The Present Value of Human Life Losses Associated with Coronavirus Disease in Africa

The coronavirus disease (COVID-19) continues to ravage human lives, social systems, and economies around the world. The objective of this study was to estimate the total present value (TPV AFC ) of human life losses associated with COVID-19 in Africa continent as of 1 August 2020. A human capital approach model was used to estimate the TPV AFC of the 19,682 human lives lost due to COVID-19 in Africa continent (excluding 44 deaths in Sahrawi Arab Democratic Republic and territories of Mayotte and Reunion). The average life expectancy for 54 countries with data and a 3% discount rate were used. A sensitivity analysis was conducted at 5% and 10% discount rates. The human lives lost due to COVID-19 had a TPV AFC of Int$1,721,030,766, and average TPV AFC of Int$87,442 per human life lost. About 81.3% of TPV AFC accrued to persons below 60 years. The TPV AFC of human life losses from COVID-19 will continue growing until the pandemic is eradicated.


Study Location and Design
This study encompassed 54 countries of the Africa continent. The Sahrawi Arab Democratic Republic (Western Sahara) was excluded because data on GDP per capita and current health expenditure per capita was missing. It was a cross-sectional assessment of the monetary value of all the 19,682 human life losses associated with COVID-19 as of 1 August 2020 (Worldometer, 2020).
Since the study involved the cumulative number of deaths up to 1 August 2020, sampling was not relevant.

Analytical Framework
Three approaches exist for monetary valuation of a statistical life, i.e. the human capital approach (HCA), the revealed preferences approach, and the willingness-to-pay approach (WTP) (Jones-Lee, 1985). The HCA was applied in the current study to value human life losses associated with COVID-19 in Africa due to the availability of relevant data.
The HCA employed in the current study owes its antecedents to the seminal work of Landefeld and Seskin (1982). Weisbrod (1961) and WHO (2009a) clarified that human life is to be valued using discounted future earnings net of the individual's consumption. Any premature death from COVID-19 (or any other cause) results in potential years of life lost (YLL), which are equal to the average life expectancy at birth for a specific country minus the age of onset of death (Kirigia & Muthuri, 2020a, 2020b, 2020c, 2020dKirigia, Muthuri, & Nkanata, 2020). In line with Weisbrod (1961) and WHO (2009a), the net per capita GDP (i.e., specific country's per capita GDP minus current health expenditure per person) is used in monetary valuation of YLL.
The TPV AFC is the sum of present value of human lives lost from COVID-19 as of 1 st August 2020 in each of the 54 countries ( 1, ,55 CPV j =  ). That is: The present value of human lives lost through COVID-19 in the j th country ( 1, ,55 CPV j =  ) is the sum of the discounted present value of lives lost among the 0 -9-year-olds (PV 0-9 ), 10 -19-year-olds (PV 10-19 ), 20 -29-year-olds (PV 20-29 ), 30 -39-year-olds (PV 30-39 ), 40 -49-year-olds (PV 40-49 ), 50 -59-year-olds (PV 50-59 ), 60 -69-year-olds (PV 60-69 ), and the 70-year-olds and above (PV ≥70 ) (Kirigia & Muthuri, 2020a, 2020b, 2020c, 2020dKirigia, Muthuri, & Nkanata, 2020). Formally: (2) Open Journal of Business and Management The i th age group present value (PV i ) equals a product of discount factor, YLL, net per capita GDP (NPCGDP), and COVID-19 deaths for age group (Kirigia & Muthuri, 2020a, 2020b, 2020c, 2020dKirigia, Muthuri, & Nkanata, 2020). That is: where: A 1 is the discount factor obtained using the formula ( ) 1 1 t r + , r is the discount rate, which was 3% in the current study (Kirigia & Muthuri, 2020a, 2020b, 2020c, 2020dKirigia, Muthuri, & Nkanata, 2020); 1 t n t = = ∑ is the summation from year 1 t = to T; t is the first YLL and T is the final year of the total number of YLL per COVID-19 human life lost within an age group; A 2 is the per capita GDP for a specific country in International Dollars (Int) or Purchasing Power Parity (PPP); A 3 is the current health expenditure per person for a specific country; A 4 is the average life expectancy at birth for a specific country; A 5 is the average age of onset of death for each age group; A 6 is the total number of human lives lost from COVID-19 in a specific country; A 7 is the proportion of COVID-19 human lives lost borne by a specific age group. The base year for the analysis was 2020. Equations 1, 2 and 3 were estimated using the Excel Software (Microsoft, New York, USA).
The average life expectancies at birth for each of the 54 countries and the world's highest life expectancy of 88.17 years in 2020 were from the Worldometer database (see Table S2) (Worldometer, 2020). The ages of onset of death  Table S4) (WHO, 2020b). The estimated NPCGDP data is in Table S5.
Data on the total number of COVID-19 deaths as of 1 August 2020 for each of the 54 countries were from the Worldometer database (see Table S6) (Worldometer, 2020). The proportions used to share the number of COVID-19 deaths in each country across the eight age groups was calculated using 2020 data from Statista database (see Table S7) (WHO, 2019). The estimated YLL by age group per country are in Table S8.

Findings Assuming World Highest Life Expectancy and 3% Discount Rate
Re-calculation of the economic model (

Key Findings
Our study succeeded in estimating the TPV AFC of human lives lost due to

Comparison with Similar Studies
The present value per human life lost from COVID-19 in Africa was lower than

Research Innovation
To the best of our knowledge, this was the first study to have estimated the present value of human life losses associated with coronavirus disease in Africa.
As explained in the WHO guide to identifying the economic consequences of disease and injury (WHO, 2009a), the evidence contained in this article can be used by the ministries of health in African countries to advocate for increased investments into health-related sectors to bridge existing gaps in the coverage of essential health services, IHR core capacities, and water and sanitation services.

Study Limitations
First, the completeness of cause-of-death data in the AFR was 6% and 32% in EMR, implying cause-of-death for 94% and 68% of deaths, respectively, is not recorded (WHO, 2019). The relatively low completeness of cause-of-death during the ordinary non-pandemic period implies that the notified COVID-19 cases and deaths could be a gross underestimate for many African countries. The under-reporting is exacerbated by the low level of COVID-19 testing in Africa (Worldometer, 2020).

Future Research Directions
First, the quality of economic evaluation studies hinges on the quality of underlying epidemiological evidence. Thus, there is need for quality epidemiological studies on morbidity and mortality due to pandemics; effectiveness of existing and potential preventive, diagnostic, management, and rehabilitative interventions from randomized controlled effectiveness trials; effectiveness of alternative ways of delivering interventions; and human behaviour in intervention uptake and adherence to recommended procedures.
Second, once the pandemic is eradicated, there will be a need for comprehensive studies into the macroeconomic effects of COVID-19 on education, financial services, trade, tourism, travel, manufacturing, and other sectors. Such evidence could be used in advocating for coordinated and managed inter-sectoral action for implementation of health-in-all policies to leapfrog equitable health development, mitigate, and better combat future public health emergencies (WHO, 2009b(WHO, , 2010(WHO, , 2012a(WHO, , 2012b. Third, the health policy development and decision-making processes require evidence on both costs and consequences (or benefits) of preventive, management, and rehabilitative interventions for COVID-19 (Drummond, Sculpher, Torrance, O'Brien, & Stoddard, 2007;Kirigia, 2009;Cookson, Griffin, Norheim, & Culyer, 2020). For comparative purposes, future studies should consider applying the WTP approach to value human life losses associated with COVID-19, which would facilitate comparison with those obtained in the current study using the HCA.

Conclusion
The estimated TPV AFC of human lives lost due to COVID-19 in Africa is likely to be an underestimate due to abovementioned limitations. COVID-19 is a burden on the NHS, the DSRS, the SDHS, and the economies of African countries. The TPV AFC will continue growing until the pandemic is eradicated. The TPV AFC evidence, in conjunction with human rights arguments (rights to life, health, medical care, clothing, food, housing, and social security) (United Nations (UN), 1948), can be used in advocacy for increased domestic and external investments to bridge existing gaps in NHS, DSRS, and SDHS. Since our study was of limited scope, assessments of the economy-wide impact of COVID-19; and costs and consequences of preventive, treatment, and rehabilitative interventions are needed to guide policy (Kirigia & Muthuri, 2020a, 2020b, 2020c, 2020d; Open Journal of Business and Management Supplement   Table S1. Names of countries and territories in the Africa continent.    Source: Statista (2020). Note: The 11 deaths whose age was unknown were not included in calculations of the proportions.