Africa faces the world’s most dramatic public health burden in any given year, given its constant fight against recurring and infectious diseases.
The emergence of the COVID-19 pandemic and the stress it has caused to some of the world’s most advanced health systems, therefore, was soberly noted by Africa’s public health community.
With high levels of poverty, urban density, widespread infectious diseases, limited access to healthcare, and overcrowded informal settlements, Africa faces a preponderance of risk factors that threaten to exacerbate the pandemic on the continent.
Using The African Union to Purchase Medical Kits
Outbid by richer countries, and not receiving medical gear from top aid donor the United States, African officials scramble for solutions as virus cases climb past 30,000.
Even in the best scenario, the United Nations says 74 million test kits and 30,000 ventilators will be needed by the continent’s 1.3 billion people this year. Very few are in hand.
The crisis has jolted African nations into creating a pooled purchasing platform under the African Union to improve negotiating power.
Within days of its formation, the AU landed more than 100,000 test kits from a German source. The World Health Organization is pitching in, approaching manufacturers for supplies.
The Africa Centers for Disease Control has a target of conducting 1 million more tests in Africa over the next four weeks and 10 million tests in the next four months. The overall effort is badly hampered by a major obstacle: The existing fragility of the health services in many African countries.
Not All Groom
It’s not exclusively bad news for Africa. South Africa has the highest number of reported cases with around 3,300 but Africa’s most developed economy is being praised for an aggressive testing program. South Africa, aided by existing infrastructure, has carried out more than 140,000 tests, according to its health minister.
But South Africa’s early and tentative signs of success — helped, maybe, by a strict lockdown — are being set off by “concerning increases” in virus cases in some countries in West Africa and East Africa, Moeti said.
Nigeria, Africa’s most populous country with 200 million people and a high population density, is a stark example of the testing and health system shortcomings prevalent across the continent.
The country has reported 873 cases of COVID-19 and 28 deaths but had conducted just 7,153 tests (at the time of writing this), according to the Nigeria Center for Disease Control.
Mauritania Beats Coronavirus
Authorities in Mauritania say the country does not have an active case of coronavirus as of today after all six patients tested negative out of the seven confirmed cases. The other patient succumbed to the disease.
Mauritania is one of the few African countries that have so far recorded single-digit infection along with the likes of Burundi, Sao Tome and Principe, South Sudan with five, four, and four cases respectively as of April 25.
Mauritania said it continued to carry out tests since March 13 when the index case was recorded. The country is currently enforcing a nigh-time curfew as part of containment efforts.
Tanzania’s Business as Usual
In Tanzania, a lawmaker has tested positive for the virus leading to calls for a suspension of parliamentary sitting. The unnamed MP is believed to have contracted the virus during a trip to the commercial capital Dar es Salaam.
The speaker of parliament has backed the president’s position that life must go on despite the need to exercise precautions amid the pandemic. Even though schools have been closed, there is no lockdown or curfew as is the case in most countries in the region.
President Magufuli has also rejected border closures stressing that most neighboring countries depended on the Tanzania corridor for much-needed supplies. Tanzania’s case count stands at 260 with 11 recoveries and 10 deaths as of April 25.
Neighboring Rwanda is in full lockdown as is Uganda while Kenya is using dawn to dusk curfew to control spread. All academic activities have been suspended.
Madagascar’s Herbal Remedy
Madagascar has announced the launch of a traditional remedy for the COVID-19 disease. President Andry Rajoelina said the medication called CVO or Covid-Organics was an improved traditional remedy composed of Artemisia & Malagasy medicinal plants.
He said it was produced following scientific studies by IMRA (Malagasy Institute for Applied Research). The currently has 121 cases of COVID-19 with 39 recoveries and no death.
In Ugandan, Speaker of Parliament, Rebecca Kadaga has unveiled what she calls her ‘coronavirus treatment’ which local media outlets report that she now calls a spray. The Observer newspaper reported that Kadaga blamed Ugandans for overreacting.
She is quoted as saying: “I didn’t call it a vaccine but a spray, which kills the virus.” The speaker came under fire a month ago for suggesting that some U.S. scientists who had visited her were close to a COVID-19 vaccine in collaboration with some Ugandans.
The East African country currently has 60 confirmed cases of the disease with eight recoveries and no death as of April 25.
Djibouti tops in the Horn of Africa region with 380 cases toppling Mauritius now second with 374.
Malawi on Lockdown
Malawians are the latest on the continent to have a feel of a national lockdown after Health Minister Jappie Mhango declared a 21-day lockdown as part of efforts to curb the spread of coronavirus.
The lockdown comes into effect at midnight on 18 April and runs till midnight on 9 May. The southern African country as of April 25 had recorded 39 coronavirus cases including two deaths with no recovery.
In an address to the nation, President Peter Arthur Mutharika stressed that the lockdown could be extended if need be. He said the borders will have beefed up security during the period and security will be high across the country.
“Fighting coronavirus is a challenging war for everyone, everywhere. It is also a very expensive war. As a nation, we require about MK150 billion for the implementation of the National COVID-19 Preparedness and Response Plan. We need to unite.
Meanwhile, the island nation of Seychelles is in a 21-day lockdown. The move which forms part of COVID-19 containment has shut down non-essential services and restricts the movement. The country has 11 confirmed cases with no death with two recoveries so far.
President Danny Faure who made the announcement said the airport will remain closed until the end of April while new maritime surveillance will be applied in the island nation. The first Seychellois patient who tested positive for Covid-19 on 14 March, and a Dutch woman who tested positive the following day, have both recovered from the disease, the president said.
In Somalia, the health ministry yesterday (April 7) that the country is now able to test for coronavirus in the capital, Mogadishu. Previously samples were taken to the Kenyan capital, Nairobi, for testing.
The ministry’s National Public Health Research Laboratory (NPHRL) has now been equipped to carry out the tests. Somalia has eight cases, one of the lowest in the Horn of Africa region. The government also announced that the academic calendar has been suspended for the year due to the virus.
In next-door Ethiopia, PM Abiy declared a state of emergency after a cabinet meeting today. The declaration is to be tabled before lawmakers for ratification.
Already, the northern Tigray Region had declared a state of emergency at a time they had recorded no cases. The region is also the first to get testing capacity outside of the national facilities in Addis Ababa.
Ghana is West Africa’s third most impacted country by the development. The country is ranked behind Burkina Faso and Ivory Coast with 364 and 323 cases respectively.
Sao Tome and Principe became the 52nd African country to record cases of the COVID-19. The island nation confirmed its first four cases on Monday, April 6.
Prime Minister Jorge Bom Jesus disclosed that the confirmation came after test results returned from Gabon. The development leaves Lesotho and Comoros as Africa’s virus-free countries as of April 16.
South Sudan, with 11 million people, currently has four ventilators and wants to increase that number, said Machar, who emphasized that people should stay three to six feet apart from others. “The only vaccine is social distancing,” said Machar.
To prevent the spread of the virus in South Sudan, President Salva Kiir imposed a curfew from 8:00 p.m. to 6:00 a.m. for six weeks and closed borders, airports, schools, churches, and mosques.
Given these challenges, many African countries followed the global trend of imposing shutdowns of businesses and human movements. Yet, with 70 percent of some African populations relying on subsistence livelihoods, it was understood that this would only be a temporary solution.
Africa’s response to the pandemic would need to be customized to its own realities, challenges, resources, and strengths. This has spurred a number of innovations and adaptations to the coronavirus response in Africa—initiatives that continue to unfold.
Presidential Task Forces
Many African countries have created presidential COVID-19 task forces of public health and sectoral experts as an institutional innovation to guide the pandemic response. The central role of professionals in these task forces has elevated the emphasis on science and evidence-based planning.
Presidential task forces, staggered mobility, support for the most vulnerable, and local innovations mark Africa’s adaptive response to the novel coronavirus pandemic.
In Uganda, a Presidential Scientific and Strategic Advisory Committee assembled economists, anthropologists, epidemiologists, public health experts, virologists, and lawyers to design and deliver an effective approach addressing various facets of the crisis.
The prominence of the members of these presidential task forces has facilitated the absorption of lessons and experiences from other parts of the world. African countries now have a better understanding of the nature of the pandemic, its challenges, and myths.
COVID-19 response strategies have also benefited widely from the professional and scientific advice of highly credentialed African experts from well-recognized bodies like the African Epidemiology Association and the Royal College of Pathologists.
The result has been an aggressive effort to mount tailored and scientifically and culturally sound public health actions, with an aim on preventive interventions, rather than relying on a therapeutic approach that would overwhelm the limited treatment options at Africa’s hospitals.
Lessons from Ebola
The presidential task forces are also drawing on Africa’s extensive experience in pandemic outbreaks. Nigeria is a good example.
Using lessons from the 2014 West Africa Ebola outbreak, Nigeria quickly set up isolation clinics separate from the regular health system to treat coronavirus patients. The idea is to avoid inundating the established health system so that it can continue serving other pressing needs such as malaria, tuberculosis, and HIV/AIDS within the population. This model is in place in around 20 countries.
The prevalence of COVID-19 task forces has facilitated information exchanges between African countries to share lessons and best practices. Some of this coordination is occurring through Regional Economic Communities, which has accelerated the sharing of lessons.
For example, the COVID-19 task forces in Southern Africa exchange information through a Regional Technical Committee established by the Southern African Development Community (SADC), consisting of the directors of public health and medical services of member states.
Given Africa’s high levels of poverty, lockdowns without social protection plans could lead to severe consequences, including starvation and the depletion of coping mechanisms, particularly among the most vulnerable.
Clashes between citizens defying movement restrictions and security forces have led to deaths and injuries in Nigeria, Rwanda, South Africa, and Uganda. Some countries have shifted to a curfew-based strategy with strict movement controls, recognizing that the informal sector provides jobs for the vast majority of citizens who need to work to feed their families.
African countries have adjusted differently to these realities. Ghana decided against a full lockdown, opting instead for a partial one backed by vigorous contact tracing and monitoring, strengthened behavior change messaging, and the provision of sanitary facilities and free water to vulnerable communities.
In Uganda, market vendors adopted self-monitoring measures to ensure compliance with emergency health regulations or face closure.
Botswana’s COVID-19 economic response plan requires the government to procure food from local communities, redirect excess supplies of vegetables back to the rural economy, and establish milk collection centers in communal areas. These measures are designed to boost household livelihoods during the emergency.
Senegal’s COVID-19 Presidential Task Force established numerous mobile response teams equipped to respond immediately and take samples when illnesses have been reported.
A common coping strategy in times of stress is for urban-based families to return to their rural homes for economic and livelihood sustenance. Facilitating this population movement can reduce the risk of rapid transmission in high-density urban areas while addressing food security challenges. Such movements, however, raise the risk of accelerating the spread of the virus to rural areas, which may not have much exposure.
Accordingly, a number of countries, including Botswana, Ghana, Nigeria, and South Africa, have established mobile testing capabilities along major transportation routes to try and identify individuals who are carrying the virus and provide them treatment.
Burundi, Kenya, Rwanda, South Sudan, and Tanzania have each set up mobile laboratories and testing units to ramp up mobile testing along cross-border transportation corridors, an idea adopted from the 16-member SADC.
Targeting Vulnerable Populations
Innovations have also been implemented to support those households most vulnerable to restrictions on mobility and the economic hardships this creates. Helping them meet basic livelihood needs such as access to food can reduce the threat of spread in Africa’s many sprawling urban informal settlements where COVID-19 could spread like wildfire due to massive congestion, poor hygiene, and pre-existing health conditions.
The U.S.-based Ethiopia Diaspora Trust Fund provided a $1 million start-up fund to assist COVID-19 mitigation efforts in Ethiopia, including food assistance and direct cash transfers to vulnerable families.
In Kenya’s informal settlements of Kawangware, Mathare, and Majjengo, indigenous organizations such as Mutual Aid Kenya, Sarafu Credit, the Kenya Red Cross Society, and Zakat Kenya are reinforcing the government’s response strategy by identifying at-risk families and providing targeted assistance through direct cash transfers, food parcels, and alternative supply chains to provide essential commodities. Sarafu Credit is using a block-chain–backed system of community currencies (credit vouchers) that communities in informal settlements can use to purchase food and other essentials.
In Kibera, the largest of these settlements, a community-run organization called Shofco has established hand-washing stations, community toilets, and clean-water kiosks in all access points, staffed by volunteers and a network of health workers.
Well over half of the population of the settlement—139,000 people—have subscribed to a WhatsApp platform that provides information about the virus, the patterns of infection in Kibera, and what they should do to protect themselves and the community.
Three thousand of the area’s most vulnerable families are receiving a direct cash transfer of $24 per month for 3 months to meet their basic needs, with financing coming from the local private sector and the Kenya Diaspora in North America.
These efforts are modeled on a Kenya government pilot initiative implemented during the 2009-2010 drought that provided $20 per month to 40,000 families in informal settlements for 9 months to meet their basic food needs.
In Botswana, a wage subsidy totaling 1 billion pula ($84 million) has been provided to small businesses as an incentive to retain their employees during the shutdown. In addition, the government will contribute 50 percent of the basic salary of every furloughed citizen or permanent resident for 3 months, along with a subsidy of 1,000-2,000 pula ($80-$168) per month to meet basic needs.
As COVID-19 continues to spread around the world, so too have rumors, misinformation, and fake news about the pandemic. Videos, voice messages, texts, and stories have swirled around conflicting information, from unproven cures to bizarre claims that Africans are somehow immune from COVID-19, despite an abundance of contrary evidence.
Africans are reacting to the challenge in different ways. In South Africa, a private firm, Praekelt.org, created a WhatsApp-based helpline that provides real-time data and automated responses in numerous languages to educate and sensitize. The app registered 3.5 million subscribers within the first 10 days of launching. Praekelt.org has now partnered with the World Health Organization to create a similar service to reach a global audience.
In South Africa, a Solidarity Response Fund was established as a public-private partnership to channel resources toward preventing transmission of the virus, understanding the magnitude of the pandemic, caring for patients, and supporting vulnerable communities. Over $50 million was raised through voluntary contributions.
Uganda’s Red Cross is distributing food items to communities in informal settlements around Kampala through a national COVID-19 fund established by the Prime Minister’s office. The country’s oldest educational institution, Makerere University, has developed a prototype low-cost ventilator using designs from the Massachusetts Institute of Technology.
In Kenya, a local factory that used to make clothing quickly pivoted its production and is now turning out 30,000 surgical masks a day. In Kibera, a community-owned company is making hand sanitizer, masks, and protective clothing for the community, other informal settlements, and the Kenyan national stockpile.
Zimbabwe’s universities are manufacturing gloves, hand sanitizers, and masks despite a lockdown, spiraling inflation, and an economic meltdown.
Some Lessons Thus Far
Africa continues to face an uphill battle against COVID-19, given its limited resources, fragile health systems, existing disease burden, urban density, conflict, and record levels of population displacement.
Operating with presidential authority has accelerated decision-making for many governments while reducing interagency squabbles.
Another lesson is that previous epidemic outbreaks provide vital lessons, local knowledge, and expertise to guide the response to the coronavirus pandemic. These experiences emphasized the need for Africa to focus on preventative rather than therapeutic strategies in limiting the spread of the virus.
Also shown to be relevant is the value of empowering affected communities to design responses tailored to address the complexities of their unique local contexts. This is what has been happening in Kibera and other informal settlements.
A further lesson is that effective pandemic responses depend on high levels of trust between the government, health professionals and scientists, the public, and private sector. This takes many forms. Respect for human rights in the course of the response is key if popular support is to be maintained for what will need to be a sustained period of cooperation.
Experience shows that heavy-handed responses to enforce stay-at-home orders depletes public trust and triggers defiance. This defeats the purpose of these efforts to limit mobility in the first place.
Trust is also indispensable to elicit the behavior change on which Africa depends to confront this crisis.