Capacity Building in African Healthcare Response

During the world-wide lockdown in the first quarter of 2020 – I was activated to serve in California Public Health response, in both civilian and military disaster response. Part of my duties were to support over surging hospitals, with creating or building outside hospital structures (like Alaskan Shelters tent clinics) and outfitting them with hospital equipment. A majority of my time was invested in supplying healthcare licensed clinicians to help relieve overwhelmed medical staff. My other project was in creating and running alternative COVID-19 hospitals, with over 100 staff under my command. During my response, there were systems that contributed to our high level of effectiveness. These systems included asset accountability databases and surveillance systems that delivered real number of active cases. This enabled us in real time to respond directly to communities with the most impact. Another capability that helped in response was the strong collaboration that existed with local, state, and federal agencies, under the joint force response incident command system.

In service – I have been trained to have the mindset of integrity first, service before self, and excellence in all I do. I am a full believer in this core value statement. However, I did have my own burden that boiled within, with no one or system to go to for answers. The personal problem was that my own mother was on lockdown in Nigeria – West Africa, and my own brothers and sisters with their kids were in Nigeria as well. I have my wife and 2 kids here in California, and there were months that I could not make it home. But my entertained fear for family members in Nigeria took a toll on me, and my service mentally, since they were far away, and out of reach, as there was no way to get to them or for them come to me. This was due to of all international Airports' operations closing in compliance to Public Health no fly instructions.

My concern has been for the very poorest, most vulnerable populations of countries in Africa. I looked for data that could report in real time, COVID-19 transmissions. The only data that were available was when somebody got hospitalized, because testing clinics were not as available or affordable as most western people enjoyed. Nigeria, for example charged the equivalent of $75 to 125 per PCR [polymerase chain reaction] test [1], I am sure other African countries have similar patterns. The practice of paying for COVID-19 testing will further increase lack of access to testing. The lack of access, and the chance that many have died without even getting a chance to be diagnosed baffles me.

Response – One thing I have learned in this pandemic is that we have consistently taken responses from western and high-income countries and assumed that they could be applied to low – and middle – income countries. For example, the idea of lockdowns was to scale up PCR, or molecular, testing – those things are simply not possible in the places I know in African countries.

Let’s think about Rivers State Nigeria. In Rivers, you have remote communities that can only be reached by a boat or small plane. PCR testing only happens in the Capital because that is where the lab capacity is. If somebody in a remote community comes into a local health clinic with a COVID-19 like symptom (a fever and a cough), even if a nasal swab test is available, you must get that swab onto a boat or small plane that may only fly one day a week (depending on budgetary capacity) to a major capital hospital. Then somebody will run the PCR. Eventually, you get a result, but by the time you get the result back to the patient in the remote rural region, it is irrelevant.

Or take the military base camp in Kogi, Nigeria. What does it mean for a military base camp to have “work at home” and lockdown? Say you did have a surveillance system in that setting, and you identify an outbreak of COVID-19. There is no ICU [intensive care unit]. There are no ICU providers. There are no ventilators. What exactly is the appropriate action item arising from the surveillance system? Even with the best data, even with the best analytics, if your intent is to have a public health impact but there are no public health interventions available, then what are you trying to achieve with your skeletal science? If you want to make a difference in the real world, among the populations that you care about – in my case, vulnerable populations – if there is no intervention resulting from even the most rigorous surveillance, then what are we doing?

I am deeply worried about the impact of global health and the poorest populations. They are going to be crippled by this pandemic, because of famine, crushing poverty, mental health problems, and humanitarian aid pipelines drying up.

With the divide in healthcare education, care, and lack in facilities, we will see measles and polio outbreaks because their vaccination programs have been paused. Infectious disease is not like other kinds of disease. If you lose traction for a year, then you’ve lost control of the whole thing. Controlling malaria, for example, requires constant and continuous application of interventions. One year of stand down, and you have lost years and years of progress. That is because the nature of infectious disease is nonlinear.[2] COVID is a terrible crisis. What is even more of a crisis is that other pathogens are going to come back to bite us.

Challenges – Africa faces a dual health crisis that will be exacerbated by COVID-19: a high long-standing disease burden and broken fragile health systems. The continent bears nearly twice the disease burden per capita, measured by disability-adjusted life years (DALYs), compared to the rest of the world. For example, Tuberculosis and HIV/AIDS are widespread, and Africa accounts for 94 percent of all malaria deaths, while mother and child deaths are fourfold higher than in other regions. These existing comorbidities could worsen the severity of COVID-19 on the continent.[3]

At the beginning of the pandemic, everything I did was very operational. I had planned on writing articles, and producing short video contents, but there was no time to complete those tasks. I was working behind the scene, basically day and night, day and night, 13 hour-days – 7 days a week, no-breaks – for months.

As the pandemic unfolds with re-emerging variants, so too is an awakening to the deeper challenges facing Africa’s healthcare systems. A broader spectrum of stakeholders are keenly facing the consequences of chronic underinvestment, and the crisis brings a renewed sense of urgency to create momentum around health-system reform and re-imagination across the continent.

?Action – African healthcare developers need to choose where and how to realize maximum impact and value. I will share five breakthrough ideas that could create impact across all countries, with short and longer-term benefits. The five ideas for your consideration are as follows:

·????????Idea 1: Build up emergency preparedness and response systems – Example, Emergency Operation Centers.

·????????Idea 2: Accelerate health financing reforms in Africa to increase budgets, accountability, advance planning, and efficiency.

·????????Idea 3: Build patient-centered digital health ecosystems – Helps in efficient workflow improvements, innovations, allocation of resources, and scaling up services.

·????????Idea 4: Ensure reliable access to high-quality medical commodities and equipment – This will rebuild trusts, ensures the safety of both staff and patients, and attract more consumers.

·????????Idea 5: Increase pay for Community Health Workers, upskill the broader healthcare workforce, and build massive retention plan to keep your high skilled clinicians in country.

Conclusion -Time will not permit me to unpack each of these ideas. However, these ideas are attainable, and number of countries are already implementing them, I can attest from work experience that these ideas are practical means to build capabilities, and to respond to disasters or emerging public health outbreaks. The success and the future sustainability of these ideas depends upon how funding is used. As well as setting up protected funds for emergencies, governments and or investors could also allocate funding to build and maintain the infrastructure and its ongoing management. Training funds will be needed to build up capabilities within the national health system and ensure that individuals and groups are well prepared for future outbreaks.?