ones. Foreign nationals without permanent residence or South African citizenship are excluded from social security benefits. Most of them survive on piece jobs in domestic work, gardening or micro-enterprises, while still sending money to family members in their home countries. The lockdown slashed their already meagre incomes, leaving them to stretch every rand even further than before. There are also many South African families who do not receive the child support grant, usually for lack of an identity document. The South African Early Childhood Review 2019 found that only 81% of caregivers of children under six accessed the child support grant, while just over a third (36%) of infants in the poorest 40% of families did not receive it.16 In most Hall, K., Sambu, W., Almeleh, C., Mabaso, K., Giese, S. & Proudlock, P. (2019). South African Early Childhood Review 2019. Cape Town: Children’s Institute, University of Cape Town and Ilifa Labantwana. Available at: https://ilifalabantwana.co.za/wpcontent/uploads/2019/09/SA-ECR_2019_12_09_2019_online_pages.pdf

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cases, the families are not to blame; rather their applications are stuck in a system that is slow and struggles to process complicated situations, like that of Mam’ Agnes Ndarana of Mdantsane. Approaching seventy, Mam’ Agnes looks after 24 children and teenagers who have no other home. Most came to her abandoned without documentation. So far she has managed to get child support grants for ten of them which means that apart from donations she can secure, the ‘family’ of 25 lives on R4 400 from child support grants and her old age pension of R1 860 per month. From June to October, she received the extra R500 caregiver allocation. All told, this household lives on R270 (USD16) per person per month. These situations play themselves out across the country, and no relief system will be able to identify or respond to the full extent of need. To repeat, the biggest contribution the food retail sector can play in times of crisis is to make nutritious foods more affordable.

Profit margins on many of the foods included on the list are already fairly modest because most are staple foods for lower-end consumers. With a bit of inside intel, we calculated that if food manufacturers and retailers waived their markup, the retail price of the basket of foods could be reduced by 20-25%. We felt that if the food industry made such a strong public statement, government could be convinced to provide an equivalent subsidy, halving the price of the basket.

It may sound like a long shot, but it had the support of some people in industry. Pick n Pay’s director of transformation, Suzanne Ackerman-Berman, liked the idea, although she cautioned that low margins and supply constraints might limit its practical value. Grow Great’s director, Kopano Matlwa Mabaso, approached the Consumer Goods Council of South Africa to coordinate this request to the food industry. It was apparently 73

discussed, but went nowhere.

In the meantime, the clamour for food was increasing.

The Solidarity Fund and other donors distributed thousands of food parcels across the country, but food parcel distribution is expensive and dangerous. In normal times, it costs the government over R1 000 to distribute a R700 food parcel through its Social Relief of Distress programme, because of the expense of logistics and distribution.17 In hungry communities in the Western Cape, children leaving school with food parcels were robbed at the gate, while in other areas, food trucks were mobbed and looted. The theft was not confined to hungry community members either as public servants joined the spree. In Mbotyi near Port St Johns on the Wild Coast, of the two hundred food parcels officially allocated, five arrived for distribution.18 Where control was inadequate, people jostling each other for food parcels increased the risk of Covid transmission.

Not all of the food distribution was chaotic though, especially that organised by civil society organisations which know how to engage with communities. The Social Change Assistance Trust showed that food parcels can still be delivered to people with dignity. It just takes extra effort, yet again facilitated by local community-based organisations (CBOs). Working with ten rural CBOs in the most remote areas of the Eastern Cape, they reached close to 200 villages and distributed 10 500 food parcels within three weeks. These local teams faced all the challenges of food distribution in hungry communities â&#x20AC;&#x201C; personal security risks, storage, flooding, treacherous roads, and long distances Department of Social Development. Estimates of National Expenditure 2020.

Available at: https://data.vulekamali.gov.za/dataset/748a20a2-be5d-44ca-b8ebd9fb7101ed75/resource/fd64cd64-20fd-4c22-b74c-c505e57e5500/download/vote19-social-development.pdf 18 Personal communication, Dr Jane Pennefather, 12 August 2020.

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travelled. Still, they ensured that records were kept and every food parcel accounted for.19 More generally, however, the risk associated with direct food deliveries was growing and attention shifted to finding a better solution. The Western Cape government approached Flash, a subsidiary of Pepkor, to try out an electronic voucher system in Ceres. Flash provides the technology backbone for over 170 000 spaza shops and general dealers across South Africa.

Their biggest competitor is Kazang, which services a further 50 000 local traders. That’s 220 000 local outlets which could redeem food vouchers, keeping the money in the community and building the local economy. Unlike the big retailers, these competitors agreed upon an interoperable voucher redeemable at spaza shops, branded CoCare and serviced by either company – with neither taking a cut in the transaction.

The model was neat. A voucher beneficiary receives a SMS message on her cellphone, telling her that she had been awarded a CoCare voucher (typically to the value of R250) that can be redeemed at a Flash or Kazang spaza shop. Grow Great then sends an SMS encouraging her to use the voucher for the 10 ‘best buy’ foods described above. She goes to the spaza shop where the unique number is entered into the cash terminal and she is able to purchase food to the value of the voucher. The trader is credited that amount and cashes it out when the next person buys electricity, airtime or an international cash transfer.

The beauty of this system is that it reaches the recipient without any transaction charges and directly supports the local economy. It also gives recipients greater dignity. While the nationwide voucher system was being set up, DGMT had responded Harding, J. (2020). Responding to a Pandemic: Funders, Intermediaries and Community Based Organisations. Submission to the Independent Philanthropy Association of South Africa, August 2020.

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to urgent needs by supporting some food parcel distribution. I cringed as I watched video clips of women – young and old – sitting on the grass outside the Chief ’s house, being instructed by his headmen to be grateful for the food parcels they were about to receive. A cellphone voucher provides greater confidentiality in a commercial transaction that’s just between the shopper and trader – no moralising power play.

However, no system is without its challenges. Our follow-up surveys found that some of the recipients ignored the cellphone messages, believing them too good to be true; and there were some spaza shop owners who charged outrageous commissions on the transaction. Of course, the system only works when people have cellphones – we found that up to 15% of households in rural areas did not. Key to its success, and to overcoming many of these problems, is a local NGO partner who identifies and registers people in real need, and who can be issued with vouchers to provide food parcels to families without cellphone access. The problem of price-gouging generally goes away when there are many traders in an area, which is not always the case in rural areas. The ideal solution would be a single interoperable voucher, redeemable at either a spaza shop or a retail store of choice. That would really give power to the recipient.

Against the backdrop of growing hunger and frenzied scenes of food distribution, a weekend meeting was convened by the Presidency in late April. Food vouchers were the obvious solution, but the big retailers were adamant that they each wanted their own branded voucher. They spoke of the technical difficulties of interoperable vouchers. I wasn’t there but from reports, no-one owned up to the possibility that the real reason for rejecting a universal voucher was to protect their respective market shares. Within days of the meeting, Shoprite, Boxer and 76

Pick n Pay were promoting their own digital coupons. This ‘free market’ solution might work for individual support to family, friends and domestic workers, especially if you know where they regularly shop, but it complicated broader relief efforts. In KwaZulu-Natal, a beneficiary community received vouchers for Boxer Superstores, located in an area 10 kilometres away. After borrowing money for the taxi fare, the road took the voucher recipients straight past the Shoprite on the edge of their own township.20 In the Western Cape, the provincial government got spooked by the potential cost and risks of implementing a food voucher system and, despite proving its viability in the local community of Ceres, the project foundered. This withdrawal was a real blow – a lost opportunity to show how families in distress could be supported in an efficient and dignified way. For example, if vouchers replaced food parcels in the national Social Relief of Distress scheme, the R407 million allocated to it for 2020/1 could reach 60% more recipients. The concept needed to be sustained, but by this time I thought DGMT already had more than enough on its plate, and so I tried to pitch the idea to others to run with it. We weren’t the only ones with our hands full, however, and there were no takers. Fortunately, our human capacity runs deep and phone calls to DGMT’s Onesisa Mtwa and Grow Great’s Nicola Eley roped in two highly effective people. They would manage the project, with Onesisa working with NGOs to identify and register beneficiaries, and Nicola collaborating with Flash to process and issue the vouchers.

A mix of donors, big and small, put up the first R5 million Ngema, T. (2020). Chatsworth food voucher recipients angry about travelling to supermarkets outside of their areas. Daily News (IOL), 21 May 2020. Available at: https://www.iol.co.za/dailynews/news/kwazulu-natal/chatsworth-food-voucherrecipients-angry-about-travelling-to-supermarkets-outside-the-area-48189199

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to get the project going. They included the Maitri Trust, Pepkor, Archbishop Thabo Makgoba of the Anglican Church, as well as hundreds of individuals who contributed what they could. We selected six areas in five provinces as pilot sites, including a mix of peri-urban and deep rural communities. Our first priority was pregnant women. They do not receive any form of government social assistance and a sudden decrease in food could have severe long-term effects on their babies, as was first noted in the Dutch Famine in World War II and many subsequent global and local conflicts. In July, a cellphone survey on the Department of Health’s MomConnect platform found that one in six new mothers reported going to bed hungry at least once in the previous week.21 Grow Great works with 350 community health workers in the provinces of Limpopo and Mpumalanga, which enabled them to identify over a thousand pregnant women. Similarly, Philani Health and Nutrition Project’s 290 Mentor Mothers identified hundreds of pregnant women in Zithulele near Coffee Bay in the Eastern Cape and in Crossroads and Khayelitsha in the Western Cape. These numbers are small relative to the need – with over a million births a year. Based on the findings of NIDS-CRAM and Ask Africa, at least 300 000 pregnant women must have been acutely affected by the shut-down. However, the project provided a model for extending social security to pregnant women in the future, in addition to helping those it reached directly.

Apart from pregnant women, local NGOs identified families in extreme need. Ziphakamise, a local community organisation established in southern KwaZulu-Natal over forty years ago, Tomlinson, M. & Spaull, N. (2020). Feeding a Family: report of the Maternal and Child Health Survey. Business Live, 15 July 2020. Available at: https://www.businesslive. co.za/fm/features/2020-07-15-feeding-a-family/

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has deep insight into patterns of deprivation in the area, as does the Small Projects Foundation in East London, founded in 1988. They provided substantiated data on families without any form of social assistance, or where the recipients of government grants were not those actually looking after the children. A clerk in the South African Social Services Agency (SASSA) or call centre agent on its helpline has no way of really assessing need or knowing how the money will be spent. On the other hand, a local organisation deeply rooted in its community knows many of the families in real need, and whether the grant will actually provide food to the child or will be diverted to other purposes.

In Khayelitsha, Philani’s Mentor Mothers reported that, while the top-up money had assisted many, some of the families they visited had used the extra cash provided through the SASSA system on a post-lockdown alcohol spree.

Those of us who advocate for greater social security and extension of the grants system tend to gloss over these stories, dismissing them as anecdotes in the face of the strong evidence that social grants protect women and children. I think that is wrong. The temporary increase in social grants was an essential component of the national response, and nothing should take away from that. However, we must acknowledge that some misuse of grant money – either in securing it improperly or using it improperly – is part of the reality of a national social security system. The point is that trusted local organisations with a deep knowledge of their communities can mitigate this risk by assessing applicants and verifying the lists prior to submission.

Without them, the leakage of public funding in the national response to any disaster, will be huge. The number of cases of fraud detected in the emergency relief packages provided by the state is sufficient evidence of this – even though they probably 79

only represent the tip of the iceberg.

Of course, this system of localised review and vetting can itself be distorted by the state, as happened with Life Esidimeni and the Community Work Programme – where ‘NGOs’ without track records were appointed to manage the projects. Yes, the leadership of legitimate NGOs occasionally goes rogue too, but this is rare. It would take a very patient fraudster to work his or her way into the leadership of an established NGO and so thoroughly corrupt its culture of care, to be in a position to steal the benefits that should accrue to the people it serves. It is ironic, and sometimes tragic, that NGOs committed to community development, established well before the end of apartheid, are overlooked in favour of newcomers whose motives have yet to be tested. They may frown at this disclosure, but the CEOs of the three NGOs mentioned above – Lulu Bodla, Paul Cromhout and Ingrid le Roux – combine over 100 years of development experience. Certainly, there must be space for rejuvenation and innovation, and sometimes older NGOs must be allowed to die.

But this evolution will happen naturally so long as the criteria for awarding funding to them is based on their ability to deliver to those who need it most, and not through some sort of stateimposed re-engineering of civil society.

Despite teething problems, the six pilot sites showed the system of food vouchers, redeemable at local trading stores, worked pretty well, with an 80% redemption rate. It didn’t work as well in some areas, where spaza shops are few and far between or where the targeted recipients are old or infirm. The trustees of the Kgalakgadi Relief Trust were greatly excited by the prospect of directing additional support to their beneficiaries who, thanks to tenacious public interest lawyers like Richard Spoor, receive compensation for lung diseases acquired while 80

working on the mines. Despite repeatedly phoning each of the prospective beneficiaries, only a third of them ever redeemed their vouchers. The reasons were complex – many of them live in remote communities in the North West province, where spaza shops are few; but the main reasons seemed to be their discomfort with technology and suspicion of unsolicited kindness. Their compensation for occupationally acquired lungdisease was hard-won in a protracted legal case. If anyone has genuine reason not to trust other people’s motives, it is they.

In most other communities, the Flash system worked – in no small part due to the active engagement of Ross Norton, its commercial & innovation director, and Carol Pieper, head of operations at Flash Connect. No issue was too big or too small.

As the system proved itself, new projects emerged. Some of them were large multi-million rand projects with thousands of recipients; others were tiny. In Mbotyi, where so many of the official food parcels were stolen, intellectual property lawyer Don MacRobert and university lecturer Jane Pennefather tried to mobilise their fellow beach cottage owners to contribute to food vouchers for its villagers. Some obliged but, from the poor response, it was hard not to conclude that most viewed the locals only as gillies, to be miserably compensated for baiting hooks and scaling fish. Nonetheless, through other donations, over 300 families in Mbotyi received R500 each to supplement their income. The local Flash Connect agent, Pathuxolo Mayile, travelled hundreds of kilometres to prime the two local spaza owners and to troubleshoot when the demand for food purchase by exuberant villagers outstripped the shops’ supplies. He then came back to Cutwini, an even smaller community near the exquisite natural attraction of Waterfall Bluff, to do the same.

When the German Development Bank, KfW, decided to 81

allocate almost R100 million for food voucher support in the Western Cape, through its local partner, Violence Prevention through Urban Upgrading (VPUU), the CoCare system made most sense. It had shown that it could reach pregnant women, foreign nationals and others in severe distress through local partners – and it could benefit the local economy. The German government’s support was quite pointed. A full 50% of the funding was allocated to needy foreign nationals, who had been excluded from any form of official relief in this country. Compare South Africa’s response with that of the Portuguese government, which declared early on in the crisis that all migrants and asylum seekers currently living in the country would be treated as permanent residents during the Covid-19 pandemic. To access health care, welfare benefits, banks and other services, they only needed to demonstrate a current residency request.22 Our country’s policy position regarding foreign nationals seemed to be conveyed only through its silence on the matter.

SASSA benefits are only for citizens and permanent residents, and nothing to the contrary was communicated during Covid.

At the very least, the government should have declared that the Social Relief of Distress grants, adjudicated locally, could be available to anyone in extreme distress – regardless of their country of birth or official status in the country. In the Western Cape, officials of the Department of Economic Development and Tourism also faced the dilemma of political principals who wanted to see South Africans benefit from stimulus packages, while the on-the-ground reality is that foreign and local economic interests are profoundly intertwined. Perhaps half or more of the spaza shops are foreign-owned, but they Infomigrants. (2020). Portugal to treat migrants as residents during coronavirus crisis. Infomigrants, 30 March 2020. Available at: https://www.infomigrants.net/en/ post/23741/portugal-to-treat-migrants-as-residents-during-coronavirus-crisis

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pay rent to local landlords. They also hire local employees and source their goods from local dealers. It’s a fine mesh of vested economic interests, which means that many people benefit from an infusion of money into the system. It also means that politicians can seriously disrupt the delicate dynamics with blunt declarations of nationalism, even leading to xenophobic attacks and disruptions of local markets. It is strange that publicly-listed companies like Standard Bank can be substantially owned by foreigners, while foreign ownership of spaza shops is frowned upon. Far more constructive would be to see the informal sector for what it is – a potent source of new growth in South Africa where formal employment has stagnated – and to get behind its energy, without trying to obstruct it because of the nationality of its entrepreneurs. It is encouraging to see some provinces and metros beginning to include the informal sector in their economic support plans, both in growing pure commercial enterprise and the social economy. At the same time, as local government elections approach, we can expect to see an uptick in narrow-minded politicking. Witness the provisions of the Gauteng Economic Development Bill that aim to keep foreign businesses out of townships. Hopefully, these will have been expunged by the time this book is published.

The social economy has many definitions, but it’s useful to think of it as a set of local economic activities that promotes enterprise and social development at the same time. A good example in South Africa is the early learning sector (often mistakenly called the ECD sector, which really is a broader term encompassing other elements of early childhood development as well). The early learning sector is operated mainly by local entrepreneurs, who may receive a subsidy from the state if they meet certain quality and infrastructural standards.

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Currently, there are about 2.4 million children in some sort of out-of-home early learning programme. Only a third of them are in centres that meet the standards for public subsidies. Inevitably, it’s the poorest children who get nothing from government because they are in facilities that can’t meet the standards. A quality service will deliver a good package of nutrition, care and early learning in any setting, provided it is one that keeps children physically safe. Shift policy gears – from exclusionary permits to service support and enhancement – and over one and a half million children could immediately be brought into the system.

The lockdown devastated both the formal and informal early learning sectors. In some provinces, government continued to pay some proportion of the subsidies, cognisant of the salaries of centre staff who still needed to be paid. In other provinces, the subsidies just stopped. As the lockdown was eased and centres started to open up, funds started to flow again to registered centres, but for informal centres, the lifting of restrictions brought no relief. Highly dependent on fees paid by parents, the economic crunch and joblessness meant a massive reduction in income. The University of Stellenbosch’s Research on SocioEconomic Policy concluded that just 13% of children aged 0-6 were attending ECD programmes by mid-August compared to 47% in 2018.23 Even as more children started to come back, the centres’ ability to feed them was seriously affected.

These dilemmas brought early learning practitioners onto the streets in their thousands following the Department of Social Development’s plan to use a R1.3 billion Covid-19 Wills, G., Kotze, J. & Kika-Mistry, J. (2020). A Sector Hanging in the Balance: ECD and Lockdown in South Africa, 30 September 2020. Available at:https://cramsurvey.org/ wp-content/uploads/2020/09/15.-Wills-G.-Kotze-J.-Kika-Mistry-J.-2020-A-SectorHanging-in-the-Balance-ECD-and-Lockdown-in-South-Africa.pdf

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economic stimulus package requested from Treasury for 36 000 youth â&#x20AC;&#x2DC;compliance monitorsâ&#x20AC;&#x2122; for early learning programmes.

Practitioners were outraged. There was not even enough funding for them to meet the required standards and now monitors would be paid to report on whether or not they met those standards! The level of mobilisation of early learning practitioners was unprecedented, with over 350 pickets held across all nine provinces.

Zaheera Mohamed is Ilifa Labantwanaâ&#x20AC;&#x2122;s director of financing. She works hand-in-hand with National Treasury and, in an occasionally more fractious relationship, with the Department of Social Development (DSD). Zaheera is seized by the opportunity to bring millions more children into a publicly-financed early learning system, and spends most of her time designing the long-term financing and human resource strategies to achieve this. But she realised that Covid-19 would set this vision back years if there were no way of supporting the women entrepreneurs in the informal market for early learning.

At the same time, she recognised that the immediate priority was not the preservation of early learning programmes, but of the minds and bodies of the children on the verge of acute malnutrition. She, together with her colleagues Laura Brooks and Colin Almeleh, lobbied National Treasury and donors for a start-up fund to show how informal entrepreneurs could be supported to re-open their programmes. After some backand-forth with the DSD, an amount of some R300 million was allocated to provinces to support the re-opening. While this was good news, Treasury decided it would still be directed through the slow and cumbersome channels of provincial departments, whereas the actual need was immediate. A more flexible response was required. Within a month, Zaheera and colleagues 85

had raised R36 million from four foundations to enable informal practitioners to meet the compliance requirement of government for re-opening in the context of Covid, while supplementing the food of ECD practitioners and their families, as well as the children in their care. It was obviously not enough, but it points the way to a more effective system.

The CoCare voucher scheme was ideal. It created the opportunity to start redesigning food value chains for children, especially in informal settlements where they are particularly weak. The hope is that the provision of these vouchers, coupled with Grow Great communication on the 10 best buys, will signal demand to spaza shop owners for more nutritious foods.

Admittedly it’s a long-term project but in time, eggs and milk products could displace the sugary drinks and orange crisps that add little except to the girth of children who end up short and fat.

To be clear, the CoCare voucher is not a food voucher per se, as it can be redeemed for any goods sold in spaza shops. It would complicate matters greatly to limit it to food, and in any case, the international evidence is that unconditional cash vouchers are most effective in facilitating access to diverse nutritious foodstuffs.24 Its positioning as a ‘food’ voucher is merely a signal to both recipients and traders that our main aim was to prevent families from tipping into acute malnutrition.

Of course, the best way to do this is to keep families well away from the edge of food insecurity in the first place. The focus of this chapter has been on emergency food relief and how it can be made to work better, especially in dense informal settlements where it is difficult to grow vegetables or where crop outputs in Doocy, S. & Tappis, H. (2017). Cash-based approaches in humanitarian emergencies: A systematic review. Campbell Collaborations. Available at: https://onlinelibrary. wiley.com/doi/pdf/10.4073/csr.2017.17

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rural areas are insufficient. However, some communities proved food resilient throughout the lockdown, for the simple reason that they were growing enough food of their own. In Mtwalume on the south coast of KwaZulu-Natal, organic farmers produced R1.4 million worth of vegetables, milled 1.1 tonnes of maize at a local Agri-Hub between April and August 2020, and planted 134 000 seedlings of colourful nutritious vegetables to be harvested over the following few months. The food is enough to feed the families of the small farmers and to sell the surplus to local spaza shops.

This initiative is part of Thanda, a local NGO founded by a wonderfully enterprising couple, Angela Larkan and Tyler Howard. Its organic farming project is managed by Mdedelwa Mkhize, who grew up locally and trained as a community extension officer. Other projects include early childhood development, after-school enrichment and creative learning.

Thanda’s young and exciting team has shown how communities can truly be empowered, starting with the basics of nutrition and effective education.

Their work may be local, but it has profound insights for national transformation in South Africa. If economic empowerment strategies focus on financial transfers and ignore the fundamentals of human capital development, the need for social and food relief during times of stress will only become more severe. Over the course of the next year, hunger and food insecurity will feature on the political radar as local government elections loom large. Whether government has the will and the flexion to direct their resources through more effective mechanisms – drawing on the experience and local knowledge of NGOs across the country – remains to be seen. Odds are 80/20, I’d say: 80% likelihood that it will just keep pushing public funding down the same government channels using the same 87

tender systems that lead to the same inefficient outcomes; 20% chance that the Ramaphosa administration will move towards smarter government where innovation is valued and every rand matters. We must do all we can to ensure that the braver bets win.

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CHAPTER 5

A NATION SOBERS UP

A few days after the 26th of March, when their home supplies were depleted, a large number of South Africa’s heavy drinkers woke up sober. Government’s announcement of a complete ban on the sales of alcohol and cigarettes, just a few hours prior to lockdown coming into effect at midnight, had caught a lot of people by surprise. They didn’t have time to stock up for the liquor drought that would last a full two months. The ban was then lifted for six weeks in June and July, and then re-imposed for a further month as hospital casualty units battled to cope with the increases in Covid and trauma at the same time.

The combined effect of the lockdown and the alcohol ban had a profound effect on levels of crime and violence in South Africa. Reports of murder, rape and common assault plunged 40% between April and June, while non-contact crimes such as arson and malicious damage to property dropped by 30%.25 In most countries, the number of cases of violence in the home increased during lockdown, but the opposite happened here.

The number of women seeking assistance at Thuthuzela Centres – those seeking help following threats or actual physical or sexual assault – decreased by 50% during this period,26 while 25 Al Jazeera News. (2020). South Africa’s crime rate falls 40 percent during lockdown, 15 August 2020. Available at:https://www.aljazeera.com/news/2020/08/south-africacrime-rate-falls-40-percent-coronavirus-lockdown-200815071420200.html 26 Gould, C. (2020). Why is South Africa not showing the rise in domestic violence cases reported elsewhere in the world? Institute for Security Studies, 11 May 2020. Available at: https://issafrica.org/iss-today/gender-based-violence-duringlockdown-looking-for-answers

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in the Western Cape (where additional analysis of these statistics was done) femicides as a proportion of total murders decreased by 40% compared to the same period last year.27 If the apparent improvement were the result of an inability to report incidents as women were shut indoors, one would have expected similar findings in other countries that had imposed hard lockdowns. The difference is that South Africa was one of a handful to implement a total ban on alcohol sales in response to the pandemic.

Level 3 lockdown restrictions were instructive, in that the sale of alcohol was allowed but we were still largely confined to our homes. The lifting of the alcohol ban coincided with an explosion of violence against women and children, with numerous highly publicised murders over the course of the next two weeks. In his speech to the nation on Wednesday, 17th of June 2020, President Ramaphosa stated that, especially in the light of the unbridled violence against women and children, â&#x20AC;&#x153;we will also need to look at further, more drastic measures to curb the abuse of alcoholâ&#x20AC;?.

The liquor industry was in a quandary. If it acknowledged a significant drop in sales at the same time as levels of violence dropped, it would be shown to be responsible for major social harm. If it maintained that alcohol consumption continued regardless, it would undermine its argument that the ban was causing significant economic damage. The tobacco lobby had gone on the offensive, blowing smoke and thunder at the ban on cigarette sales that was eventually lifted on the 17th of August. On the other hand, the response of the alcohol industry had been measured and smooth, at least in its official communication. It pointed to its significant role in the economy, â&#x20AC;&#x153;supporting over Faull, A. (2020). Lockdown lessons on violence and policing in South Africa.

Institute of Security Studies, 2 September 2020. Available at: https://issafrica.org/isstoday/lockdown-lessons-on-violence-and-policing-in-south-africa

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one million jobs and contributing 3% to the GDP”.28 When members of the Gauteng Liquor Forum clearly didn’t get the memo and threatened to mount legal action, it just took a few calls for them to calm down and toe a more placatory line. The official industry line was clear: the lockdown undermined the benefit of the industry to the South African economy, and if it could just be reversed, excise taxes would start rolling in, jobs would be saved and the country would be a lot better off.

At the same time, a less subtle campaign – aimed more at gut than head – unfolded at a respectable social distance from the formal industry communication. An article penned by an excise manager at South African Breweries popped up on a number of online news sites, entitled ‘5 myths about the alcohol ban in South Africa’,29 while an anonymous video with remarkably similar content did the rounds on social media.

Interestingly, on some of the sites, the articles were published under the byline, Carmen van Niekerk, excise manager at South African Breweries (SAB). In others, she was still quoted, but the article was penned by a ‘Staff Writer’.30 It makes one wonder about the cosy relationship between some media houses and the alcohol industry, and how willing they would be to publish articles critical of it. Certainly, my attempts to get Independent Media’s Business Report to publish an article in response failed, Liquor Industry. (2020). Alcohol industry calls for collaboration with Govt in the safe reopening of trade during level 3 to protect over 1 m jobs in the sector. Vinpro, 23 May 2020. Available at: https://vinpro.co.za/alcohol-industry-calls-for-collaborationwith-govt-in-the-safe-reopening-of-trade-during-level-3-to-protect-over-1-m-jobsin-the-sector/ 29 Van Niekerk, C. (2020). 5 myths about the alcohol ban in South Africa., Business Report (Opinion), 22 May 2020. Available at: https://www.iol.co.za/business-report/ opinion/5-myths-about-the-alcohol-ban-in-south-africa-48320013 30 Staff Writer. (2020). 5 myths about the alcohol ban in South Africa. BusinessTech, 24 May 2020. https://businesstech.co.za/news/trending/399749/5-myths-about-southafricas-alcohol-ban/ 28

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and I resorted to fulminating in the Daily Maverick.31 It seems to value media independence more.

This advertorial, written by a gullible or conspiratorial staff writer or the SAB’s representative, used an old marketing trick called the straw man fallacy – making an exaggerated claim that no reasonable person would actually make and then showing up the inanity of the claim. In this case, the “myth-busting” exposé first invented and then rubbished the contentions that “the ban on alcohol sales means that nobody has been drinking in lockdown” and that it “stopped the trade in alcohol”. Of course, such absolute statements could be discredited by just one wayward drinker or illicit exchange posted on Instagram, which leaves a lot of room for rebuttal. And rebut the campaign did, arguing that “millions of photos on social media of people having a drink… is evidence enough” of the failure of the alcohol ban. Of course, the implication was that if everyone is still drinking yet crime and violence has decreased sharply, then it can’t be the alcohol, mate!

If anecdotes are legal tender in this debate, one could ask why there were such long queues outside bottle stores on the first day the ban was lifted. Or why hospital casualties filled up the same night. Eyewitness News reported that according to Baragwanath Hospital’s CEO, Nkele Lesia, the number of cases in the trauma unit almost doubled within 24 hours of the introduction of Level 3. The majority, he said, were drunk.32 The rather silly contention of zero-effect of the ban lost 31 Harrison, D. (2020). What the liquor industry really fears about the lockdown.

Daily Maverick, 5 June 2020. Available at: https://www.dailymaverick.co.za/ opinionista/2020-06-05-what-the-liquor-industry-really-fears-about-the-lockdown/ 32 Eyewitness News. (2020). Trauma cases almost double 24 hours after alcohol ban lifted – Bara Hospital. Eyewitness News, 2 June 2020. Available at: https://ewn. co.za/2020/06/02/trauma-cases-almost-double-24-hours-after-alcohol-ban-liftedchris-hani-baragwanath-hospital

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steam as retail companies reported their financial losses during the lockdown, with Massmart reporting liquor sales R2.3 billion less than the same trading period in 2019.33 Most likely, alcohol consumption was substantially down but – as in the United States during Prohibition in the 1920s – not nearly as much as a total ban would imply. Black market sales of both genuine liquor and illegal concoctions increased, as did home brewing – possibly by enough to quench the thirst without making everybody drunk.

It is illuminating that perhaps a moderate decrease in national alcohol consumption can significantly reduce its social harm by curbing excess, while leaving temperate drinkers largely untouched. Perhaps the President does not need to look to drastic measures to curb the abuse of alcohol, but fairly modest ones that together make a big difference.

These considerations underpin the World Health Organisation’s ‘best buy’ measures to reduce the social and economic damage of excessive alcohol consumption. They have been shown to be highly cost-effective, feasible and implementable at low cost.34 On the 24th of June 2020, DGMT – together with the SA Medical Research Council (SAMRC), the Chronic Disease Initiative of the University of Cape Town and the Public Health Association of South Africa – submitted a petition to the President, Speaker of Parliament, Ministers of Health, Social Development and Trade, Industry and Competition, as well as the Premiers and parliaments in all nine provinces. The petition was signed by 166 academics, researchers and community activists, and called for government to: BusinessTech. (2020). Makro and Game owner counts the cost of South Africa’s liquor ban, 17 June 2020. Available at: https://businesstech.co.za/news/business/408137/ makro-and-game-owner-counts-the-cost-of-south-africas-liquor-ban/ 34 Chisholm, D., Moro, D., Bertram, M., Pretorius, C., Gmal, G., Shield, K., & Rehm, J. (2018). Are the “best buys” for alcohol control still valid? An update of the comparative cost effectiveness of alcohol control strategies at the global level. Journal of Studies on Alcohol and Drugs, Vol. 79(4): p514-522.

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1. Place a ban on advertising of alcohol (except on the site of sale, where it should not be visible to those under 18 years) 2. Increase the price of alcohol, both through excise taxes and by introducing a minimum price per unit of pure alcohol in liquor products.

3. Reduce the legal limit for drinking and driving to a blood alcohol content of 0.02% or below.

4. Reduce the availability of alcohol, especially in residential areas (by limiting the density of liquor outlets, shorter trading hours, and ending the sale of alcohol in larger containers like 1 litre bottles of beer).

5. Intensify the availability of counselling and medicallyassisted treatment for persons struggling with dependence.

The petition noted that binge-drinking is a strong proximate risk factor for violence against women and children â&#x20AC;&#x201C; alcohol being an acknowledged factor in the perpetration of more than 40% of rape and a notable contributor to intimate femicide.35 It cited evidence that 50-60% of South African men who drink alcohol drink in heavy, episodic ways (> 5 units at one time)36 â&#x20AC;&#x201C; the definition of binge-drinking â&#x20AC;&#x201C; which is strongly associated with interpersonal violence, motor vehicle accidents and risktaking behaviour. These associations are even stronger in poorer communities than wealthier ones.37 The draft submission stoked a bit of controversy among 35 Mathews, S., Abrahams, N., Jewkes, R., Martin, L. J. & Lombard, C. (2009). Alcohol use and its role in female homicides in the Western Cape, South Africa. Journal of Studies on Alcohol and Drugs, Vol. 70(3): p321-327.

36 National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC) & ICF. (2017). South African Demographic and Health Survey 2016: Key indicators report. Pretoria, South Africa, and Rockville, Maryland, USA. 37 Probst, C., Parry, C., Wittchen, H.-U. & Rehm, J. (2018). The socio-economic profile of alcohol attributable mortality: A modelling study. BMC Medicine, Vol. 16: 97. Available at: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1080-0

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gender activists invited to sign, who argued that gender-based violence (GBV) is about power – male domination driven by oppressive attitudes and actions. Their concern was that a focus on alcohol would deflect from the most fundamental drivers of GBV. But there is evidence that liquor adds fuel to the fire, especially in the context of social and economic marginalisation.38 Recent neuroimaging research provides some biological basis for the violent behaviour of binge-drinkers, showing that they exhibit less empathic responses to images of pain in others.39 It may explain why they are more prone to violence when drunk, and is a useful reminder that the distinctions between research disciplines are purely academic – at least within the inner workings of the brain. When men feel both entitled and inadequate, and when their personalities are brittle and impulsive, then alcohol can push them over the edge.

Clearly, the strain between gender and alcohol activists had existed for some time and the petition brought it to a head. The debate was opinionated but respectful, although I suspect there was some deft manoeuvring behind the scenes by the SAMRC President Glenda Gray to keep everyone on board. Ultimately, both sides were satisfied by a clarifying statement in the text, which read: “Gender-based violence is driven by gender inequality, made worse by social and economic marginalisation, failures of policing and justice, and the abuse of drugs and alcohol. No single intervention will address it, and we must tackle all of these factors at the same time. We note the steps that have been taken as part Crane, C., Godleski, S., Przybyla, S., Schlauch, R. & Testa, M. (2016). The Proximal Effects of Acute Alcohol Consumption on Male-to-Female Aggression: A MetaAnalytic Review of the Experimental Literature. Trauma Violence Abuse, Vol. 17(5): p520–531.

39 Rae, C., Gierski, F., Smith, K., Nikolau, K., Davies, A., Crichley, H., Naasila, M. & Duka, T. (2020). Differential brain responses for perception of pain during empathic response in binge drinkers compared to non-binge drinkers. NeuroImage: Clinical, Vol. 27.

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of the National Strategic Plan to Combat Gender-Based Violence.

We also agree with the President that it “is not alcohol that rapes or kills a woman or a child. Rather, it is the actions of violent men.

But if alcohol intoxication is contributing to these crimes, then it must be addressed with urgency.”

Some people chose not to sign the petition, even though they generally agreed with its sentiments. It highlighted the complex role that alcohol plays in our lives. Some find it difficult to take a strong stand against excessive alcohol consumption when they themselves are social drinkers – and the line between social and excessive drinking can be a fine one. Those of us who choose to be teetotallers can be perceived to be judgmental – because some of us are and because our abstinence hits a nerve and seems like we’re showing drinkers up. My view is that both sides need to get over themselves and unite – drinkers and nondrinkers alike – in ensuring that women and children do not bear the brunt of excessive alcohol consumption.

Arguably, what the alcohol industry feared most about the temporary ban on sales was not its immediate effects on their bottom line, although that must have hurt. Rather, the effect of the ban was to show that things could be different; that communities do not have to lock themselves away every weekend – and women and children can feel safer.

The alcohol industry is quick to divert attention away from children with foetal alcohol syndrome or battered women or other violent crimes, by pointing to the economic benefits of the industry. Finance ministers are kept on industry’s side because pressing fiscal constraints, relieved to an extent by sin taxes, usually trump strategies for long-term economic growth and development. Yet when the direct costs of alcohol-related crime and injuries are taken into account, the net economic 96

benefit of the South African liquor industry is halved (to about 1.5% of GDP). When alcohol-related premature morbidity and mortality is factored in, that ratio flips, meaning that the industry actually costs the country at least twice as much as it contributes.40 Assign any value to human lives lost and the cost to benefit ratio just keeps heading south.

The answer is not a complete ban on alcohol. Civil liberties aside, the prohibition on alcohol in the United States – which was in large part facilitated by the Spanish flu of 1918-9 – showed that it does not work. People find a way around the ban, and bootlegging and illegal brewing perpetuate the harm without adding to the fiscus. Far more effective is to focus on changing the specific social behaviour causing the damage, namely a culture of binge-drinking that, in South Africa, is among the worst in the world.

Actually, relatively few South Africans drink alcohol compared to people in other countries – 31% here compared to 43% of the total world population of adults. Yet, according to the WHO’s Global Status Report on Alcohol and Health, those who drink tend to drink far more than their global counterparts. The world average for heavy episodic drinking among drinkers (≥5 drinks) on a single occasion in the past 30 days is 50%. In this country, it is 59%. Worse, our heavy drinkers drink even more heavily than most, consuming an average of twice as much pure alcohol a day (64.6g vs 32.8g). Men are far heavier drinkers – 70% of those who drink, binge-drink, compared to a third of women.41 These patterns are set in late adolescence and early adulthood, while the brain is still particularly susceptible to toxins. Almost 80% of young male drinkers – 15-34 year olds Matzopoulos, R., Truen, S., Bowman, B. & Corrigall, J. (2014). The cost of harmful alcohol use in South Africa. South African Medical Journal, Vol. 104(2): p127-132.

41 World Health Organisation. (2018). Global Status Report on alcohol and health. Available at: https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1 40

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– binge-drink.42 Admittedly, there are a lot of numbers in this single paragraph but they all point to one conclusion that, every which way you look at it, we South Africans have a serious drinking problem.

The origins of our drinking problem go back to 1833, when the British Slavery Abolition Act abolished slavery in most British colonies, freeing more than 800 000 people within a year, mainly in the Caribbean and South Africa. Here, the wine farmers in the Cape Colony were eager to retain cheap, pliant labour, which they did by supplementing meagre wages with tots of wine, administered up to five times a day.43 One consequence of the ‘dop system’ is the high prevalence of foetal alcohol spectrum disorder (FASD), which still affects up to a quarter of children in some communities of the Western Cape.44 That part of history is pretty well known, but few South Africans know of the collusion between the apartheid government and the liquor industry in building the bantustans while grinding down their people.

It started with the state’s co-option of beer production and distribution as instruments of control and compliance, through the Liquor Act of 1928. Until then, the sorghum beer industry had been the remit of black women entrepreneurs. But the Pact government of the National and Labour Parties, under General Barry Hertzog, declared a monopoly on its production, robbing the women of their livelihoods and encouraging public drinking by establishing National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC) & ICF. (2017). South African Demographic and Health Survey 2016: Key indicators report. Pretoria, South Africa, and Rockville, Maryland, USA 43 London, L. (1999). The `dop’ system, alcohol abuse and social control amongst farm workers in South Africa: a public health challenge. Social Science & Medicine, Vol. 48(10), p1407-1414.

44 Marais, D., Jordaan, E., Viljoen, D., Olivier, L., de Waal, J. & Poole, C. (2011). The effect of brief interventions on the drinking behaviour of pregnant women in a high-risk rural South African community: a cluster randomised trial. Early Child Development and Care, Vol. 181:(4), p463-474.

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municipal beerhalls for working men. In terms of the Act, African people were forbidden from drinking ‘European liquor’ – wine and spirits – except for “educated male natives” who could apply for a permit to do so. It took a couple of decades for the financial stupidity of this decision to sink in, during which time illicit sales boomed and unregulated taverns (‘shebeens’) sprang up across the townships – serviced via the back door by the forerunner to South African Breweries. By 1960, things were decidedly uncomfortable for then Prime Minister Hendrik Verwoerd. His decision to leave the Commonwealth and declare a republic had lost South Africa its preferential trade status. At the same time, Verwoerd faced internal opposition to repressive legislation both from the liberation movements and from his own Afrikaner constituency, who did not want to fund the massive infrastructure required for separate development. Not that they didn’t want apartheid; they just didn’t want their taxes going to blacks.

As a result, the Liquor Act was amended in 1962 to allow Africans to buy ‘European liquor’ at beerhall outlets and ‘NonEuropean off-sales’. Most significantly, it required that 80% of the municipalities’ net profits from these sales should go to Bantu Areas Administration Boards (BAABs) to fund township upgrades. However, as the homeland policy took root and bantustan leaders required more money for their fiefdoms, revenue was increasingly diverted away from the townships.

Government’s monopoly in the sorghum beer industry did not extend to the ‘homelands’. It wasn’t given back to black women entrepreneurs, but handed to the South African Breweries, by now firmly in the hands of Afrikaner Nationalists.45 In the words of Professor Anne Mager, who has written Mager, A. (2008). Apartheid and business: Competition, monopoly and the growth of the malted beer industry in South Africa. Business History, Vol. 50:(3), p272-290.

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extensively on the history of the alcohol industry in South Africa, “Africans were effectively drinking themselves deeper into apartheid and urban squalor”.46 These actions shaped racial and class patterns of drinking that continue to this day. In the racial terms of apartheid, a quarter of Indian men and two-fifths of white men who drink, say they binge-drink. The comparable figures for African and Coloured men is three out of every five. Similar differences are found between salaried and casual workers. Almost half (47.2%) of salaried drinkers report binge-drinking, compared to 60.6% of casual workers. Not surprisingly, the proportion of unemployed men who drink heavily is in-between (52.2%).47 These figures reflect the reality that social and economic marginalisation drives heavy drinking, and heavy drinking perpetuates socio-economic marginalisation. It’s a vicious cycle that continues to generate inequality in South Africa.

Alcohol (27.8%) and smoking (7.4%) together account for a third of measured inequalities in health,48 with alcohol alone accounting for some 60 000 deaths a year in South Africa.49 We must all confront our national drinking problem, but the structural origins of our culture of binge-drinking places a special obligation on the state to intervene. The reality is that Mager, A. (1999). The First Decade of ‘European Beer’ in Apartheid South Africa: The State, the Brewers and the Drinking Public, 1962-72. The Journal of African History, Vol. 40(3), p367-388. Available at: www.jstor.org/stable/183619 47 National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC) & ICF. (2017). South African Demographic and Health Survey 2016: Key indicators report. Pretoria, South Africa, and Rockville, Maryland, USA. 48 Mukong, A., Van Walbeek, C. & Ross, H. (2018). The Role of Alcohol and Tobacco Consumption on Income-related Inequality in Health in South Africa. Economic Research Southern Africa. Available at: https://econrsa.org/publications/policy-briefs/ role-alcohol-and-tobacco-consumption-income-related-inequality-health 49 Probst, C., Parry, C.D.H., Wittchen, H.-U., & Rehm, J. (2018). The socioeconomic profile of alcohol attributable mortality in South Africa. BMC Medicine, Vol. 16.

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socio-economic circumstance shapes life choices. The alcohol industry’s appeal to ‘responsible drinking’ obscures that reality, as well as the industry’s own complicity in inter-generational patterns of abuse. Although important, industry self-regulation is not enough, and it is the state’s duty to ensure a responsible alcohol industry.

South Africa’s democratic government has done so with great success in the past, with the introduction of a ban on tobacco advertising and curbing of public smoking. The proportion of adults who smoke decreased from 32.6% to 20.9% between 1993 – 2010, with the biggest declines among younger people and lower income-earners – this against the backdrop of sharp increases in smoking in the rest of Africa over that time period.50 The international evidence is also helpful: a review of 102 countries found that comprehensive advertising bans can reduce consumption, but that partial bans have little or no effect.51 The effect of media exposure applies similarly to alcohol.

A study in Tshwane found that among young people, the more they were exposed to alcohol advertising, the more likely they were to drink. Exposure to seven different media platforms (TV, radio, social media, etc.) doubled their likelihood of drinking.52 Internationally, a 16-country study showed a 1.2% reduction in prevalence of harmful drinking through comprehensive bans on Morojele, N., Lombard, C., et al. (2018). Alcohol marketing and adolescent alcohol consumption: Results from the International Alcohol Control Study (South Africa).

South African Medical Journal, Vol. 108(9): p782-788.

51 Saffer, H. (2000). Tobacco Advertising and Promotion. In: Jha, P., Chaploupka, F. (eds). Tobacco Control in Developing Countries. New York: Oxford University Press, Inc. Available from: http://www1.worldbank.org/tobacco/tcdc.asp.

52 Morojele, N., Lombard, C., et al. (2018). Alcohol marketing and adolescent alcohol consumption: Results from the International Alcohol Control Study (South Africa).

South African Medical Journal, Vol. 108(9): p782-788.

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alcohol advertising. 53 It doesn’t sound like a lot, but that would mean 90 000 fewer heavy drinkers in this country.

That number would be even bigger if the ban on advertising were accompanied by pricing strategies targeting heavier drinkers. When we petitioned government to implement the WHO’s five best buys, some people were concerned that by targeting heavier drinkers, we were targeting poorer people who could afford it least. Their concern was that their families would suffer as even more of the family’s income went to booze.

There is some truth in that, but the more enduring effect is to reduce the amount of heavy drinking among poorer people – which makes more families suffer less, and that is exactly what is needed if we are to break the vicious cycles of inequality in South Africa.

The ‘price elasticity of demand’ measures what happens to consumer demand when you increase the price of a particular good. Typically, the price and demand go in opposite directions – the higher the price, the lower the demand, and vice versa. But the correlation is almost never one to minus one, as people are reluctant to give up their consumption by as much as the price goes up. They absorb some of the price increase by buying less of something else or saving less. Corné van Walbeek and Grieve Chelwa of the University of Cape Town analysed the data of the National Income Dynamic Studies to assess the price elasticity d of demand (Ep ) for alcohol. Not surprisingly, they found that moderate drinkers are more sensitive to price increases. Their d Ep is -0.4, meaning that for every 10% increase in price, the quantity they drink declines by 4%. Binge-drinkers and other 53 Chisholm, D., Moro, D., Bertram, M., Pretorius, C., Gmal, G., Shield, K. & Rehm, J. (2018). Are the “best buys” for alcohol control still valid? An update of the comparative cost effectiveness of alcohol control strategies at the global level. Journal of Studies on Alcohol and Drugs, Vol. 79(4): p514-522.

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heavy drinkers are more resistant, only drinking 2% less for every 10% increase in price. If heavy drinkers were paying the same amount as moderate drinkers for a unit of alcohol, there would be little value in hiking the price, because the increase would have to be so substantial that moderate drinkers would lose out most. However, Van Walbeek and Chelwa found that, on average, heavy drinkers actually pay five times less for a drink than moderate drinkers. Part of it is that they go for cheaper hooch, but part is due to differential pricing by the alcohol industry, with wine and beer sold much cheaper in the townships than the suburbs. If a minimum price was introduced on a unit of alcohol (i.e. 15ml or 12g of pure alcohol), it would raise the price for heavy drinkers far more than for moderate drinkers who already pay close to the minimum unit price, if not more. Currently half of all periodic heavy drinkers pay less than 60% of the overall median price of a unit of alcohol. Pushing the price up to 70% of the median price would decrease their consumption by about 6.5%. Pushing it right up to the current median unit value would mean that heavy drinkers drank about 9% less.54 Thatâ&#x20AC;&#x2122;s pretty substantial.

In the past few years, Russia, Scotland and Wales have all introduced minimum unit pricing (MUP) for alcohol to curb heavy drinking. In Russia, and despite some hiccups, there has been a significant reduction in alcohol consumption since its introduction in 2010, together with other restrictions on advertising and availability. Total pure ethanol per capita consumption per annum dropped from 20.4 litres in 2004 to 54

Van Walbeek, C.P. & Chelwa, G. (2019). Using Price-Based Interventions To Reduce Abusive Drinking In The Western Cape Province. University of Cape Town. Available at:https://www.news.uct.ac.za/article/-2019-04-23-a-minimum-unit-price-onalcohol-could-limit-heavy-drinking

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11.7 litres in 2016.55 Similarly, introducing an MUP in Scotland in 2018 led to a 5% reduction in alcohol consumption, with greatest effect on heavy drinkers. It seems like a particularly smart thing to do here too.

That’s a pricing strategy targeting heavy drinkers, but we need to have another uncomfortable conversation too. This may be hard to swallow, but you pay less for alcohol than it actually costs, which is only possible because taxpayers subsidise that glass of wine or beer in your hand. And even if you only buy the finest wine or liqueur at an exorbitant price, it’s the manufacturer who creams it and not the taxpayer.

This is because the full cost to society is not factored into the price; it is ‘externalised’ and borne by police services, hospitals, traffic departments, social welfare offices and communities.

One way that government can build these costs into the price of alcohol is through taxes. In real terms, the excise tax on tobacco is higher than it has ever been, and this has contributed to the decline in rates of smoking in South Africa. On the other hand, duties payable on alcohol are just the opposite, with the real tax on beer and spirits lower than it was in the 1960s.56 As much as no-one wants to pay more for anything, let alone their liquor, excise taxes must rise to at least the levels they were in the 1960s to ensure that industry pays more of the actual cost. Whether they wish to try to pass it on to their customers is their call.

As for our own personal reluctance to pay more, look at it this way: most of us would agree that the costs of environmental rehabilitation should be recouped as part of the toll road fee on Editorial. (2019). Russia’s alcohol policy: a continuing success story. The Lancet, Vol. 394(10205).

56 National Treasury. (2014). A review of the taxation of alcoholic beverages in South Africa: A discussion document. Available at:https://static.pmg.org.za/140505alcohol_ tax_review_-_may_2014_discussion_paper.pdf (Updated figures for 2015-2018).

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the Wild Coast of the Eastern Cape. We want to use the road and we want to protect our environment. So why would we resist paying more of the external costs of alcohol, which has social utility but also has damaging side-effects? In fact, pricing strategies for reducing alcohol harm are even better than trying to repair the damage of toll roads, because they prevent harm and don’t only try to rehabilitate; they cause heavy drinkers to drink less and so cause less societal damage in the first place.

Another critical preventive strategy is to reduce the allowable blood alcohol content (BAC) for drivers, which is measured as the number of grams of pure alcohol per 100 millilitres of blood.

For short, it’s styled as a percentage. As BAC increases, the risk of dying in a car accident increases exponentially. For example, probability of death in a single vehicle accident where the driver’s BAC is 0.02% is double that of 0.00%; but by 0.05%, the relative risk is already seven to 10 times greater – and it skyrockets from there. Studies show that reducing the BAC limit from 0.08% to 0.05% saves 10% of lives lost in traffic accidents and that countries with limits of 0.02% (like Russia, Sweden and China) save even more lives.57,58 Currently, the legal limit in South Africa is 0.05%, or a tenth of a teaspoon of pure alcohol per litre of blood. That limit is reached by having two standard drinks in an hour. It will stay at that level if you keep having one more drink an hour.

The Road Traffic Amendment Bill (2017) was recently amended Fell, J. C. & Scherer, M. (2017). Estimation of the Potential Effectiveness of Lowering the Blood Alcohol Concentration (BAC) Limit for Driving from 0.08 to 0.05 Grams per Deciliter in the United States. Alcoholism, Clinical and Experimental Research, Vol. 41(12), p2128-2139.

58 Fell, J. C. & Voas, R.B. (2009). Reducing illegal blood alcohol limits for driving: effects on traffic safety. In: Verster J.C., Pandi-Perumal S.R., Ramaekers J.G. and de Gier J.J. (eds). Drugs, Driving and Traffic Safety. Birkhäuser Basel.

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to propose zero-tolerance of any alcohol in the blood – a BAC of 0.00%. This amendment is now actively championed by the Transport Minister, Fikile Mbalula. It’s a little impractical. We don’t want the courts clogged with people pleading the effects of alcohol-based medication or the after-effects of the night before. A BAC of 0.02% would be more realistic and is the level at which the neurological effects of alcohol are clinically detectable. Perhaps the Minister knows that, and his opening gambit is to bid low and be able to concede some.

However, alcohol harms reduction cannot be the responsibility of national government alone. The dramatic lockdown effects were essentially the result of less liquor being available which outside of a declaration of disaster, is the remit of provincial liquor boards and local authorities. The 16-country study already mentioned showed that reducing the physical availability of alcohol leads to a 1.8-2.1% reduction in prevalence of heavy drinking in men, and 4% among women.59 Here, the starting point is to limit the density of liquor outlets, especially in residential areas, because high-density outlets are associated with higher rates of interpersonal violence in those communities.60 Another strategy is to restrict trading hours, both for on-premises drinking and for retail and off-sales. Not surprisingly, alcohol consumption outside of the home is associated with heavier drinking, usually late into the night. You’re almost twice more likely to drink excessively at a tavern than if you drank at home; with South Africa living up to its reputation as a boozy sporting nation: drinkers in sports clubs are almost 16 times more likely to drink heavily 59 Chisholm, D., Moro, D., Bertram, M., Pretorius, C., Gmal, G., Shield, K. & Rehm, J. (2018). Are the “best buys” for alcohol control still valid? An update of the comparative cost effectiveness of alcohol control strategies at the global level. Journal of Studies on Alcohol and Drugs, Vol. 79(4): p514-522.

60 Livingston, M., Chikritzhs, T. & Room, R. (2007). Changing the density of alcohol outlets to reduce alcohol-related problems. Drug Alcohol Rev, Vol.26(5), p557–566.

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than if you’re watching rugby on the home telly.61 These measures are aimed at reducing the availability of alcohol by curbing inappropriate consumer behaviour, but what of the liquor industry’s behaviour? An infamous example was the introduction of Stella Artois into the United Kingdom, with an alcohol content of 5.2% – higher than the other beers typically sold there. Its rising popularity in the 1980s coincided with a rise in violent and anti-social behaviour, and it soon became known as ‘the wife-beater’. The Belgian company lowered its alcohol content to 4% in 2008, and the brand’s specific association with intimate partner violence all but disappeared. South Africa’s home-grown malted beer, Castle Lager, has an alcohol content of 5%. It is synonymous with Springbok rugby. The alcohol content of Carling Black Label is 5.5%, even higher than Stella Artois. Nicknamed Zamalek – after an Egyptian soccer team strong enough to defeat Kaiser Chiefs in the early 1990s – it largely targets the black population. Over the past few years, it has moderated its macho marketing – it even sponsors an antiGBV helpline – but still retains its extra 0.5% alcohol to keep black men drinking too much. It is now the leading beer brand in South Africa.

Another industry trick is to sell liquor in outsized beer bottles and wine cartons. People who drink from above-average -sized containers are nearly eight times more likely to drink heavily than those drinking from average-sized containers.62 Not only are the containers bigger, but the price per unit of alcohol Trangenstein, P. J., Morojele, N. K., Lombard, C., Jernigan, D. H. & Parry, C. (2018).

Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control study. Substance Abuse Treatment, Prevention, and Policy, Vol. 13(1), article no. 43.

62 Trangenstein, P. J., Morojele, N. K., Lombard, C., Jernigan, D. H. & Parry, C. (2018).

Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control study. Substance Abuse Treatment, Prevention, and Policy, Vol. 13(1), article no. 43.

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is cheaper. Charles Parry is South Africa’s leading researcher on issues of substance abuse, and he recently perused the Makro supermarket shelves. The price for a standard unit of alcohol (12g) for a 330ml bottle of Carling Black Label was R8.54, but if you really want bang for your buck go for the bigger bottles – R4.82 per unit for the 750ml bottle or R5.52 for the litre bottle.63 Putting a lid on the size of the containers in which alcohol is sold will discourage heavy drinking.

The pragmatic reader will point out that all of these laws and by-laws will have little effect unless they are properly enforced. There is some deterrent value in the laws themselves, as communities self-regulate to some extent. Nonetheless, the point is well made: without proper enforcement of national and provincial legislation and of local by-laws, their potency will be pretty watered down.

However, alcohol harms reduction strategies can’t only be about laws and restraints. They must also be about support for individuals battling with alcohol dependence and motivation for behaviour change. In South Africa, up to a fifth of patients treated for alcohol use or dependence are younger than twenty.64 Brief psycho-social interventions can make a big difference, reducing the prevalence of harmful drinking in men (15-59 years) by 13-21% and older women (>60 years) by 11-17%, according to international studies.65 In South Africa, which has amongst the highest rates of foetal alcohol spectrum disorder 63 Personal communication, Dr Charles Parry, Director of the Alcohol, Tobacco &

Other Drug Research Unit at the SA Medical Research Council, 17 August 2020.

64 Morojele, N. & Ramsoomar, L. (2016). Addressing adolescent alcohol use in South

Africa. The South African Medical Journal, Vol. 106(6): p551-553.

65 Chisholm, D., Moro, D., Bertram, M., Pretorius, C., Gmal, G., Shield, K. & Rehm, J.

(2018). Are the “best buys” for alcohol control still valid? An update of the comparative cost effectiveness of alcohol control strategies at the global level. Journal of Studies on Alcohol and Drugs, Vol. 79(4): p514-522.

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(FASD), counselling and support has been shown to reduce heavy drinking among pregnant women by a third.66 We may not have sufficient professional therapists, but we have a massive network of community health workers and others who can be trained to provide this support. The Mentor Mothers of Philani Health and Nutrition Programme in Khayelitsha have shown how this can be done. It is not easy â&#x20AC;&#x201C; many of them live with the effects of alcohol abuse in their own extended families, but they certainly know what drives excessive drinking in the communities and how people can be supported in their own homes to reduce it.67 None of the proposals above is drastic or outrageously restrictive. Together they could make a big impact in the rate of heavy drinking in South Africa, and from that would flow many social benefits. We sent the petition making this case to the political leadership of South Africa in late June 2020. Within three weeks, we had a response from the Speaker of Parliament, Thandi Modise, saying that she had sent it to the parliamentary portfolio committees of Police, Justice & Correctional Services, Social Development, Health, and Trade, Industry & Competition.

Shortly thereafter we presented to the Portfolio Committee on Social Development and in a webinar hosted by the Ministry of Women, Youth & People with Disabilities. The respective ministers and deputy ministers participated too. The response was unequivocal: we must act now to reduce the prevalence of heavy drinking and its impact on women and children in particular, and the Department of Social Development seems to Marais, D., Jordaan, E., Viljoen, D., Olivier, L., de Waal, J. & Poole, C. (2011). The effect of brief interventions on the drinking behaviour of pregnant women in a high-risk rural South African community: a cluster randomised trial. Early Child Development and Care, Vol. 181:(4), p463-474.

67 Personal communication, Dr Claudine Bill, consulting doctor, Philani Health & Nutrition Programme, 18 September 2020.

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be taking a far more proactive stance than in the past. If they do carry it through, perhaps something good will emerge from the Covid-19 pandemic.

These may prove to be heady conclusions â&#x20AC;&#x201C; or at least overly optimistic about what can be achieved in the short term. After all, the roots of heavy drinking in South Africa are at least 200 years old, and in any case, alcohol is by no means the only problem. It was sobering to note that while murders in the Western Cape decreased by 40% during the Level 5 and 4 lockdown and alcohol bans, they increased sharply once the alcohol ban and other restrictions were eased during Level 3a; and kept rising (by 6% compared to the same period in 2019) when the second alcohol ban was instituted for a month. A possible reason is that traders and tavern-owners got wise and stockpiled liquor as rumours swirled ahead of the second sales ban; but it also shows that firearm-related violence is endemic in many areas of our country. As Andrew Faull of the Institute of Security Studies says, alcohol restrictions must be accompanied by the full regulation of firearms, focusing particularly on the removal of illegal firearms. 68 That proposal is sure to put the wind up another industry, that which runs the ultimate protection racket â&#x20AC;&#x201C; pushing us to buy guns to stop guns. One would have to down quite a few Zamaleks to be convinced that the munitions industry has any social benefit whatsoever.

Faull, A. (2020). Lockdown lessons on violence and policing in South Africa.

Institute of Security Studies: Available at: https://issafrica.org/iss-today/lockdownlessons-on-violence-and-policing-in-south-africa

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CHAPTER 6

HUMAN SPIRITS

At the height of the Covid surge in the Western Cape, John Maytham of CapeTalk invited me onto his radio show to try and explain some strange human behaviour. He had interviewed me several times during my time as CEO of loveLife, South Africa’s national HIV-prevention programme for young people, when he wanted to understand why young people still have unprotected sex when they know the risks. I’d explained that all of us sit somewhere in the bell curve of risk-takers. Some are risk averse, while others are far more tolerant of personal hazard. Most of us are in the middle. However, I argued, our risk preferences are not fixed, but shift in relation to other risks we might be facing. Subliminally, we’re involved in a constant calculus of the trade-offs between one hazard and another, which might explain why a young woman may engage in unprotected sex with an older partner who gives her both physical and financial security. In fact, I reasoned, there is not just one bell curve for all communities. Rather, there are several overlapping but distinct ones, based on where people live – their position along the continuum of risk-taking determined by gradients of poverty and marginalisation. For example, people in an informal settlement in Crossroads generally have a higher risk distribution than people in Constantia. I also trotted out behavioural economic research that showed that while humans 111

value their long-term health, it is short-term considerations – like the need for food or safety – that predominantly shape their behaviour.69 Now John asked me a similar question. He was driving through Constantia on the way to the studio, he said, when he passed a peloton of well-kitted cyclists, obviously from that suburb. They rode close together and shouted into each other’s faces in an effort to be heard above the wind. Thing is, John said, not one of them was wearing a mask. These were not struggling township youths, but most likely investment managers, accountants, business owners, maybe even doctors. Why would they not protect themselves and each other, despite the risks? I had to admit I didn’t know. Sure, I had theories: only the highrisk takers might be out on the streets, while the more fearful sequestered themselves at home; maybe they knew that their actual risk – as younger people – was pretty small, and either they didn’t have elderly parents or weren’t thinking about them; maybe they just hadn’t seen enough dying to take it seriously.

Truth is I still don’t know, although I suspect it’s a combination of the above. But it raised the question: what would it take for people to take the risks of Covid-19 seriously?

It hadn’t helped that government’s initial response had been overly martial and officious. Some cabinet ministers seemed to relish the additional authority conferred by the declaration of national disaster. The public was first scared, then increasingly belligerent as images of police and military excesses spread through social media. Then the surveys of public opinion came in, showing that government had lost the trust of a large part of the population, just as it was starting to realise that the only way Lowenstein, G. & Prelec, D. (1992). Anomalies in Intertemporal Choice: Evidence and an Interpretation. The Quarterly Journal of Economics, Vol. 107, p573-597.

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to really stop the pandemic was to get the public on its side.

If viruses are into precision targeting, this one sure knew how to hit the sweet spot – mild enough that most people can shake it off, but just serious enough to kill a discomfortingly high number of people. No behaviour change communication is easy, but this one was particularly tricky. On the plus side, it didn’t only affect poor people, so there was no shortage of media coverage.

Usually, there is battle to get illnesses like TB or HIV onto the radar, even though they kill more people in South Africa than Covid-19. Also, the incubation period of coronavirus infection is so short that there was no problem in linking cause and effect.

One cannot forget that the long incubation period of HIV gave President Mbeki and his Health Minister, Manto TshabalalaMsimang, the room to deny that HIV causes AIDS. Now, to put it bluntly – people were dying quickly, but in insufficient numbers to jolt others into safer behaviour.

I was invited to give input into a communications subcommittee advising the Minister of Health. The central question was how to shift the public response from ‘anxiety to agency’ – how people could take more responsibility for their own protection.

The rote response is to tell people what to do: “Wash your hands, keep a distance, wear a mask”. It reminded me of the ABC mantra of HIV prevention: “Abstain, be faithful, condomise” – and that sort of didactic approach had failed miserably. Certainly, people need to know what to do, but they also need to understand why they should do it. Most importantly, it needs to make sense in the context of their own lives. The same wintry morning as John Maytham had watched the bare-faced cyclists almost spitting in each other’s faces, I had seen construction workers piling under the steamy canopy of an enclosed truck on their way to work. If they didn’t climb aboard, there would be no money to take home.

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So much for social distancing.

Instead of telling the public what to do, communication should help people really understand how the virus is transmitted and what they can do about it – and then give people handholds of hope. The focus should be on immediate actions, not future outcomes: “Imagine the virus in the air, on your hands, coming out of your nose and mouth. You’re feeling frustrated in lockdown? So is the virus if you keep a social distance. You’re short of airtime? You can keep the virus short of airtime too if you wear a mask. No taxi money for your next ride? Washing your hands can stop the virus’ free ride to the next person.” It may seem oblique, but this type of open-ended communication allows people to engage and apply it to their own particular circumstances, without feeling judged, and it formed the basis for the Sikhaba iCovid-19 radio shows. Occasionally, we had to redact the rough comments of some celebrities and politicians who exhorted their audiences to wear a mask so as not to kill granny. They were well-meaning, but scare tactics tend to lead to guilt and fatalism. The reality is that anyone can get Covid-19, even if they practise safe behaviours. It’s just that their risk is far lower if they do. This reality was tragically brought home to the communications committee when one of its most animated and engaged members, Anil Bhagwanjee, succumbed to Covid-19.

While deaths may have been lower than predicted, and scarcely comparable to the Spanish flu or even HIV, they still affected many families. In our own DGMT team, a number of people lost close family members and friends, and even life partners. I stood in awe of these team members, who took too little time off to grieve and then were back at work trying to ensure that the next family did not have to experience what they were going through. We organised counselling support for them 114

and for the staff of NGOs across the country who had also lost loved ones. It was too little, we knew, but hopefully helped some people onto the long and slow path of healing.

These deaths were in addition to the other deaths that inevitably happen each year. We were devastated by the unexpected death of Malini Mohana, from a medical cause unrelated to Covid. Malini was a young clinical psychologist who was passionate about community development and led the psychosocial support team for Masked Heroes. On top of the Covid deaths, it all seemed too much.

While my own family has thankfully been spared Covid to date, the pressures on me started to mount. I and other members of the DGMT leadership team were trying to ‘be there’ for those of the team who were ill or grieving. At the same time, we felt like we were fighting an uphill struggle on many fronts – trying to get PPE out, to respond to the desperate calls for food, to compel the network operators to put poorer children first in their zerorating of mobile data. On top of it all, we received notification from the Department of Cooperative Governance that it was not renewing a long-standing agreement with DGMT that had already facilitated early learning for 200 000 children, and vocational training and meaningful work for 6 000 unemployed women. It was an agreement that cost the Department nothing – just a nod of the head that the Community Work Programme implementing agents paid by government could continue to work with SmartStart and Nal’ibali’s early learning and reading programmes. It seemed such a slap in the faces of the children who benefited and the women who took such pride in their new work.

We couldn’t reconcile this cold administrative act with President Ramaphosa’s television appeals for the nation to all work together, to protect each other and hold our communities together.

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It was at that time that we had a DGMT board meeting and, after my management report, the chairperson John Volmink asked me what the hardest aspect was of all that we were trying to do. He caught me off guard. I was feeling particularly low that day as it would have been my mother’s 80th birthday. She was a real community activist and fighter for justice, and would have stood with me every step of the way. We had planned a major family celebration, but she had died unexpectedly six months before. I hoped that the computer screen’s reflection in my reading glasses masked my moist eyes, although I suspected a rather thin voice gave my emotions away. I said that the hardest thing to deal with was the apparent lack of caring from the government officials. Of course, I knew there were many officials who did care and who were working flat-out to meet people’s needs – and ultimately the intervention of the Minister and her special adviser softened the decision and paved the way for a stronger working relationship with the Department’s new look leadership. But there were others who seemed totally unmoved – and it was not just the petty officials who didn’t seem to care, but some of those in senior political leadership as well.

In Gauteng, aerial photographs had captured long lines of people, kilometres long, waiting patiently for food parcels – pictures reminiscent of Election Day in 1994, only this time people wanted food more than the vote. It was an irony lost on some politicians. A few days after the 26th anniversary of Freedom Day, a senior cabinet minister posted a message panning an NGO feeding 15 000 people in Olievenhoutbosch: “Some of the NGOs which get their money from official places are clearly out of order,” she ranted. “There are many illegal foreign nationals in the crowd and others are there because free food is being given at the expense of people who deserve.” These 116

and other similar comments oozed xenophobic heartlessness, and the subsequent disclosures of widespread PPE corruption and fraud just heightened the cynicism towards political leaders who were meant to be holding our society together.

Compare these attitudes to those of people working and volunteering in civil society networks. In the greater Cape Town area, local Community Action Networks (CANs) set up over 150 temporary soup kitchens, providing warm meals to thousands of people. One of them was run by retired chef Peter Wagenaar who, despite objections and threats from some of the Atlantic-side elite, provided a delicious breakfast and lunch to up to 200 homeless people in Green Point every day. He woke up one morning in early June to find that his Mini Cooper had been torched in the night. On the lunch menu was roast chicken, savoury rice and vegetables, with a custard dessert, and over 180 homeless people still got their food that day.

Heidi Segal heads the Outliers project, which supported 15 000 young people to continue studying during the lockdown. She wrote to Peter assuring him that such hatred was not the sentiment of all people living in Sea Point. He wrote back: “I can truly say to you that I didn’t even skip a heartbeat this morning. I just felt truly saddened that a fellow human being could have such disdain for another who lovingly prepares meals for such vulnerable folk who have just the skin on their back, flimsy clothes and worn hands, and in most cases weary hearts. And then (some) in society still look further down upon them. Yet somehow they awake each day and muster the strength to face another day of nothingness – mostly with a smile as they go their way. We are truly blessed to be able to serve them and to get to know them slightly better as they open up to us.”

The nation’s needs were not only physical, and new networks 117

were quickly established as psychological safety nets as well.

Julie Mentor leads Embrace, a national movement to support and celebrate motherhood. She quickly picked up on the anxiety pervading social media posts. “I am pregnant,” read one, “will my partner still be allowed into the delivery room?” Another read, “What does Embrace know about Covid and babies?” Julie contacted the director of the Perinatal Mental Health Project, Simone Honikman, as well as Grow Great’s Kopano Mabaso and Buhle Mabaso from Side-by-Side. Within two weeks, they had launched Messages for Mothers (M4M), providing information and care to anxious moms.

Nor was it not only South Africans who cared. The Blazing Youth Community of Wenzhou in China contacted us through a young South African doctor, Brett Lyndall, who had studied medicine in Hubei, coincidentally the province hardest hit by Covid. These high-school students raised funds for half a million masks to be shipped to South Africa. It was heart-warming to participate in a handover ceremony one very early morning, as the children in China read poems and pasted hand-drawn hearts onto the boxes of PPE that would soon be on their way to the port of Durban. The poignancy was all the greater for the bucketsful of bile that had been directed at the Chinese people in the early days of the pandemic.

Xenophobia and callousness are easy to condemn, but more pervasive and subtler race issues surfaced as well. New York City was the first to notice that African Americans were both more likely to get Covid-19 and to die from it, even when possible confounding factors like co-morbidity were controlled for. ‘Being black’ puts you at risk. Of course, it’s not the colour of the skin, but the myriad of ways in which prejudice and deprivation play out – how crowded your home is, whether you have medical aid, what 118

health facility you use, whether you can get there in the middle of the night – even whether you’re deemed sick enough for admission.70 The same thing happened in South Africa, with the National Institute for Communicable Diseases (NICD) showing that Black Africans and Coloureds were more likely to succumb to the disease in South Africa, compared to whites.71 These divides run deep through the bodies, hearts and minds of South Africans, as the spin-firm Bell Pottinger was quick to exploit a few years back. Inevitably, some of the responses to Covid-19 were racialised, though perhaps more in perception than reality. White minority support groups like AfriForum and the trade union Solidarity (not the fund of the same name) protested loudly that the Tourism Relief Fund was only accessible to blacks. Whether that was the Tourism Minister’s original intent, it was soon clarified that it was open to all – but sought to benefit those in the smallest towns and villages as well as the cities.72 Occasionally, DGMT itself felt the edge of the race whip.

A non-profit company had wanted money well beyond the small contribution to running costs that we were able to provide and, after considerable engagement, was excluded from the list of local organisations receiving PPE. Its disgruntled director complained to the President’s Office of “racial gatekeeping by DGMT’s subsidiary REDISA”. The allegation and factual error were easy enough to refute, but it played into the fallacy that Millett, G., Jones, A. et al. (2020). Assessing differential impacts of COVID-19 on black communities. Annals of Epidemiology, Vol.47: p37-44 71 SA Government News Agency. (2020). Black Africans, Coloureds and males likely to die of COVID-19, 20 August 2020. Available at: https://www.sanews.gov.za/southafrica/black-africans-coloureds-and-males-likely-die-covid-19 72 Talk of the Town. (2020). Tourism minister Mmamoloko Kubayi-Ngubane says funds not specifically for black people, 31 July 2020. Available at: https://www. talkofthetown.co.za/2020/07/31/in-quotes-tourism-minister-mmamoloko-kubayingubane-says-funds-not-specifically-for-black-people/ 70

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white people always call the shots in civil society organisations.

In fact, the leadership of civil society in South Africa has always been predominantly black. This was true during apartheid when community-based organisations served as sites for political mobilisation, and it remains true today â&#x20AC;&#x201C; even though a substantial part of the grassroots leadership was taken up into the first democratic government. This mass exodus narrowed the pipeline of black leaders within the larger non-government organisations (NGOs) which survived the transition, and many of the leaders in civil rights organisations that sprung up in the post-Mandela era were white. It is also true that many of the better funded sector-specific NGOs had white founders who were tapped into both local and international philanthropy; there may even have been funder bias towards organisations under white leadership in the first decade of democracy, but I do not believe that is the case now. The reality is that there are now far fewer funders and those that remain are serious about transformation. A new cohort of black leadership has also emerged in these organisations, either starting new initiatives or replacing NGO founders who retire. Close to home, of the 12 national initiatives incubated by DGMT over the past decade, 11 are led by women and nine by black people.

These realities notwithstanding, there must be stronger recognition of the thousands of leaders of non-government and community-based organisations across the country who are black. They are part of almost every town and village across the country, providing first-level support and protection to families in greatest need. To disregard them is to be blind to an enormous social tapestry holding our nation together; and their role is not only in providing material support, but in shaping the way people think and act. As we seek to weave together the various 120

strands of our nation, they are best-placed to take the lead in slowly excising the identities of ‘oppressed’ or ‘oppressor’ mindtattooed in the colours of our skin. On the new canvas must still be space for both black and white in the nation’s leadership.

Whoever we are, whatever our hue, we must use our skills and aptitudes to the fullest – finding thrilling opportunities for personal fulfilment while levelling the playing fields at the same time.

And indeed, levelling the playing fields is our greatest challenge. In an article in the Daily Maverick, I noted that if the death rate for whites is an acceptable norm for South Africa, then there are roughly 200 000 excess deaths every year among people categorised as black. That’s five times the upper projections of about 40 000 Covid-19 deaths in South Africa in 2020. The National Burden of Disease Study (1997–2012) found that age-standardised death rates for Africans were 2.2 times higher than for whites (1 388 vs 631 per 100 000).73 In other words, regardless of your age, you are more than twice as likely to die in the coming year if you are ‘black African’ than if you are white. In fact, many of these deaths are easier to avoid than coronavirus transmission, but the truth is that we have just got accustomed to them. They are the price of inequality to which society is largely indifferent because it is charged to poorer people who lack political and economic power. 74 As the epidemic unfolded, one couldn’t help comparing the magnitude of the state’s response to Covid with the denialism of Pillay-van Wyk, V., Msemburi, W., Laubscher, R. et al. (2016). Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease.

Lancet (Global Health), Vol. 4(9): p642-653.

74 Harrison, D. (2020). Covid must be used to disrupt long-term mortality trends – and radically improve our education system. Daily Maverick, 9 June 2020. Available at: https://www.dailymaverick.co.za/opinionista/2020-06-09-covid-19-must-be-used-todisrupt-long-term-mortality-trends-and-radically-improve-our-education-system/ 73

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HIV/AIDS in the Mbeki era that killed at least ten times as many people.75 This time, the President was clear: “We have to save lives.” If we are to continue to save lives over the next decade, and diminish the massive differentials between white and black, we must now do what makes most sense. Every service and every sector needs funding, but we cannot keep investing in ways that just keep widening the gaps. I am with Finance Minister Tito Mboweni when he calls for zero-based budgeting. We now have a major cash crunch, and it’s time to recalibrate both what we spend our money on and how we spend it.

Ultimately, our nation will only achieve justice when economic productivity increases.76 But there are no short cuts to getting there, and we will only do so if our children are properly fed and intellectually stimulated from birth. That means investing in nutrition and early childhood development – now, as national priorities. And despite my professional roots in the health sector, if push comes to shove, we will be more successful in reducing health inequalities if we do that rather than spending billions more on a national health insurance scheme. Certainly, we must ensure access to health care for all, but as the Nobel Prize winner for Economics, Angus Deaton, has shown, spending more on medical care doesn’t change the inequity of health outcomes.77 Instead of constantly looking for more taxes, we must make our public funding go much further. It is utterly frustrating to hear the sums of monies bandied about and lost not only to corruption, but through inefficient use. The sum total for all of the DGMT-led activities described in this book was R200 Nattrass, N. (2008). AIDS and the scientific governance of medicine in postapartheid South Africa, African Affairs, Vol 107/427: p157-176.

76 Piketty, T. (2014). Capital in the Twenty-First Century. Harvard University Press.

77 Deaton, A. (2013). The Great Escape: Health, Wealth, and the Origins of Inequality.

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million (USD12 million). That’s roughly a tenth of the public money stolen by crooked officials and their cronies in the PPE feeding frenzy.78 Just imagine if those funds were used well.

These criticisms are not intended as an attack on government.

‘Government’ is not a monolith. It is made up of many people, competent and inept, friendly and bristly – and everything in between. Come to think of it, just like people in the corporate sector and civil society. Neither should any person or group of people be written off as intractably indifferent or past redemption. As Aleksandr Solzhenitsyn said, “the line separating good and evil passes not through states, nor between classes, nor between political parties either – but right through every human heart”.

Not only do we all have the capacity for good or bad, but how we behave is not immutable either. Yes, people can change.

The NIDS-CRAM Wave 2 survey found that self-reported maskwearing increased from 49% to 74% from April to June. Some of that increase may simply reflect social desirability bias as respondents got to know the ‘correct’ answer to the question: “Do you wear a mask?” But a 50% jump in reported usage is substantial and suggests some real shifts in behaviour. It makes sense too: people do want to live, and to live better lives.

There is huge goodwill from most of the public and assurances of a better life for all from the governing party, yet powerful influences within that same party keep pulling in the opposite direction. In this tug-of-war, foundations such as DGMT cannot be neutral. The stakes are too high. We, together with the rest of civil society, must use our inventiveness to augment the efforts of those parts of government that are trying Medical Brief. (2020). Corruption feeding frenzy involving R2.2bn of pandemic relief funds. Medical Brief, 29 July 2020. Available at: https://www.medicalbrief.co.za/ archives/corruption-feeding-frenzy-involving-r2-2bn-of-pandemic-relief-funds/

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to make things work. At the same time, we must reserve our right to challenge government when it persistently fails its people and ensure that a politically literate society makes informed choices in the next elections â&#x20AC;&#x201C; whatever that choice may be.

The next few years will be tough. There will be new storms and thunderous rumblings of discontent. But if we listen carefully, we will discern them as millions of voices asking to be heard, looking for opportunity, seeking to be part of our common future. And no matter how dire the present, we always stand on the cusp of new opportunity for ourselves and for our nation.

We should not feel threatened by the rumblings, but find ways to channel them into a more inclusive and innovative society.

The problems may loom large, but they can be overcome if we are willing to think simply and radically. And at its most radical, a caring and creative spirit is all that is required to harness the thunder.

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