Advancing a Pandemic Preparedness, Readiness and Resilient Culture in Africa: My Experience from The Work in 25 African Countries

Establishing resilient social protection systems and structures translate into social-bio-cultural transformation which in turn contribute to human capital development in Africa.

Ecosystems that facilitate engagement in efforts where all people have access to the full range of services they need, when and where they need them without housing, food and financial hardships, require a high fidelity, commitment, empowered communities and political will.

There is need to address inadequate numbers of trained health workers, rationalising salaries for health workers, shortage of essential drugs, poor attitude of the health workers, modernising health and development systems, high health costs, and long distances to health facilities, underfunding, understaffing, poor deployment, inconsistent equipment, devices and drug distribution, this would translate into Pandemic Preparedness and Resilience (PPR), climate-change countermeasures, quality integrated service delivery, and strong social protection.

In the case of Pandemic Preparedness and Resilience (PPR): the different governments have a centralised platform updating health response to the pandemic; a database with self-reported data by the different governments; external evaluations organised by the AU’s CDC and WHO; Central governments are constitutionally mandated and obligated to provide basic health services and to promote good health and wellbeing; updating the Global Health Security Index; Individuals, charities, and private organisations supported to provide health care; public funding of health care focused on health promotion and prevention of diseases; central governments support policy formulation, technical guidance, oversight over how private sector and local authorities deliver services; private sector and non-governmental organisations supported to become the key providers of health and social services.

Primary Health Care and decentralisation up to village level are the planned, publicly accessible systems and structures funded through user charges, philanthropy, extended family support, self-help groups, associative collateral, remittances and money from taxation.

The services include integrated referral networks, medical, food, technologies, equipment, linkage to care and knowledge and provides wide coverage of most mainstream social, cultural, biological, medical, political, economic, gender, civic, structural and legal services. Single-issue advocacy needs to be replaced with multi-issue advocacy.

Ideally multi-systems and structures should offer social, economic and financial protection against climate change, disasters, crises, cataclysms and catastrophic costs that may ensure good health and wellbeing, housing stability, food security and livelihoods.

The services have been affected by forces of marketisation and commodification. The quality life promoting services affect social-bio-cultural transformation. The services are riddled with challenges in the form of access, availability, affordability and acceptability. Most cited reasons are: transport fares, mobility, long distances, costs, preferences, political affinity, long waiting times, service quality.

I have worked in 25 African countries and asked a simple question about COVID-19 Vaccination. This informed my vaccine uptake and hesitancy reports for the 25 countries. COVID-19 vaccination in most countries is low because of many reasons. Vaccination is a key to breaking the cycle of progression for most vaccine-preventable diseases. There is a range of players, stakeholders, systems and structures that need to be in place facilitating vaccine development, roll out, engagement in life promoting practices and creating good health and wellbeing seeking culture.

Self-reporting, Village Health Teams, Health Volunteers, Community Change Agents and other Social Development Actors are some of the first points of contact with a service provider who in turn escalates the demand for interventions appropriately. Three forms of service delivery structures exist: a gate-keeper approach; social-welfare offices and central department outreach services.

COVID-19 is still treated as an emergency, primary service with standard protocols to follow once there is a positive diagnosis; this is within the call for vaccination and several vaccination points are in places where the public can access these services. Secondary and tertiary services include: food provision, housing stabilising initiatives, care and prescription medicines, technologies and devices.

What is prevailing is rooted in economic status; complacence; lackadaisical political will to invest in, say, PPR by governments; a shifting interest in vaccine manufacturing; overwhelmed but poorly facilitated local administrations; irrational detailing of PPR-related local planning; and facilitation levels of oversight and logistical deliveries. This has repercussions.

Low investment in national health insurance coverage in many African countries, existence of private health insurance provided by insurance companies and accessible to few elites. Inequalities continue to be a fundamental challenge for aspirations such as PPR.

Inequalities arise due to a lack of effort for demand creation at grassroots-based communities, co-morbidities, poorly planned and built structures, long distances to specialised service points, remoteness, reproductive, maternal, child and adolescent health, financial hardship and pay out of pocket for health care. Poor facilitation of monitoring and oversight platforms which would have reported health or development inequalities. This affects information provided to decision-makers who may lack evidence to formulate more equity-oriented policies, programmes and practices towards the progressive realization of better health and wellbeing goals. This data would have reflected gender inequalities, socioeconomic disadvantages, and specific issues faced by different populations and how they cope in the face of conflict and economic and environmental crises. Multi-issue advocacy in Africa sets the ground for addressing failures of market-based reforms. This in turn will cause social-bio-cultural transformation in communities.  

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