This is an interesting paper from authors at the Nigeria Centre for Disease Control. Citation, abstract, key messages, selected extracts - and a comment from me below. The full text is open access and available here: https://innovations.bmj.com/content/7/2/347
CITATION: Ochu CL, Akande OW, Oyebanji O, et al. ‘Fighting a Global War Using a Local Strategy’: contextualism in COVID-19 response in Africa. BMJ Innovations 2021;7:347-355.
Correspondence to Dr Oluwatosin Wuraola Akande: email@example.com
With a considerably high level of poverty, high population density and relatively fragile health systems, most African countries have a predominance of factors that could contribute to the rapid spread of the COVID-19 pandemic. Despite these challenges, the continent has shown capacity in its response to the pandemic. This may be related to the continent’s experience in responding to several infectious disease outbreaks such as Ebola disease, Lassa fever and cholera. Since the beginning of the COVID-19 pandemic, several local innovations have been developed and implemented. These innovations take into consideration unique circumstances in countries such as multiple government levels, belief in traditional medicine, limited access to medical supplies and others. This paper describes the various strategies developed in African countries across leadership and coordination, surveillance, laboratory capacity, case management, infection, prevention and control, risk communications, points of entry, research, logistics and supply chain, partnership, food security and education. We highlight the impact of these strategies on the response so far, and lessons that other regions across the world can learn from Africa’s response to COVID-19. Finally, we recommend the urgent need for increased investment in African health and social institutions to enable the development of African-owned and led strategies in response to disease outbreaks.
What is already known?
- The African continent has arguably outperformed the predicted trajectory of the COVID-19 pandemic.
- In response to the pandemic, there is a surge in innovative strategies and capacities.
What are the new findings?
- Country-developed strategies and innovations are being used across countries in Africa.
- Countries should be empowered to implement indigenous solutions tailored to unique challenges.
There has been widespread misinformation and myths regarding the pandemic in Nigeria such as the virus being a hoax. Addressing misinformation, various strategies were adopted which include collaboration with non-government, non-partisan fact-checking organisations and public health associations to debunk rumours and misinformation. Video documentaries and human interest stories were also disseminated, including stories from HCWs, patients and survivors. Cartoons and opinion pieces targeted towards different segments of the population were designed and distributed via social and traditional media. Innovative community engagement strategies such as coproduction of risk communication strategies, audio diagnosis of jingles (playing jingles to community groups and receiving feedbacks), use of trusted voices, community volunteers and town criers all facilitated risk communication in Nigeria. Other African countries faced similar myths and misinformation challenges. To combat these challenges, a South African private firm created a pro bono WhatsApp bot that disseminates timely and accurate information to the public in multiple languages...
As the outbreak progressed with community transmission of the virus, transition to home-based care (HBC) for asymptomatic and mild cases was made to avoid overburdening the healthcare system. NCDC developed an HBC handbook to guide patients, their relations and caregivers on safe practice of this innovative strategy.31
African countries have explored the use of local herbs as traditional remedies for COVID-19, although with varying levels of scientific scrutiny. While many herbal remedies are self-acclaimed and yet to undergo preclinical and clinical trials, some are in advanced stages of research and development and very few have completed phase II clinical trials.26 The novelty of the outbreak and high cost of conventional antiviral agents have spurred many African countries into a scientific spree in search of possible cost-effective local herbal remedies.
'The African continent has arguably outperformed the predicted trajectory of the COVID-19 pandemic.' Many African countries have seen (as yet) relatively fewer cases and deaths from COVID-19 as compared with Europe and the Americas. But it is hard to attribute this directly to a difference in strategies and innovations, and harder still to know which strategies might have had an impact. Interestingly, the article does not discuss 'maintaining essential health services', except to note that 'home-based care for asymptomatic and mild cases was made to avoid overburdening the healthcare system'.
On HIFA we have noted that provision of essential health services in some African countries has been substantially impacted during the pandemic *despite* relatively low COVID-19 case numbers. My concern is that any future surge in sub-Saharan Africa would have disproportionate effects on already weak health systems, with potentially devastating consequences.
Best wishes, Neil
Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19
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