Iberoamerican Journal of Medicine
Iberoamerican Journal of Medicine

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

Bamidele Johnson Alegbeleye, Rana Kadhim Mohammed

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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.


COVID-19 Preparedness; SARS-CoV-2; Resource-Constrained Settings; HealthCare Systems; Sub-Saharian Africa


1. Kavanagh MM. Authoritarianism, outbreaks, and information politics. Lancet Public Health. 2020;5(3):e135-e136. doi: 10.1016/S2468-2667(20)30030-X.
2. Skrip LA, Selvaraj P, Hagedorn B, Ouédraogo AL, Noori N, Mistry D, et al. Seeding COVID-19 across sub-Saharan Africa: an analysis of reported importation events across 40 countries. medRxiv preprint. 2020. doi: 10.1101/2020.04.01.20050203.
3. A ticking time bomb’: Scientists worry about coronavirus spread in Africa. Science | AAAS. 2020; published online March 15. Available from: https://www.sciencemag.org/news/2020/03/ticking-time-bomb-scientistsworry-about-coronavirus-spread-africa (accessed March 31, 2020).
4. Gilbert M, Pullano G, Pinotti F, Valdano E, Poletto C, Boëlle PY, et al. Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study. Lancet. 2020;395(10227):871-7. doi: 10.1016/S0140-6736(20)30411-6.
5. e-SPAR Public. Available from: https://extranet.who.int/e-spar (accessed March 27, 2020).
6. Global Health Security Index, Building Collective Action and Accountability. Center for Health Security, Johns Hopkins Bloomberg School of Public Health, 2019. Available from: https://www.ghsindex.org/reportmodel/.
7. Moore M, Gelfeld B, Okunogbe A, Christopher P. Identifying Future Disease Hot Spots: Infectious Disease Vulnerability Index. Rand Corporation, 2016. Available from: https://play.google.com/store/books/details?id=YNO1DQAAQBAJ.
8. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi: 10.1001/jama.2020.2648.
9. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020. doi: 10.1056/NEJMoa2002032.
10. de-Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global. Global Health. 2010;6:5. doi: 10.1186/1744-8603-6-5.
11. Azevedo M, Alla S. Diabetes in sub-saharan Africa: Kenya, Mali, Mozambique, Nigeria, South Africa and Zambia. Int J Diabetes Dev Ctries. 2008;28(4):101-8. doi: 10.4103/0973-3930.45268.
12. Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 2017;5:622-67. doi: 10.1016/S2213-8587(17)30181-X.
13. Mbithi A, Gichangi A, Kim AA, Katana A, Weyenga H, Williamson J, et al. Tuberculosis and HIV at the national level in Kenya: results from the Second Kenya AIDS Indicator Survey. J Acquir Immune Defic Syndr. 2014;66 Suppl 1:S106-15. doi: 10.1097/QAI.0000000000000120.
14. Murray CJL, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):1005-70. doi: 10.1016/S0140-6736(14)60844-8.
15. Kenya police under fire over ‘excessive force’ as curfew begins. Al Jazeera. Available from: https://www.aljazeera.com/news/2020/03/kenya-police-fire-excessive-force-curfew-begins200328101357933.html (accessed March 30, 2020).
16. Coronavirus Prevention Measures Turn Violent in Parts of Africa as Nations Go Into Lockdown. Time 2020; published online March 28. Available from: https://time.com/5811945/coronavirus-prevention-africa/ (accessed March 30, 2020).
17. COVID-19 Educational Disruption and Response. UNESCO. 2020; published online March 4. Available from: https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures (accessed March 30, 2020).
18. Africa: SA in lockdown, curfews in the west as continent braces for Covid-19 wave. RFI. 2020; published online March 24. Available from: http://www.rfi.fr/en/africa/20200324-lockdown-curfew-restrictionsafrica-coronavirus-covid-19 (accessed March 30, 2020).
19. Salcedo A, Cherelus G. Coronavirus Travel Restrictions, Across the Globe. The New York Times. 2020; published online March 15. Available from: https://www.nytimes.com/article/coronavirus-travel-restrictions.html (accessed March 30, 2020)
20. Randall VR. Current Challenges to Effective Communicable Disease Control - Bioterrorism, Public Health and the Law; Law 801: Health Care Law Seminar- excerpted from: Lawrence O. Gostin, Scott Burris, Zita Lazzarini, the Law and the Public's Health: a Study of Infectious Disease Law in The United States, 99 Columbia Law Review 59-118, 89-101 (January, 1999) (271 Footnotes)
21. Paintsil E. COVID-19 threatens health systems in sub-Saharan Africa: the eye of the crocodile. J Clin Invest. 2020. doi: 10.1172/JCI138493.
22. Woo PC, Lau SK, Lam CS, Lau CC, Tsang AK, Lau JH, et al. Discovery of seven novel Mammalian and avian coronaviruses in the genus deltacoronavirus supports bat coronaviruses as the gene source of alphacoronavirus and betacoronavirus and avian coronaviruses as the gene source of gammacoronavirus and deltacoronavirus. J Virol. 2012;86(7):3995-4008. doi: 10.1128/JVI.06540-11.
23. Li W, Shi Z, Yu M, Ren W, Smith C, Epstein JH, et al. Bats are natural reservoirs of SARS-like coronaviruses. Science. 2005;310(5748):676-9. doi: 10.1126/science.1118391.
24. Gouilh MA, Puechmaille SJ, Gonzalez JP, Teeling E, Kittayapong P, Manuguerra JC. SARS Coronavirus ancestor's foot-prints in South-East Asian bat colonies and the refuge theory. Infect Genet Evol. 2011;11(7):1690-702. doi: 10.1016/j.meegid.2011.06.021.
25. Tong S, Conrardy C, Ruone S, Kuzmin IV, Guo X, Tao Y, et al. Detection of novel SARS-like and other coronaviruses in bats from Kenya. Emerg Infect Dis. 2009;15(3):482-5. doi: 10.3201/eid1503.081013.
26. Hu B, Zeng LP, Yang XL, Ge XY, Zhang W, Li B, et al. Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus. PLoS Pathog. 2017;13(11):e1006698. doi: 10.1371/journal.ppat.1006698.
27. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. doi: 10.1056/NEJMoa2001017.
28. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-74. doi: 10.1016/S0140-6736(20)30251-8.
29. Li F. Structure, Function, and Evolution of Coronavirus Spike Proteins. Annu Rev Virol. 2016;3(1):237-61. doi: 10.1146/annurev-virology-110615-042301.
30. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3. doi: 10.1038/s41586-020-2012-7.
31. Makoni M. Africa prepares for coronavirus. Lancet. 2020;395(10223):483. doi: 10.1016/S0140-6736(20)30355-X.
32. World Health Organization.. Update on COVID-19 in the Eastern Mediterranean Region Feb, 16, 2020. Available from: http://www.emro.who.int/media/news/update-on-covid-19-in-the-eastern-mediterranean-region.html. Accessed March 30, 2020.
33. Control NCoD. An update of COVID-19 outbreak in Nigeria 2020. Available from: https://ncdc.gov.ng/diseases/sitreps/?cat=14&name=An%20update%20of%20COVID19%20outbreak%20in%20Nigeria. Accessed March 30, 2020.
34. Patel KS, Rathic JC, Raghuvanshib K, Dhimana N. Coronavirus (SARS-CoV-2): Preventions, keys to diagnosis and treatment of SARS-CoV-2. Iberoam J Med. 2020. doi: http://doi.org/10.5281/zenodo.3715266.
35. Rodriguez-Morales AJ, Cardona-Sospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and metaanalysis. Travel Med Infect Dis. 2020;101623. doi: 10.1016/j.tmaid.2020.101623.
36. World Health Organization. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/globalresearch-on-novel-coronavirus-2019-ncov
37. Favre G, Pomar L, Qi X, Nielsen-Saines K, Musso D, Baud D. Guidelines for pregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis. 2020. doi: 10.1016/S1473-3099(20)30157-2.
38. Scientific American. Available from: https://www.scientificamerican.com/article/how-chinas-bat-woman-hunteddown-viruses-from-sars-to-the-new-coronavirus1/
39. Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-9. doi: 10.1038/s41586-020-2008-3.
40. Ayebare R, Waitt P, Okello S, Kayiira M, Ajok MA, Nakatudde I, et al. Leveraging investments in Ebola preparedness for COVID-19 in sub-Saharan Africa (Open Letter). AAS Open Research 2020;3:3. Last updated: 20 Mar 2020. doi: https://doi.org/10.12688/aasopenres.13052.1.
41. World Health Organization: Ebola Operational Readiness and Preparedness-Preparedness Map. Available from: https://apps.who.int/ebola/preparedness/map. (Accessed on 02 Feb 2020).
42. Biedron C, Lyman M, Stuckey MJ, Homsy J, Lamorde M, Luvsansharav UO, et al. Evaluation of Infection Prevention and Control Readiness at Frontline Health Care Facilities in High-Risk Districts Bordering Ebola Virus Disease-Affected Areas in the Democratic Republic of the Congo - Uganda, 2018. MMWR Morb Mortal Wkly Rep. 2019;68(39):851-4. doi: 10.15585/mmwr.mm6839a4.
43. WHO: Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). 30 January 2020 Statement, Geneva, Switzerland. Available from: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
44. Huber C, Finelli L, Stevens W. The Economic and Social Burden of the 2014 Ebola Outbreak in West Africa. J Infect Dis. 2018;218(Suppl 5):S698-S704. doi: 10.1093/infdis/jiy213.
45. Parpia AS, Ndeffo-Mbah ML, Wenzel NS, Galvani AP. Effects of response to 2014-2015 Ebola outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerg Infect Dis 2016;22(3):433-41. doi: 10.3201/eid2203.150977.
46. Walker PG, White MT, Griffin JT, Reynolds A, Ferguson NM, Ghani AC. Malaria morbidity and mortality in Ebola-affected countries caused by decreased healthcare capacity, and the potential effect of mitigation strategies: a modelling analysis. Lancet Infect Dis 2015;15(7):825-32. doi: doi: 10.1016/S1473-3099(15)70124-6.
47. Assessment Capabilities Project. Brief paper: Ebola impact on health systems. Geneva, Switzerland: Assessment Capabilities Project, 2015.
48. Bartsch SM, Gorham K, Lee BY. The cost of an Ebola case. Pathog Glob Health. 2015;109(1):4-9. doi: 10.1179/2047773214Y.0000000169.
49. Mohammed H, Vandy AO, Stretch R, Otieno D, Prajapati M, Calderon M, et al. Sequelae and other conditions in Ebola virus disease survivors, Sierra Leone, 2015. Emerg Infect Dis. 2017;23(1):66-73. doi: 10.3201/eid2301.160631.
50. Wang M, Cao R, Zhang L, Yang X, Liu J, XU M. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research. 2020;30(3):269-71; doi: 10.1038/s41422-020-0282-0.
51. Mulangu S, Dodd LE, Davey RT Jr, Tshiani Mbaya O, Mukadi D, Lusakibanza Manzo M, et al. A randomized, controlled trial of ebola virus disease therapeutics. N Engl J Med. 2019;381(24):2293-303. doi: 10.1056/NEJMoa1910993.
52. Yan L, Hai-Tao Z, Yang X, Maolin W, Chuan S, Jing L, et al. Prediction of criticality in patients with severe Covid-19 infection using three clinical features: a machine learning-based prognostic model with clinical data in Wuhan. medRxiv 2020;02.27.20028027. doi: https://doi.org/10.1101/2020.02.27.2002 8027.
53. Zumla A, Chan JF, Azhar EI, Hui DS, Yuen KY. Coronaviruses - drug discovery and therapeutic options. Nat Rev Drug Discov. 2016;15(5):327-47. doi: 10.1038/nrd.2015.37.
54. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924. doi: 10.1016/j.ijantimicag.2020.105924.
55. Yang Y, Islam MS, Wang J, Li Y, Chen X. Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective. Int J Biol Sci. 2020;16(10):1708-17. doi: 10.7150/ijbs.45538.
56. Lee PI, Hu YL, Chen PY, Huang YC, Hsueh PR. Are children less susceptible to COVID-19? J Microbiol Immunol Infect. 2020. doi: 10.1016/j.jmii.2020.02.011.

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