Health and Healthcare Systems

Here's how Africa can fight the COVID-19 pandemic 

A health worker wearing a protective suit takes a swab from a resident during a door-to-door testing in an attempt to contain the coronavirus disease (COVID-19) outbreak, in Umlazi township near Durban, South Africa, April 4, 2020. REUTERS/Rogan Ward - RC2QXF99ZXLQ

African governments face numerous challenges, including limited resources and healthcare systems Image: REUTERS/Rogan Ward

Arkebe Oqubay
Senior Minister and Special Adviser to the Prime Minister , Ethiopia
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  • COVID-19's impact on Africa could be much worse than in other parts of the world.
  • African countries face significant challenges in tackling the virus.
  • Policymakers should learn lessons from other countries' responses to the crisis.

The COVID-19 death toll is still mounting in the developed West, but the pandemic’s impact on Africa could be much worse. African and international leaders must act boldly, decisively, and immediately to prevent a catastrophe.

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Many African countries were ill-prepared to tackle the Ebola epidemic that erupted in 2014. And COVID-19 presents a much graver danger because it can spread exponentially, including via asymptomatic carriers, while African governments remain constrained by weak health-care systems, limited resources, and economic and spatial constraints on social-distancing measures.

Since Egypt reported Africa’s first confirmed case of COVID-19 on February 14, the number of cases has risen to more than 10,000, with Algeria, Egypt, Morocco, and South Africa each recording over 2,000. The continent’s death toll already exceeds 500, implying a mortality rate well above the global average. This high death rate, together with the low number of confirmed cases, may reflect Africa’s very low rate of COVID-19 testing.

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Many African governments have signaled a readiness to respond to the pandemic. But designing measures that reflect reality, and ensuring that they are effective, will be difficult. Under South Africa’s national lockdown, for example, the country’s most vulnerable social groups are struggling to feed their families, cannot wash their hands regularly because they have no access to clean water, and cannot self-isolate if they live in crowded slums.

Other African countries – with far less developed social-welfare systems than South Africa – face even bigger challenges. According to the World Health Organization, the continent has just 1.06 nurses and midwives for every 1,000 inhabitants. And current evidence suggests that the belief that Africa’s tropical climate will help to suppress the coronavirus is a myth.

In the coming weeks and months, millions of Africans may become infected with COVID-19. Researchers at Imperial College London recently estimated that, even under the most optimistic scenario, the virus would kill 300,000 people in Sub-Saharan Africa – not to mention the immense economic costs it would impose, owing to lost export revenues, severed supply chains, and plummeting demand.

African governments therefore must make COVID-19 their top priority, and urgently design and implement ambitious, well-informed policies to combat it. After all, international support – although much-needed – is no substitute for resolute national action.

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For starters, African leaders must learn from countries that have already experienced the pandemic, in the way that South Africa is drawing lessons from South Korea. Furthermore, it is vital that governments collaborate effectively, share their experiences of tackling the virus, mobilize experts – both local and from the diaspora – and strengthen their coordination with the WHO.

Indeed, every African government should coordinate action by private and public actors and civil society, but without resorting to force. And while governments should establish wartime-like organizational structures and seek to maximize coordination among national and local agencies, they should not use the crisis as an excuse permanently to constrain or remove individual freedoms. Rather, political leaders should encourage the public to hold them accountable for their management of the public-health crisis, and accept checks and balances on government power.

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Africa has just 1.06 nurses and midwives for every 1,000 inhabitants Image: World Health Organization

Managing the coming economic crisis also will be critical. This means reducing the damage to the most dynamic sectors as much and as early as possible, because more productive activities have bigger spillover effects and are crucial for recovery and large-scale employment. The biggest mistake would be to place all economic activities on an equal footing and try to make everyone happy.

Instead, policymakers should focus on export industries, which are vital to ensure foreign-exchange liquidity, ease balance-of-payments constraints, and generate employment. Encouraging services exports and high-value service activities is also critical, as is ensuring affordable food supplies.

Current and former African leaders, prominent international figures such as former UK prime minister Gordon Brown, and organizations such as the International Monetary Fund have called for greater international cooperation to support Africa. But if the virtual G20 meeting in March is any indication, governments’ current appetite for such efforts appears limited.

Nonetheless, international action is essential and must be guided by several critical principles. First, any support needs to focus on emergency health measures to help African countries to control the pandemic. Second, international cooperation must include development assistance to help countries manage economic crisis and humanitarian needs. It should also include support for foreign-exchange liquidity in order to limit insolvency and protect essential economic activities. And an economic-stimulus package, including a large new issue of IMF Special Drawing Rights and favorable terms for developing countries, is essential to a faster recovery.

Third, debt relief is indispensable. With their exports hard hit, African countries will not be able to afford the $50 billion of debt payments that fall due this year. IMF and World Bank shareholders therefore should take the lead in waiving debt service for the coming years, not just for 2020.

Debt relief and new funding should be most generous for those African countries (typically non-resource-rich and less politically strategic) that are least able to borrow in commercial markets and least able to spend on building health-care systems. And while accountability is important, it would be wholly inappropriate to make such assistance conditional on specific market reforms.

Above all, the response to Africa’s COVID-19 plight must be rapid and at scale. In a world where progressive global leadership is in short supply, and where rules-based global governance is under threat, this is a chance for African and international policymakers to take decisive action.

South African President Cyril Ramaphosa is showing the way in this regard, and not merely by acting swiftly at home. In his role as the African Union’s Chair, he has appointed four of the continent’s most respected leaders – Ngozi Okonjo-Iweala, Donald Kaberuka, Tidjane Thiam, and Trevor Manuel – as special envoys to negotiate debt relief. If the crisis in Africa is to be halted, similar dynamism will be needed elsewhere.

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