The COVID-19 pandemic has tested African public health systems. It revealed weaknesses, gaps and inequalities – but also some potential solutions.
The challenges posed by the pandemic are an opportunity for African health systems to overcome their current limitations. Many have been driven to develop innovative approaches.
Countries have rapidly developed their diagnostic and genomics capacities and increased the use of electronic health records. Nations and sectors (public and private) have pooled their resources in response to the logistical challenges of rapidly implementing an adult immunization program. Scientific capacity across the continent, although limited, brought together in effective partnerships.
These experiences, lessons and solutions – if backed by long-term political leadership and financial investment – can be used to develop health systems fit for the 21st century and beyond. African political and public health leaders should identify and invest in what works.
As a public health professional who has worked for many years to strengthen health systems on the African continent, I would like to offer some thoughts on these emerging opportunities.
A useful framework for these reflections comes from the director of the Africa Centers for Disease Control and Prevention (CDC), Dr. John Nkengasong. He described four essentials for a new public health order for Africa. These are: stronger institutions; local manufacturing; public health personnel; and respectful partnerships. I would add a fifth: autonomous citizens.
Strengthened public health institutions
Sharing knowledge and skills has proven to be an effective way to utilize scarce resources across the continent during the pandemic. Africa CDC has taken the lead as the coordinating institution for the continent in promoting a “do it once and share” approach.
The strengths of African scientific and health institutions have been pooled to strengthen others. For example, the Institut Pasteur Dakar Senegal has provided training across the continent on PCR testing for COVID-19. It raised diagnostic capability from two countries (Senegal and South Africa) in January 2020 to 48 African Union Member States by the end of April 2020.
The Africa Center of Excellence for Genomics of Infectious Diseases, based in Nigeria, has worked with Africa CDC’s Africa Pathogen Genomics Initiative to expand the skills across the continent.
National public health institutes have strengthened their capacity to monitor and respond to situations. They built on the experience of past epidemics and adopted new technology for faster event-based electronic information management systems.
The scarcity of supplies during the COVID pandemic has led to the emergence of African solutions for procuring resources, from medical equipment to vaccines.
the Africa Vaccine Acquisition Task Team could be a game-changer by improving value for money through group purchasing and supporting a national manufacturing market.
Africa has the highest burden of HIV in the world and yet depends on other regions to produce diagnostic tests. Fair 1% of Africa’s vaccine needs are produced locally. The same goes for drugs to treat high-burden African diseases. The lack of diagnostic capacity persists and the history of vaccine inequality is well documented.
Read more: New pledges won’t fill global COVID-19 vaccine shortages. here’s why
African leaders have recognized the importance of a healthcare manufacturing ecosystem. There is a renewed commitment to develop a system to deliver 60% of the continent’s vaccine needs by 2040. This ambition has stimulated support for the African Medicines Agencybody responsible for regulating the manufacture of pharmaceutical products.
A pharmaceutical manufacturing ecosystem on the continent will drive research and development focusing on Africa’s health needs.
A stronger health workforce
Africa has much less health professionals than he needs. The pandemic has shed light not only on the number and cadres of health personnel required, but also on the quality.
At the start of the pandemic, when the only control measures relied on community engagement – isolation, personal hygiene and contact tracing – community health workers were essential. They are now supporting the COVID-19 vaccination program. The possibility exists for them to be absorbed into health systems to support the wider health service.
Shared training has made it possible to develop standardized quality care for COVID-19 patients. This approach lends itself to the development of quality guidelines for other priority diseases across the continent.
The COVID-19 pandemic has prompted unprecedented collaboration between the public and private sectors. The growth of the private sector laboratory diagnosis capacity is noteworthy. The response to COVID-19 is the first time that private sector capacity has contributed so much to a public health response.
The development of the African Vaccine Acquisition Trust as a centralized procurement agent on behalf of the African Union Member States and the African Medical Supplies Platform are continental premieres. They show what is possible through strong, trusted partnerships.
Collaborations like these can be applied to other challenges in the march towards universal health coverage.
Advocacy and Empowered Citizens
The COVID-19 pandemic has engaged ordinary citizens in ways that can only be positive for the future of healthcare on the continent. The entire globe and continent have grappled with the same issues. The weakness and lack of resources of African health systems – and the dependence on aid for health services – have been laid bare.
Citizens are beginning to challenge their political leadership. The opportunity now exists for their claims to be harnessed in a broader debate about investing in health care. As election cycles progress, investing in the health system must be on the agenda. African Heads of State must be challenged to meet the commitments of the Abuja Declaration of April 2001 – to devote at least 15% of annual national budgets to improving the health sector.
The pandemic has demonstrated that improvements are possible even with limited resources. Leaders must build on this momentum to establish a new public health order for Africa.
This article is part of a media partnership between the Africa Centers for Disease Control and The Conversation Africa for the first Africa Public Health Conference.