The COVID-19 pandemic and health systems in Africa: a review of the scope of preparedness, impact and response – World

Gizachew A Tessema, Yohannes Kinfu, Berihun Assefa Dachew, Gebresilassie Tesema, Yibeltal Assefa, Kefyalew Addis Alene, Atsede Fantahun Aregay, Mohammed Biset Ayalew, Woldesellassie M Bezabhe, Ayele Geleto Baliko, D. Lembremichae Geedamane Geehketesdu, Gebremichael Geehketades Baliko, D. Lembremichael Geeamane Temedades Eyob Alemayehu Gebreyohannes, Yalemzewod Assefa Gelaw, Hailay Abrha Gesesew, Getiye Dejenu Kibret, Cheru Tesema Leshargie, Maereg Wagnew Meazew.


Background The COVID-19 pandemic has overwhelmed health systems in both developed and developing countries. Africa has one of the weakest health systems in the world, but there is little evidence on how the region is prepared, affected and responded to the pandemic.

Methods We performed a scope review of PubMed, Scopus, CINAHL to search for peer-reviewed articles and Google, Google Scholar, and pre-publication sites for gray literature. The scoping review captured studies on preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by the Arksey and O’Malley methodological framework. The information retrieved was documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes for Scope Reviews expansion checklist. Finally, the resulting data were analyzed thematically.

Results Twenty-two eligible studies, of which 6 reported on health system readiness, 19 described the impacts of COVID-19 on access to general and essential health services, and 7 focused on responses taken by health systems were included. Major setbacks in health system preparedness included the lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing and surge capacity for COVID-19. Reduced patient flow and missed appointments were among the most common impacts of the COVID-19 pandemic. The health system responses identified in this review included the availability of telephone consultations, the reorientation of available services and the establishment of isolation centers, and the provisions of COVID-19 guidelines in certain settings.

Conclusion Health systems in Africa were insufficiently prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the scale of the problem. Interventions that will improve and strengthen the resilience and financing of the health system through local, national and global engagement should be prioritized.

About Mark A. Tomlin

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