The Global South, with its diverse economic development and health profiles among its population, has been suffering from different degrees of public health problems and challenges. These challenges ranged from poor access to health services, poor distribution of resources, inequalities in health, and large out-of-pocket spending. The challenges were intertwined and complicated with the new challenges triggered by the COVID-19 pandemic. This theoretical study aims to provide a comprehensive view of those challenges using secondary data sources that are used to compare the cases before and after the pandemic. The extracted data are used to analyze the various health and socioeconomic implications of COVID-19 in the Global South by focusing on the most vulnerable groups like children, women, and the informal employment. Some of the findings were represented using graphs, bar charts or tables. The results of the study indicate that most countries in the Global South suffered from weak healthcare systems prior to the pandemic which exacerbated the effects of the virus. In addition, there were secondary effects associated with COVID-19 either because of the prevention and containment measures taken to curb the virus or because of its economic consequences. Finally, the study provides recommendations and discusses opportunities that governments have if they are willing to build a more prepared and resilient health system for the future.
Most Global South countries suffer from prolonged and persistent public health problems and challenges. These challenges are triggered by the limited access to quality healthcare services. Access to healthcare is influenced by the existence of health insurance, good healthcare infrastructure, limited financial barriers, and low health inequities across and within countries. First, health insurance coverage in the Global South is very low. The average coverage rate of health insurance was 31.1%, with wide disparities across country-income groups (Hooley et al., 2022). Except for the upper classes, people cannot afford this type of social protection. As a result, some countries resorted to community-based mutual health insurance schemes (Eze et al., 2023), where community members pay regular contributions to face the high costs of illness. However, people living in the poorest areas still lack the financial resources to pay for such schemes. Additionally, many countries lack adequate health facilities, including hospitals, clinics, and primary healthcare centers and some rely on outdated or obsolete medical equipment due to budget limitations which can compromise the accuracy and efficiency of diagnoses and treatments.
Another important setback is the shortage of trained healthcare professionals. This is partly due to the migration of healthcare workers or “brain drain”. Healthcare professionals migrate seeking better job opportunities, higher salaries, improved working conditions, and access to advanced medical technology. This exacerbates the workforce leading to challenges in delivering essential health services.
As a share of GDP, health spending in 2019 represented 4.9% on average in lower-middle income countries compared to 8% in high income countries. As a result of the insufficient public funding, people in most of the Global South countries rely heavily on out-of-pocket expenditures to finance healthcare. This spending accounted for almost 40% of current health spending in low-income countries, which is almost double the number in high-income countries.(Global Health Observatory) As a result, illness represents a permanent threat to the people’s income-earning capacity, especially for the informal employment that is most prevalent in the Global South. According to the World Bank and the World Health Organization, one consequence of this is 100 million people pushed into extreme poverty each year.
Furthermore, health inequalities in the Global South countries often translate into inequalities in other dimensions of welfare (World Bank, 2006).The lowest life expectancy and highest maternal mortality rates are found in the poorest countries in the world. Besides, many countries suffer from conflicts and political instability, so access to healthcare may be severely disrupted, exacerbating existing health inequalities. Lower levels of education are also associated with poorer health outcomes. Women with lower socioeconomic status may have limited access to prenatal care, leading to higher rates of maternal and infant mortality. In addition, gender disparities in the formal employment sector can negatively affect women’s access to healthcare.
The onslaught of COVID-19 has exacerbated the pre-existing health challenges and even created new ones. The fragile health systems together with the strict containment measures have profound impact on people’s well-being in the short- and long-run. This paper is divided into three parts. The first part considers the challenges posed during the early outbreak of the pandemic. The second part discusses the economic and health challenges post-pandemic. The third part recommends actions to build a strong health system that is resilient enough to be able to face the next pandemic.
Since the onset of the COVID-19 pandemic a load of research has aimed at understanding and analyzing its impacts and identifying effective solutions. The literature has covered numerous disciplines and addressed different time periods. Several research focused on the pre-existing vulnerabilities that have exacerbated the challenges faced by the Global South countries. Jensen L. & Molina G., (2020), have explained how fragile health systems were prior to the pandemic in lower-income countries and the expected devastating consequences of the pandemic. The authors have emphasized the expected dimensions of the virus triggered by the lack of health facilities and the limited infrastructure. Ahmed F. et al (2020) emphasized the significant role of inequality in the spread of the virus. People living in poorer areas with crowded living conditions and limited access to essential services are the most affected by the pandemic. According to Loembé M. et al. (2020), African countries faced unique challenges in combating the virus due to the prevailing poverty and inequality. Although the initial infection rates were low compared to other regions, limited healthcare infrastructure, inadequate testing capacity and the predominant chronic diseases have exacerbated the effects of the pandemic.
Actions to curtail the virus like lockdowns, school closures, and restrictions of movements have also negative impacts on people. As per the FAO, (2023), the percentage of hunger rose during the pandemic because of the lockdown measures. Bundervoet T. et al., (2022) have reported that these measures also caused widespread job losses, reduced incomes, food insecurity, and disruptions in learning. Tondl G. (2021) discussed the economic consequences of COVID-19 in the developing countries. The author examined the changes in trade patterns and how exports from developing countries were negatively affected by the reduction in demand from developed countries. The author recommended restructuring of the trade specializations and the increased dependency on digital technologies.
In a similar fashion, Carmody P. et al. (2020), have reflected on the profound effects of the pandemic on the Global South. The authors have explored the challenges faced by the countries ranging from economic and social challenges to the environmental consequences. They have also highlighted the actions taken by governments and international organizations to mitigate the effects of the pandemic.
Most of the literature has mainly highlighted the challenges and impacts of the pandemic either during its early stages or at its peak. The post-pandemic period was not yet fully shaped, which caused some policies and recommendations to rely on estimations and projections. The primary aim of this paper is to identify a recent, up-to-date analysis of the pandemic’s impacts and responses in the Global South. The paper provides insights into the economic and health challenges posed by the pandemic in its early stages, at its peak, and afterwards. In addition, it explores the effectiveness of various policies implemented to combat the virus during its three phases. With over four years of data, the paper attempted to explore the potential long-term consequences of the pandemic, including its impact on mortality patterns, human capital, poverty, and social inequalities. It was also able to identify lessons learned from the pandemic, thus providing recommendations for future preparedness and response efforts to similar public health emergencies.
This paper seeks to answer these questions: What are the key health and economic challenges faced by countries in the Global South as a result of the COVID-19 pandemic? And what are the most affected sectors of the economy? How did the containment measures of the virus (lockdowns, restrictions) affect the socioeconomic status of vulnerable populations, such as women, children, and informal workers? What are the secondary effects of the COVID-19 pandemic on the economic and health outcomes? And finally, what strategies can governments in the Global South adopt to build a more resilient healthcare system in the post-pandemic world?
The main objective of this paper is to comprehensively examine the multifaceted challenges faced by countries in the Global South during and post COVID-19 pandemic, by focusing on the socio-economic, health, and developmental implications, and to propose effective strategies for recovery and preparedness of the countries in the future.
Identifying the specific challenges posed by COVID-19 is crucial for designing effective economic recovery measures and strategies to strengthen resilience and capacity-building efforts. Interventions can thus be better targeted and effective responses to mitigate the impacts and promote recovery can be attained.
This paper follows a descriptive approach. It is largely based on secondary data sources collected from several international published reports, articles, research papers from multiple journals, books, periodicals, the World Bank databank, the International Labour Organization, the United Nations Educational, Scientific and Cultural Organization databank, and the World Health Organization. Data collected from these sources mainly covered the years from 2021 to 2023 and some prior sources are used to compare the cases before and after the pandemic. The extracted data are used to analyze the various health and economic implications of COVID-19 and suggestions are made to overcome those challenges and be well-prepared for a next pandemic.
The COVID-19 virus has first been discovered in Wuhan, China and spread to many countries worldwide with cases rising rapidly in Africa. Many countries began to impose travel restrictions and closed borders. Most of the Global South countries entered the crisis with inadequate health services and fragile health systems, in addition to the weak or even non-existent welfare systems, and with much employment in the informal sector.
Many low-income countries suffered from the closure of food markets and restrictions on labor movement. Prior to the pandemic, 7.9% of the world population were suffering from hunger. By 2022, the percentage rose to 9.2% (FAO, 2023). Furthermore, the prevalence of informal economies in many Global South countries made it challenging for individuals to comply with lockdowns and social distancing measures without a stable income. Worldwide, casual, unskilled, and informal labor (especially women and migrant labor) were losing jobs, and many migrants were driven from host countries. This disruption in migration patterns negatively affected remittance flows to families in the Global South, hence impacting their ability to afford essential goods and services.
However, lockdowns were not as effective as expected everywhere. Low income prevented poor people from staying at home, which negatively impacted the effectiveness of the lockdown.
Many countries acted promptly and closed schools and universities in a belief that children can spread the virus quickly. School closures have deprived nearly 1.6 billion students of school (Azevedo et al., 2020) and schools were replaced by remote learning. Yet, most school-age children in poor countries lack access to computers and reliable internet, which led to many dropping out of school. The percentage of children engaged in learning activities during school closures in low-income countries was almost half that in upper- and middle-income countries (Bundervoet et al., 2022) and children were least likely to continue learning. In addition, children with disabilities or learning difficulties were also negatively affected.
There was a quick rise in unemployment levels in most regions during the pandemic compared with 2018 statistics (figure
During school closures, many children in poorer countries were unable to participate in any educational activities. This intensified the pre-existing disparities in educational access between wealthier and poorer nations, as well as within countries among households of varying economic statuses. Learning losses caused by education disruptions would be most significant for children whose parents have lower levels of education, reside in rural areas, and belong to the bottom welfare quintiles (Bundervoet et al., 2022). These consequences would hinder the accumulation of human and physical capital, limit social mobility across generations, and exacerbate persistent and widening inequality.
The pandemic led to a dramatic rise in poverty and inequality in developing countries. Job losses, wage cuts, and declines in workers’ remittances during COVID-19 have exacerbated the effects of the pandemic. After decades of continuous global poverty reduction and a significant improvement in global inequality, the combined crises of the pandemic, the rising cost of living, and the war in Ukraine have pushed 165 million people into poverty, most of them living in low- and lower-middle-income countries (Ecker et al., 2023.). Additionally, in 2020 the world witnessed the largest increase in global inequality since 1990, where Gini index rose by 0.7 points (World Bank, 2023). The pandemic also affected inequality both across and within countries. Within-country inequality saw an increase of 0.3 points in developing economies and 0.4 points in low-income countries (Moyer et al., 2022).
Many families were pushed into poverty due to several reasons. First, the income losses associated directly with the morbidity or mortality of the breadwinner. Second, the decline in remittances and private transfers, as many countries were sending migrants back home. Third, the large out-of-pocket health spending during COVID-19, where people turned to private hospitals because the public ones were overburdened. Fourth, inflation and disruptions of markets which led to the rise in food prices.
Furthermore, developed countries spent an average of 7.4 percent of GDP by the end of 2020 to mitigate the pandemic’s negative effects on people and businesses. However, developing countries lacked the fiscal capacity to offer comparable relief, with low-income countries spending only 2.4 percent of GDP. Consequently, the impact on households and vulnerable people has been significantly more severe (Bundervoet et al., 2022).
During the pandemic, the decline in gross domestic product (GDP) was not solely attributable to lockdowns, but also to the global slowdown and its repercussions on tourism, trade, and capital flows. All countries have experienced negative GDP growth rates in 2020 of around 3.1 percent. The recession was more severe in high-income countries (-4.2 percent) than low- and middle-income countries (-1.2 percent) (World Bank, 2020). This can be explained by the implementation of fewer and less strict lockdown measures in many developing countries (Tondl, 2021). In Latin America and the Caribbean, the recession was much deeper than in other developing economies because of the already persistent recession and high inflation in Venezuela and Argentina. In contrast, the emerging and developing Asian countries like China and India, showed the lowest recession, with a decline of only 0.8% in 2020. China even achieved a positive growth rate of 2.3 in 2020 (International Monetary Fund, 2021). Also in Sub-Saharan Africa, the recession in 2020 was less severe compared to the global average. This was credited to the slower spread of COVID-19 and strong agricultural growth (World Bank, 2021). (Figure
In 2015, the global community pledged to implement the 2030 Agenda for Sustainable Development, which comprises 17 Sustainable Development Goals (SDGs). These goals aim to eradicate poverty, safeguard the planet, and secure peace and prosperity for all people by 2030. Prior to the pandemic, the world was not making sufficient progress towards achieving numerous goals, with several regions lagging behind (United Nations, 2019). Since the early 2020, the crisis instigated by the pandemic, risked the accomplishment of the goals and caused some goals to be slowed or even reversed. The COVID-19 pandemic affected many aspects of life like health, education, employment, and economic growth, which are directly related to the SDGs. For instance, the attempt to end poverty (SDG 1) and hunger (SGD 2) by 2030, to achieve equitable quality education (SGD 3), to promote full and productive employment (SDG 8) and to reduce inequality within and among countries (SDG 10) has become even more unattainable for many countries.
As a result of the pandemic, an estimated 575 million people will continue to live in extreme poverty by 2030, and only about one-third of countries are expected to achieve the target of halving national poverty levels. Additionally, global hunger levels have regressed to those of 2005, exacerbated by high food prices. By 2030, approximately eighty-four million children are expected to be out of school, and even 300 million students who attend school will leave without basic literacy skills (United Nations, 2023). Moreover, childhood vaccinations have seen the most significant drop in three decades, and deaths from tuberculosis and malaria have risen compared to pre-pandemic levels (United Nations, 2023). Inequality between nations has also experienced the most significant increase in three decades. Over 12% of the decline in disparities between nations, that was achieved from 1990 to 2019, will be wiped out due to the pandemic (Mahler et al., 2022), thus, undermining the achievement of SDG 10 (reduced inequalities). Another adverse impact of the COVID-19 virus on the SDGs is the disruption of data collection, which is crucial for tracking the achievements in SDGs (United Nations, 2020)
The pandemic has exacerbated gender disparities in the Global South where women make up the vast majority of workers in the informal sector (table
Women working informally receive, on average, lower wages than their male counterparts and earn on average 52 percent of the wages of women formally employed (International Labour Organization, 2018). Unfortunately, these women are often deprived of formal social protection measures, protection of labor laws, and benefits such as pensions or health insurance (International Monetary Fund, 2020). Pandemics always hit the informal sector hard, and the informal workers suffered the most from containment measures like lockdown and restrictive government policies. School closures had also threatened advances in gender equality. It is estimated that by the next decade ten million more girls will be placed at risk of early marriage and dropping out of school (Azevedo J., et al, 2021). Additionally, during COVID-19 women faced increased challenges in balancing work and family responsibilities, resulting from shutdown measures such as school closures and precautions for vulnerable elderly parents (International Monetary Fund, 2020). Furthermore, gender-based violence incidents against women and girls increased particularly because of lockdowns and ‘stay at home’ measures, in addition to the mass unemployment that hit women the most.
Although children were far less likely to be infected by COVID-19, the virus had a profound effect on their wellbeing. Worldwide, almost 6.7 million children have lost a primary and/or secondary caregiver to COVID-19 by January 2022 (Unwin et al., 2022). Many Global South countries have more than 25,000 children who experienced COVID-19 orphanhood and caregiver loss. Over half of these high-burden nations are in Africa, in addition to India, Brazil, Mexico, Peru, Islamic Republic of Iran, Colombia, Indonesia, Pakistan, Iraq, Argentina, Philippines (USAID et al., 2022).
Learning losses had been substantial and unequal especially in younger and disadvantaged children. For example, in Brazil students missed almost 72% of their in-class learning, and the risk of dropping out tripled. In rural India, students lost a lot of their simple math skills. (Azevedo J., et al, 2021) Children’s health was also affected during the pandemic. Because of the overburdened healthcare centers, 25 million children failed to get their routine immunizations in 2021, compared to 19 million in 2019 (United Nations, 2023). Lockdowns also threatened children’s safety, and many suffered from domestic violence and abuse. Moreover, child labor has increased in many developing countries. With limited access to online learning and the need for children to contribute to household income, families facing financial difficulties resorted to child labor as a source of additional income. Ecuador witnessed a rise in child labor by more than one third compared to the pre-pandemic data and in São Paulo Brazil child labor increased by 26% between May and July 2020. In West African countries children reported working because there was no school and in Burkina Faso more children were working with their parents in mining because their parents did not want to leave them at home unattended (International Labour Organization, 2021).
COVID-19 took a catastrophic toll on global health and caused a substantial increase in mortality worldwide. It led to severe illness and fatalities, especially among older adults and individuals with pre-existing health conditions. Mortality rates have varied across countries and regions, induced by factors like healthcare capacity, public health measures, and the effectiveness of pandemic response strategies. The pandemic has caused notable short-term variations in mortality rates between 2019 and 2021, leading to a decrease in worldwide life expectancy at birth by more than 1.5 years. This marks a historic shift in global life expectancy trends, a reversal not seen since the early 1960s. (Pirlea & Suzuki, 2023). (figure
The attack of COVID-19 has intensified the pre-existing problems of the healthcare systems in low- and middle-income countries. A significant level of health service delivery was impacted as the pandemic had disrupted both preventive and curative services for communicable and noncommunicable diseases (Haileamlak, 2021). The burden on healthcare facilities led to delays in providing essential services. For example, cancer screening dropped significantly in 2020 compared to 2019 (Lucas et al., 2023). Non-urgent surgeries were postponed, emergency department visits declined, and waiting times for non-urgent surgeries lengthened. Primary care consultations dropped, and teleconsultation services expanded in all countries.
Healthcare workers were significantly impacted by the pandemic in its early stages. Many healthcare workers were redeployed or voluntarily shifted from their usual areas of specialization to help address the surge in COVID-19 cases. This had negatively affected resources for other prevalent diseases including HIV, tuberculosis, and malaria. Furthermore, healthcare workers were under-protected and overexposed due to the absence of adequate personal protective equipment. The World Health Organization reports that health workers represented around 1.29 million COVID-19 cases or 8% of the cases in 2020 globally, and 68% of them were women (World Health Organization, 2021). The pandemic has also affected the next generation of health workers. Having online classes in replacement of in-person classes caused a loss of combined experiences that can be a notable setback for education. Cancelling conferences and symposiums caused medical students to miss out on the chance for personal development through conference presentations, which has an adverse impact on their medical education now and their future careers later (Ferrel & Ryan, 2020).
The pandemic emphasized how Global South countries must build robust, resilient health systems. Resilience refers to the capacity of systems to anticipate, act, recover from, and adjust to significant shocks (OECD, 2023). Health systems must be resilient to shocks beyond pandemics. This will require more investments in health, global cooperation and solidarity, and a direction towards sustainability.
Health spending is an investment more than just an expenditure. It is an investment in people who will be healthier and thus more productive in the future. Improving people’s health is viewed as an investment in human capital, which will aid in rising employment levels, poverty reduction and overall economic growth. The share of health in total government spending reflects health priority. Given the modest government spending on health in many developing countries, governments must think about reprioritizing public spending. This can be achieved by generating more savings through tackling wasteful spending, reducing fuel subsidies, or by levying pro-health taxes. Such taxes target health-damaging products, like sugar-sweetened beverages, tobacco, and alcohol, and have a positive effect on population health in the long-run and in turn the sustainability of health financing (Morgan D. & James C., 2023). Furthermore, revenues from these taxes can be substantial. In 2021, a study carried out by the World Bank estimated that excise taxes that increase the prices of sugar-sweetened beverages, tobacco, and alcohol by 50% could raise the tax-to-GDP ratio by almost 0.7 percentage points in low-and middle-income countries, approximately $18.8 billion (Kurowski et al., 2021).
Governments must also invest in creating an emergency budget for immediate action towards pandemics or other major emerging shocks that can cause surges in healthcare needs. This will strengthen the capability of health systems to act swiftly and effectively. But equally important is a focus on long-term investments to strengthen resilience.
During the pandemic, health professionals represented the first line troops in attacking the disease. Unfortunately, many Global South countries suffer from the brain-drain of health workers, which poses a challenge for these countries. As a result, health spending must include direct benefits such as appropriate salaries and training for health workers, especially for crisis management, and indirect benefits such as creating fair working conditions, providing needed personal protective equipment, and ensuring occupational safety (Haileamlak, 2021).
The 2030 Agenda for Sustainable Development can serve as a valuable tool for post-pandemic recovery efforts and building future resilience. Progress towards the SDGs can be seen as a double-edged weapon. The goals can play a dual role in both post-pandemic actions and recovery plans, with countries leveraging the crisis as an opportunity to attain the 2030 Agenda for Sustainable Development. This can be accomplished by prioritizing sustainability at the heart of recovery plans (Barbier B. & Burgess C., 2020).
These systems can enable countries to respond more quickly and efficiently to emerging health threats by facilitating the mobilization of resources and reducing costs. The COVID-19 pandemic took almost two months to spread to Africa and Latin America, which meant that countries had time to prepare. However, many countries were slow in closing their borders and even the lockdown measures were not as stringent as required. As a result, having an effective early warning system appeared to be the key to pandemic readiness and response.
Efforts to build strong and resilient health systems in the Global South require collaboration among countries and international organizations. Reorganizing existing programmes needs a global comprehensive response involving parties from the North and South, public or private and South-South cooperation (OECD, 2020).
The 2023 Hiroshima G7 Global Health Task Force (Japan Center for International Exchange, 2023) emphasized in its draft recommendation the important role of the G7 in the global recovery post-COVID-19. Given their prominent positions in science and technology, the G7 countries can serve as significant sources of external financial and technological support and partnership. They have also expressed intentions to decentralize research and development (R&D) to facilitate faster and more equitable delivery of vaccines and medical products. Moreover, the G7 should promote digital transformation in healthcare globally for more reliable surveillance and tracking systems. This entails enhancing the ability of healthcare workers to utilize digital tools and ensuring access to digital health services for individuals with disabilities. Additionally, they recommend providing grants to low- and middle-income countries to build and bolster health infrastructure, particularly in rural and marginalized areas.
The post-COVID-19 world will never be like the world that existed before. The COVID-19 crisis extends far beyond a mere health crisis. This unparalleled period in human history has placed immense strain on healthcare systems worldwide, impacting regions across both the Global South and the Global North. The COVID-19 revealed some of the previously unsolved problems most of the Global South countries have been facing for decades. The weak health systems, the pre-existing health inequalities, and the large out-of-pocket spending have aggravated the effects of the virus. Even though it was argued that developing countries’ youth can endure the negative health issues more than the developed countries’ elders, the presence of infectious diseases curtailed this assumption. It was also noted that those who suffered most were the people in the informal economy. Since the beginning of the pandemic, lockdowns and movement restrictions have even affected their ability to access food. School closures and disruption of learning would have negative effects on the human capital in the long-run and would deepen inequality inside and among countries. Women have been disproportionally affected in terms of higher levels of unemployment, imbalances in education and domestic responsibilities. More girls were even placed at risk of early marriage and dropping out of school.
The challenges triggered by the pandemic brought to light the importance of building resilient healthcare systems, by directing more savings towards the health sector and creating emergency funds for immediate response posed by health emergencies. As a way of improving preparedness, early warning systems must be enforced to effectively tackle future health crises before they get out of control. The Sustainable Development Goals and poverty alleviation must also be a necessary part of the recovery plans. This needs strong political leadership and effective collaborations among the countries. Furthermore, achieving more inclusive economic growth and stronger productivity requires policymakers to introduce new training programs to generate a more skilled- post-pandemic labor force. The Covid-19 crisis has also showed how digital transformation and e-commerce served as a lifeline for businesses, students, healthcare professionals, and government agencies. They were able to adapt and remain active during the crisis. This shows how crucial it is to accelerate a digital transformation process in all economic sectors to align with contemporary technological standards, thus enhancing economic integration, productivity, and welfare.
| Regions | Total | Women | Men |
|---|---|---|---|
| Africa | 84% | 88% | 81% |
| - North Africa | 69% | 62% | 71% |
| - Sub-Saharan Africa | 87% | 90% | 84% |
| Latin America and the Caribbean | 53% | 52% | 54% |
| Asia and the Pacific | 66% | 62% | 68% |
| - Southeast Asia | 69% | 69% | 69% |
Data Source: International Labour Organization, Women and Men in the Informal Economy: A Statistical Update, 2023