First Ebola then COVID: Africa Needs to Strengthen Health Systems to Prepare for Next Pandemic
African health experts reflect on lessons learnt from the pandemic.

The COVID-19 pandemic has been a “wake-up call” to African countries to build resilient health systems, boost local manufacturing of medicines, and improve the skills of health workers, according to Rwanda’s President Paul Kagame.

Opening the continent’s first-ever Conference on Public Health in Africa this week, Kagame – chairperson of the African Union Commission – said that the continent could not depend on “external funding” to build resilient health systems.

He outlined a new public health order based on four components:

  • Building the capabilities and professionalism of continental health bodies including the  Africa Centres for Disease Control (CDC) and the African Medicines Agency (AMA),
  • Increasing domestic funding for public health,
  • Investing in national health systems that have the ability to implement critical health programmes, including regular mass vaccination campaigns, and
  • Implementing the Partnership for African Vaccine Manufacturing “to ensure that Africa does not remain at the back of the queue for life-saving medicines and vaccines”.

Meanwhile, Dr John Nkengasong, director of the Africa Centre for Disease Control (CDC), said that the conference marked the beginning of “self-determination” in public health for the continent.

“The Ebola outbreak in West Africa was a signal to all of us that something big was going to come. Hardly have the memories of that devastating outbreak died down, then COVID showed up. And perhaps COVID could be telling us that we have to prepare aggressively for something even worse to come,” warned Nkengasong at a media briefing on Wednesday.

Building the health workforce

Dr Githinji Gitahi, CEO Amref Health Africa, called for investment in the public health workforce was a priority given huge shortages in skilled staff – for example, the continent only had 1,900 epidemiologists but needed at least 6000.

Gitahi added that each country needed to build “strong national public health institutes that are not working independently but are coordinated by the Africa CDC.

Working conditions for health workers are notoriously bad in many countries, and there have been a number of strikes by health workers during the pandemic.

In Uganda, for example, doctors went on strike on Wednesday in support of medical interns who were fired last week after a five-week strike after the government failed to pay them. Other grievances include lack of equipment and poor working conditions.

 Changing the care model

South Africa’s Professor Helen Rees said that COVID-19 had enabled Africa “to break the old world order” where research questions on the continent were dominated by researchers from high-income countries.

Rees called for a “diagnostic on what actually happened to stop the flow of vaccines to the African region”, including asking questions of high-income countries that hoarded vaccines and profit-driven pharmaceutical companies.

“Next time around and as we go on, there needs to be tiered pricing from the outset and commitment to access,” said Rees.

However, Rees said that the continent had to make health systems patient-friendly to reach the poorest people who always fared worst in diseases.

People were expected to travel long distances and queue for hours at clinics to get healthcare, but with some creativity, they could be served better.

One way to do this was to offer integrated services for all members of families instead of  separate “vertical programmes” for different diseases, usually based on funding.

The conference, which attracted over 15,000 online delegates, came as less than 20 African countries had met the global goal of vaccinating at least 10% of the adult population by 30 September, while nearly 90% of high income-countries met this target. 

As of 3 December 2021, only 7% of the African population has been fully vaccinated, as many countries face a surge in new infections and the emergence of the SARS-CoV-2 variant of concern Omicron.


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