African countries

How African Countries Coordinated the Response to COVID-19: Lessons for Public Health

The COVID-19 pandemic has spread a lot slower on the African continent than in the rest of the worldcontrary to forecasts.

As of July 20, 2022, a total of 562,672,324 confirmed cases of COVID-19 and 6,367,793 deaths had been registered all over the world. Only 1.63% (9,176,657) of global cases and 2.73% (173,888) of recorded global deaths were from the African continent – ​​which has approximately 17% of the world’s population.

Multiple reasons for the slower spread have been advanced. One was that the continent’s population is relatively young and the youngest were at lower risk serious illness in the event of infection with SARS-CoV-2. The possible contribution of pre-existing immunity against other viral infections was also highlighted. And it has been suggested that the slower spread might not be the real picture: there might be an underestimation of the true scale of the pandemic, resulting from weak surveillance systems.

However, there is another aspect to consider. It is possible that what countries have done to slow the spread of SARS-CoV-2 infections has indeed worked to some degree. Various sectors and disciplines collaborated towards the common goal of mitigating the effects of the pandemic.

In our recent study we traced policies retrospectively and linked them to disease patterns. We sought to understand how the 47 countries forming the African Region of the World Health Organization (WHO) coordinated the response to COVID-19 – and what we could learn from their strategies. By coordination, we mean management aimed at ensuring unity of effort.

Our analysis showed that decentralization strategies and innovation played a key role in coordination. Funding was a challenge for coordination.

Three levels of coordination

The 47 countries of the WHO African Region have established three distinct multi-level coordination mechanisms: strategic, operational and tactical.

Most countries (41) have implemented strategic coordination. This means that the highest government authority or a designated authority oversaw the entire response. An example is the strong leadership of the President of Seychelles, who is also Minister of Health. Another is the National Council for Disaster Risk Management led by the Office of the Deputy Prime Minister in Ethiopia.

The second layer was operational coordination. This is the supply of day-to-day technical and operational support to the in-country response team. It has been implemented by 28 countries and led by experts from public health emergency operations centres. An example is public health emergency operations which provided operational level leadership in Ivory Coast under the General Directorate of Health.

The third level was tactical coordination. It is decentralized coordination at the local level (such as districts, states or counties) and has been implemented by 14 countries. For example, existing district surveillance teams were immediately called into action to respond to the virus in their jurisdictions by Uganda.

Coordination mechanisms and preparedness levels may not have been strong enough during the first wave of infections. Each country was trying to do a lot in a short time. Many countries were testing to see what worked and what didn’t.

Nevertheless, the three coordination mechanisms combined may have played a key role in slowing the spread of the initial wave of the pandemic and the duration of subsequent waves. The results of our study showed that the duration of the second wave was shortened by an average of 69.73 days among the countries that combined the three coordination mechanisms in tandem compared to those that only combined the strategic and the tactical.

Governments applied what they learned on the job. For instance, Senegal used treatment regimens that looked promising and collaborated with private partners to use a diagnostic test for COVID-19 that could be performed at home.

Figure 1: Layered coordination mechanisms in Africa (source, Ngoy. et al.)


Our analysis highlights several lessons about preparing for and responding to health emergencies.

Engage different actors. Countries must hold actors such as government officials, technocrats, expert advisors, development partners, UN agencies and private companies accountable. Governments must also invest in the technical expertise that can coordinate the multiple elements of a pandemic. These elements include logistics, fundraising, management, collection and analysis of health care data.

Organize emergency funding. Setting aside an emergency funding pot will reduce dependency on development partners. Overreliance on partners has slowed response coordination in most countries. A transparent institutional framework responsible for funds is also helpful.

Invest in decentralized emergency response. Countries that have decentralized their emergency response to subnational (or district or grassroots) levels have been able to slow community transmission.

For example, using Provincial Incident Management Teams in South Africa or existing district surveillance teams and district task forces in uganda left central government to focus on strategy development and resource mobilization.

Botswana built on existing community health platforms which had been strengthened over the years through PEPFAR investments to address the HIV epidemic. This helped with contact tracing and helped health workers manage COVID-19 cases as there were few cases in hospitals.

For all of these decentralized strategies to work, countries must have strong political commitment to provide the necessary resources and sanitation facilities. They also need a well-coordinated flow of information from the center to the periphery. Information is key to building accountability for response actions and countering misinformation. Additionally, it allows communities to be part of the solution.

Keep building on projects and innovations. Building on the existing structures used during past emergencies, such as the Ebola outbreak in Sierra Leonefacilitated response activation.

Read more: Ebola in the DRC: an expert shares key lessons learned in Liberia

Countries should also develop and use new and appropriate technologies. For example, Rwanda used drones to share public information. In Ghana, robots were used for screening and hospital care. Liberia used a communication platform called mHero to connect the Ministry of Health and health workers. Niger used an app called Alerte COVID-19. Today’s health technology innovations suitable for pandemic response can be adapted for wider use in the future.

Organized and well-directed coordination mechanisms provide a structured pandemic management plan or outline of targeted actions. Having a collaborative approach involving different stakeholders is essential for future emergencies.