• 1.

    Lucero-Prisno DE, Adebisi YA, Lin X, 2020. Current efforts and challenges facing responses to 2019-nCoV in Africa. Glob Health Res Policy 5: 21.

    • Search Google Scholar
    • Export Citation
  • 2.

    Nkengasong JN, Tessema SK, 2020. Africa needs a new public health order to tackle infectious disease threats. Cell 183: 296300.

  • 3.

    Ogunkola IO, Adebisi YA, Imo UF, Odey GO, Esu E, Lucero-Prisno DE 3rd, 2020. Rural communities in Africa should not be forgotten in responses to COVID-19. Int J Health Plann Manage 35: 13021305.

    • Search Google Scholar
    • Export Citation
  • 4.

    Lucero-Prisno DE 3rd, Essar MY, Ahmadi A, Lin X, Adebisi YA, 2020. Conflict and COVID-19: a double burden for Afghanistan’s healthcare system. Confl Health 14: 65.

    • Search Google Scholar
    • Export Citation
  • 5.

    David KB, Adebisi YA, 2020. Proposed model for hospital and community pharmacy services during COVID-19 pandemic in Nigeria. Int J Pharm Pract 28: 544545.

    • Search Google Scholar
    • Export Citation
  • 6.

    Africa Centers for Diseases Control, 2020. Coronavirus Disease 2019 (COVID-19). Available at: https://africacdc.org/covid-19/. Accessed November 16, 2020.

  • 7.

    Adebisi YA, Alaran AJ, Akinokun RT, Micheal AI, Ilesanmi EB, Lucero-Prisno DE, 2020. Sex workers should not Be forgotten in Africa’s COVID-19 response. Am J Trop Med Hyg 103: 17801782.

    • Search Google Scholar
    • Export Citation
  • 8.

    Adebisi YA, Lucero Prisno DE III, 2020. Towards an inclusive health Agenda: people who inject drugs and the COVID-19 response in Africa. Public Health, doi: 10.1016/j.puhe.2020.10.017.

    • Search Google Scholar
    • Export Citation
  • 9.

    Maclachlan M, Khasnabis C, Mannan H, 2012. Inclusive health. Trop Med Int Health 17: 139141.

  • 10.

    Africa renewal, 2020. COVID-19: People with Disabilities Facing Tougher Times. Available at: https://www.un.org/africarenewal/magazine/coronavirus/april-2020-special-edition-covid-19/covid-19-people-disabilities-facing-tough-times. Accessed November 16, 2020.

    • Search Google Scholar
    • Export Citation
  • 11.

    Yap J, Chaudhry V, Jha CK, Mani S, Mitra S, 2020. Are responses to the pandemic inclusive? A rapid virtual audit of COVID-19 press briefings in LMICs. World Dev 136: 105122.

    • Search Google Scholar
    • Export Citation
  • 12.

    Gachohi J, Karanja S, Mwangi C, 2020. Challenges facing harm reduction interventions in the era of COVID-19 in Africa. Scientific Afr 9: e00506.

    • Search Google Scholar
    • Export Citation
  • 13.

    Muntingh LM, 2020. Africa, prisons and COVID-19. J Hum Rights Pract, doi: 10.1093/jhuman/huaa031.

  • 14.

    Pallangyo E, Nakate MG, Maina R, Fleming V, 2020. The impact of covid-19 on midwives’ practice in Kenya, Uganda and Tanzania: a reflective account. Midwifer 89: 102775.

    • Search Google Scholar
    • Export Citation
  • 15.

    Omorogiuwa TBE, 2020. COVID-19 and older adults in Africa: social workers’ utilization of mass media in enforcing policy change. Int Soc Work.

    • Search Google Scholar
    • Export Citation
  • 16.

    Okereke M, Ukor NA, Adebisi YA, Ogunkola IS, Iyagbaye EF, Owhor GA, Lucero‐Prisno DE III, 2020. Impact of COVID-19 on access to healthcare in low- and middle-income countries: current evidence and future recommendations. Int J Health Plann Manage.

    • Search Google Scholar
    • Export Citation
  • 17.

    Relief Web, 2020. Ethiopia: COVID-19 Humanitarian Impact - Situation Update No. 02, As of 13 April 2020. Available at: https://reliefweb.int/report/ethiopia/ethiopia-covid-19-humanitarian-impact-situation-update-no-02-13-april-2020. Accessed November 16, 2020.

    • Search Google Scholar
    • Export Citation
  • 18.

    Adebisi YA, Alaran AJ, Bolarinwa OA, Akande-Sholabi W, Lucero-Prisno DE, 2020. When it is available, will we take it? public perception of hypothetical COVID-19 vaccine in Nigeria. medRxiv. Available at: https://www.medrxiv.org/content/10.1101/2020.09.24.20200436v2 Accessed December 10, 2020.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

COVID-19 Highlights the Need for Inclusive Responses to Public Health Emergencies in Africa

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  • 1 Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria;
  • 2 Global Health Policy Unit, University of Edinburgh, Scotland, United Kingdom;
  • 3 Global Public Health Department, Karolinska Institutet, Stockholm, Sweden;
  • 4 Society for the Study of Women’s Health (SSWH), Old Yundum, Gambia;
  • 5 Federal University of Technology Minna, Minna, Nigeria;
  • 6 Institute of Health, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom;
  • 7 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom

ABSTRACT

COVID-19 is a global public health emergency affecting many countries around the world. Although African governments and other stakeholders are making efforts to contain the pandemic, the outbreak continues to impact human rights and exacerbates inequalities and disparities that are already in existence. The concept of inclusive health focuses on good health and well-being for everyone, and this entails health services that are equitable, affordable, and efficacious. Creating equitable access to mainstream health and healthcare services and ensuring inclusive health responses remain a means of addressing health inequities and disparities. In this article, we argue on the need for inclusive responses to public health emergencies in Africa using COVID-19 as a case example. Africa’s response to public health emergencies needs to recognize that for every marginalized/vulnerable group, it is important to strategize to address their particular needs in such a way to surmount any barrier to the right to health. For Africa’s public health response to be more inclusive, we therefore need to be more strategic and proactive in reaching out to specific groups and to identify and address their needs. Strengthening the healthcare systems of African countries through increased political will, increased funding to health care, collaboration and cooperation among stakeholders, and effective leadership remains essential in ensuring inclusive responses to health emergencies.

COMMENTARY

The COVID-19 pandemic continues to threaten public health systems around the world, and the African continent is not spared.13 The pandemic presents an unprecedented humanitarian crisis that has impacted health systems and disrupted the livelihood and overall well-being of people globally.4,5 Although the number of COVID-19 cases in Africa is currently lower than that of other regions of the world, these numbers are increasing gradually.1 As of November 14, 2020, 1,965,485 cases and 47,134 deaths have been reported in the African region.6 The pandemic has made evident weaknesses in responding to public health emergencies such as COVID-19, on the continent.1 Although African governments and other stakeholders continue to make efforts to contain the pandemic, there is more to be done to put the pandemic to an end. Nonetheless, the COVID-19 pandemic continues to impact human rights and exacerbates inequalities and disparities that are already in existence. Despite the efforts to address the COVID-19 pandemic on the continent, the marginalized and underrepresented groups have been reported to be left behind and discriminated against in the course of the COVID-19 responses.7,8 Creating equitable access to mainstream healthcare services and ensuring inclusive health responses serve as a means of addressing health inequities and disparities. In this article, we argue on the need for inclusive health response to public health emergencies in Africa using COVID-19 as a case example.

The concept of inclusive health focuses on good health and well-being for everyone; and this entails health services that are equitable, affordable, and efficacious.9 This concept also resonates with a rights-based approach to health including political, social, economic, scientific, and cultural actions that are geared toward advancing the cause of good health and well-being for all.9 With the emergence of the COVID-19 pandemic, it is increasingly important to ensure an inclusive health approach to health emergencies on the continent. It is now evident that it is not all about achieving “health for all” but an “inclusive approach” in meeting the health needs and responding to public health emergencies.9 In the context of the COVID-19 pandemic and other public health emergencies, health responses need to be genuinely empowering so that vulnerable, underrepresented, and marginalized “voices” are included in social discourse, policy, and the health response. Although most health policy documents may refer to “all people,” “for all,” “all citizens,” or “everybody,” they often end up privileging “some” over “all.”9 Vulnerable and marginalized populations usually have greater healthcare needs than others and are therefore more vulnerable to the impact of low-quality, inaccessible healthcare services as well as noninclusive uniform public health responses than others.8

In addressing public health issues, it is important to make it clear that no one is more important than the other, and the response efforts must not leave behind the most disadvantaged groups. The impact of public health response needs to be viewed from the lens of how it will affect the marginalized group and what can be done to prevent any form of inequity. Right to health is a human right, so the approach to responding to health emergencies needs to be able to ensure that right to equitable health is not infringed on and the outcome of the response should not weigh negatively on the vulnerable groups. It is also worthy to note that if public health responses exclude the marginalized “voices,” there is a potential threat of reversal in any hard-won progress and efforts in addressing such public health crisis.7,8 This highlights the need for African governments, national health authorities, and other stakeholders to lead the path in ensuring inclusive responses to public health emergencies.

Sex workers in some African countries (e.g., Nigeria, Uganda, and Botswana) are excluded from the government’s safety nets in response to COVID-19.7 This forced some sex workers back to work amid the lockdown imposed by the national health authorities in the early days of the pandemic. Lockdown policies in many African countries and globally have significantly affected access to antiretroviral drugs and care services among people living with HIV. People living with disabilities have also been significantly affected by uniform response activities in many African countries.10 According to a rapid virtual audit of pandemic-related press briefings and press conferences issued by governments and international organizations, only 54% of sub-Saharan African countries have a sign language interpreter present in COVID-19 press briefings and conferences.11 COVID-19 has already caused interruptions in vaccination schedules in many African countries, further putting many children at risk of vaccine-preventable diseases. It has also weakened public health responses to ailments such as malaria and meningitis outbreaks and reduced access to maternal and reproductive health services, further discriminately affecting at-risk groups. COVID-19 also highlights the vulnerability of healthcare professionals to the impact of public health emergencies and how they can be discriminately affected. This vulnerability is compounded by limited access to protective equipment and stigmatization, which impacts on their mental health, as reported in some African countries.5

Some researchers have also reported how people who use drugs are left out of the COVID-19 responses in some African countries, for example, Kenya and Nigeria, with the potential threat of affecting HIV response and access to healthcare services among this group.8,12 COVID-19 has also been reported to exacerbate long-standing problems in Africa’s prisons and how precautionary measures, such as handwashing and physical distancing to reduce disease transmission among the inmates, are challenging to observe because of poor infrastructure.13 A report from Kenya, Tanzania, and Uganda, the regions with consistently high maternal and neonatal mortality rates, also revealed that the COVID-19 pandemic has grossly affected antenatal care services.14 The disruption of these services, if not addressed, may affect the achievement of Sustainable Development Goal 3 Target 1, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. The noted disruption in healthcare services in Africa is also affecting older adults with chronic diseases in the region.15 Access to healthcare services among people living with chronic diseases,16 people with lower socioeconomic status, homeless people, migrants, minorities, and other vulnerable groups is discriminately affected before the pandemic, and the urgent need to address the COVID-19 pandemic has exacerbated this challenge.

Although some efforts have been made in Africa toward ensuring an inclusive response, more efforts still need to be carried out. For instance, Ethiopia is translating COVID-19 health information into local languages17 and the country plans to make communication materials accessible to those with seeing, learning, and hearing difficulties, as well as people living with mental illness.10 It has also been reported that South Africa has granted $10.6 million aid to assist small, medium, and microenterprises, with people living with disabilities and women prioritized.10 In Nigeria, a faith-based organization is helping with sign language interpretation of COVID-19 health information.10 Africa’s response to public health emergencies needs to recognize that for every marginalized/vulnerable group, it is important that any health intervention designed to meet their needs must be carried out in a way that surmounts any barriers to accessing health care.

For Africa’s public health response to be more inclusive, there is a need to be more strategic and proactive in reaching out to specific groups to identify and address their peculiar needs (Table 1). An inclusive health approach needs action and not just mere inclusion in policy documents. The approach will not only foster solidarity, health equity, and effective community response to public health interventions and emergencies, it is also in line with the sixth element of the Universal Health Coverage movement—“Move Together”—which involves setting up diverse multi-stakeholder strategies aimed at engaging and involving everyone without discrimination. The significance of an inclusive, dynamic, multi-stakeholder response remains critical in the context of COVID-19 and other public health emergencies. A commitment to an inclusive health response implies that response activities will be compassionate and sensitive to all. The aftermath of a noninclusive public health response is expensive. For instance, if marginalized or vulnerable groups with poor access to healthcare services experience COVID-19–related symptoms, they may delay or even forgo being tested and may consequently turn to medical care only in late stages, resulting in worse outcomes. This may put their families at risk, facilitating community spread of the virus. Furthermore, African governments need to start devising means and strategies to ensure inclusive access to COVID-19 vaccine when it becomes available.18

Table 1

Specific health needs of some vulnerable groups amid the COVID-19 pandemic and recommendations

Vulnerable groupSpecific health needs in the context of COVID-19Recommendations
Older adultsAccess to personal protective equipment (PPE)Use telemedicine and other remote consultation strategies
Social and mental health supportIntegrate older adults’ care into primary healthcare systems
Clear risk communication languageUse geriatrics differentiated healthcare services
Undisrupted access to medicines and healthcare services, including COVID-19 testingLeverage community health workers for nonspecialized healthcare support
Pregnant womenAntenatal care services including medications and specialist consultationDevise locally compatible strategies to ensure uninterrupted antenatal care services
Access to PPE
Social and mental health support
Women and girlsAccess to sexual and reproductive care services including family planningEnsure access to sexual and reproductive health services, keeping clinics open and/or telehealth
Access to menstrual hygiene care and productsEnsure access to contraceptives and other essential medicines
Mental health and social care support to those facing violence and abuse
People living with disabilitiesHealth needs associated with the impairment must be prioritizedLeverage community health workers for nonspecialized healthcare support
Information on COVID-19 in accessible formatsInclusive engagement for people living with disabilities
Access to PPE
Social and mental health support
People living with mental health disordersAccess to antipsychotic medications and psychosocial support should be prioritizedUse telemedicine and other remote consultation strategies
People who use drugsAccess to harm reduction services including needle exchange and opioid substitution therapyWork with drug use advocacy groups and civil society organizations to ensure access to health services
Access to care and prevention services for HIV, hepatitis, COVID-19, and sexually transmitted diseasesDecriminalization of drug use and avoidance of discrimination and stigmatization of people who use drugs
Social and mental health support
Rehabilitation and drug treatment centers must be prioritized
People living with HIVSustained access to HIV drugs and care servicesStrengthening of HIV differentiated care services
Social and mental health supportDecentralization of HIV care and use of telemedicine
COVID-19 testingWork with HIV advocacy groups to ensure access to health services
Treatment and care services for tuberculosis and other opportunistic infections must be prioritized
Access to condoms and PPE
People living with chronic diseases, for example, diabetesAccess to medicines and PPEUse telemedicine and other remote consultation strategies
Clear risk communication language
Social and mental health support
Sex workers, men who have sex with men, and transgender peopleAccess to HIV care and prevention servicesWork with the relevant advocacy groups and civil society organizations to ensure access to health services
Access to hepatitis, COVID-19, and sexually transmitted diseases testingDecriminalization and avoidance of discrimination and stigmatization of vulnerable groups should be prioritized to ensure access to health services
Access to condoms and PPE
Social and mental health support
People in prisons and other closed settingsPrison-based harm reduction servicesEnsure that the right to health among inmates is not infringed on
Access to condoms and PPEDirect investment to enable African prisons to cope with public health emergencies
Structures that allow for physical distancing and proper ventilation
Access to clean water and soap
COVID-19 testing

CONCLUSION

Africa’s COVID-19 and other health emergencies response strategies must be inclusive of marginalized and vulnerable groups to ensure they maintain respect for dignity, human rights, and fundamental freedoms and avoid widening already existing health and social disparities. This reinforces the need to ensure full participation of the communities affected and relevant civil society organizations in preparedness and response planning, including maintaining the commitment to universal health coverage and ensuring that the most disadvantaged groups are not forgotten amid the urgent need to respond to any public health emergencies. Strengthening the healthcare systems of African countries through increased political will, increased funding to health care, collaboration and cooperation among stakeholders, and effective leadership remains essential in ensuring inclusive responses to health emergencies.

ACKNOWLEDGMENTS

We appreciate the reviewers for their insightful comments. The American Society of Tropical Medicine and Hygiene has waived the Open Access fee for this article due to the ongoing COVID-19 pandemic and has assisted with publication expenses.

REFERENCES

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    Lucero-Prisno DE, Adebisi YA, Lin X, 2020. Current efforts and challenges facing responses to 2019-nCoV in Africa. Glob Health Res Policy 5: 21.

    • Search Google Scholar
    • Export Citation
  • 2.

    Nkengasong JN, Tessema SK, 2020. Africa needs a new public health order to tackle infectious disease threats. Cell 183: 296300.

  • 3.

    Ogunkola IO, Adebisi YA, Imo UF, Odey GO, Esu E, Lucero-Prisno DE 3rd, 2020. Rural communities in Africa should not be forgotten in responses to COVID-19. Int J Health Plann Manage 35: 13021305.

    • Search Google Scholar
    • Export Citation
  • 4.

    Lucero-Prisno DE 3rd, Essar MY, Ahmadi A, Lin X, Adebisi YA, 2020. Conflict and COVID-19: a double burden for Afghanistan’s healthcare system. Confl Health 14: 65.

    • Search Google Scholar
    • Export Citation
  • 5.

    David KB, Adebisi YA, 2020. Proposed model for hospital and community pharmacy services during COVID-19 pandemic in Nigeria. Int J Pharm Pract 28: 544545.

    • Search Google Scholar
    • Export Citation
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    Africa Centers for Diseases Control, 2020. Coronavirus Disease 2019 (COVID-19). Available at: https://africacdc.org/covid-19/. Accessed November 16, 2020.

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    Adebisi YA, Alaran AJ, Akinokun RT, Micheal AI, Ilesanmi EB, Lucero-Prisno DE, 2020. Sex workers should not Be forgotten in Africa’s COVID-19 response. Am J Trop Med Hyg 103: 17801782.

    • Search Google Scholar
    • Export Citation
  • 8.

    Adebisi YA, Lucero Prisno DE III, 2020. Towards an inclusive health Agenda: people who inject drugs and the COVID-19 response in Africa. Public Health, doi: 10.1016/j.puhe.2020.10.017.

    • Search Google Scholar
    • Export Citation
  • 9.

    Maclachlan M, Khasnabis C, Mannan H, 2012. Inclusive health. Trop Med Int Health 17: 139141.

  • 10.

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  • 11.

    Yap J, Chaudhry V, Jha CK, Mani S, Mitra S, 2020. Are responses to the pandemic inclusive? A rapid virtual audit of COVID-19 press briefings in LMICs. World Dev 136: 105122.

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    • Export Citation
  • 12.

    Gachohi J, Karanja S, Mwangi C, 2020. Challenges facing harm reduction interventions in the era of COVID-19 in Africa. Scientific Afr 9: e00506.

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    • Export Citation
  • 13.

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  • 14.

    Pallangyo E, Nakate MG, Maina R, Fleming V, 2020. The impact of covid-19 on midwives’ practice in Kenya, Uganda and Tanzania: a reflective account. Midwifer 89: 102775.

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    • Export Citation
  • 15.

    Omorogiuwa TBE, 2020. COVID-19 and older adults in Africa: social workers’ utilization of mass media in enforcing policy change. Int Soc Work.

    • Search Google Scholar
    • Export Citation
  • 16.

    Okereke M, Ukor NA, Adebisi YA, Ogunkola IS, Iyagbaye EF, Owhor GA, Lucero‐Prisno DE III, 2020. Impact of COVID-19 on access to healthcare in low- and middle-income countries: current evidence and future recommendations. Int J Health Plann Manage.

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    • Export Citation
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    Relief Web, 2020. Ethiopia: COVID-19 Humanitarian Impact - Situation Update No. 02, As of 13 April 2020. Available at: https://reliefweb.int/report/ethiopia/ethiopia-covid-19-humanitarian-impact-situation-update-no-02-13-april-2020. Accessed November 16, 2020.

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    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Yusuff Adebayo Adebisi, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria. E-mail: adebisiyusuff23@yahoo.com

Disclosure: The authors have completed the ICMJE Unified Competing Interest form (available on request from the corresponding author).

Authors’ addresses: Yusuff Adebayo Adebisi, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria, E-mail: adebisiyusuff23@yahoo.com. Aniekan Ekpenyong, Global Health Policy Unit, University of Edinburgh, Scotland, United Kingdom, E-mail: aniekanpearl@gmail.com. Blaise Ntacyabukura, Global Public Health Department, Karolinska Institutet, Sweden, E-mail: dableze@gmail.com. Mat Lowe, Society for the Study of Women’s Health (SSWH), Old Yundum, Gambia, E-mail: sswhgambia@gmail.com. Nafisat Dasola Jimoh, Federal University of Technology Minna, Minna, Nigeria, E-mail: jmotunrayo24@gmail.com. Toyyib Oladimeji Abdulkareem, Institute of Health, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom, E-mail: toyyibdimeji@yahoo.com. Don Eliseo Lucero-Prisno III, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: don-eliseo.lucero-prisno@lshtm.ac.uk.

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