United Nations COVID-19 Emergency Appeal Zambia (May - October 2020) (Revised July 2020)

COVID-19 Emergency Situation & Response Priorities

Direct health impact on people and systems

Zambia recorded its first case of COVID-19 on 18 March 2020. As of 7 July, a total 1,895 confirmed cases had been confirmed out of which 42 had died. Of the 42 deaths, 24 were brought in dead, highlighting the likelihood of wider prevalence in the community. Out of the country's 119 districts, 35 have reported COVID-19 cases.

Indirect impacts on people and systems

The COVID-19 pandemic is unfolding at a time when Zambia is struggling to recover from consecutive drought and flood disasters which have resulted in increased food insecurity in more than 58 districts for the past two seasons. While there has been an improvement in food security conditions following a good harvest during the 2019/2020 season, many communities are now being impacted by COVID-19. The nutritional status of children and women is expected to deteriorate because of limited access to basic commodities and services, while availability of food could be affected by disruptions in the market. The disruption of school feeding programs that 97,000 children depended on could lead to further deterioration of nutrition conditions of the most vulnerable. Prolonged school closure puts children, especially girls, at risk of protection violations, including sexual abuse, child marriage and other harms. Zambia has one of the highest child marriage (31 per cent) and teenage pregnancy rates globally, according to the most recent ZDHS: 32 per cent of girls aged 15-19 years have already given birth or were pregnant with their first child and over 46 per cent of adolescence girls and women are exposed to GBV.

Most affected and at-risk population groups

About 70 per cent of the urban population reside in informal settlements that are highly dense, with inadequate basic services, such as water supply, sanitation and no proper solid waste disposal facilities. Further, overcrowded areas including refugee camps are at risk and require specific interventions. Zambia hosts 88,064 refugee population in five refugee settlement areas in Lusaka, Luapula, North, North Western and Western province. Prevalence of HIV/AIDS in Zambia among females aged 15-49 years is 11.3 per cent, which could be exacerbated with increased protection risks.

COVID-19 response priorities and achievements

Immediately after the first confirmed case, the Government of the Republic of Zambia introduced measures to mitigate against the spread of the virus including closure of international airports, restrictions of public gatherings, closures of religious institutions, bars and restaurants. In May, the Government launched its COVID-19 Multi-sectoral Contingency and Response Plan together with the UN and partners’ COVID-19 Emergency Appeal, which complements the Government Plan. The Emergency Appeal targets 6.2 million most at-risk and vulnerable people with urgent assistance.
Under the Appeal, partners have scaled-up their response:

• Over 4,505,347 people have been reached with COVID-19 messaging on prevention and access to services; with 400,000 at-risk people have been sensitized in a door-to-door campaign in Lusaka

• Approximately 656,000 vulnerable and food insecure people residing in high-density, low-income urban and peri-urban compounds of Lusaka, Kafue, Livingstone and Kitwe will receive cash-transfers from July to December 2020 to meet their basic food needs.

• Approximately 100,000 households in urban and peri-urban COVID-19 hotspot areas will receive social protection emergency cash transfers by December 2020

• 7,389 schools supported with provision of PPE and sanitary-hygiene supplies, building capacity of teachers, sensitization of parents/ caregivers to support children’s distance learning and back-to-school when operation of schools resume, targeting 550,000 children and adolescents.

• 307 health care facilities and isolation centres benefitted from WASH and infection prevention and control (IPC) improvement measures while 2,579 healthcare facility staff were trained on IPC.

• Over 28,000 people were provided access to safe water while 106,66 people and over 96 schools were provided with WASH supplies including soap and/or hygiene kits.

• 169,546 children & women have received essential healthcare services, including immunization, prenatal, postnatal, HIV & GBV care nutrition

• 14,318 children and adults accessed safe channels to report sexual exploitation and abuse; 12,969 children, parents and primary caregivers have been provided with community based mental health and psychosocial support during the COVID-19 response

Response gaps and challenges

Partners are concerned that there is a noted relaxation of people’s adherence to proven recommended public health measures including wearing masks, hand hygiene and social distancing. Continuity of learning is a challenge to many vulnerable children who cannot access TV, Radio and on-line learning and other platforms that have been established by the Ministry of General Education. Many schools in the rural area are under-resourced and poor-equipped to provide support to the students learning at home and parents are unable to support children’s learning, widening the equity gap between the well-off and worse-off in learning, potentially leading to life-long negative impact. Furthermore, an increase in the caseload and the number of brought-in-dead points to the potential of wider community transmission, alongside lack of healthcare-seeking behaviour. There is insufficient testing and supplies to accurately determine the prevalence and trends of COVID-19 in Zambia. PPEs supplies are insufficient to equip, capacitate and protect all front-line workers and provide appropriate monitoring and support to POEs and health facilities.

Overview of the Crisis

The Government of Republic of Zambia reported the first confirmed cases of COVID-19 on 18th March 2020. As of April 27th, 2020, there were 89 confirmed cases, three deaths and 42 recoveries. Confirmed cases are located in three provinces: Lusaka (83 cases), Copperbelt province (5 cases) and Central (1 case). Zambia introduced a series of measures including closure of three international airports, closure of all schools, movement restrictions and closure of non-essential services such as restaurant, bar, gym and public gatherings to curb the transmission rate.
However, international land borders remained open, including movement of commercial and border crossing, to avoid negative impact on trade and the economy. The Government of the Republic of Zambia (GRZ), Disaster Management and Mitigation Unit (DMMU) estimates that 7.6 million people in 43 districts are at risk of COVID-19 due to presence of main border crossing, location on major highways or transport corridors, population density, industrial activities and populations with pre-existing health conditions. Urgent response is needed to meet the needs and protect the most vulnerable people from direct public health and indirect impact of COVID-19 on the social and economic impact of the crisis.
COVID-19 pandemic travel and movement restrictions will have a devastating impact on livelihoods for vulnerable populations, particularly those without a salary who rely on informal sectors to earn a living. Over 65.4 per cent of Zambians work in the informal sector where women, who account for the majority of workers in informal sector (including street vendors) will be particularly affected. Other vulnerable groups who rely on the informal sector to support their basic needs such as person living with HIV/AIDS, women, children, adolescent girls and the elderly will be adversely affected.
The COVID-19 pandemic is unfolding at a time when, the country is struggling with recent drought and flood disasters which has resulted in increased food insecurity in more than 58 districts for the past two seasons. While there has been improvement in food security conditions following a good harvest during the 2019/20 rainy season, according to preliminary results of a WVI/WFP rapid assessment. Most communities indicated that the food that they harvested will only last them for an average period of 6 months before they can resort to other sources such as markets.
Despite a recent improvement in malnutrition (reduction of Global Acute Malnutrition rates from 7 per cent in to less than 4 per cent currently) the nutritional status of children and women is expected to deteriorate as a result of limited access to basic commodities and services.
Availability of food and basic commodities could be significantly affected by disruptions in the market including a slowdown of imports due to the movement restrictions. Further, the disruption of school feeding programs that 97,000 children depended on, could lead to further deterioration of nutrition conditions of the most vulnerable.
Zambia's health system is also expected to come under severe stress owing to COVID-19 pandemic with human resource, essential health commodities and supplies being diverted to support the response.
Pregnant and lactating women and people living with HIV/AIDS are particularly at risk. Zambia has the highest fertility rate in Africa with an average fertility rate of 6 children and approximately 2,062 births per day. This is attributed to the lack of access for family planning for young girls. In 2018, the maternal mortality rate was 183 deaths per 100,000 live births1 . Further, there is an increased risk of mortality and morbidity due to chronic non-communicable and communicable diseases (TB and malaria) and the occurrence of resistance to ARVs for PLWHIV. In addition, maintaining the country wide vaccination strategies is critical to ensuring the lives of children under age 5 are not undermined (to date, only 68 per cent of children in Zambia are considered to be fully immunized). People with chronic conditions such as hypertension, diabetes mellitus, persons living with HIV (PLWHIV)may also have difficulty obtaining drugs and other essential health service and supplies from health facilities.
Lack of adequate health, water and sanitation services may pose serious challenges for effective Infection Prevention and Control (IPC) of COVID-19 and further increase vulnerabilities, particularly of women, children, people with disabilities, the elderly and people living with HIV.
According to 2018 Zambia Demographic and Health Survey (DHS) more than 36 per cent of Zambia’s population lacked access to safe water and more than 67 per cent lacked access to basic sanitation5 . An estimated 10 per cent of the population practiced open defecation while 76 per cent of households did not have access to a hand washing facility. About 70 per cent of the urban population reside in informal settlements that are highly dense, with inadequate basic services, such as water supply, sanitation and no proper solid waste disposal. Further, overcrowded areas including refugee camps are at risk and require specific interventions.
Zambia hosts 88,064 refugee population in five refugee settlement areas in Lusaka, Luapula, North, North Western and Western province. The refugee population in Zambia has limited health and basic service access with in the settlement areas.
Nation-wide school closures will impact children’s overall well-being and exacerbate socio-economic inequalities. Since 20March 2020, all schools are closed as part of Government of Zambia measure to stop the spread of the virus, resulting in disruption of learning for more than 4.4 million children and adolescents. According to the Human Development Report of 2019, child marriage below the age 18 is as high as 31 per cent in Zambia2 . Prolonged school closure puts children especially girls, at increased risk of teenage pregnancy, sexual abuse, child marriage and other harms. Teachers also face unprecedented challenges of ensuring the continuity of learning for their pupils while caring for their own and their families’ safety. Many schools in rural area are under-resourced and ill--equipped to provide support to the students learning at home and parents are unable to support children’s learning, widening the equity gap between the well-off and worse-off in learning, potentially leading to life-long negative impact.
An increase of protection risks is extremely high as people resort to negative coping mechanisms such as transactional sex, violence, and increased child marriage and child labor. Zambia has one of the highest child marriage and teenage pregnancy rates globally. According to the Zambian Demographic Health Survey 32 per cent of girls aged 15-19 years have already given birth or were pregnant with their first child. Over 45.9 per cent of adolescence girls and women are exposed to GBV. Prevalence of HIV/AIDS in Zambia among females aged 15-49 years is 11.3 per cent.
The protection risks, including increased child marriages, could exacerbate the high HIV/AIDS prevalence in the country.
The scale of the social impact of the pandemic could decrease cohesion and further deepen inequalities leading to stigma and discrimination and greater potential for conflict against refugees and those who have been identified as having brought COVID-19. The rise of harmful stereotypes, the resulting stigma and pervasive misinformation related to COVID-19 can potentially contribute to more severe health problems, ongoing transmission, and difficulties controlling the disease outbreak.
Stigma and misinformation even among the host communities especially in the urban settlements where most migrants live and work, increase the likelihood of preventing potentially infected people from immediately seeking care. House holds could also hide sick family members for fear of discrimination, especially for minorities and marginalized groups. Targeting and violence against individuals, households or communities affected by COVID-19 may also increase. In camps, rural and peri-urban communities and compounds where basic services like WASH facilities are accessed from a common point, stigmatization could prevent households to access the services. Further, frontline duty bearers in law enforcement such as police officers are at risk to contract the virus.3 The pandemic is likely to have a lasting impact on the country’s socio-economic conditions with an estimated 1.2 million households that could fall further behind including nearly 230,000 female-headed households4 . The COVID-19 pandemic and measures taken by the government is highly likely to impact the macroeconomic conditions. As a result, the economic sectors such as the manufacturing, mining and other commodity supply chains will be disrupted, likely to create a snowball effect resulting in job losses in several sectors of the economy (tourism, transportation, retail and restaurants, amongst others).