How to ensure the Covid-19 response in Africa benefits future generations

COMMENT

Africa’s largest roll-out of vaccines and other health products is underway in response to Covid-19. This is a unique opportunity for governments and decision-makers to invest strategically to strengthen overstretched health systems. Practical, long-term and cost-effective actions are needed to alleviate pressure on frontline health workers and improve care delivery to patients in Africa. From conversations with more than 30 health specialists involved in the Covid-19 crisis response, we have prioritised six practical actions that can save lives today and build health systems for tomorrow.

Africa is against the clock to vaccinate its population. At least 60% of Africa’s population — more than 800-million people — are targeted for vaccination by the end of 2022. In tandem, countries and their partners are rolling out Covid-19 tests, therapies and other products to populations in Africa, and making health systems investments to ensure they reach the right individuals. A roll-out of this scale, speed and reach has never been seen before.

Fully vaccinating 60% of the populations would involve an estimated 1.65-billion patient visits (assuming a two dose schedule). This implies tremendous pressure on healthcare systems, with workforce shortages in Africa estimated at 4.2-million prior to the pandemic.

Meanwhile, the continent is facing other major health challenges and has, so far, been less affected by the pandemic than some regions. For example, malaria alone kills more than 400 000 people a year, mostly infants in sub-Saharan Africa. Disruptions to antimalarial treatment of 25% or 50% could cause an additional 46 000 or 100 000 deaths in the region, respectively.

Six ways to mobilise investments strategically

Since the pandemic, a broad spectrum of stakeholders has mobilised significant funding to accelerate roll-outs of health products. If well-designed, these investments offer unmatched potential to also reorganise and strengthen health systems and improve future resilience at national and global levels.

From our consultations with experts and leaders in Africa, we hear a clear demand for decision-makers to embed vaccine roll-outs as part of broader efforts to strengthen health systems, and ensure that any gains against Covid-19 do not reverse progress against other health priorities. We urge global organisations and decision-makers to start investing in health systems now alongside the Covid-19 response. Given the historic scale of the current response, relatively small additional investments could make a big difference.

Based on our research, we see six practical options that decision-makers can implement as they plan immunisation roll-out.

1. Formalise the role of community health workers

Community health workers are essential in the response to disease outbreaks and sustaining healthcare. But they frequently work on a transient or voluntary basis, receiving only sporadic training. Over the pandemic, the Africa Centres for Disease Control and Prevention has helped to deploy 17 154 Community health workers in 25 countries, supporting wider government measures to mobilise and incentivise new and existing workers with training, supervision and income. Liberia’s experience after the Ebola epidemic shows that formalising such measures beyond a health crisis can expand the reach of the health system and improve health outcomes.

2. Develop a health worker census

The health workforce is being deployed at an unprecedented scale. As authorities start to vaccinate a larger health workforce, they could consider collecting health worker data by qualification, skill set, and location. Governments could harness or scale up existing health worker information systems, such as those used in Uganda and Kenya’s North Eastern Province, to build the census. This could transform workforce planning and improve future emergency preparedness.  

3. Expand information systems for stock management and tracing

Africa relies on imports for at least 80% of its pharmaceuticals. Inefficiencies in national stock management systems can lead to delays in procuring and distributing those supplies, as well as increase the risk of counterfeits and wastage. It is crucial that investments made today to strengthen the management of Covid-19 vaccine procurement and distribution are scoped so that they benefit the distribution of other health products.

4. Support and scale home-based and digital health models

Reduced operations of in-person health facilities have accelerated a transition to  self-care and expanded digital care models, with Rwanda pioneering what would be the world’s first digital-first universal primary care service. Designing investments to scale up emerging home-based models, together with policies that promote equitable and high-quality digital services, can foster more accessible, participatory and affordable healthcare beyond Covid-19.

5. Integrate the delivery of additional health services

On average, 40% of health services have been disrupted in Africa between January and March this year. As countries vaccinate their populations against Covid-19, they could consider reinstating healthcare through carefully designed service integrations. Vaccinators could share simple health messages with people arriving for vaccination, for example to combat vaccine misinformation. Vaccinating centres could also provide basic health services such as malaria bed nets, simple screening for common health conditions such as heart disease, as well as family planning advice and counselling.

6. Invest in local-level public finance systems

Governments have invested heavily in their healthcare systems. But bureaucracy and fragmentation in financial systems can inhibit fund distribution to frontlines, especially in centralised models. As institutions finance procurement and delivery of Covid-19 vaccines, they should consider leveraging investments to build more dependable local-level finance systems, under government stewardship, to ensure that vital resources reach the frontline more quickly and reliably in the long-term.

 With billions of funding allocated to the Covid-19 response, this is a once-in-a-generation opportunity to accelerate and sustain the new normal of service provision, new public health order data collection and finance. We should invest now to strengthen health systems across Africa, help bounce back post-Covid — and prepare for future pandemics. In short, now is the time to turn urgency into legacy.

Dr Nicaise Ndembi, senior science adviser, Africa Centres for Disease Control and Prevention (Africa CDC, African Union), Dr Amir Hagos, senior adviser, Global Financing Facility for Women, Children and Adolescents (GFF, World Bank Group) and former minister of health of Ethiopia, Miles Kemplay executive director, Children’s Investment Fund Foundation (CIFF), Dana Hovig, programme director, William and Flora Hewlett Foundation, Erin Barringer and James Eustace, partners at Dalberg