COVID-19, Vulnerability, and Health in South Africa: Evidence on the Changing Role of Social Cash Transfers

The COVID-19 pandemic generated severe health and livelihood shocks in South Africa, yet much of the existing evidence has focused on mental health rather than broader measures of overall wellbeing. This paper examines changes in self-reported health before and during the pandemic and assesses whether social cash transfers mitigated the adverse health effects associated with vulnerability. Using linked data from the National Income Dynamics Study and the NIDS-Coronavirus Rapid Mobile Survey, we compare pre-pandemic and pandemic-period health outcomes and estimate probit models of poor self-reported health. The results show that the prevalence of poor self-reported health more than doubled during the pandemic and remained elevated across survey waves. Household hunger, chronic illness and income loss were associated with a higher probability of reporting poor health, with the effects of hunger and chronic illness intensifying over time. Household receipt of social grants was associated with a lower probability of poor health at the onset of the pandemic, but this protective association disappeared in later waves. These findings suggest that while cash transfers were associated with short-term protection, cash support alone may be insufficient to address the broader and cumulative health impacts of a prolonged crisis. Future pandemic and crisis responses should therefore combine income support with nutrition interventions, continuity of primary healthcare, chronic medication access and targeted support for vulnerable groups.