Resilience in the perspective of health systems strengthening after COVID19: has Africa really been spared by the pandemic?

Albert ZE, Ph.D, Research Institute for Heath and Development (IRESADE)

Introduction

At the end of December 2019, the world discovered with amazement a virus coming straight from Asia with a certain impact on global economies that is still perceptible today. The first quarter of 2020 marked its expansion in almost all countries around the world with various economic impacts.

Depending on the structure of the economies, the countries of the South and particularly Africa have been the subject of great concern from all informed observers around the world, given the fragility of the economic and health systems. Nearly four years after the outbreak of the virus, and several months or even a year later a certain lull, we would like to return to the contrast between the predictions and the reality observed within the economies of the African continent.

From the first cases of COVID-19 in Africa, the gloomiest predictions were made about the coming health and economic catastrophe on the continent, due to a number of characteristics believed to favor the spread of the epidemic.

The situation of the covid19 crisis in Africa: gap between prediction and reality

In April 2020, the World Health Organization (WHO) warned that Africa could become the epicenter of the Coronavirus with up to 10 million cases in the six months following the appearance of the pandemic. In the Organization's most optimistic scenario, Africa could record 122 million contaminations, 2.3 million hospitalizations and 300,000 deaths. For its part, the United Nations Commission for Africa (ECA) estimated on April 17, 2020 that the pandemic was to cause the death of around 300,000 people on the continent.

In mid-December 2020, the Covid19 epidemic in Africa did not experience an outbreak comparable to that which occurred on other continents. The African continent, which has more than a billion inhabitants, recorded approximately 2,170,843 cases and 51,915 deaths, Africa accounted for only 3.6% of the world's recorded cases. These results are much lower than those of Europe, Asia or the Americas. We were far from the forecasts established in the first months after the appearance of the first cases.

Low impact of covid19 in Africa: can the explanation came from the level of health systems resilience?

The question of the low impact on the Covid19 crisis on the African continent has continued to animate debates a few months after the appearance of the first cases on the continent. Several studies have attempted to provide answers to this concern which very quickly became global.

To this end, four lines of explanation have been put forward:

• A rapid response with, for example, systematic temperature checks at airports. The quarantine, in many countries on the continent, of passengers arriving from China. The closure of countries intries points and the implementation of response plans after the first cases…etc.
• Better preparation: with a large part of the continent continually facing health problems, populations have adopted behaviors that can help limit the spread of the virus
• A specific context: in this case, the explanation focused on the climate, which through heat would be unfavorable for the virus, which has never been scientifically demonstrated. However, other factors are being studied, namely the youth of the population and the difference in lifestyles with northern countries.
• A special humanity. A high level of vitamin D in the bodies of Africans emerges as an explanation at this level. This vitamin is provided in particular by exposure to the sun, this being more the case in Africa than in Europe.

It must be admitted that all of these remain strong hypotheses when we see the alarming results of the Ebola and Cholera epidemics in each episode.The temperature control had visible and palpable limits. Furthermore, the implementation of the response after the occurrence of the first cases constituted a major failure, because from that moment the countries began to run behind the virus due to the lack of preparation for prevention.

It is with this in mind that this study aims to assess the capacity of African health systems to respond to a shock such as the Covid19 crisis, in order to find an explanation for this concern.

After estimating the resilience index, it appears that all health systems in African countries are not resilience (Resilience nul). Which means that these systems are completely insensitive, because their ability to sense shock is non-existent. The loss of this capacity could therefore be an explanation for the low impact of covid19 on the continent.

It must be remembered that an insensitive health system (resilience nul) is in a state in which its properties can no longer be restored. This is explained, for example, by the strong recurrence of epidemics on the continent; but also in the context of the management of covid19, the weak mobilization in general.

In the case of health systems with resilience nul, it is quite possible that the crisis will take root deep within the population without this being visible. Indeed, in the context of a crisis like covid19, the more screening tests we carry out the more cases we have and the less we do the less we have. Overall, a country that has not carried out any testing will have no cases even though the virus is certainly circulating in the population. Thus, on this aspect of the tests, Africa has not been up to par compared to European countries, hence the low number of cases.

According to testing data, cumulatively since the start of the covid19 pandemic until August 2023, Africa has only carried out 93 tests per 1000 inhabitants; which remains significantly lower than all the countries where the situation was worrying (Graph).

We cannot therefore claim to have had fewer cases without having sufficiently tested the population.

This analysis can also be carried out in the case of epidemics such as cholera, a pathology which roams the population of several African countries without being worried. Most often, the number of patients is never controlled because the health systems of these countries do not feel the effects of the circulation of the disease.

Overall, African health systems do not always have the capacity to face with a crisis. Several efforts have been made, but these systems continue to experience one of the greatest difficulties which is their weak organization coupled with a structure that is poorly adapted to the socio-economic and cultural realities of the continent.

Because of this insensitivity, it cannot therefore be claimed that Africa has been less affected by the crisis, because there has been no real evaluation of the effects leading to precise conclusions.