Protecting Africa’s Health Workers Against COVID-19 Despite Weak Health Systems, Poor Infrastructure
COVID-19 responders receive training on how to don and doff protective equipment

Ibadan, Nigeria – As the number of health care worker infections continues to rise in Africa, Health Ministers are calling attention to increasing pressure on Africa’s health system – and the people running it.

Lack of personal protective equipment, adequate infection prevention protocols, and burnout have led to widespread dissatisfaction among doctors in recent weeks, culminating in health worker strikes in some countries.

Over 10,000 health workers across 40 countries in Africa have tested positive for COVID-19, representing about 2% of the continent’s total number of coronavirus cases, according to African Health Ministers and experts present at a World Health Organization press briefing on Thursday.

While globally, some 10% of all cases are among health workers, the large shortage of healthcare workers in Africa predating the pandemic has many experts and Health Ministers concerned. On average, most African countries have less than 1 physician per 1000 people, and less than 2 nurses or midwives per 1000 people, according to World Bank data.

And in four Sub-Saharan countries, health workers make up more than 10% of all infections.

In Gambia, 22% of individuals that tested positive for COVID-19 are health workers, according to the WHO African region’s 21st COVID-19 situation report published July 22. This is followed by Niger Republic, where health workers account for 16.6% of COVID-19 cases in the country. 

In Africa, WHO noted that there is limited information on health worker infections, but health workers make up more than 5% of cases in 14 countries in sub-Saharan Africa.

WHO described the increasing number of health workers infected with COVID-19 as a sign of the challenges that medical staff on the frontlines of the outbreak face. It added that some countries are approaching a critical number of infections that can place stress on health systems as the pandemic continues to wax stronger across the continent further exposing health workers to the virus.

“The growth we are seeing in COVID-19 cases in Africa is placing an ever-greater strain on health services across the continent,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This has very real consequences for the individuals who work in them, and there is no more sobering example of this than the rising number of health worker infections.”

Regional Director for WHO Africa Matshidiso Moeti

Aside from personal exposure to COVID-19, Moeti added that health workers are also afraid of taking the virus home, potentially exposing their family members to the pandemic. 

And the availability of personal protective equipment, and infection prevention and control measures were often inadequate and weak in many countries in Africa.

The agency added that health workers can also be exposed to patients who do not show signs of the disease and are in the health facilities for a range of other services. 

“Risks may also arise when health personnel are repurposed for COVID-19 response without adequate briefing, or because of heavy workloads which result in fatigue, burnout and possibly not fully applying the standard operating procedures,” WHO stated.

It is therefore not surprising that health workers in several African countries have expressed their dissatisfaction with a number of industrial actions, including strikes.

African Governments’ Limited Options – Sierra Leone’s Case

In Sierra Leone, three doctors, two community health workers and one nurse have died of COVID-19.

In all, about 10% of the country’s COVID-19 cases are among health workers. Moreover, a row between doctors and the country’s government over what doctors described as misuse of funds for the coronavirus response in the country and a lack of protection and compensation for health workers escalated into strike action early July. Even doctors treating patients with COVID-19 refused to continue working.

The country’s Medical and Dental Association said the government bought about 30 4×4 vehicles for managers from money intended for the fight against the virus rather than drugs and equipment.

But the country’s Minister of Health and Population, Dr Alpha Wurie acknowledged that healthcare workers in Sierra Leone were the first to be affected by COVID-19 while participating in a WHO press conference on Thursday.

Sierra Leone’s Minister of Health and Population Alpha Wurie

“It so happens that while COVID-19 treatment centers were in readiness and had enough PPEs, this was not so in the other hospitals,” Wurie said.

He also described how a doctor and several nurses at one of the country’s designated COVID-19 treatment centres, tested positive, resulting in the closure of the facility.

While admitting that the country has not become fully confident in the ways it is striving to prevent the spread of COVID-19, he countered that the case fatality management for COVID-19 has been satisfactory – compared with the outcomes of the country’s cycles of Ebola outbreak.

“The recovery rate for COVID-19 has been very good and the case fatality rate has been very low at 3.8%,” Wurie said.

Nurses Can’t Social Distance in Ghana

Dr. Jemima Dennis-Antwi, an Accra-based international maternal health and midwifery specialist, decried the paucity of published information on the true magnitude of health professionals’ infectivity which she described as an information that is highly guarded by countries.

Ghana has reported 2,035 cases of health workers infected with COVID-19. Some 91% fully recovered and there have been nine deaths which included four doctors, one nurse and three laboratory workers.

In addition to the use of PPEs, maintaining social distancing is another major COVID-19 prevention measure. But for several health workers, especially nurses, this is unrealistic.

“Nurses and midwives have the majority of infectivity – over 410 nurses and midwives have been affected in Ghana in the line of duty. This is because we are designated to serve our patients 24/7,” Antwi said.

Jemima Dennis-Antwi, an Accra-based international maternal health and midwifery specialist

Increasing exposure of health workers to COVID-19 without adequate provision of PPEs has led to health workers refusing to attend to patients, causing psychological stress to self and families, and constant threat of legal action. She noted that the implication of the development has impacts on a wide array of health issues other COVID-19 and other infectious diseases.

“This has serious implications for quality care, especially reproductive, maternal, newborn, child and adolescent care,” she said.

While calling for urgent action to keep Africa’s health professionals alive to provide the care they are trained to give, Antwi added that health workers on their part also needs to be more proactive and take actions that would boost their immune systems and will also clear respiratory pathways which is the major route of entry for COVID-19.

Tracking & Adjusting to Realities in Burkina Faso

Moeti also admitted that more needs to be done to reveal the true status of the pandemic among the continent’s health workers and to guide the enactment of appropriate policies.

“We are looking at improving the collection of data on health workers so that we can determine the extent of infection at work, and to inform the health workers on how to limit transmission at home,” she said.

In Burkina Faso for example, 8.5% of confirmed cases of COVID-19 are from health workers. While admitting that health professionals in the country are exposed to the pandemic, Dr Léonie Claudine Lougue, Minister of Health of Burkina Faso said the country has introduced a surveillance measure to screen its health workforce for COVID-19.

Léonie Claudine Lougue, Minister of Health of Burkina Faso

But a bigger problem still exists, persisting even as African countries continue to deal with COVID-19 – it is the limited capacity of the continent’s health institutions. 

WHO stated that in many African countries, infection prevention and control measures aimed at preventing infections in health facilities are still not fully implemented. 

“When WHO assessed clinics and hospitals across the continent for these measures, only 16% of the nearly 30 000 facilities surveyed had assessment scores above 75%. Many health centres were found to lack the infrastructure necessary to implement key infection prevention measures, or to prevent overcrowding. Only 7.8% (2213) had isolation capacities and just a third had the capacity to triage patients,” WHO stated.

Wurie however expressed optimism noting that in spite of the weak health systems across the continent, health workers will still be able to handle the pressure and threats from COVID-19 considering the case fatality ratio is rapidly reducing as the number of confirmed cases continues to rise.

“For people that may be infected, most of them are asymptomatic. The confidence of each country in being to manage the pandemic is getting better and the more we provide psychosocial support services for our health workers, the more their confidence also develops,” Wurie said.

 

Image Credits: WHO AFRO, HP-Watch/P Adepoju.