Contextualism in COVID-19 Response in Africa
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Review BMJ Innov: first published as 10.1136/bmjinnov-2020-000637 on 7 April 2021. Downloaded from ‘Fighting a Global War Using a Local Strategy’: contextualism in COVID-19 response in Africa Chinwe Lucia Ochu ,1 Oluwatosin Wuraola Akande ,1,2 Oyeronke Oyebanji,3 Olaolu Aderinola,4 Oladipo Ogunbode,1 Rhoda Atteh,5 Tochi Okwor,1 Emeka Oguanuo,1 Tijesu Ojumu,1 Chinenye Ofoegbunam,5 Blessing Ebhodaghe,1 Gbenga Joseph,4 Priscilla Ibekwe,6 Chikwe Ihekweazu6 For numbered affiliations see ABSTRACT end of article. Summary box With a considerably high level of poverty, high population density and relatively fragile Correspondence to What is already known? Dr Oluwatosin Wuraola Akande, health systems, most African countries have a ► The African continent has arguably Prevention, Programmes and predominance of factors that could contribute Knowledge Management, outperformed the predicted trajectory of Nigeria Centre for Disease to the rapid spread of the COVID-19 pandemic. the COVID-19 pandemic. Control, Abuja, 240102, Federal Despite these challenges, the continent has ► In response to the pandemic, there is Capital Territory, Nigeria; shown capacity in its response to the pandemic. a surge in innovative strategies and akande. wuraola@ gmail. com This may be related to the continent’s experience capacities. Received 22 December 2020 in responding to several infectious disease What are the new findings? Revised 8 March 2021 outbreaks such as Ebola disease, Lassa fever and Country- developed strategies and Accepted 10 March 2021 ► Published Online First cholera. Since the beginning of the COVID-19 innovations are being used across 7 April 2021 pandemic, several local innovations have been countries in Africa. ► Countries should be empowered to developed and implemented. These innovations http://innovations.bmj.com/ take into consideration unique circumstances in implement indigenous solutions tailored to unique challenges. countries such as multiple government levels, belief in traditional medicine, limited access to medical supplies and others. This paper is caused by SARS-CoV -2, had been describes the various strategies developed reported in all African countries.1 in African countries across leadership and The pandemic has caused significant coordination, surveillance, laboratory capacity, strain on health systems across the globe.2 case management, infection, prevention and With high population density, fragile control, risk communications, points of entry, communities, weak health systems and on September 30, 2021 by guest. Protected copyright. research, logistics and supply chain, partnership, developmental challenges, many African food security and education. We highlight the countries have a prevalence of risk factors impact of these strategies on the response so far, that could aggravate the pandemic.3 and lessons that other regions across the world There is considerable disparity across can learn from Africa’s response to COVID-19. countries in terms of demography, socio- Finally, we recommend the urgent need for cultural and economic attributes. Given increased investment in African health and its global focus, evidence-based recom- social institutions to enable the development of mendations from WHO are not always African- owned and led strategies in response to contextualised to the specific needs of disease outbreaks. individual countries.4 Therefore, coun- © Author(s) (or their employer(s)) 2021. No tries need to adapt these recommenda- commercial re- use. See rights tions to their context. and permissions. Published by The reality of contextual differences has BMJ. INTRODUCTION prompted several in- country innovations To cite: Ochu CL, The first case of COVID-19 in Africa was and adaptations to the pandemic response. Akande OW, Oyebanji O, et al. reported in Egypt on 14 February 2020. This paper aims to describe the diverse BMJ Innov 2021;7:347–355. As of 13 May 2020, COVID-19, which and innovative strategies implemented in Ochu CL, et al. BMJ Innov 2021;7:347–355. doi:10.1136/bmjinnov-2020-000637 347 Review BMJ Innov: first published as 10.1136/bmjinnov-2020-000637 on 7 April 2021. Downloaded from African countries against the pandemic, based on 12 SURVEILLANCE most important thematic areas, with more focus on To rapidly detect and monitor trends of COVID-19 Nigeria, the most populous country in the continent. cases across the continent, many African countries have adopted innovative strategies and adapted LEADERSHIP AND COORDINATION existing systems to strengthen surveillance activities. The need for high- level coordination within and across In April 2020, the WHO Regional Office for Africa countries to counter the pandemic was recognised by hosted its first virtual hackathon which brought about African governments. At regional level, the Africa innovative local solutions to improve surveillance for Centres for Disease Control and Prevention (Africa the pandemic from 100 leading innovators across CDC) has been at the forefront of regional coordina- sub- Saharan Africa.11 An array of local solutions were tion efforts.5 The organisation has played a significant proposed, including mobile- driven self- diagnosis leadership role in providing guidelines and frame- applications, an X-ray -based self-screening platform, works, building capacity, planning for vaccine devel- mobile- based screening and mapping tools, low- cost opment and access, and ensuring access to medical methods for the production of personal protective supplies for African countries. They have dissemi- equipment (PPE), and so on. It may be too early to nated information on the SARS- CoV-2 variants in assess the true impact of the hackathon. Nonetheless, the continent, training resources for health workers, considering the plethora of good ideas that never get frameworks for supply chain management, outbreak implemented, a clear monitoring and accountability briefs and communiques on expedited regulatory framework is required to ensure that these innovations authorisation process for emergency use of COVID-19 come to fruition. 6 vaccines. In some countries like Nigeria, Benin, Ethiopia, African leaders, on their part, have coordinated Kenya, South Africa and Uganda, mobile location response to the pandemic by showing ingenuity in the data tracking applications were deployed for contact implementation of innovative public health and social tracing.12 For example, an innovation hub in Kenya measures. From the creation of national task forces, called the FabLab created Msafari, a mobile applica- to the implementation of economic stimulus measures tion which tracks passengers on public transport.13 in form of monetary and fiscal policies, to the enact- Passengers enter a code and the vehicle registration ment of a recovery plan, these are all measures which number on their phone. If any passenger tests positive 7 were created during the pandemic. National task to the virus, all the passengers who might have had forces on COVID-19 consisting of experts from contact with the case will be traced. Similarly, Wiqa- diverse fields, provided high- level strategic coordi- ytna is a mobile application that has been downloaded nation of the national response and served as plat- over a million times in Morocco.14 This free applica- http://innovations.bmj.com/ forms for exchange of experiences and best practices tion tells users if another user who was nearby in the 8 9 across countries. In Nigeria, the Presidential Task last 21 days becomes positive for COVID-19. Force (PTF) on COVID-19 and its national public Digitisation of surveillance supported real- time health institute—Nigeria Centre for Disease Control reporting and early notification of cases. In Nigeria, (NCDC)—provided strong leadership and coordina- the Surveillance, Outbreak, Response Management tion of response to the pandemic. The PTF, comprising and Analytical Software was scaled to all the 36 states ministers (from Health, Interior, Aviation, Human and the Federal Capital Territory, a great leap from Affairs, Disaster Management and Social Services, its prepandemic presence in only 18 states. Digital Education, Environment sectors), director- generals surveillance is also being implemented in over 16 on September 30, 2021 by guest. Protected copyright. (from the National Emergency Management Agency, other African countries including Cameroon, Congo, Department of State Services, NCDC) and the WHO Ethiopia, Ghana and South Africa.15 16 Nigeria also country representative, was established on 9 March 10 adopted other innovative strategies for surveillance 2020, about 2 weeks after the country’s index case. using community volunteers from the polio immuni- The PTF has ensured a coordinated intersectoral sation programme to serve as community liaison for response with oversight leadership from the Secretary disease surveillance and notification. to the Government of the Federation, ensuring the highest level of political commitment to the response. Working together, the PTF and NCDC provide regular LABORATORY CAPACITY updates, with the PTF leading on policy direction and Recognising its limited resources and the need to NCDC focusing on scientific and technical guidelines strengthen laboratory and testing capacity as part across the country.9 Furthermore, a national Emer- of the COVID-19 response, many African coun- gency Operations Centre (EOC) led by NCDC was tries developed competence in this field during the activated to coordinate COVID-19 response activities response. The National Institute for