Abstract
The majority of COVID-19 cases in sub-Saharan Africa are found in South Africa, where one third of young people are not in employment, education or training. As the world continues to fight the COVID-19 virus spread, an increasing volume of studies are analysing and trying to predict the consequences of the pandemic on the economy and on physical and mental health. This article describes the economic and psychological impact of COVID-19 in South Africa’s youth specifically, the efforts made to tackle these issues, and the opportunities to integrate mental health into the country’s social protection measures, such as the Child Support Grant.
As of September 2020, sub-Saharan Africa accounted for only 3.4% and 2.5% of COVID-19 cases and deaths globally. Yet 60% of cases in the region were found in South Africa, which became the regional epicentre of the pandemic (Zeufack et al., 2020). Broadly, in line with Western countries, South Africa underwent a period of strict lockdown, followed by an easing when daily cases started to decline, only to resume curfew and other stringent measures between December and January 2021 as the faster-spreading new variant increased the number of infections in a more severe second wave (International Monetary Fund, 2021). The new variant of the virus (501Y.V2) was announced on 18 December 2020, with preliminary studies suggesting an increased transmissibility, as this variant rapidly displaced other lineages (World Health Organization [WHO], 2020a). This has resulted in the suspension of the country’s first immunisation campaign with AstraZeneca’s vaccine planned for early February 2021, due to the low efficacy against the new variant found in a trial conducted with about 2,000 people (Cohen, 2021).
As the world continues to fight the COVID-19 virus spread, an increasing volume of studies are analysing and trying to predict the consequences of the pandemic–and governments’ measures to tackle it—on the economy and on physical and mental health, with particular focus on the increasingly visible challenges for the poor. According to the World Bank’s January 2021 updated estimates, the pandemic alone may have driven between 119 and 124 million people into extreme poverty in 2020 (measured using the international poverty line of $1.90/day), and between 143 and 163 million in 2021 (Lakner et al., 2021), partially reversing the trend in decrease of extreme poverty that existed since 1999. There is historical evidence of the substantial and potentially long lasting negative impact quarantine measures can have on mental health, including depression, post-traumatic stress, anger and emotional exhaustion (Brooks et al., 2020). Preliminary studies suggest this has also been the case with COVID-19, with similar psychological reactions to this environment such as anxiety and depression (Kola et al., 2021; Rajkumar, 2020).
In this context, and particularly for South Africa, a vulnerable segment of the population is the 3.4 million young South Africans (15–24 years old) who are not in employment, education or training (NEET) (International Labour Organization, 2019). This article describes the economic and psychological impact of COVID-19 in South Africa’s youth, specifically the efforts made to tackle these issues, and the opportunities to integrate mental health into the country’s social protection measures, such as the Child Support Grant.
Economic impact of COVID-19 on South African youth
The negative economic implications of COVID-19 have not been evenly spread across the population in South Africa. In a country that registers the highest inequalities in the world and where approximately 20% of the population lives in extreme poverty, COVID-19 threatens to push 3 million South Africans into poverty (World Bank, 2020). While higher income professionals and managers have been able to maintain physical distancing, areas of high transmission have emerged in dense zones with workplace clusters, affecting mainly manual workers in mining, manufacturing, retail and services (Erero & Makananisa, 2021). Survey data suggest that traditionally more vulnerable groups, such as women, black Africans, youth, and less educated groups, have been disproportionately negatively affected (Ranchhod & Daniels, 2020). For young people in particular, the lockdown during the second quarter of 2020 left approximately 13 million students without adequate education in a country where already 80% of students experience learning poverty (defined by the World Bank as being unable to read and understand a simple text by age 10), and the high unemployment rate among this segment of the population has been further aggravated by the decline in economic activity (Zeufack et al., 2020).
In an initial survey of almost 6,100 adults aged 18 to 59 conducted in March-April 2020, results showed a decrease of employed individuals in the sample from 57% in February to 48% in April (Ranchhod & Daniels, 2020). For young people aged 18 to 29, data from the same survey shows a decrease in employment rates from 42% to 35% between February and April, impacting a country which already registered 29.1% unemployment before the pandemic, with almost twice the rate in the case of young people (World Bank, 2020). In the second quarter of 2020, 2.2 million people lost their jobs (Francis, 2020) as South Africa was subject to widespread lockdown restrictions, driving a year-on-year contraction in real gross domestic product (GDP) of 17.1%, with an expected decline in the overall 2020 GDP of 7.2% (Zeufack et al., 2020). This would mark six consecutive quarters of negative GDP growth given that the economy was already in decline during the second half of 2019 (Erero & Makananisa, 2021).
Mental health impact
The negative impact of COVID-19 on mental health in South Africa is clear. A survey among the general population was conducted by the South Arican Depression & Anxiety Group (SADAG) following the first lockdown regulations in March 2020. Results indicated that despite being in favour of the restrictions, 65% of respondents were feeling stressed during lockdown (Speak Your Mind, 2020). Another country-wide online survey among 5,693 youth aged 18 to 35 years found that young people were especially affected by the pandemic, with 72% reporting being at risk of depression (Mudiriza & De Lannoy, 2020). Among these, the prevalence was higher for the unemployed (73%) and those living in urban informal areas (75%), suggesting that limited access to resources may have exacerbated mental health issues. Gittings et al. (2021) conducted semi-structured interviews among adolescents and young adults in two South African provinces to identify challenges they faced as the country entered the first lockdown in March 2020. Findings indicated heightened psychosocial stress linked to uncertainty around education and future employment. Finally, one study conducted among university students indicated that loneliness, which is associated with a range of mental health problems such as depression, suicidal risk and substance use (Wang et al., 2017), had increased considerably among that group compared to loneliness levels before the COVID-19 pandemic (Padmanabhanunni & Pretorius, 2021).
Social protection responses
For years cash transfer programmes (CTs) have been an important instrument for social protection globally, having shown multiple positive effects on human wellbeing, including education, economic conditions and mental health, in particular for children and young people (Cooper et al., 2020; Millán et al., 2020). Like other social protection programmes, CTs have been modified globally to adapt to current exceptional circumstances and mitigate the adverse social and economic consequences of the COVID-19 pandemic.
To tackle the economic impact of the COVID-19 pandemic on its population, the South African government put in place several income support measures for individuals and households in the country. These have included the creation of a temporary 6-month COVID-19 Social Relief of Distress grant, as well as child support grants and food assistance programmes at scale (South African Government, 2021a), thanks to the support from various financing instruments from institutions including the International Monetary Fund (IMF), the African Development Bank, and the World Bank (2020). They have also included tax measures such as the Employment Tax Incentive and tax payment deferrals.
A particularly relevant social assistance measure for young people in the country was applied to the South African flagship Child Support Grant (CSG) programme, which was first introduced in 1998 and has since become one of the most comprehensive social protection systems in the developing world. During the pandemic, the CSG programme was increased by R300 (US$13) per month in May 2020 and by R500 (US$26) per month from June to October 2020 from the original amount of R440 (US$20) per month; this was transferred to about 7 million parents or other caregivers for approximately 12.5 million children (Gentilini et al., 2020). This measure was important as it also provided indirect assistance to informal sector workers who did not benefit from the Unemployment Insurance Fund or the COVID-19 Social Relief of Distress grant of R350 (US$18) per month introduced for unemployed people not yet receiving any social grant (South African Government, 2021b).
Opportunities to jointly address poverty and mental health
The South African government has therefore proven to be effective in addressing economic issues swiftly, including income support measures among others. However, little initiative has been taken from the government to avoid the long-term consequences of the pandemic on youth mental health in the country. Globally, numerous studies have reported the psychological impact of lockdown and other restrictions since the start of the COVID-19 pandemic (Blanco et al., 2020; Brooks et al., 2020), alerting policy makers to the mental health problems associated with the situation and calling on governments and institutions to attend to these issues when assessing programmes and measures. Recommendations have also been made on how to shift the focus of cash transfers in a way that also allows policy makers to address the potential long-term consequences of the pandemic on youth mental health and ultimately their future life chances (Bauer et al., 2021).
Addressing youth mental health in the context of COVID-19 is important because poverty and mental health problems interact in a negative cycle across the life course (Haushofer & Fehr, 2014; Lund et al., 2011). The effects of COVID-19 on education and employment among youth are likely to induce depression and anxiety symptoms (such as negative perceptions of self and the future, apathy and avoidance of opportunities). These symptoms make it more difficult for young people to escape circumstances of poverty and adversity. It is therefore vital that cash transfer programmes such as the Child Support Grant are accompanied by mental health promotion, prevention and treatment interventions that strengthen the resilience of young people, and give them the emotional, cognitive and behavioural tools to escape poverty and the consequences of the pandemic.
Fortunately, there is now a growing evidence base for ‘what works’ in youth mental health promotion and prevention. The World Health Organization’s (WHO, 2020b) Helping Adolescents Thrive (HAT) initiative provides a wealth of evidence on mental health promotion and prevention interventions that can be delivered universally (for all adolescents and youth), for those at risk (selective prevention) and for those who have sub-clinical symptoms (indicated prevention). Other initiatives such as the WHO Sustainable Technology for Adolescents to Reduce Stress (STARS) programme (WHO, 2019), uses digital technologies to deliver brief evidence-based psychological interventions for young people with symptoms of depression and anxiety. Initiatives are already under way to adapt and apply these interventions in South Africa, through research being conducted by Stellenbosch University and the University of Cape Town, in partnership with WHO and UNICEF.
Relevant aspects to consider when integrating mental health into social protection programmes include, among others, targeting young people more susceptible to developing mental health conditions by identifying clusters of populations with risk factors; assessing the mental health and economic impact of the programmes, which can help in understanding the relationship between poverty, mental health and life chances, and providing access to soft skills modules and mental health interventions that may ultimately boost resilience.
This is therefore an open chapter in the government’s agenda, which offers a unique opportunity to link mental health initiatives to current cash transfers, particularly for children and youth. In the face of the potential economic crisis accompanying the COVID-19 pandemic and the corresponding budgetary restrictions for the South African government, careful planning and revision of social protection programmes will be essential. This context provides a unique opportunity to strengthen such programmes and strategies, leveraging relevant evidence on how improving children and young people’s mental health increases their life chances. Such an opportunity cannot be missed.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This article was supported by a grant from the UK Economic and Social Research Council (ESRC, ES/S001050/1) for the project: “Poverty reduction, mental health and the chances of young people: understanding mechanisms through analyses from 6 low- and middle-income countries (CHANCES-6) (UK Research and Innovation Global Challenges Research Fund).
