Getting wiser after the low blow

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South Africa’s President Cyril Ramaphosa says “the storm is upon us”.

For nearly two months now, epidemiologists and other health experts have warned that the first wave of COVID-19 in Africa would be nothing compared to the second wave.

All predictive analyses and algorithms pointed to a spike in cases predicated on a variety of factors, among them: a premature dropping of the guard fuelled by the misinformed belief that coronavirus was an Asian, European or American problem; the onset of the traditional influenza season; and the need for normal economic activity to resume so that bread can be put on the table.

Unfortunately, that premature dropping of the guard has happened and the result has been a surge in COVID-19 infections across the continent and Africa - like other parts of the world - it seems fell into the age-old “panic-and-forget” cycle.

We panicked when corona reached our shores early in the year. Our governments went into a commendable sensitisation and prevention overdrive such that even infants were wary of anyone sneezing near them.

The initial panic has passed, we have dropped the guard, and we are paying the price.

This past week, South Africa’s cumulative infections surpassed 300,000, surpassed the United Kingdom, and surpassed those of all the countries in the world except for just seven.

President Ramaphosa says the predictive analysis points to as many as 50,000 South African deaths from the novel coronavirus this year alone.

In Namibia, in Zimbabwe, in Zambia, in the DRC, indeed across Southern Africa, governments are reawakening to the reality that the worst could still be ahead of us.

Painful, inconvenient and stressful as it is, we have to go back to the basics that informed our initial attitudes towards COVID-19 and allowed Africa to prove the doom-mongers wrong when they prophesied dead bodies on our streets months ago.

We all know what we must do, but we have relaxed and are either not doing these things at all, or merely doing the bare minimum that we incorrectly think will suffice.

For that reason, we will belabour the point and reiterate those basics:

  • Regularly and thoroughly clean your hands with an alcohol-based hand rub, or wash them with soap and water;
  • Maintain at least one metre distance between yourself and others;
  • Avoid going to crowded places;
  • Avoid touching your eyes, nose and mouth;
  • Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze, dispose of used tissue immediately, and clean your hands as recommended;
  • Stay home and self-isolate even with minor symptoms such as cough, headache, and mild fever. If you need to leave your house, wear a mask;
  • If you have a fever, cough and difficulty breathing, seek medical attention. Telephone in advance if possible and follow the directions of health experts; and
  • Keep up to date on the latest information from trusted sources.

We all appreciate that times are tough and people need to eat, but following these tried and tested recommendations greatly reduces the risk of contracting and/or spreading COVID-19.

But that is not all.

Inasmuch as people now generally know these basics, governments and other stakeholders must go beyond advocacy and information dissemination, and enforce regulations by any means necessary.

This is not the time to whine about governments stopping you from going to a pub or the police ordering you to go back home because you just want to step into town for a bit.

Governments and their agencies must enforce public health regulations firmly, but compassionately, and the public must realise that we are all in this together.

And again, that is not all.

Our governments must go beyond information dissemination and enforcement regulations. They must start seriously investing in building multi-sectoral capacity to deal with COVID-19 in particular and future health emergencies in general.

Public health experts will tell you that prevention, preparedness, readiness, responsiveness and recovery are part of a continuum.

This means deliberate governments must deliberately plan public health systems with long-term views that go beyond merely setting aside money every year and calling it a health budget.

A robust public health system requires a holistic approach that goes beyond just financing health ministries. It requires integration of public health in national development policy implementation, with a strong appreciation of the cross-border nature of healthcare.

Sustained, holistic planning and financing of healthcare is where our salvation lies. Which brings us to the issue of the 2001 Abuja Declaration.

In 2001, African leaders agreed to commit no less than 15 percent of the annual national budgets to healthcare.

A decade later, 27 African Union members had indeed increased their healthcare allocations, but only Rwanda and South Africa had surpassed the 15 percent agreement.

Then another five years later, in 2016, the positive trend had already been bucked and 19 countries were actually spending less on health than they did before enthusiastically adopting the Abuja Declaration.

Some countries have since gone above the 15 percent threshold - for example Ethiopia, Gambia and Malawi – but the vast majority of African governments have for nearly two decades now treated the Abuja Declaration as one of those feel-good agreements they regularly sign so that politicians can tell the voters why they need to fly to AU Summits.

We are now doing penance for not living up to the Abuja Declaration.

Had we invested in healthcare for the 19 years since the Abuja Declaration as we promised we would, our public health systems would right now be in a better position to deal with COVID-19.

In this regard, where shall our public health systems be in another years? Will another pandemic catch us so off guard again?

Similarly, our governments and the private sector must also invest in research.

A 2014 World Bank report said Africa, though home to 17 percent of the world’s population, was responsible for less than one percent of global research output. Other reports say Africa has just 79 scientists for every million citizens. Compare this to the United States where the ratio is 4,500 scientists per million people, or Brazil’s quotient of 656 per million.

Right now, Africa’s two main contributions to the pharmaceutical value is providing the “guinea pigs” for Western manufacturers to test their drugs, and importing the drugs when they finally make it onto the market.

All said, COVID-19 has been a real kick in Africa’s collective nether regions. We should be wiser now. We should simply invest in our health.

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