The Honorable Dr. Mohamed Juldeh Jalloh, Vice-President of Sierra Leone and Dr. Vanessa Kerry, cofounder and CEO of Seed Global Health, discuss the potential for African countries to use their response to the Covid-19 pandemic to transform their healthcare systems.
As Covid-19 continues to spread around the world, the anticipated explosion of Covid-19 cases in Africa has entered the global spotlight. Over 90,000 Covid-19 cases have already been recorded on the continent. A recent analysis published in the BMJ predicted that up to 250 million people could become infected in Africa in 2020. The rising case count is especially concerning as many countries on the continent struggle to provide even basic health services for their populations. Managing a widespread Covid-19 outbreak presents a nearly insurmountable challenge for health systems barely scraping by.
Understanding the potential to repeat a history of disproportionate death in the face of a pandemic, many African countries including Sierra Leone necessarily implemented swift, aggressive and proactive measures to prevent Covid-19’s spread. As a result, countries on the continent were able to deter their first Covid-19 cases until March and April.
Most governments in Africa have not questioned the need for early public health counter measures. Health systems are too fragile and health burdens too grave to do otherwise. Many of its countries bear the world’s highest burdens of HIV, malaria and neglected tropical diseases but have the lowest numbers of health providers to address those burdens. Sierra Leone is no exception. Years of civil war has eroded Sierra Leone’s infrastructure, human resources, and health budget to medically manage many severely ill patients. Today, Sierra Leone has one of the lowest life expectancies in the world at 60 years, one of the highest maternal mortality rates at 112/10,000 live births, and only 1.4 doctors, nurses, and midwives per 10,000 people.
For many countries on the continent a comprehensive medical response to Covid-19 is not currently feasible.
Covid-19 has already started to inevitably slip through the cracks of even the best public health protective measures. As it escalates, the struggle will fall to the medical centers to manage critically ill patients with limited resources. This struggle is familiar in West Africa where the 2014 Ebola outbreak killed over 11,300 in over 24 months.
While surveillance and outbreak preparedness systems were strengthened following the Ebola epidemic, the essential health services required to provide basic care to the population remained severely lacking. Trade-offs in the allocation of resources during the Ebola crisis stymied progress towards improving the overall health of the population. In some cases, the health system even suffered setbacks. For example, the severe disruption of measles vaccination rates have put more people at risk of dying from measles than Ebola itself in the immediate years after and have contributed to the reduction in access to care for pregnant women in West Africa including in Sierra Leone.
A more ambitious approach will not only save lives from Covid-19 but can transform countries and the long-standing narrative of Africa.
Africa has for too long been imprisoned by a cycle of poverty and poor health. The novel Covid-19 pandemic only portends further entrenchment of this cycle if we do not vigorously change how we deliver health services in countries like Sierra Leone. To this end, the response to Covid-19 must be more comprehensive than just an immediate public health response to limit the number of cases. It must also involve the creation of robust, well-staffed, well-equipped and stronger health systems to respond to Covid and the ongoing health needs of populations. It must look beyond an immediate response to the pandemic and design the health investments today for resilient health systems of tomorrow which can deliver quality care long after Covid-19.
A more ambitious approach will not only save lives from Covid-19 but can transform countries and the long-standing narrative of Africa. Lessons learned from the past four decades have demonstrated the power of health to transform countries not only through just numbers of deaths averted but through economic growth and stability. These same investments have also conferred resilience in the face of Covid-19. For example, Vietnam, a country of 96 million and in close proximity to China where Covid originated, has had only 328 documented Covid-19 cases as of May 31 and no deaths. Vietnam is committed to the vision of universal health coverage, and strong primary care.
Rwanda, an African nation of 12 million has also rewritten its expected history through investments in health. Though mired in violence and genocide in the mid-1990s, investments in its health workforce, access to primary care, and health-financing has translated into the most precipitous declines in HIV, tuberculosis, and maternal mortality of any country in the last 20 years.
Sierra Leone and other African nations can follow the same path. Through strong leadership from government to enforce new paradigms for longer term, more intensive investment in health system strengthening, progress can far exceed surviving Covid-19. Instead, success in the aftermath of Covid-19 can come when every citizen has access to quality, comprehensive healthcare on a daily basis and the opportunity to be a part of a stronger future. Covid-19 can, and should, be used as a catalyst for change.