As most African countries enter month six of dealing with the Corona virus, the continent is nearing the one million mark in number of cases and WHO is warning that the world is in for a deep, long crisis.
What preliminary conclusions can Africa draw and how can we manage COVID-19 better going forward? Every crisis is also opportunity, is Africa seizing the opportunities that COVID-19 offers?
Let us examine some of Africa’s key systems, analyze, learn and seize the opportunity going forward.
The Health System
Much has been written about the inadequacies of Africa’s health systems. Some of the key elements characterizing them are:
- Insufficient and inadequately trained personnel. According to WHO, Africa needs to increase health personnel by 63% to ensure adequate health coverage to citizens. In addition, the health sector suffers from a severe brain drain as doctors and nurses trained in Africa head to Europe, the U.S. and other countries where they can earn decent salaries and work in minimally acceptable conditions.
- Insufficient and poor-quality health infrastructure. Accessing healthcare is challenging for all Africans, but particularly so for the 60% who live in rural areas. Not only are there not enough health centers, those that do exist lack equipment, personnel and basic supplies.
- Lack of health information and data. While Africa continues to appear to be less impacted by COVID-19 than other continents, the truth is no one really knows. Nigeria which is among the top 10 African countries carrying out the most testing is averaging 1.3 tests per 1000 people. South Africa which has carried out the highest number of tests on the continent is at 48 tests per 1000 people. In comparison, the UK is testing 134 people per thousand and the US, 162. In both countries the testing level is considered to be insufficient.
In addition, many African countries lack the data on deaths from previous years to be able to make comparisons on comorbidities or abnormally high death rates.
- Lack of research and development capacity to test innovations. Ordinary Africans have reacted to the COVID-19 crisis as they should, by innovating. From herbal remedies to ventilators and tests, Africans young and old have put their know-how and creativity to work to find solutions for coronavirus. Is there a miracle cure or a savvy tech application that can reduce testing time and cost somewhere on the continent? Hard to tell. The continent lacks the research and development facilities to test, improve and scale these innovations.
In the midst of all the crisis activity that goes into fighting a pandemic what are some of the systemic solutions African countries should be implementing to ensure that African health systems come out of this crisis stronger and more resilient than ever? There are many. Here are just five suggestions:
1 – A percentage of aid, debt forgiveness and/or new debt should be used to invest in structural solutions for health infrastructure and training of personnel.
COVID-19 and Africa’s estimated needs of over $200 billion to respond to COVID-19 have triggered a variety of initiatives for debt cancellation, debt suspension and debt standstill.
The G20, OECD, the African Development Bank, the African Union and others are all mobilizing funds to enable Africa to respond to COVID-19. While this must be handled with flexibility and adapted to each country’s situation, it is imperative that access to these resources be conditioned by a percentage being used for structural investments in African healthcare systems such as:
- Upgrading training institutions in an aim to improve short-term training for healthcare workers facing the crisis as well as increasing the quantity and quality of healthcare workers in African countries in the medium term. The African Union should consider setting a minimum quota of increase in healthcare workers which will condition funding.
- Making use of green technology to ensure that energy supplies to healthcare facilities are sustainable and independent of dysfunctional national grids. This will also generate green jobs for the healthcare and other sectors.
- Making efficient use of technology for:
- Distance learning for healthcare workers
- Telemedecine to increase access to healthcare and specialized health services for citizens
- Providing information and education for preventive health measures
This will also require investment in internet infrastructure to improve connectivity which has been discovered to be highly insufficient in Africa during this crisis.
2 – Decentralize, decentralize, decentralize (see STRATEGIES! upcoming article on the Municipal Approach to fighting COVID-19)
While many countries have zoned their national territory into health districts, generally these districts remain extremely weak in decision-making power and resources. While it is important to maintain norms and quality standards at national level, COVID-19 like most health challenges requires proximity healthcare management. Empowering local health districts to work with decentralized branches of the health ministry and local elected officials will enable African countries to improve access to healthcare by bringing services much closer to the population. It will also greatly improve the ability to collect health information from the population.
3 – Build a national health information system
Weak information systems and the lack of data are compromising understanding of the virus and decision-making in African countries. It is extremely important that COVID-19 is used as an opportunity to make a quantum leap in health information systems.
The crisis has created a focus on health systems for governments and for citizens. It is the opportunity to set up an information system to collect data at all levels, from individual clinics and hospitals to districts and up to national level.
Almost all African countries have vibrant tech communities full of young entrepreneurs who could be instrumental in devising and running these information systems. It is therefore an opportunity to digitalize health systems, create jobs and vastly improve data collection and analysis in the health system which will improve evidence-based decision-making.
4 – Partner with the Diaspora to obtain high-level skills
Tens of thousands of African medical professionals trained on the continent, work in other parts of the world. This is mainly due to poor working conditions: salary, professional growth, equipment, etc. in many African countries. At the emergence of COVID-19, many of these doctors and nurses put their knowledge at the disposal of their home countries, demonstrating the attachment they have to Africa no matter where they are in the world.
COVID-19 is the opportunity for African countries to innovate and create short and medium term programs where African medical professionals in the Diaspora can “give back” by providing highly specialized services and training that African countries have difficulty accessing.
A wide variety of NGOs have already enabled African Diaspora medical personnel to return home for short term medical missions. African governments should learn from this and envisage programs where Diaspora could return home for 3 to 24 months to teach, mentor and transfer skills. If investment is made in the overall working conditions of medical staff, there is no doubt a certain percentage of them would return definitively.
It is estimated that 1/5 doctors trained on the continent, work outside of it. It is time for Africa to go on the offensive and stem the brain drain.
5 – Build national, regional and continental systems for research and development
It is the job of citizens who can, to create and innovate. It is the job of states to channel that innovation, test it, help improve it and scale it so that it can be used to solve the problems of a society. COVID-19 has stimulated a rash of innovation in Africa. Unfortunately, few countries have put into place systems to harness this innovation and do the work necessary to transform it into solutions for the country, the continent and perhaps the world.
Africa needs to improve on this at all levels. In this moment of crisis, every country should put into place a system for collecting innovative ideas, technology, systems and concepts. Of course, a high percentage will be of no use. This is part of the process. Research and development centers where these ideas can be tested should be put in place at national level if possible, but certainly at regional and continental levels. Finding African solutions to African problems begins with harnessing and testing new ideas. COVID-19 offers a wonderful opportunity for Africa to build systems that do this.
It remains unclear whether Africa has truly lucked out where COVID-19 is concerned and unclear whether it will be comparatively less impacted by the disease. What is clear, is that this crisis provides opportunity for African countries to make fundamental systemic changes that will improve healthcare on the continent for decades. There are a myriad of systemic changes to be made. The above five are just a sample. In the necessary frenzy of fighting the pandemic in the immediate, this opportunity for tremendous systemic change should not be missed.
N.B. Upcoming articles by STRATEGIES! on “Systemic changes for the African economy during COVID-19” and “The Municipal Approach to fighting COVID-19
Testing in Africa – https://www.bbc.com/news/world-africa-53181555