5 Ways to Strengthen African Healthcare Systems During COVID-19

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

Sources

Testing in Africa – https://www.bbc.com/news/world-africa-53181555

Debt forgiveness – https://www.un.org/africarenewal/magazine/july-2020/external-debt-complicates-africas-post-covid-19-recovery-mitigating-efforts

Diaspora – https://www.universityworldnews.com/post.php?story=20200624152928519

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908684/

Key Impacts of COVID-19 in Africa

africa map Key Impacts of COVID-19 in Africa

As soon as Africa recorded its first case of coronavirus in mid-February, multiple projections on the disease’s impact on the continent were made.  Though it is still difficult to ascertain how COVID-19 is evolving on the continent due to very limited testing and research at national levels, four months after the coronavirus outbreak, here are some of the most important effects of the pandemic on Africa in health, socio-economic and politics.

 

1. Impact of Covid-19 on Health

Impact of Covid-19 on Health

According to Africa CDC data, all 55 countries in Africa are now affected by COVID-19. The numbers on June 12, 2020 (9 am East Africa Time) show 216,446 reported cases, 5,756 deaths and 97,068 people recovered. Specifically, these data showed that:

  • Southern Africa appears to be the most affected region (for total cases) with 61,772 Cases 1,239 Deaths 33,156 Recoveries. But northern Africa is very close behind in terms of total number of cases (61,615) and recorded more deaths (2,454) than any other region. It is to be noted however, that the Northern African countries were the first to begin testing and have, on average, tested in larger numbers than the rest of the continent except South Africa.
  • South Africa, which is the country that has tested the largest number of people (1,028,399 tests), is the country with the highest number of Covid-19 positive cases with 58,568 cases, while Egypt has the highest death rate with 1,377 fatalities.
  • The 10 most affected countries (South Africa, Egypt, Nigeria, Algeria, Ghana, Cameroon, Morocco, Sudan, Senegal and DRC) account for 166,864 positive cases out of the 216,446 cases reported, i.e. more than 77% of the continental record. Once again, these are, for the most part, the countries with the highest testing numbers.
  • Health facilities are overcrowded with growing number of COVID-19 leading to patients with high burden diseases like AIDS, tuberculosis and malaria lacking access and/or adequate care. In most countries COVID-19 is predictably having a negative impact on access to healthcare in general.
  • Increase of Sexual and gender-based violence: Across Africa, governments, police and activists report an increase in attacks against women and girls who are locked up with an abusive partner or parent. In the first week of confinement, the South African police received 2,320 complaints of domestic violence, an increase of 37 per cent. As a result, on May 6, 2020, 6 African countries joined 53 others to sign the Joint Declaration on Protecting Sexual and Reproductive Health and Rights and Promoting Gender Equality during the Covid-19 Crisis.

On the basis of official figures to date, Africa appears to be the least affected continent by the COVID-19 pandemic.  It is clear that the impact of the virus appears for the moment much less catastrophic than anticipated by everyone.  However, the truth is that these numbers are only telling part of the story.

Given the newness of COVID-19, research is also at very initial stages. Several factors are being examined that may explain the seemingly reduced impact in Africa.

reduced impact of Corona virus in Africa

  • Demography – In other parts of the world, COVID-19 has had devastating effects on the elderly. In a continent where 60% of the population is less than 25 years old, youth may be providing resilience to the disease.
  • Heat – Though the research is far from conclusive, some studies appear to show that the virus is less potent and multiplies less quickly in hot, humid environments.
  • The Malaria Advantage – Malaria medication including the now famous hydroxychloroquine may provide some protection from coronavirus. Given the prevalence of malaria in Africa and the large percentage of the population that have taken malaria treatment, this may be providing some resistance to COVID-19. Many of the remedies both clinical and herbal developed and used against COVID-19 in countries such as Benin, Madagascar and Cameroon use anti-malaria components as a base.
  • Less Travel – Africans travel less, and the continent only receives about 5% of the world’s tourists. Given the coronavirus was largely spread by travellers, Africa may have simply not “received” the virus in as large quantities as the rest of the world.

While it is clear that COVID-19 is present and that numbers of infected are climbing, it is also clear that the disease is not behaving in Africa as it did in other parts of the world.  Unfortunately for now, the level of testing and the research do not permit conclusions beyond these initial observations. We are still far from getting a true picture of the African COVID-19 story.

 

Evolution of numbers in Africa as of June 16th

COVID-19 reported cases  by Region in Africa

2.Economic effects of Covid – 19 crisis

Economic effects of Covid – 19 crisis

The African Union commission Forecasts show a negative growth from 3.4% to between -0.8% to -1.1% due COVID-19 outbreak. (1)

There have also been significant disruptions in some of the continent’s economic dynamics:

  • Decrease in export revenues due to weak global demand for raw materials. This concerns both oil exporting countries such as Angola or Nigeria and mineral exporting countries such Democratic Republic of Congo, South Africa, Tanzania just to name a few. The United Nations Economic Commission for Africa (UNECA) estimates COVID-19 could lead to Africa’s export revenues from fuels falling at around US$ 101 billion in 2020. (2)
  • Decreased in diaspora transfer. The World Bank estimates that as a result of the Covid-19 pandemic, remittance flows to Sub-Saharan Africa are expected to decline by 23.1 percent to reach $37 billion in 2020 in comparison to $48 billion in 2019. ​
  • Increase of the unemployment rate due to the cessation/ reduction of activities. The African Union notes that the pandemic could cause the loss of nearly 20 million jobs on the continent.
  • Tourism, which accounts for a consistent percentage of some African countries Gross Domestic Product (GDP) like Morocco (12.3 million tourists), Egypt (11.35 million tourists), South Africa (10.47 million tourists), Tunisia (8.3 million tourists), Zimbabwe (2.57 million tourists) are witnessing a deep contraction, as is the airline industry that contributes to it. A recent study from the African Union estimates that the tourism and travel sector in Africa could lose at least $50 billion due to the pandemic outbreak and at least 2 million direct and indirect jobs (3) .  The International Air Transport Association (IATA) on its own estimates the economic contribution of the air transport industry in Africa at USD 55.8 billion, supporting 6.2 million jobs and contributing 2.6% of the continent’s GDP.
  • Graph Top five of most visited african countries
  • Food insecurity due to trade disruptions, lower agricultural production, food shortages, rising food prices, fewer imports and transport difficulties. The United Nations estimates that nearly 30 million more people could fall into poverty and the number of acutely food-insecure people could significantly increase. In addition to climate change, growing violence, agricultural disruptions, locust plague in East Africa, there is therefore an urgent need to provide adequate responses to food insecurity so that post-coronavirus Africa does not sink into starvation.

While the health impact of COVID-19 in Africa is uncertain, the economic impact is not.  The African economy is suffering greatly and will continue to suffer throughout 2020 and more than likely 2021. As many as 49 million people may be pushed into extreme poverty because of COVID-19, 27 million of them live in Africa.

 

  1. Political impact of the Covid – 19 crisis

While the political impact of COVID-19 is at various levels, we will take a close look here at the impact on elections.

  • The 2020 Electoral Calendar

              Elections and political impact of covid19 in Africa

Elections in Africa are still for the most part precarious operations which in many cases have direct impact on the levels of violence, security and stability in the country. COVID-19 puts countries which have elections scheduled in a dilemma. To hold or not to hold? Both options entail significant risks.

Table from the Africa Center for Strategic Studies 

Covid19 and elections in Africa

  • To hold or not to hold elections in this context?

Over 30 elections (presidential, legislative, municipal and regional elections) were scheduled this year in Africa.

  • 10 of the 12 presidential polls are scheduled as of June 2020
  • Over 10 elections (legislative and other local elections) are also scheduled in the same period.

Countries are caught between holding elections on schedule and risking the lives of millions. Some countries such as Burundi (general elections of 20 May 2020) and Malawi (presidential elections scheduled for 2 July 2020, have decided to go on with elections as scheduled.  A few weeks after intensive campaigns former President Nkurunziza of Burundi is dead and his wife is undergoing treatment for COVID-19 in Nairobi.  Other countries have decided to postpone as Ethiopia has done with its legislative elections. Neither solution is ideal.

Elections held in the context of the Covid-19 pandemic will:

  • By default, extend mandates of current elected officials which poses the challenge of legitimacy and could be problematic in many countries
  • More than likely limit the participation of citizens in a key moment for exercising political rights.
  • Provide cover for actions of fraud and corruption in the countries where this is already a problem.
  • Put the country in a budget dilemma where it must choose between providing resources to fight COVID-19 and providing resources to organize elections.

With either solution, in countries where political stability is precarious, there is a risk of increased instability, insecurity and violence.

4 – The urgency of an effective, systemic, comprehensive and sustainable response

An analysis of the direct effects and repercussions of COVID-19 in Africa shows that while there is still much uncertainty in many areas, it is unquestionable that effective management of the crisis requires a real paradigm shift in governance in many African states. Proactivity, anticipation and evidence-based planning should be central to the vision and actions of every leader and every government.

Furthermore, it is imperative for our states to really put the human beings that are their citizens at the heart of decisions and policymaking. The African Union, development partners, international organizations and RECs that design and implement programmes with countries need to be supporting and insisting on systemic solutions that now more than ever, address the practical needs of citizens as the utmost priority.

For the last 25 years, STRATEGIES has worked with local, regional and international organizations in the areas of governance, management systems, planning, capacity building and more. Through its work, STRATEGIES! supports government agencies, organizations, international and regional institutions in developing effective and innovative strategies to address the complex challenges of improving local, national and regional governance structures in various areas in Africa.

Today more than ever, STRATEGIES! believes that there is a need to accompany political, economic and social actors on the African continent in developing appropriate responses to mitigate the effects of the current crisis and put in place robust systems to enable African communities to bounce back stronger than ever by building resilience to crises as a whole.

In the current context imposed by the COVID-19 and characterized by the closing of the borders and reduced mobility of people, STRATEGIES! and its team of consultants have adapted quickly, developing tools and processes that allow us to continue to support clients and partners from a distance.

In this COVID-19 period, the health of individuals, companies, organizations and governments is at stake.  We must preserve all. At STRATEGIES! we continue to develop solutions to enable organizations maintain their performance and achieve their goals.

 

By STRATEGIES ! Team : Franck ESSI, Vanessa TCHINDJE & Joel S. SOSSO Njanga (Consultants)

Working amidst Covid-19 at STRATEGIES!

STRATEGIES! in the world. We are globetrotters. We earn our living by travelling around the world and gathering people together to plan, think, learn, solve problems, create, share and so on.

With the spread of Covid-19 across five continents, everything happened so quickly: closing of borders, sharp slowdown of economic and social activities, closure of schools, universities and training centers, imposition of measures for “social distancing”.

What an incredible crisis for us!

 

A few key words describe how STRATEGIES! consultants are working amidst and despite the Covid-19 crisis, three months in.

 

STUNNED: An unprecedented impact on mass transport and travel

In our wildest imaginations, we could not have imagined that a disease would cause all commercial flights worldwide to be suspended overnight, causing the temporary closure of airports, train stations and subways, as well as thousands of hotels and hospitality facilities around the world.

As consultants, this meant we could not travel, we could not work.

Or could we?

An unprecedented impact on mass transport and travel

PROACTIVITY: A need to adapt, adjust and plan as never before

Faced with this sudden global paralysis, we had to understand, adjust and plan both for ourselves and for our clients. It was time to truly test the proactivity which is one of the fundamental principles of our brand.

Understanding the disease

We had been following COVID-19 and wondering about its impact on our clients.  In early March when the first case in Cameroon was confirmed, reality hit home. We did what consultants naturally do. Gather information (there was so much of it, yet so much was uncertain), analyze and make decisions.  After a series of initial analysis and meetings with our team, we made quick decisions.

  1. We had to keep everyone safe and healthy. This meant shutting down the office and working from home.
  2. We were extremely lucky to have work that could tide us over the next six months, on condition that we adapted quickly and found solutions for our clients.
  3. We had to determine the equipment, methods and tools that would enable us to make this adjustment within about 10 days in order not to lose contracts and enter a company financial crisis.

The shift to teleworking

We had always prided ourselves on remote work, 98% of our business is done outside Cameroon. However, having everyone shift to remote work and delivering from start to finish at a distance was a whole different level.  We realized some people needed equipment; everyone needed stable, strong internet connections from home, a whole new type of methodology needed to be developed.

The frequency and timing of meetings in the first week was absurd. Meeting after meeting, brainstorming after brainstorming, almost everyone at STRATEGIES! was online from 8:00 a.m. to 11:00 p.m. We were thoroughly exhausted and luckily figured out in the following weeks how to pace and space online meetings so we could get offline work done and so we could rest.

METHODOLOGY: Figuring out how to do full workshops online

The crisis hit 15 days into a 58-day consultancy and two weeks before we had the first workshop to deliver. The consultancy included three in-person workshops. The client was at project closure. STRATEGIES! was determined to meet initial contractual deadlines despite the crisis.

Using a combination of WhatsApp, Skype and Google Suite tools, we figured out how to work as a 6-person team to deliver three virtual workshops with participants from 15 countries.

Zoom was our very best friend as we wrote the first draft of a Youth Agribusiness Strategy for Africa with five consultants in five locations.

Today STRATEGIES! has a clear methodology not just for 1-2 hour webinars, but for 2-3 day workshops online to do problem analysis, work through solutions and develop strategic plans. STRATEGIES! can do research, analysis and report-writing using a team of consultants working 100% virtually. We can deliver what we did in-person, online.

Developing this methodology has enabled many of our clients to stay on course and deliver their own work on schedule. In a world economy that is faltering, keeping our clients, our suppliers and ourselves working is an achievement we are extremely proud of.

 

HOME: The pleasures and inconveniences of working from home

Working from home of course has at least as many advantages as inconveniences.

The pleasures:

  • All of us are appreciating more time with family and especially with children. Both enjoying the moments and discovering various anomalies that time at the office made us blind to.
  • Recipes, menus and cooking – almost all of us are enjoying food more.
  • Reduced travel time. For those who live far away from the office, the reduction in travel time means a significant reduction in stress.
  • Exercise – with a few exceptions, most of us have been able to maintain our exercise (STRATEGIES! provides exercise sessions for staff at the office). Some have renewed with the pleasure of long walks.

The demands: Needless to say, working from home means more distractions and interruptions. We have gotten used to the noise of children, construction work and traffic in the background of online calls.

Strategies working from Home

Here are a few practical elements that have enabled us to maintain our productivity at home:

  • Choosing a corner of the house that is conducive to work.
  • Being strict about the hours dedicated to work.
  • Maintaining continuous contact with laptop and phone during working hours to stay permanently connected with the team.
  • Remaining focused even when distractions are present.

Three months into living with COVID-19, STRATEGIES! has negotiated what we hope will be the sharpest turn. However, we remain alert and continue to track the disease and adjust our working methods.  Unfortunately, it seems COVID-19 is here to stay and that we in Africa may have the longest curve.  Unfortunately, STRATEGIES! is based in a country that is not doing a very good job of managing COVID-19.

Within STRATEGIES! we are still stunned, struggling to be proactive and working to adapt methodology.  However, it is also clear that we as a continent and as a globe, shall surmount this disease. At STRATEGIES! we intend to stay at the forefront of those in Africa and in the world who are doing so.

By STRATEGIES!  Team | Led By Joel S. Sosso Njanga, Consultant

STRATEGIES! Supports STAND UP FOR CAMEROON in the development of a municipal plan to fight COVID-19

Communal Approach Cameroon to Fight Against COVID 19

As part of the fight against COVID-19, STRATEGIES! supported the STAND UP FOR CAMEROON movement in the design and development of a municipal plan to fight against the virus. This plan is a tool which gives municipalities the ability to build a complete response to COVID-19. The tool includes a global approach and a strategy with the four key aspects:

  • Coordination
  • Prevention
  • Care
  • Security

The final part of the municipal plan includes key steps which will enable a city council to begin implementation of its fight against COVID-19 within 10 days.

STRATEGIES! made its expertise in decentralization available to STAND UP FOR CAMEROON in the framework of a working group including researchers, doctors, economists and managers to develop this municipal plan which is made available to the public free of charge.  Click here to download the plan

STRATEGIES! has over 22 years of experience in municipal planning, participatory management at local level, local economic development, internal and external communication of a municipality, etc.

In the face of this global crisis, STRATEGIES! stands ready to support municipalities, local governments and their partners in the search and implementation of effective solutions to fight COVID-19 at the local level.