Covid-19 in Africa: Perfect jab for ailing health sector?

Africa’s healthcare sector is poised for a big leap if investments made and lessons learnt during the Covid-19 pandemic outlive the distress, health experts predict.

Billions of dollars from government coffers and development partners have flowed into the sector, with a good chunk going directly into improving the healthcare systems’ capacity to respond to the pandemic. 

“We have installed more medical equipment than has ever happened since the country’s independence,” said Kenya’s President, Uhuru Kenyatta, during a national Covid-19 conference held on September 28.

It is projected that investment in areas such as facilities, human resource, equipment and research, will last beyond Covid-19 crisis and see the sector grow a lot faster than it has in the past.

“The investments made and lessons learned this year about leveraging technology for different areas, including management, training, and information management could pay dividends, along with investments in community engagement and the integration of service delivery,” Dr Matshidiso Moeti, the World Health Organization Regional Director for Africa, told Nation Newsplex, the data journalism desk of the Nation Media Group.

Health systems in almost all African countries were already struggling by the time the pandemic reached the continent on February 14. Confronting a highly infectious respiratory disease was bound to be a big challenge.

In Kenya, two in four facilities did not offer chronic respiratory disease diagnosis and/or management services, according to the Kenya Harmonised Health Facility Assessment 2018/2019.

Additionally, only 12 per cent of health facilities surveyed had all items for standard precaution for infection prevention.

By May, only 16 per cent of 30,000 health facilities surveyed on the continent were at least 75 per cent ready to handle Covid-19, according to a study conducted by the World Health Organization. About eight per cent (2,213) had isolation capacities and just a third had the capacity to triage patients.

Then the money started pouring in.

In the name of Covid-19, the International Monetary Fund alone has channelled over US$ 15.8 billion into sub-Saharan through urgent limited conditionality loans. Kenya qualified for ($739 million, on May 6), the fourth-highest amount, after South Africa ($4.3 billion, on July 27) Nigeria ($3.4 billion, on April 28) and Angola ($765 million, on September 16). Uganda sought and qualified for $491.5 million and Rwanda $111.06 million. 

Additionally, countries have received loans and grants from other organisations such as the World Bank, the European Union, Africa Development Bank as well as from individual countries under bilateral arrangements. The funds improved nations’ capacity to respond to the pandemic.

“We have seen a lot of investment in health sector building blocks such as hiring of workers, promoting the culture of handwashing, construction of laboratory infrastructure, and participation of the private sector, all which is going to remain post-Covid,” says Dr Githinji Gitahi, group CEO, Amref Health Africa.
In Kenya, a total of Sh13.1 billion of Covid-19 funds was available to counties between March 13 and July 31, according to the Office of the Controller of Budgets. 

Intensive care 

This was followed, on June 7, by President Kenyatta directing that each county sets up at least a 300-bed isolation facility, at a time when there were only eight nationally. The country now has 7,411 isolation beds, according to the briefs given by the government at the national Covid-19 conference. Seven counties have achieved the minimum 300 beds target, and 13 each has a bed capacity of over 200. The country has also tripled its intensive care capacity from 162 and 492 beds.

The pandemic has seen the clinical care capacities increase in the 47 African countries, according to the WHO. Since February, the number of Intensive Care Unit (ICU) beds has more than doubled from about 4,700 to over 10,000, and that of functional ventilators and oxygen concentrators have each doubled from around 3,000 to more than 6,000. At the onset of the pandemic, there were reports that a number of African countries did not have a single ICU bed in their public hospitals.

However, such investment in facilities and equipment can deliver a stronger sector only if loss of healthcare workers to Covid-19 is kept as low as possible. This is important because the region has only 21 doctors for every 100,000 people, over 12 times lower than of Europe and Central Asia (249) and seven times the global average of 149, according to the WHO. Kenya has 20 and at least 18 countries in the continent, including Uganda and Tanzania, each has less than 10 doctor per 10,000 people.

The virus had claimed 240 healthcare workers in South Africa by August 4, 159 in Egypt by August 11 and 84 in Algeria, by August, according to an Amnesty International tracker. Kenya has lost 16 healthcare workers to the virus, according to the Ministry of Health. These numbers are low compared with those in other hotspots such as Mexico (1,820, by August 25), the US (1,077, by August 26), Brazil (634, by August 24) and India (573, by August 30). However, the deaths are a bigger blow considering that such professionals are now missing from a much smaller number of healthcare workers in countries where not as many people have died of the disease as was projected.

Some 39,525 healthcare workers from 42 countries had been infected in Africa by August 31, according to the WHO. South Africa accounted for two-thirds per cent (25,841) of the cases. About 2,175 had been infected in Nigeria by September 10 and 1,029 in Kenya to date. These numbers are low, relative to the situations in other continents.

To protect workers, the WHO has trained more than 50,000 health workers in infection prevention and control and is planning to train over 200 000. 

Many governments have also responded to the pandemic by hiring more health professionals. In the six months of the pandemic, Kenyan counties collectively hired over 10,000 workers, growing the workforce to 66,935 up from 56,328.
Experts hold that despite the positive disruption caused by the pandemic, a healthier Africa will only be realised if the negative effects of Covid-19 are well managed. 

Poverty level is projected to increase due to economic shrinkage and job loss. This will hinder access to health services and proper nutrition. The pandemic has cost Africa millions of jobs. In Kenya, some 1.7 million jobs were lost between March and June alone, according to the Kenya Bureau of Statistics. Further, the Federation of Kenya Employers warned on September 25 that a million formal sector workers were at risk of losing income by the end of the year as 51 per cent of enterprises they interviewed planned to downsize within the next six months.

The situation is likely to be dire in countries where a majority of the population live below the poverty line such as South Sudan (82 per cent), Madagascar (71 per cent), Burundi (65 per cent) and the Democratic Republic of Congo (64 per cent).

Experts have observed that pervasive job loss and measures such as lockdown, curfew and social distancing have had a toll on the mental health of a significant share of the population, including healthcare workers. This is a burden the health sector will have to bear past the pandemic, even as underfunding remains the main challenges in addressing mental illness in Africa. Only 21 per cent of health facilities in Kenya have common medicines for mental and neurological illnesses, according to KHFA 2018/2019.

In some countries such as Chad, Ethiopia, Nigeria and South Sudan, the pandemic led to a suspension of measles preventive mass vaccination campaigns, leaving exposed about 21 million children that were due for vaccination.
 “For diseases such as measles, you need to retain a very high level of immunisation to keep the disease at bay. When that is interrupted then you have a resurgence of the disease,” says Dr Gitahi, adding that there will be a need to accelerate vaccination and take it back to where it was before.

Paying debt

Unfortunately, even as there will be need for governments to invest more in the health sector, it is projected that they will in fact reduce spending on health, instead channelling more resources to paying debt. Seven African countries (Eritrea, The Gambia, Mozambique, Republic of Congo, Sao Tomé and Principe, South Sudan, and Zimbabwe) were already in debt distress in 2019, according to the IMF. Nine others (Burundi, Cape Verde, Cameroon, Central African Republic, Chad, Ethiopia, Ghana, Sierra Leone, and Zambia) were at high risk of joining the fold. 

World Bank data show that African countries spent an average of 5.3 per cent of their budget on the health sector in 2016, lower than the 15 per cent recommended by the Abuja Protocol. There is little indication that the share has grown substantially. Kenya (national and county governments combined) allocates between seven and eight per cent to health, Tanzania, about seven per cent, Rwanda, an average of 8.9 per cent in the last four years and Uganda 7.9 per cent in the 2019/2020 budget. 
“We do not know when another pandemic will be here so we must continue to invest in healthcare post-Covid-19 even in difficult economic situations,” says Dr Gitahi.