Local evidence crucial in Africa’s responses

Kenyatta National Hospital (KNH) health workers in full personal protective equipment (PPE) display packed swab samples during the KNH's mass staff testing for COVID-19. [Elvis Ogina, Standard]

The World Health Organisation (WHO) declared Covid-19 a pandemic on March 11, 2020. All the continents except Antarctica have so far reported thousands of coronavirus cases and/or deaths. Globally, more than a million cases have been reported with 24 per cent of deaths affecting a broad range of ages. Africa has been lucky to have a delayed onset of the spread of Covid-19.

The continent has had the benefit of time to learn from measures and contingencies that are working in other countries. However, there is need to take caution not to generalise and mirror policies being implemented in other places without consideration of Africa’s unique context i.e. demographic structure, population, disease burden health care systems and living conditions.

Globally, coronavirus has spread rapidly and countries are using various measures to curb the pandemic disease. These measures include complete and/or partial lockdowns, shifting to remote working, online schooling, promoting hand-washing, and social distancing.

Seemingly, many countries have adopted lockdown policies where majority of citizens are advised to stay home and prepare for what could be months of isolation and social distancing. However, some of the recommended measures are not practical in the African setting.

Coronavirus has so far spread to over 52 African countries within weeks, reaching 16,200 cases and 873 deaths. For the countries that have not reported any cases, there are concerns that the absence of cases is as a result of lack or weak testing capacity.

WHO is supporting African governments with early detection by providing Covid-19 testing kits, training health workers, and strengthening surveillance in communities. 47 out of 54 countries in the WHO African region can now test for Covid-19. For instance, Nigeria and Togo among other West African countries can test 1,500 patients each day. Early detection of cases is one of the measures of curbing the spread of coronavirus as it allows coronavirus-infected patients to be separated from non-infected people.

Experts are worried about Covid-19 rapidly spreading in Africa and numbers rising to those recorded in countries such as China and Italy. A major concern is the fragile health systems in most African countries that often suffer from minimal or no medical supplies and equipment, inadequate funding, shortage of adequately trained healthcare personnel, and inefficient data transmission and use.

Economic problems

These weak healthcare systems are currently overburdened by diseases such as malaria, HIV, tuberculosis, cholera, cancer, diabetes, and maternal and child health issues. Clearly, these systems currently have no capacity to deal with Covid-19. Experts therefore fear that the pandemic could be difficult to manage in Africa, and could cause huge numbers of deaths and grave economic problems if it spreads widely.

In the last three years, Africa has had significant experience having dealt with different epidemics like Ebola, polio and cholera. Hence, drawing lessons learnt on preparedness and response to previous epidemics is crucial in enabling African countries develop effective strategies to curb the spread of Covid-19.

For example, there is undocumented evidence that Taiwan and Singapore took quick drastic measures to curb Covid-19 due to their experience with Severe Acute Respiratory Syndrome (SARS). Active surveillance network, among other, measures helped to control and prevent massive spread of the disease epidemics in their countries. Documenting evidence on the lessons from African countries that experienced and addressed Ebola could also be valuable in designing country responses to COVID-19.

Certainly African leaders need evidence from African contexts and other similar contexts to provide practical policies and programmatic solutions to Covid-19. This context-sensitive evidence needs to inform the adaptation of global solutions to COVID-19 so that these are more responsive to Africa’s unique context.

In most African countries, however, the institutional systems and structures that can readily provide such locally relevant evidence are either weak or missing altogether. For instance, there are no existing evidence review and synthesis centres supporting policy decisions being made by ministries of health.

At best, these ministries rely on university departments and research institutes to provide the research needed with minimal or no funding. This is partly the reason why many African countries are simply replicating global solutions to Covid-19, with minimal adaptation and contextualisation because the local evidence needed to help adapt the global solutions is missing.

In some cases, these governments are also not reaching out to local scholars and institutions to provide the evidence they need to adapt global solutions to Africa’s contexts.

The African Institute for Development Policy (AFIDEP) is currently contributing to addressing the weak institutional capacities for access to evidence by ministries of health in Kenya and Malawi. This work, initiated in September 2019, hope to support the two ministries to strengthen their existing structures for research and knowledge gathering, synthesis, and sharing in order to readily access and use evidence as and when needs arise.

Dr Hussein is a research and policy analyst, AFIDEP