The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response

Abstract

BackgroundThe COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic.MethodsWe conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O’Malley’s methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed.ResultsTwenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings.ConclusionsThe health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised.

Demographic and professional risk factors of COVID-19 infections among physicians in low- and middle-income settings; findings from a representative survey in two Brazilian states

“…It was also surprising to see similar odds of infections among public and private sectors physicians, particularly as publicly funded health systems are believed to have borne the brunt of the COVID-19 pandemic (45,46), particularly in Brazil. (47) In the case of Brazilian’s physicians it is more likely that blurred boundaries between public and private employment may have made it difficult to accurately distinguish between physicians of the Unified National Healthcare System (SUS), from those of the private sector.…”

“…But it is also likely that the definition of what constitute 'frontline health services' may not be that clear-cut, particularly in LMICs settings during an epidemic, where boundaries and functions become blurred, and health workers end up carrying out whatever functions are needed. It was also surprising to see similar odds of infections among public and private sectors physicians, particularly as publicly funded health systems are believed to have borne the brunt of the COVID-19 pandemic(45,46), particularly in Brazil (47). In the case of Brazilian's physicians it is more likely that blurred boundaries between public andprivate employment may have made it difficult to accurately distinguish between physicians of the Unified National Healthcare System (SUS), from those of the private sector.…”

Epidemiology, Clinical Characteristics, and Mortality of Hospitalized Patients with Severe COVID-19 in Uganda, 2020–2021

“…Little is known about the clinical epidemiology of severe COVID-19 in sub-Saharan Africa (SSA), a high HIV-burden region where vaccine coverage remains poor and surges of COVID-19 have overwhelmed under-resourced health systems (1)(2)(3)(4). We sought to determine the epidemiology, clinical characteristics, and outcomes of patients with severe COVID-19 admitted to a national COVID-19 referral hospital in Uganda during 2020-2021.…”

The Governance of Pandemics in Primary Health Care: The Governance Strategies Adopted by Health Facility Governing Committees in Times of COVID Pandemic in Tanzania

“…Indeed, the DHFF arrangement has empowered HFGCs to come out with several interventions such as financial allocation and planning that could not be possible initiated prior to DHFF implementation [5], [37]. As suggested by [1], [38] frequently strengthening governance institutions are fundamental for proving relevant governance decisions in times of pandemics. This is the impact of DHFFin the decisions that have been made by some of the health facilities in addressing the COVID 19 pandemic.…”