COVID-19 has shown that its primary care infrastructure is in much need of strengthening. But we should not mistake COVID-19 as the biggest pandemic of our time. If anything, it is only a dry run, with other epidemics brewing on the horizon. Therefore, if the global community is serious about epidemic preparedness, global health security, and protecting the most vulnerable, we need to redesign health systems for resilience. Africa’s lessons from the COVID-19 pandemic, as well as from concurrent outbreaks of cholera, Ebola virus disease, yellow fever, and chikungunya,
could provide a roadmap.
Most African countries set up special funds in response to the COVID-19 pandemic. Only four countries drew from reserve funds (Uganda, South Africa, Malawi, and Kenya).
In early 2020, 47 member states of the WHO African region adopted a strategy for scaling up health innovations in Africa. Examples of the use of big data in response to COVID-19 include WhatsApp chatbots in South Africa, self-diagnostic tools in Angola, contact tracing apps in Ghana, and mobile health information tools in Nigeria.
African efforts to address this imbalance have been ongoing at the regional level and country levels. Regional efforts include the establishment of the UN commission on the status of women, the Africa Union award for women scientists, the United Nations Educational, Scientific and Cultural Organization (UNESCO) STEM and gender advancement, the African Development Bank’s gender equality index, The Boardroom Africa Initiative, and the Gender Summit Africa platform. Efforts at the national level have mainly been via developmental and poverty-reduction agendas and strategies.
COVID-19 has spurred innovation across Africa; out of 1000 new or modified technologies that have been developed worldwide to support different areas of the COVID-19 response, Africa accounts for 12·8%.
A classic example of innovation in Africa is the partnership forged between local bottling plants and shopkeepers, who transport antidiarrhoeal kits to the remote areas of Zambia by packaging them in the empty space in Coca-Cola deliveries. Health system innovations should enable digital data collection, confidential self-reporting, and epidemic control measures such as health messaging, and they should aid investigation. Crucially, we should encourage reverse innovation; innovation can flow from low-income and middle-income countries to high-income countries, providing simple, low-cost solutions. To reach the full innovation potential, we need to challenge the idea that technical expertise flows in one direction only, and instead harness bidirectional expertise for resilient health systems.
Such workers, as trusted members of the community, form a quick link between clinical and community-based services necessary for effective outbreak response. Additionally, there is a need for a workforce development strategy that will address the labour shortage in critically needed fields.
it is paramount that governments include marginalised communities, such as refugees, migrants, and internally displaced populations, in their policies and actions.
COVID-19 has shown us that we must work collectively to ensure capacity globally. Without such global capacity, available to all, no country is safe from future pandemics. Despite the urgency to manage the immediate, medium, and long-term effects of COVID-19, it is key that we start now to identify and strengthen the critical characteristics of resilient health systems not just for emergencies but for health care in general. We posit that Africa provides multiple examples of these important characteristics.
We declare no competing interests.
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Published: February 10, 2021
© 2020 The Author(s). Published by Elsevier Ltd.
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