Building resilient and sustainable health systems

Introduction Africa currently faces health and economic challenges that are testing its social, economic and political resilience. The population of those infected and affected by COVID-19 continues to strain our health systems, over and above our pre-existing challenges. The relatively slow emergence of COVID-19 in Africa afforded most countries with valuable time to develop mitigating measures informed by the experience of other regions. In collaboration with the World Health Organization and the Africa Centers for Disease Control, many national governments in Africa have deployed preventive measures. In an effort to contain the spread of the virus, these governments have implemented measures to detect and trace new cases, enforce social distancing and the use of masks, improve personal and environmental hygiene and restrict movement. These and other interventions have helped to mitigate the pressure on their already-strained healthcare systems. As containment and treatment continue, what lessons can we derive from the pandemic that will help to further improve the resilience of our health systems? Human resources are integral to health infrastructure A shortage of health workers presents major challenges at the best of times. Shifting medical staff to COVID-19 care aggravates human resource shortages in other health services, with potentially long-lasting consequences. To enhance health workforce capacity, some countries have allowed medical students in their last year of training to start working immediately and under supervision. They have also mobilised pharmacists, care assistants and community health workers and volunteers. The World Health Organisation’s 2019 Health Statistics report shows that 40% of WHO Member States have less than 10 medical doctors per 10,000 people. Africa suffers more than 22% of the global burden of disease but has access to only 3% of health workers, and the availability of hospital beds and their occupancy rates vary widely. Equipping health systems with reserve capacity will require creative approaches, such as the intensified recruitment of community health workers/volunteers who can be quickly mobilised, acquiring and storing a reserve capacity of supplies such as personal protection equipment and maintaining care beds that could be quickly transformed into acute care beds. Investing in our health workforce and facilities and ensuring their near proximity to patients will help to ensure good access to health care for all - now and in the future.

"Investing in our health workforce and facilities and ensuring their near proximity to patients will help to ensure good access to health care for all - now and in the future."

Use technology to enhance disease prevention and health infrastructure Africa has amassed a considerable amount of data about infectious diseases and other health conditions. It is also the continent with the youngest population globally. Technology has great and largely unexploited potential to improve Africa’s health infrastructure. Mobile penetration and connectivity rates continue to rise across the continent. The combination of data, a young population and mobile technology indicates the significant potential for Africa to develop its own predictive modelling that will guide decisions on health, including the containment of infectious diseases. Telecommunications data is a real-time tool for informed decision-making. Mobile data can be used to model and predict the health and economic impact of specific interventions in the formal and informal sectors, and at a household level. This information can guide decisions on future intervention and mitigation efforts, such as identifying which will have the greatest impact. Another challenge to disease prevention is the absence of digital health records. When medical information can be extracted and shared promptly, health systems can conduct real-time disease monitoring, clinical trials and health system management more efficiently. Other innovative digital solutions are also emerging. Kenya's main referral hospital, Kenyatta National Hospital, launched a telemedicine technology centre which will enable Kenya’s local doctors to collaborate with their counterparts from other parts of the world. Their use of big data, connectivity and artificial intelligence aids real-time interpretation of CT scan images, for example, to facilitate the early diagnosis and management of medical cases. The facility is also being used for training. Smartphone applications can allow those in quarantine to report their symptoms and progression as well as to monitor their quarantine compliance. Artificial intelligence initiatives to track the spread of the virus and predict where it may appear next are being developed. In Ghana for example, drones are being used to transport samples from testing sites to laboratories. Applying lessons from Africa’s history of infectious disease epidemics Leveraging their experience in fighting pandemics such as HIV/AIDS, malaria, tuberculosis and Ebola, among others, many African countries already operate multidisciplinary task forces to direct their emergency responses to COVID-19. As the COVID-19 epidemic runs its course, these teams must evolve and collaborate to strengthen national public health institutions. Africa needs to enhance epidemic preparedness before the next outbreak. Domestic financing and increased investments in the public health system and preparedness in one country will impact the capacity of the whole region to contain and manage the pandemic; no country can address the pandemic single-handedly and every country must do its part. Investments in research, medical infrastructure and manufacturing African governments must urgently increase their investments in scientific research and medical infrastructure and proactively seek partnerships in Africa and globally. Scientists at the Pasteur Institute of Dakar are already leading the way, working with a biotech laboratory in the United Kingdom to produce a cheap, rapid diagnostic test for COVID-19, manufactured in Senegal, that could reduce diagnosis time from 4 hours to 10 minutes. Kenya and other African countries have also started producing personal protective equipment and ventilators locally to manage demand, demonstrating the capacity of local industry to address global challenges. Domestic health financing and Public Private Partnerships The momentum and goodwill of African Heads of State and Governments has already enhanced health financing across the continent. During the 32nd Summit of the African Union held in February 2019, African leaders launched a landmark initiative aimed at increasing commitments for health, improving the impact of spending and ensuring the achievement of universal health coverage across Africa’s 55 countries. In the fight against COVID-19, some African Countries have called for the increased participation of the private sector. Kenya has established a COVID-19 Emergency Response Fund with private sector oversight. 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.

Once the pandemic subsides, these initiatives must be sustained and strengthened. There are many lessons to learn from the health and economic consequences of COVID-19. The pandemic could well become a catalyst for a paradigm shift in Africa’s quest to achieve universal health coverage and many of the Sustainable Development Goals.

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Joseph Kagiri

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