COVID-19: Africa needs unprecedented attention to strengthen community health systems

Nepomnyashchiy, Lyudmila; Dahn, Bernice; Saykpah, Rachel; Raghavan, Mallika

doi:10.1016/s0140-6736(20)31532-4

Cited by 39 publications

(28 citation statements)

References 6 publications

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“…High life expectancy is often related to an older population, and death data implies that COVID-19 is more predominant for such population compared to Africa with the youngest population of the world [ 50 ], though the strength of its health system might play a critical role in the determination of the number of deaths and recoveries. Therefore, an effective health system (e.g., better hospitals facilities—ICUs, testing laboratories, personal protective equipment, properly trained health personnel) in Africa could help better identify COVID-related deaths and also facilitate more recoveries [ 51 ]. Hence, countries with more effective health systems might experience less COVID-19 related deaths.…”

Section: Discussionmentioning

confidence: 99%

Assessing sub-regional-specific strengths of healthcare systems associated with COVID-19 prevalence, deaths and recoveries in Africa

et al. 2021

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Introduction The coronavirus 2019 (COVID-19) has overwhelmed the health systems of several countries, particularly those within the African region. Notwithstanding, the relationship between health systems and the magnitude of COVID-19 in African countries have not received research attention. In this study, we investigated the relationship between the pervasiveness of the pandemic across African countries and their Global Health Security Index (GHSI) scores. Materials and methods The study included 54 countries in five regions viz Western (16); Eastern (18); Middle (8); Northern (7); and Southern (5) Africa. The outcome variables in this study were the total confirmed COVID-19 cases (per million); total recoveries (per million); and the total deaths (per million). The data were subjected to Spearman’s rank-order (Spearman’s rho) correlation to determine the monotonic relationship between each of the predictor variables and the outcome variables. The predictor variables that showed a monotonic relationship with the outcome were used to predict respective outcome variables using multiple regressions. The statistical analysis was conducted at a significance level of 0.05. Results Our results indicate that total number of COVID-19 cases (per million) has strong correlations (rs >0.5) with the median age; aged 65 older; aged 70 older; GDP per capita; number of hospital beds per thousand; Human Development Index (HDI); recoveries (per million); and the overall risk environment of a country. All these factors including the country’s commitments to improving national capacity were related to the total number of deaths (per million). Also, strong correlations existed between the total recoveries (per million) and the total number of positive cases; total deaths (per million); median age; aged 70 older; GDP per capita; the number of hospital beds (per thousand); and HDI. The fitted regression models showed strong predictive powers (R-squared>99%) of the variances in the total number of COVID-19 cases (per million); total number of deaths (per million); and the total recoveries (per million). Conclusions The findings from this study suggest that patient-level characteristics such as ageing population (i.e., 65+), poverty, underlying co-morbidities–cardiovascular disease (e.g., hypertension), and diabetes through unhealthy behaviours like smoking as well as hospital care (i.e., beds per thousand) can help explain COVID-19 confirmed cases and mortality rates in Africa. Aside from these, other determinants (e.g., population density, the ability of detection, prevention and control) also affect COVID-19 prevalence, deaths and recoveries within African countries and sub-regions.

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Section: Discussionmentioning

confidence: 99%

Assessing sub-regional-specific strengths of healthcare systems associated with COVID-19 prevalence, deaths and recoveries in Africa

et al. 2021

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“…In many countries, the COVID-19 pandemic has both exacerbated existing inequities and fragilities in the health system, while accelerating windows for opportunity for reformthe Reform Cycle can help make the most of these opportunities. 39 This framework is based on the premise that building and sustaining community health programs requires employing the tools of institutional These 8 stages offer a roadmap for those seeking to support the scale-up and institutionalization of CHW programs.…”

Section: Resultsmentioning

confidence: 99%

The Community Health Systems Reform Cycle: Strengthening the Integration of Community Health Worker Programs Through an Institutional Reform Perspective

Chen¹,

Raghavan²,

Albert³

et al. 2021

Glob Health Sci Pract

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Despite strong interest and policy commitments from many countries, models for community-based primary health service delivery have been slow to achieve full scale or deliver quality that matches their potential. n Reform requires a carefully choreographed effort to enroll key stakeholders to support change by spotlighting a locally relevant gap in the existing health system's performance. n Designing and launching community health programs depends heavily on local context and must draw from models that are available within a given health system and that align with the resources, capabilities, and commitments of key stakeholders. n Reform should be viewed as an ongoing adaptive and evolutionary process; learning, governance, and management systems must be designed with this trajectory in mind. Key Implications Ministries of health, development partners, and other reform stakeholders can: n Use the principles in the reform cycle process to identify gaps and priorities for technical work or investment n Examine community health efforts to identify where technical approaches can be complemented by political, institutional, and reform approaches n Critically examine projects that implement termlimited, externally driven interventions and adapt designs to promote sustained, well-integrated community health programs at scale

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“…Unfortunately, many African countries spontaneously adopted same lockdown measures without requisite knowledge of the COVID-19 infection rate and the context-specific relevance of these measures. 30 , 33 , 34 , 41 , 43 , 45 , 46 Ghana, for instance, observed three weeks partial lockdown in the two most urbanised regions as part of the early control measures without sufficient evidence. Unlike other continents, Africa was fortunate to record COVID-19 cases months after other continents recorded cases.…”

Section: Discussionmentioning

confidence: 99%

“… 41 Likewise, inter-sectoral collaboration with government institutions, non-governmental organisations (NGOs), religious bodies, industry players and national security agencies have been effectively leveraged in many countries in Africa towards COVID-19 fight. 12 , 33 , 43 , 45 , 46 , 51 , 52 The role of the media and civil society in propagating health education and communication on COVID-19 prevention and control has equally been phenomenal in Africa. 51 In addition, the ingenuity of many African countries in developing locally manufactured handwashing devices and PPE is especially commended in the bit to promote self-reliance and sustainability in the wake of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Urban health nexus with coronavirus disease 2019 (COVID-19) preparedness and response in Africa: Rapid scoping review of the early evidence

et al. 2021

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Introduction: Severe acute respiratory syndrome coronavirus 2 also called coronavirus disease 2019 was first reported in the African continent on 14 February 2020 in Egypt. As at 18 December 2020, the continent reported 2,449,754 confirmed cases, 57,817 deaths and 2,073,214 recoveries. Urban cities in Africa have particularly suffered the brunt of coronavirus disease 2019 coupled with criticisms that the response strategies have largely been a ‘one-size-fits-all’ approach. This article reviewed early evidence on urban health nexus with coronavirus disease 2019 preparedness and response in Africa. Methods: A rapid scoping review of empirical and grey literature was done using data sources such as ScienceDirect, GoogleScholar, PubMed, HINARI and official websites of World Health Organization and Africa Centres for Disease Control and Prevention. A total of 26 full articles (empirical studies, reviews and commentaries) were synthesised and analysed qualitatively based on predefined inclusion criteria on publication relevance and quality. Results: Over 70% of the 26 articles reported on coronavirus disease 2019 response strategies across Africa; 27% of the articles reported on preparedness towards coronavirus disease 2019, while 38% reported on urbanisation nexus with coronavirus disease 2019; 40% of the publications were full-text empirical studies, while the remaining 60% were either commentaries, reviews or editorials. It was found that urban cities remain epicentres of coronavirus disease 2019 in Africa. Even though some successes have been recorded in Africa regarding coronavirus disease 2019 fight, the continent’s response strategies were largely found to be a ‘one-size-fits-all’ approach. Consequently, adoption of ‘Western elitist’ mitigating measures for coronavirus disease 2019 containment resulted in excesses and spillover effects on individuals, families and economies in Africa. Conclusion: Africa needs to increase commitment to health systems strengthening through context-specific interventions and prioritisation of pandemic preparedness over response. Likewise, improved economic resilience and proper urban planning will help African countries to respond better to future public health emergencies, as coronavirus disease 2019 cases continue to surge on the continent.

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COVID-19: Africa needs unprecedented attention to strengthen community health systems

Cited by 39 publications

References 6 publications

Assessing sub-regional-specific strengths of healthcare systems associated with COVID-19 prevalence, deaths and recoveries in Africa

Assessing sub-regional-specific strengths of healthcare systems associated with COVID-19 prevalence, deaths and recoveries in Africa

The Community Health Systems Reform Cycle: Strengthening the Integration of Community Health Worker Programs Through an Institutional Reform Perspective

Urban health nexus with coronavirus disease 2019 (COVID-19) preparedness and response in Africa: Rapid scoping review of the early evidence

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