Challenges of healthcare delivery in the context of COVID-19 pandemic in Sub-Saharan Africa

Introduction: Public health security is concerned with infection prevention and control worldwide. These measures are the concern of all and sundry to ensure prevention of any outbreaks of diseases that has epidemic potential. Africa may be uniquely positioned to have the most severe and under-detected outcomes related to COVID-19 infection. This article seeks to highlight such challenges of healthcare delivery systems in the context of the COVID-19 pandemic in sub-Saharan Africa. The communique also suggests possible strategies for improvement in such settings. Method: We identified relevant articles to date using a manual library search, journal publications on the subject, and critically reviewed them. Results: We identified and exhaustively discussed the main limitations to public health security in sub-Saharan Africa as follows i) Continuing deterioration of the public health infrastructure for disease control, ii) The changing outlooks of contagious diseases, iii) Private sector reforms like the managed care, iv) Relatively weak health care systems, and v) Poor organizational structures. Conclusion: Most Africans are eager to see the desired transformation in our public health systems. Unfortunately, the political will to invest in public health infrastructure is lacking. Also, the system is characterized by human resources shortage and diverted resources, which significantly impacted the provision for emerging COVID-19 pandemic –related care. Interestingly the monumental breakthroughs in research development for bio-therapeutics and vaccines in African countries appear a mirage even with extensive past study experience with such products from China and the Western world. Finally, notwithstanding these challenges in our public health systems as elaborated, the facts are that enormous capacities exist that can be harnessed in African countries for the COVID-19 preparedness and response.

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Crowdsourcing Covid-19 signals in sub-Saharan Africa: Leveraging digital contributor networks for participatory surveillance of Covid-19 symptoms and deaths (Preprint)

10.2196/preprints.26347 ◽

2020 ◽

Author(s):

Ngozi A Erondu ◽

Sagal A Ali ◽

Mohamed Ali ◽

Schadrac C Agbla

Keyword(s):

Public Health ◽

Sub Saharan Africa ◽

Specific Information ◽

Surveillance Systems ◽

Health Seeking ◽

African Countries ◽

Cross Sectional Survey ◽

Local Networks ◽

The World ◽

Sub Saharan

BACKGROUND In sub-Saharan Africa, underreporting of cases and deaths has been attributed to various factors including, weak disease surveillance, low health-seeking behaviour of flu like symptoms, and stigma of Covid-19. There is evidence that SARS-CoV-2 spread mimics transmission patterns of other countries across the world. Since the Covid-19 pandemic has changed the way research can be conducted and in light of restrictions on travel and risks to in-person data collection, innovative approaches to collecting data must be considered. Nearly 50% of Africa’s population is a unique mobile subscriber and it is one of the fastest growing smart-phone marketplaces in the world; hence, mobile phone platforms should be considered to monitor Covid-19 trends in the community. OBJECTIVE We demonstrate the use of digital contributor platforms to survey individuals about cases of flu-like symptoms and instances of unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia, and Zimbabwe. METHODS Rapid cross-sectional survey of individuals with severe flu and pneumonia symptoms and unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia and Zimbabwe RESULTS Using a non-health specific information platform, we found COVID-19 signals in five African countries, specifically: •Across countries, nearly half of the respondents (n=739) knew someone who had severe flu or pneumonia symptoms in recent months. •One in three respondents from Somalia and one in five from Zimbabwe respondents said they knew more than five people recently displaying flu and/or pneumonia symptoms. •In Somalia there were signals that a large number of people might be dying outside of health facilities, specifically in their homes or in IDP or refugee camps. CONCLUSIONS Existing digital contributor platforms with local networks are a non-traditional data source that can provide information from the community to supplement traditional government surveillance systems and academic surveys. We demonstrate that using these distributor networks to for community surveys can provide periodic information on rumours but could also be used to capture local sentiment to inform public health decision-making; for example, these insights could be useful to inform strategies to increase confidence in Covid19 vaccine. As Covid-19 continues to spread somewhat silently across sub-Saharan Africa, regional and national public health entities should consider expanding event-based surveillance sources to include these systems.

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Climate Change and Health Preparedness in Africa: Analysing Trends in Six African Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094672 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4672

Author(s):

Samuel Kwasi Opoku ◽

Walter Leal Filho ◽

Fudjumdjum Hubert ◽

Oluwabunmi Adejumo

Keyword(s):

Public Health ◽

Climate Change ◽

South Africa ◽

Human Health ◽

Health Systems ◽

Health Professionals ◽

Health Problems ◽

Sub Saharan Africa ◽

Basic Knowledge ◽

African Countries

Climate change is a global problem, which affects the various geographical regions at different levels. It is also associated with a wide range of human health problems, which pose a burden to health systems, especially in regions such as Africa. Indeed, across the African continent public health systems are under severe pressure, partly due to their fragile socioeconomic conditions. This paper reports on a cross-sectional study in six African countries (Ghana, Nigeria, South Africa, Namibia, Ethiopia, and Kenya) aimed at assessing their vulnerabilities to climate change, focusing on its impacts on human health. The study evaluated the levels of information, knowledge, and perceptions of public health professionals. It also examined the health systems’ preparedness to cope with these health hazards, the available resources, and those needed to build resilience to the country’s vulnerable population, as perceived by health professionals. The results revealed that 63.1% of the total respondents reported that climate change had been extensively experienced in the past years, while 32% claimed that the sampled countries had experienced them to some extent. Nigerian respondents recorded the highest levels (67.7%), followed by Kenya with 66.6%. South Africa had the lowest level of impact as perceived by the respondents (50.0%) when compared with the other sampled countries. All respondents from Ghana and Namibia reported that health problems caused by climate change are common in the two countries. As perceived by the health professionals, the inadequate resources reiterate the need for infrastructural resources, medical equipment, emergency response resources, and technical support. The study’s recommendations include the need to improve current policies at all levels (i.e., national, regional, and local) on climate change and public health and to strengthen health professionals’ skills. Improving the basic knowledge of health institutions to better respond to a changing climate is also recommended. The study provides valuable insights which may be helpful to other nations in Sub-Saharan Africa.

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Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312449 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12449

Author(s):

Ahmad Alkhatib ◽

Lawrence Achilles Nnyanzi ◽

Brian Mujuni ◽

Geofrey Amanya ◽

Charles Ibingira

Keyword(s):

Public Health ◽

Cardiovascular Disease ◽

Sub Saharan Africa ◽

Lifestyle Interventions ◽

African Countries ◽

Middle Income ◽

Non Communicable Diseases ◽

Economic Disparity ◽

Middle Income Countries ◽

Sub Saharan

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.

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Reflections on Climate Change and Public Health in Africa in an Era of Global Pandemic

10.5772/intechopen.97201 ◽

2021 ◽

Author(s):

Edlyne Eze Anugwom

Keyword(s):

Public Health ◽

Climate Change ◽

Health Planning ◽

Full Range ◽

Good Health ◽

Sub Saharan Africa ◽

Health Security ◽

Mitigation And Adaptation ◽

Global Pandemic ◽

Sub Saharan

The study examined the impact of climate change on public health provisioning in Sub-Saharan Africa. In addition to recognising the multifarious influence of climate change on health, it argues that the quest for global health security can only be achieved against the backdrop of concerted mainstreaming of climate change response into public heath provisioning, especially in the developing world. Adapting to climate change and mitigating its impact would logically require integrating it into public health planning, programming and interventions. Therefore, if health security entails provisioning and catering to the full range of health needs of people, climate change given its undoubted implications for health should be in the forefront of health security globally. Despite the global discourse of climate change and health security, tangible actions and programmes at different levels are needed to achieve the goals of good health and effective health security. This is no less the case now that the pandemic has challenged and stretched health institutions and provisions. However, the complex and intertwining effects of climate change and its manifold nexus with public health and health security can easily be apprehended through the systems perspective. There is the need for both radicalization of the public health system in Sub-Saharan Africa and concerted efforts across disciplines and actors to achieve effective climate change mitigation and adaptation and thus further strengthen health security.

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Willingness to Pay for Condoms among Men in Sub-Saharan Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010034 ◽

2018 ◽

Vol 16 (1) ◽

pp. 34 ◽

Cited By ~ 2

Author(s):

William Evans ◽

Kuyosh Kadirov ◽

Ibou Thior ◽

Ramakrishnan Ganesan ◽

Alec Ulasevich ◽

...

Keyword(s):

Public Health ◽

Willingness To Pay ◽

Condom Use ◽

Sub Saharan Africa ◽

Linear Regression Models ◽

African Countries ◽

Donor Funding ◽

Sub Saharan ◽

Tool Building ◽

Hiv Aids

HIV/AIDS and other sexually transmitted infections (STIs) continue to be among the greatest public health threats worldwide, especially in sub-Saharan Africa (SSA). Condom use remains an essential intervention to eradicate AIDS, and condom use is now higher than ever. However, free and subsidized condom funding is declining. Research on how to create healthy markets based on willingness to pay for condoms is critically important. This research has three primary aims: (1) willingness of free condom users in five African countries to pay for socially marketed condoms; (2) the relationship between specific population variables and condom brand marketing efforts and willingness to pay; and (3) potential opportunities to improve condom uptake. Nationally representative samples of at least 1200 respondents were collected in Kenya, Nigeria, South Africa, Zambia, and Zimbabwe. We collected data on a range of demographic factors, including condom use, sexual behavior, awareness of condom brands, and willingness to pay. We estimated multivariate linear regression models and found that free condom users are overwhelmingly willing to pay for condoms overall (over 90% in Nigeria) with variability by country. Free users were consistently less willing to pay for condoms if they had a positive identification with their free brand in Kenya and Zimbabwe, suggesting that condom branding is a critical strategy. Ability to pay was negatively correlated with willingness, but users who could not obtain free condoms were willing to pay for them in Kenya and Zimbabwe. In a landscape of declining donor funding, this research suggests opportunities to use scarce funds for important efforts such as campaigns to increase demand, branding of condoms, and coordination with commercial condom manufacturers to build a healthy total market approach for the product. Free condoms remain an important HIV/AIDS prevention tool. Building a robust market for paid condoms in SSA is a public health priority.

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Public health systems research: the state of the field

Australian Health Review ◽

10.1071/ah080721 ◽

2008 ◽

Vol 32 (4) ◽

pp. 721 ◽

Cited By ~ 3

Author(s):

Prue Bagley ◽

Vivian Lin

Keyword(s):

Public Health ◽

Systems Approach ◽

Building Blocks ◽

Research Attention ◽

Public Health Systems ◽

Health Goals ◽

Systems Research ◽

Public Health Infrastructure ◽

Health Infrastructure ◽

Public Health Systems Research

Public health infrastructure provides the building blocks required for the system to achieve public health goals. A systems approach to public health has been suggested as a means to tackle persistent and emerging problems. Systems and infrastructure are attracting increased research attention. A review of the Australian and international literature suggests an absence of empirical evidence about how the system and its component parts does, or should, work and highlights some of the difficulties associated with generating such evidence. It also indicates there is significant scope for further research.

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Sub-Saharan Africa preparedness and response to the COVID-19 pandemic: A perspective of early career African scientists

Wellcome Open Research ◽

10.12688/wellcomeopenres.16070.2 ◽

2020 ◽

Vol 5 ◽

pp. 163

Author(s):

Gisele Umviligihozo ◽

Lucy Mupfumi ◽

Nelson Sonela ◽

Delon Naicker ◽

Ekwaro A. Obuku ◽

...

Keyword(s):

Public Health ◽

Case Fatality ◽

Early Career ◽

Health Interventions ◽

Sub Saharan Africa ◽

Public Health Interventions ◽

African Countries ◽

Scientific Publications ◽

First Case ◽

Sub Saharan

Emerging highly transmissible viral infections such as SARS-CoV-2 pose a significant global threat to human health and the economy. Since its first appearance in December 2019 in the city of Wuhan, Hubei province, China, SARS-CoV-2 infection has quickly spread across the globe, with the first case reported on the African continent, in Egypt on February 14th, 2020. Although the global number of COVID-19 infections has increased exponentially since the beginning of the pandemic, the number of new infections and deaths recorded in African countries have been relatively modest, suggesting slower transmission dynamics of the virus on the continent, a lower case fatality rate, or simply a lack of testing or reliable data. Notably, there is no significant increase in unexplained pneumonias or deaths on the continent which could possibly indicate the effectiveness of interventions introduced by several African governments. However, there has not yet been a comprehensive assessment of sub-Saharan Africa’s (SSA) preparedness and response to the COVID-19 pandemic that may have contributed to prevent an uncontrolled outbreak so far. As a group of early career scientists and the next generation of African scientific leaders with experience of working in medical and diverse health research fields in both SSA and resource-rich countries, we present a unique perspective on the current public health interventions to fight COVID-19 in Africa. Our perspective is based on extensive review of the available scientific publications, official technical reports and announcements released by governmental and non-governmental health organizations as well as from our personal experiences as workers on the COVID-19 battlefield in SSA. We documented public health interventions implemented in seven SSA countries including Uganda, Kenya, Rwanda, Cameroon, Zambia, South Africa and Botswana, the existing gaps and the important components of disease control that may strengthen SSA response to future outbreaks.

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Informatics Metrics and Measures for a Smart Public Health Systems Approach: Information Science Perspective

Computational and Mathematical Methods in Medicine ◽

10.1155/2017/1452415 ◽

2017 ◽

Vol 2017 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Timothy Jay Carney ◽

Christopher Michael Shea

Keyword(s):

Public Health ◽

Health Systems ◽

Health Informatics ◽

Information Science ◽

Situational Awareness ◽

Systems Approach ◽

Healthcare Delivery ◽

Public Health Informatics ◽

Healthcare Delivery System ◽

Public Health Systems

Public health informatics is an evolving domain in which practices constantly change to meet the demands of a highly complex public health and healthcare delivery system. Given the emergence of various concepts, such as learning health systems, smart health systems, and adaptive complex health systems, health informatics professionals would benefit from a common set of measures and capabilities to inform our modeling, measuring, and managing of health system “smartness.” Here, we introduce the concepts of organizational complexity, problem/issue complexity, and situational awareness as three codependent drivers of smart public health systems characteristics. We also propose seven smart public health systems measures and capabilities that are important in a public health informatics professional’s toolkit.

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Prevention of Congenital Transmission of Malaria in Sub-Saharan African Countries: Challenges and Implications for Health System Strengthening

Journal of Tropical Medicine ◽

10.1155/2012/648456 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Kayode O. Osungbade ◽

Olubunmi O. Oladunjoye

Keyword(s):

Health System ◽

Health Systems ◽

Preventive Measures ◽

Sub Saharan Africa ◽

Health System Strengthening ◽

African Countries ◽

Congenital Transmission ◽

Public Health Burden ◽

Sub Saharan ◽

Congenital Malaria

Objectives. Review of burden of congenital transmission of malaria, challenges of preventive measures, and implications for health system strengthening in sub-Saharan Africa.Methods. Literature from Pubmed (MEDLINE), Biomed central, Google Scholar, and Cochrane Database were reviewed.Results. The prevalence of congenital malaria in sub-Saharan Africa ranges from 0 to 23%. Diagnosis and existing preventive measures are constantly hindered by weak health systems and sociocultural issues. WHO strategic framework for prevention: intermittent preventive therapy (IPT), insecticide-treated nets (ITNs), and case management of malaria illness and anaemia remain highly promising; though, specific interventions are required to strengthen the health systems in order to improve the effectiveness of these measures.Conclusion. Congenital malaria remains a public health burden in sub-Saharan Africa. Overcoming the challenges of the preventive measures hinges on the ability of national governments and development partners in responding to the weak health systems.

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Building a new platform to support public health emergency response in Africa: the AFENET Corps of Disease Detectives, 2018–2019

BMJ Global Health ◽

10.1136/bmjgh-2020-002874 ◽

2020 ◽

Vol 5 (10) ◽

pp. e002874

Author(s):

Ben Masiira ◽

Simon N Antara ◽

Herbert B Kazoora ◽

Olivia Namusisi ◽

Notion T Gombe ◽

...

Keyword(s):

Public Health ◽

Health Workforce ◽

Health Workers ◽

Rapid Response Team ◽

Public Health Emergency ◽

Sub Saharan Africa ◽

Public Health Workforce ◽

Health Security ◽

Field Epidemiology ◽

Sub Saharan

Public health emergency (PHE) response in sub-Saharan Africa is constrained by inadequate skilled public health workforce and underfunding. Since 2005, the African Field Epidemiology Network (AFENET) has been supporting field epidemiology capacity development and innovative strategies are required to use this workforce. In 2018, AFENET launched a continental rapid response team: the AFENET Corps of Disease Detectives (ACoDD). ACoDD comprises field epidemiology graduates and residents and was established to support PHE response. Since 2018, AFENET has deployed the ACoDD to support response to several PHEs. The main challenges faced during ACoDD deployments were financing of operations, ACoDD safety and security, resistance to interventions and distrust of the responders by some communities. Our experience during these deployments showed that it was feasible to mobilise and deploy ACoDD within 48 hours. However, the sustainability of deployments will depend on establishing strong linkages with the employers of ACoDD members. PHEs are effectively controlled when there is a fast deployment and strong linkages between the stakeholders. There are ongoing efforts to strengthen PHE preparedness and response in sub-Saharan Africa. ACoDD members are a competent workforce that can effectively augment PHE response. ACoDD teams mentored front-line health workers and community health workers who are critical in PHE response. Public health emergence response in sub-Saharan Africa is constrained by inadequacies in a skilled workforce and underfunding. ACoDD can be utilised to overcome the challenges of accessing a skilled public health workforce. To improve health security in sub-Saharan Africa, more financing of PHE response is needed.

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