Monitoring COVID-19 Monitoring COVID-19 impacts REPORT NO. 3 REPORT NO. 3 on households in Ethiopia 11 / August / 2020 11 / August / 2020 Impacts on Households in Ethiopia Results from a High-Frequency Phone Survey of Households Authors: Christina Wieser, Alemayehu A. Ambel, Tom Bundervoet, and Asmelash Haile The COVID-19 pandemic and its economic and social effects on households have created an urgent need for timely data to help monitor and mitigate the social and economic impacts of the crisis and protect the welfare of the least well-off Ethiopians. To track how the pandemic is affecting Ethiopia’s economy and people and to inform interventions and policy responses, the World Bank is conducting a customized high-frequency phone survey of households (HFPS-HH). The HFPS-HH builds on the national longitudinal Ethiopia Socioeconomic Survey (ESS) that the Central Statistical Agency (CSA) carried out in 2019 in collaboration with the World Bank. The HFPS-HH subsample of the ESS sample is representative of households with a working phone. The same households are tracked for six months, with selected respondents, typically household heads, completing phone-based interviews every three to four weeks. To support new responses to the pandemic as they become necessary, this high-frequency follow-up allows for a better understanding of its effects on households and their responses to it in what is almost real time. This brief is based on a sample of 3,058 households in both urban and rural areas in all regions of Ethiopia. The original sample consisted of 3,249 households, of which 3,058 responded to round 3 (R3) calls.1 The 15-minute questionnaire covers such topics as access to basic needs, child educational activities during school closures, employment dynamics, household income and livelihood, income loss and coping strategies, food security and assistance received. HIGHLIGHTS – ROUND 3 At baseline (R1), nearly all respondents had heard about the coronavirus and were aware of the actions necessary to reduce the spread. Four months into the pandemic, R3 respondents reported changes in behavior. Almost everyone washed their hands, though at varying degrees of frequency with handwashing more frequent in urban areas. Similarly, about 61 percent of urban and 32 percent of rural respondents reported always wearing a face mask. The majority of the respondents are concerned about the impact of the coronavirus on their health and livelihoods. About 71 percent are very or somewhat worried that they or a family member will fall ill with COVID-19. Similarly, about 81 percent made it clear that pandemic is a substantial or a moderate threat to their finances. Nationwide, in households with children who had been in school before the outbreak, about 29 percent of primary school students and 39 percent of secondary school students were engaged in distance learning activities. This means that during school closures 7 of every 10 primary students and 6 of every 10 secondary students have no opportunity to learn. Employment rates, which in Ethiopia plunged in the early days of the pandemic but then rebounded, seem to have stabilized at about 86 percent, a level similar to that reported in R2. Employment rates, however, are still much lower than they were pre-pandemic. About half of R3 respondents surveyed in June 2020 reported having experienced moderate or severe food insecurity, with the prevalence similar in both rural and urban areas. However, there are significant differences by consumption quintile: about 6 in 10 Ethiopians from the poorest quintile had suffered such food insecurity compared to 3 in 10 from the richest quintile. To prevent the spread of COVID-19 and to ensure that measures to slow it, such as mobility restrictions, are effective, it is essential that people be aware of the need to change their behavior. In R1 virtually every household (99.7 percent) had heard about the coronavirus or COVID-19, with respondents reporting being well-informed about actions to reduce the spread. In R3, we checked whether people’s changes in behavior were still in place four months into the pandemic. Almost all were still washing their hands, though at varying degrees of frequency and with handwashing more frequent in urban areas (Table 1). In general, there is adherence to wearing face masks: As Table 2 shows, about 85 percent in urban and 61 percent in rural areas indicated they wear face masks at least some of the time. About 61 percent of urban respondents wear a face mask all the time, almost twice as 1The data were collected by Laterite (Ethiopia) Ltd. When R3 began on June 4, 2020, Ethiopia had 1,636 confirmed COVID-19 cases 6. By June 26, when R3 ended, confirmed cases had soared to 5,425. Monitoring COVID-19 impacts REPORT NO. 3 on households in Ethiopia 11 / August / 2020 many as the 32 percent in rural areas. However, these results should be interpreted with care: there seems to be a tendency to over-report positive behavior changes. Table 1: Frequency of Handwashing, R3, Percent Table 2: Frequency of Wearing Face Masks, R3, Percent About About All the Most of Some of None of All the Most of Some of None of half the half the time the time the time the time time the time the time the time time time Rural 69.2 18.1 5.7 5.6 1.4 Rural 31.5 13.2 5.7 10.4 39.2 Urban 83.1 10.7 2.4 3.7 0.2 Urban 60.8 10.6 5.7 8.1 14.8 National 73.8 15.7 4.6 5.0 1.0 National 41.1 12.3 5.7 9.6 31.2 Respondents are quite concerned that they or a family member will fall ill with COVID-19: about 71 percent reported being very or somewhat worried (Table 3). Notably, they are even more concerned about the effect of the pandemic on their finances: 81 percent consider it either a substantial or a moderate financial threat to the household (Table 4). Urban and rural differences are small. Table 3: Respondent Concerns about Falling Ill with COVID-19, Table 4: Respondents Perceiving COVID-19 as a Financial Threat, R3, Percent R3, Percent Very Somewhat Not too Not worried Substantial Moderate Not much of Not a threat worried worried worried at all threat threat a threat at all Rural 54.5 14.0 12.9 18.7 Rural 53.5 25.1 7.0 14.4 Urban 56.6 18.7 8.2 16.5 Urban 72.4 12.2 5.2 10.2 National 55.2 15.5 11.3 17.9 National 59.7 20.9 6.4 13.0 The survey asked respondents whether their household had been able to buy enough medicine and enough of the most important food items during the week preceding the interview.2 When they were not, we asked why. In R3, 85 percent of households that needed to buy medicine were able to do so (Table 5). Of those that could not, 74 percent cited lower regular income. Most households were able to buy enough food staples—teff (61 percent), wheat (78 percent), maize (81 percent), and edible oil (74 percent)—and changes to the previous survey round were either small or not significant. Of those that could not buy enough food, the biggest problems were higher prices or less regular income—affordability was a concern for over 90 percent of households. Table 5: Ability of Households to Buy Certain Items, R3, Percent Rural Urban National Medicine 81.5 90.1 84.7 Teff 46.9 76.4 61.2 Wheat 70.3 86.4 78.0 Maize 79.4 84.1 80.7 Edible oil 68.9 83.2 73.4 On March 16, 2020, Ethiopia closed all primary and secondary schools. In addition to students losing valuable months of schooling, school closures deprive many por children of food because they often rely on school feeding programs; for example, all children in Addis Ababa public schools participate in a twice-daily school feeding program. Temporary school closures may also lead to children from vulnerable households dropping out permanently, especially in rural areas, where even in ordinary circumstances early drop-out is rife. The long-term impacts of lost months of schooling and the lack of good nutrition will be particularly severe for children in poor families because it jeopardizes their ability to build human capital and thus their earning potential. R2 of the survey indicated that about one-third of the children who had attended school before the COVID-19 outbreak had engaged in learning activities during the three weeks before the interview. While still modest in terms of magnitude, in that round we found an encouraging increase in distance learning activities since the school closures, particularly in rural areas—yet two-thirds of school-aged Ethiopian children were still not engaged in any learning activity. In R3, we changed the structure of the questions to better understand whether distance learning activities are more common among primary or secondary school students. The survey asked households how many children had been in primary and secondary school before the outbreak began and whether they are now engaged in any learning activities. In R3, households with children who had been in primary school (67 percent), 29 percent were engaged in distance learning. In households with children who had been in secondary school (24 percent), in R3, 39 percent were so engaged. Yet nationwide that means that during the school closures 7 out of 10 primary school children and 6 out of 10 secondary school children have had no opportunity to learn. 2 According to the 2018‒19 ESS, the four most important food items are edible oil and teff, wheat, and maize as grain or flour or cooked. Monitoring COVID-19 impacts REPORT NO. 3 on households in Ethiopia 11 / August / 2020 Rural children still trailed urban children in benefitting from distance learning. Almost twice as many urban children who had previously attended primary or secondary school are now engaged in learning activities (Figure 1). For rural children, by far the most widespread activity is listening to educational radio programs, as occurred in 50.6 percent of the households with primary school learners and 40 percent of those with secondary school learners (Table 3). About 31 percent of rural primary school children and 25 percent of rural secondary school children complete assignments provided by the teacher; among rural children, 28.7 percent of secondary students meet with teachers—almost double the 16.2 percent of those in primary school. However, in urban areas the most common activity is to complete assignments provided by the teacher—59 percent of primary learners and 43 percent of secondary learners—followed by using mobile learning apps, which at 27.0 percent is a particularly important option for secondary learners. Figure 1: Households with Children who Previously Attended Table 6: Educational Activities Students Engage in During School School and now Engage in Learning Activities, R3, Percent Closures, R3, Percent Primary Secondary Primary school Secondary school Rural Urban Rural Urban Session/meeting with lesson 16.2 15.4 28.7 15.8 58.1 teacher (tutor) 45.7 39.0 Used mobile learning apps 4.6 17.9 16.2 27.0 30.4 28.9 23.7 Watched educational TV 9.5 24.6 11.7 28.8 programs Completed assignments 30.7 59.0 24.7 43.2 provided by the teacher Listened to educational RURAL URBAN NATIONAL 50.6 14.8 40.3 17.1 programs on radio One of the channels through which households suffer economically from the pandemic and its associated restrictions on movement and assembly is through reduced income. In R1, we asked households about their income sources over the last 12 months and followed up by asking whether the income from a particular source had risen or fallen since COVID-19 broke out. In R3, we asked about income sources between rounds and whether income from a particular source rose or fell. Table 7: Household Income Sources, R3, Percent Rural Urban National Farming, livestock, or fishing 56.5 13.7 42.4 Nonfarm business 6.1 22.8 11.6 Wage employment 10.6 43.6 21.5 Remittances from within Ethiopia 1.8 5.5 3.0 Remittances from abroad 0.0 1.2 0.4 Income from properties, investments, and savings 5.5 10.5 7.1 T Pension 0.1 4.2 1.5 Government assistance 2.3 1.8 2.1 Assistance from an NGO or charitable organization 1.1 0.5 0.9 In R1, we observed that, for all labor income sources, household income had gone down since COVID-19 broke out. In R2 and R3, the percentage of households that suffered a further decrease in income in the three weeks since the last previous survey round is lower for all income sources but there is a slight increase in households reporting higher income from labor sources (Figure 2). Figure 2: Change in Household Income, by Source, Percent Farming, livestock, fishing Non-farm business Wage-Employment 100 80 60 40 20 0 R1 R2 R3 R1 R2 R3 Reduced or total loss Increased Note: Only income sources from which more than 10 percent of households generate income are included in the figure. Monitoring COVID-19 impacts REPORT NO. 3 on households in Ethiopia 11 / August / 2020 R1 found that both domestic and international remittances had plunged since the outbreak. In R3, fewer households received remittances between rounds (Table 7), but remittance losses seem to have bottomed out. Although about 15 percent of households receiving remittances saw a further reduction, for about 20 percent remittances had gone up in the previous three weeks. Figure 3: Households Receiving Remittances, Percent 20 15 10 5 0 R1 R2 R3 R1 R2 R3 R1 R2 R3 Rural Urban National Relatively few households in R3 reported government assistance or assistance from an NGO or other charitable organization as a source of income (Table 7). Only 2 percent of households reported that government assistance had been a means of livelihood in the three weeks preceding the interview. For 46 percent of the relatively few households receiving assistance, incomes from government had increased. R1 found that 55 percent of households had experienced either a reduction or a total loss of income since the viral outbreak. Though in R2 and R3 fewer households reported further income erosion, apparently income losses have not yet bottomed out: 40 percent of households reported a drop in income in the three weeks between R2 and R3 (Figure 4). R3 households suffering from less or no income were then asked what, if any, coping strategies they had used to manage the lower income. We found that almost half had not yet applied a strategy to compensate for the lost income (Table 8). The most common coping strategy was to draw on savings, which was the choice of 26 percent of those households—42 percent in urban and 15 percent in rural areas. The second and third most prevalent strategies were to reduce food consumption (23 percent of households) and reduce nonfood consumption (18 percent). Coping strategies changed very little from one survey round to the next. Figure 4: Households with Reduced or Total Table 8: Coping Strategies Used, R3, Percent Loss of Income, Percent Rural Urban All 61.1 Sold assets, agricultural or nonagricultural 1.4 3.0 2.0 54.8 Engaged in additional income-generating activities 3.8 3.0 3.5 51.7 48.6 47.1 Received assistance from friends and family 1.0 9.4 4.3 45.8 44.5 40.0 Borrowed from friends and family 3.4 4.7 3.9 36.5 Reduced food consumption 19.0 28.6 22.7 Reduced nonfood consumption 17.0 19.2 17.8 Relied on savings 15.4 41.6 25.6 Did nothing 55.4 31.9 46.2 All others 7.1 2.9 5.5 R1 R2 R3 R1 R2 R3 R1 R2 R3 Rural Urban National The COVID-19 pandemic is clearly affecting economic activity in Ethiopia: R1 had already found that households had less work. Though the State of Emergency declaration prohibits firms from laying off workers, R1 showed a sizable negative impact on employment, particularly for Ethiopians who were self-employed or working as casual labor. R2, however, found a strong rebound in employment rates3: the share of respondents who worked at least one hour in the seven days before the interview jumped between R1 and R2—though it was still lower than before the pandemic. In R3, employment rates had stabilized at their R2 level of about 86 percent (Figure 5); there had been no statistically significant changes between the rounds. However, in the latest round employment rates were 3 The employment rate refers here to the share of phone survey respondents who worked at least one hour in the seven days preceding the interview. Monitoring COVID-19 impacts REPORT NO. 3 on households in Ethiopia 11 / August / 2020 still significantly lower (86.6 percent) than they had been pre-COVID (89.5 percent). It appears that so far COVID- 19 has had a small yet persistent effect on jobs volume in Ethiopia. Of respondents who were employed in R2, just over 3 percent had lost their job by R3. Of these, one-third attributed the job loss to the COVID-19 outbreak. Job losses between R2 and R3 were highest for respondents in the hospitality sector. At the same time, by R3 24 percent of respondents who were not employed in R2 had found work. The net effect is a small and statistically insignificant increase in the employment rate between R2 and R3. In R2, about 20 percent of households ran a nonfarm Figure 5: Respondent Employment Rate, Percent household enterprise. By R3 one month later, 67 percent of 100.0 these enterprises were still operational; the other 33 percent 95.0 had closed, some temporarily, some permanently. In most 90.0 cases closures were a consequence of the COVID-19 outbreak: 85.0 “Usual place of business closed because of Coronavirus” (53 80.0 percent) and “no customers” (13 percent). 75.0 70.0 Of those R3 households still operating a nonfarm family 65.0 business, almost two-thirds indicated that income from the 60.0 business was less than it had been at R2 (Figure 6). The 55.0 reasons most often stated were that (1) there were no 50.0 customers, (2) the place of business is closed because of Pre-COVID R1 R2 R3 coronavirus, and (3) they are unable to sell their products (Figure 7). Rural Urban National Male Female Figure 6: Nonfarm Family Businesses: Changes in Income Figure 7: Reasons for Lower Business Income since the Pandemic between R2 and R3, Percent Began, Percent Illness in the household 2.9% Unable to sell or transport outputs 9.0% Higher than usual Unable to acquire or transport… 25.4% The same as usual No customers Less than usual Seasonal closure 62.7% No income Business closed for another… Business closed because of corona 0.0 50.0 100.0 One drawback of the phone survey is the necessary restrictions on questionnaire length and complexity, which prevents us from asking in detail about other household members. However, given our concern about employment, we did ask about the employment status of other household members. R2 had found that about 10 percent of households had members other than the respondent who were wage-employed. Of those, slightly over 4 percent had since lost their jobs, and 87 percent of these related the job loss directly to the pandemic. . Food security is a major concern in Ethiopia, particularly for rural residents, and is at the heart of the country’s social protection system. To monitor how Ethiopians were faring on food security indicators during the pandemic, the survey applied the Food Insecurity Experience Scale (FIES).4 FIES was fielded in both R2 and R3. Nearly half of the population (about 48 percent in R2 and 45 percent in R3) had experienced moderate or severe food insecurity (Figure 8). The prevalence rates are similar in urban and rural areas.5 However, differences by consumption quintile are significant (Table 9): about 6 in 10 of the poorest individuals experienced moderate or severe food insecurity compared to 3 in 10 of the richest. 4 In this survey FIES consists of eight questions (http://www.fao.org/policy-support/tools-and-publications/resources-details/en/c/1236494/). The questions are household referenced and the recall period is 30 days preceding the survey. Prevalence rates are calculated by population. 5 There are slight differences in prevalence rates of rural and urban populations as well as between R2 and R3 surveys. However, in both cases the differences are within the margin of error. Monitoring COVID-19 impacts REPORT NO. 3 on households in Ethiopia 11 / August / 2020 Figure 8: Food Insecurity Prevalence, Percent Table 9. Prevalence of Food Insecurity by Consumption Quintile, Percent R2 R3 R2 R3 Moderate Moderate 49 48 47 & Severe MoE MoE & Severe MoE Severe MoE 46 44 42 Poorest 61.4 13.4 19.2 9.5 58.4 13.5 19.7 10.5 Poorer 47.2 11.1 12.4 6.5 44.7 11.3 10.4 6.4 13 13 12 12 11 10 Middle 51.8 10 13.2 7.1 54.1 10 13.0 7.0 Richer 42.6 9.3 10.4 5.6 39.4 8.9 7.1 4.7 SEVERE SEVERE SEVERE MODERATE+SE MODERATE+SE MODERATE+SE Richest 31.1 7.7 6.8 3.7 28.7 7.4 4.0 2.8 Note: Prevalence by population. MoE = margin of error. VERE VERE VERE NATIONAL RURAL URBAN Although households were hit hard by the COVID-19 pandemic, only 4 percent had received outside assistance from government, NGOs, or religious institutions (Table 10). For those receiving assistance, the main types were free food (67 percent) and direct cash transfers (32 percent). The government contributed 72 percent of assistance. Table 10: Assistance to Households, Previous Three Weeks by Type and Source, R3, Percent Rural Urban National Household received assistance: Any source 3.8 3.7 3.8 Assistance type: Free food 60.0 81.6 66.9 Assistance type: Food or cash for work 2.2 3.0 2.5 Assistance type: Direct cash transfer 37.8 19.1 31.8 Assistance source: Government 84.4 47.0 72.4 Assistance source: NGO 7.4 1.8 5.6 Assistance source: Religious organization 8.3 14.8 10.4 Assistance source: Volunteer or youth organization 0.0 10.7 3.4 Note: Assistance source and type conditional on household receiving assistance. This survey brief is the third in a series reporting on the findings of the HFPS-HH. It reports results from rounds 1, 2, and 3, related to the effects of and responses to the COVID-19 pandemic. Data collection will continue by following up with the same households every four weeks. For each round, the survey brief, table of indicators, and microdata will be available at https://www.worldbank.org/en/country/ethiopia/brief/phone-survey-data- monitoring-covid-19-impact-on-firms-and-households-in-ethiopia. Monitoring COVID-19 impacts REPORT NO. 3 on households in Ethiopia 11 / August / 2020 The high-frequency phone survey monitors the economic and social impacts of the COVID-19 pandemic on households and their responses in terms of such topics as access to food staples, access of children to educational activities during school closures, employment dynamics, household incomes and livelihoods, income losses and coping strategies, and external assistance. The final dataset will cover a panel of about 3,000 households that are representative of households that can be reached by mobile phone nationally and also of urban and rural areas. To the extent possible, the same households and respondents will be tracked for six months, with selected respondents completing phone- based interviews every three to four weeks. This high-frequency follow-up allows for a better understanding of the effects of and responses to the COVID-19 pandemic on households; the results can inform interventions and policy responses and monitor their effects. The respondent is typically the household head; where that person cannot be reached despite numerous call-backs, another knowledgeable household member is selected as the respondent. The HFPS-HH sample consists of a subsample of those interviewed for the Ethiopia Socioeconomic Survey (ESS) in 2019—households with access to a phone—covering urban and rural areas in all regions of Ethiopia. The HFPS-HH called the 5,374 households that in the ESS had provided a valid phone number. Phone penetration in rural Ethiopia is low; about 40 percent of rural households have access to a phone compared to over 90 percent of urban households. This not only means that the rural sample is relatively small but there is also a systematic difference between households that own a phone and those that do not. Phone-owning households are better off in terms of total consumption, educational attainment, access to improved water and sanitation, access to assets, and access to electricity. The sample of the HFMP-HH is therefore representative only of households who have access to phones in urban and rural Ethiopia. Data collection parameters, round 3 ❖ Data collection period: June 4–26, 2020 ❖ Completed interviews: 3,058 households (934 in rural areas, 2,124 in urban areas) ❖ Average duration of interview: 14 minutes