Debating Ideas is a new section that aims to reflect the values and editorial ethos of the African Arguments book series, publishing engaged, often radical, scholarship, original and activist writing from within the African continent and beyond. It will offer debates and engagements, contexts and controversies, and reviews and responses flowing from the African Arguments.
South Africa is the most unequal country in the world measured in terms of both income and wealth. Inequality in South Africa is deeply racialized, gendered and spatialized. The Covid-19 pandemic is threatening previously cushioned sections of society with what poor and working class individuals and households have always lived through: struggle to access food, quality education and adequate healthcare.
According to the daily case count updates by the government, there are just above 10,000 confirmed cases of Covid-19 with 134 deaths and 3,153 recoveries. This is after the government eased a three-week nationwide total lockdown that was imposed on March 26. During the lockdown, pharmacies, supermarkets and other entities categorised as ‘essential’ were allowed to operate limited hours, observing social distancing and other protocols. All flights were cancelled, and the country was closed off from all ‘non-essential’ foreign and local travel.
The total lockdown was eased on May 1 and replaced by a stage-wise lockdown ranging from Levels 1–5, with Level 5 being total lockdown. The country is currently under Level 4 lockdown. The following are allowed to operate under the current Level 4 lockdown if they observe social distancing and other safety protocols: public transport, food retail, spaza shops (tuck shops/kiosks), car washes, construction firms, craft vendors, food vendors, stationery shops, car dealerships, warehousing, breakdown services, agents and consultants, photographic studios, workshop and repairs, cleaning services and dry cleaners, manufacturers, driving schools, hawkers and furniture shops.
While Covid-19 as epidemiology threatens all sections of society, the accompanying social crisis deepens existing social differentiation. The Black working class and poor are the most affected. They carry the burden of the healthcare needs of society as nurses, cleaners in hospitals and fumigators of spaces where cases are confirmed, while providing other lifesaving services. Other groups of workers provide services that have been categorised as ‘essential’. This creates a class-specific dimension of risk of infection. Even in performing the socially necessary functions that keep society moving in the midst of the crisis, workers are denied adequate protection forcing many to stage protests.
One of the many class dimensions of the current crisis is that workers, many of whom live in overcrowded shacks in townships and are therefore unable to either social distance or regularly wash their hands, have to further expose themselves to the risk of Covid-19 infection as they meet the needs of suburban South Africa where the globally mobile middle and upper classes go to shop while they observe social distancing, isolate themselves and continue to work and earn incomes remotely.
Such workers serve middle and upper classes who have adequate healthcare through private insurance companies. The divide between a well-funded private healthcare system serving less than 20% of the population and an overburdened and underfunded public healthcare system catering for the vast majority of the working class and the poor is one of the major fault lines of South African society. It is an indicator of class position, class relations and class-based social outcomes in South Africa.
The public healthcare system currently caters for more than 80% of the population, mainly the working class and the poor. It is characterised by a critical shortage of doctors, nurses and community healthcare workers; old and dilapidated hospital infrastructure; lack of medication; long waiting periods, overcrowding, inadequate beds and lack of essential medical equipment.
Over and above these structural challenges, access to the facilities is also determined and undermined by one’s socio-economic position. The working class and the poor spend most of their time travelling to, and waiting in queues; at healthcare facilities and for transportation to return home. A simple check-up can cost an individual the entire day and a day’s earnings.
The plight of the rural population is far worse. Given that healthcare services are provided according to population density, areas that are sparsely populated end up with primary healthcare facilities such as a clinic, and in some instances villages share a clinic located within 5 km radius of each village. This, in a situation where the rural population is often old and sickly, living in areas with bad road infrastructure and inadequate public transport facilities. These conditions define the rural and urban healthcare divide.
A study by the Rural Health Advocacy Project found that 33% of rural households spend between 30-90 minutes travelling to access healthcare. While more than 90% of those in urban areas reach health facilities in under 20 minutes.
The relationship between poverty, healthcare and health outcomes has been well established; not only do poor people experience higher burdens of disease as a result of various social determinants, they also have less access to care. Given this pre-existing social condition, the needs and state of the poor and the working class ought to inform Covid-19 responses. Unsurprisingly that is not happening. The current response has instead placed the lives of workers in danger. The government only passed occupational health and safety regulations on 29 April 2020 after several workers tested positive for the virus.
Over 200 supermarket workers have tested positive for the coronavirus in the Western Cape alone, the Province now at the epicentre of the pandemic. Some stores were forced to close down after workers tested positive in Gauteng and other provinces. Currently, statistics reveal that 328 health care workers have contracted the Covid-19 virus, 133 health workers contracted the virus in public facilities and 195 in private facilities.
Organised groups of big business and their allied advocates of the unbridled free market are pressing the government to open the economy and allow all workers to return to work because the ‘economy is suffering’. The call for business as usual shows not just the disposability of workers, but also the readiness of the owners of capital to put the lives of workers on the line in order to secure profits. South Africa’s racial capitalism has consumed numerous Black working class lives. A virus whose curtailment necessitates valuing all lives has proven insufficient to halt a drive for accumulation that trumps lives.
 NDoH guidelines stipulate that nobody should live more than 5 kilometres from their nearest clinic, but physical proximity alone does not assure access.