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African nations are precariously positioned to fight Covid-19. What can they learn from Kerala?

Saturday April 25, 2020
By Mohamed Ali

Medical staff members of a government-run medical college collect swabs from people to test for Covid-19 at a newly installed walk-In sample Kiosk in India's southern state of Kerala CREDIT: REUTERS

According to the Africa CDC there are now more than over 17,700 confirmed Covid-19 cases with over 900 deaths across 54 African countries. Many countries in this region have introduced lockdowns and strict containment measures seen across Europe to slow the spread of the virus.

Testing and contact tracing have both been difficult to achieve and this has made it difficult for African governments to understand the extent of the spread. The African Union has said that many of the African countries have been struggling to compete with wealthier countries for testing kits and ventilators and this has delayed the response.

Aggressive testing, intense contact tracing and strategic lockdowns are pivotal as the World Health estimates that there are less than 5,000 intensive care unit beds across 43 of the 54 countries in the region.

African nations are precariously positioned in their battle with Covid-19. Faced with the triple encumbrance of acute poverty, poor health indices and the burden of infectious diseases, complete lockdowns as enforced by many nations may not be economically sustainable in Africa.

Early research from the London School of Hygiene & Tropical Medicine (LSHTM) suggest that African countries can prevent both the potential implosion of healthcare infrastructure and the economic damage of Covid-19 by combining the self-isolation of those affected and moderate social distancing measures in order to shield the virus from high risked communities placed in ‘green zones’.

The research modelled the impact of possible intervention approaches in Nigeria, Niger and Mauritius as these countries have the youngest, median age and oldest populations in Africa.

Notably, shielding high risk communities in green zones, which were defined as dedicated areas to those with co-morbidities at household, neighbourhood or at camp level were projectioned to potentially reduce deaths in Nigeria from 605,000 (without intervention) to 285,000 deaths over the next year.

Yet, the modellers from LSHTM are adamant that such intervention would likely result in future epidemic waves after the first year as well as signficant socio-economic restrictions.

Although rapid testing may not be feasible immediately, the above measures coupled with further strategies that empower community driven responses could help stop the spread of the virus.

The pandemic response strategy by the Indian State of Kerala makes a strong case for this and the measures can be applied to most African countries, considering both their demographic profiles. 

The Indian state of Kerala has long been an exemplar to other Indian states as well as many African nations when it comes to producing successful health outcomes to its 34 million population. In 2011, Kerala achieved the highest Human Development Index of all Indian states based on its performance in key measures. 

The state has had an extensive history of implementing health focused policies that aimed to eradicate communicable diseases. Notably, Kerala was one of the first states in India to conduct state-wise polio vaccinations in 1994.

Citizens of the state have a life expectancy of 75 years at birth coupled with over 92 per cent literacy rate for both male and females, which is comparable to many developed nations.

These successes were underpinned by large investment in health infrastructure, creating a multi-layered health system that has been able to provide direct access to healthcare resources at community level.

Kerala’s response to Covid-19 has been hailed by many as it continues to “flatten the curve”. The South-Western State followed multi-pronged state monitored preventive and participative approach by carrying out rapid testing, early detection, rigorous contact tracing and a strict 28-day home quarantine for suspected individuals.

The state’s response strategy has benefitted from the multi-layered public health infrastructure with the powers devolved to the village councils to micromanage the functioning of Sub Centres (SCs) and Primary Health Centres (PHCs). This decentralisation has enabled villages to prioritise local health needs based on community participation.

Health is a state subject in India. The State government had sounded the Covid alert as early as 18 January to set the state machinery rolling. Screening of passengers travelling from abroad commenced at airports soon thereafter.

Ambulance and other emergency response services were linked to all five airports in the state. Procurement of PPEs, masks and essential medicines were expedited. District hospitals were instructed to earmark isolation wards for Covid-19 patients.

Rapid Reaction Teams were constituted in each of the 19,489 wards in the State. Confirmed cases were quickly transferred to the nearest health facility and suspected individuals were sent into a compulsory 28-days home quarantine ensured by the village councils.

A Health Information System, still being developed by the State, to compile household data for population health management and disease surveillance proved to be a great enabler in ensuring this. 

Daily feedback travelled up from across all the wards to the Chief Minister and his council of ministers to ascertain the efficacy of the containment strategy. Volunteers were invited from across the State and imparted training on public health and other essential services.

Supply chain of food items and essential commodities were decongested, and community camps were set up for street dwellers and migrant workers. Advance pension for seven months was released and cash transfers to the needy expedited.

While, the first Covid-19 case in India was reported in Kerala as early as January, it has been able to curb the spread with just one new positive case being reported as of the 17th of April. Out of 426 total cases reported in Kerala, 307 have recovered; 117 are still undergoing treatment.

With just two deaths, 72 percent of positive patients have recovered in the state, higher than elsewhere in India. Participative approach backed by timely policy decisions by the State government and community-level preparedness has proved to be the game changer in Kerala’s fight against Covid-19 pandemic. 

The timely response by Kerala was underpinned by years of healthcare building, other efforts such as early detection, rigorous contact tracing and mandatory self-isolation that mitigate the burden of the virus among those most vulnerable can be replicated in an African context.

The obilisation of community stakeholders by the state involving the locals to micromanage the outbreak is an intervention that has already been used by African nations in the Ebola outbreak. 



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