The COVID-19 pandemic was a profound global event that disrupted lives, economies and systems worldwide. For Africa, it was not just a health crisis but a moment of reckoning for its healthcare infrastructure, governance systems and socio-economic policies. As the virus surged across the globe in early 2020, the continent braced itself. Given Africa’s existing health challenges, including a high disease burden, inadequate healthcare infrastructure and limited resources, the pandemic posed a real and present danger. Yet, despite these hurdles, Africa’s response to COVID-19 demonstrated resilience and a capacity for learning that can inform future health crisis preparedness.
While the pandemic unveiled deep-rooted vulnerabilities in health systems across the continent, it also highlighted remarkable adaptability. From setting up makeshift COVID-19 testing centres to rapidly mobilising community health workers, African countries showcased an unprecedented level of innovation in responding to the health crisis. This article analyses the key lessons learnt from Africa’s response to COVID-19, focusing on healthcare infrastructure, early warning systems and strategies for future preparedness.
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A Mirror to Our Systems
The pandemic was a devastating wake-up call for African countries to reassess their healthcare systems. The initial waves of infections exposed the continent’s struggle with inadequate infrastructure. A 2021 study conducted across 471 healthcare facilities in 11 African countries revealed alarming data about the region’s readiness. The facilities, with an average capability score of just 58 out of 100, struggled significantly to provide adequate care in the pandemic’s early stages. Rural facilities were particularly strained, scoring an average of 53.6, compared to 65.2 in urban centres.
The research identified critical gaps. An overwhelming 71% of healthcare facilities lacked the necessary specimen collection materials for COVID-19 testing, 43% did not have N95/FFP2 respirators and 19% had no medical masks at all. Additionally, many lacked clinical management guidelines, triage protocols and isolation procedures. These shortcomings hampered timely care and effective outbreak management.
What is clear from the data is that Africa’s healthcare system, while resilient, remains underfunded and ill-equipped for large-scale health emergencies. The pandemic has exposed systemic inefficiencies that can no longer be overlooked.
Healthcare Infrastructure Challenges
One major takeaway from COVID-19 is that Africa’s healthcare infrastructure, while capable of delivering basic services, is deeply inadequate for managing large-scale health crises. Countries with smaller economies or those in conflict zones saw their systems stretched to the brink.
Take Nigeria, for instance. As Africa’s most populous country, it faced immense pressure to ramp up testing and healthcare capacity. The Nigeria Centre for Disease Control (NCDC) coordinated national efforts, yet the country’s infrastructure remained critically underdeveloped. A 2021 report highlighted that Nigeria had only 12,000 ventilators for a population exceeding 200 million, a ratio far below the World Health Organisation’s recommended levels.
In Zambia’s rural regions, hospitals lacked basic supplies and trained personnel. The WHO reported that many hospitals in low-income African countries had fewer than two intensive care unit (ICU) beds per 100,000 people. By contrast, high-income countries had over 20 ICU beds per 100,000.
This infrastructural inadequacy was worsened by a lack of mental health support for healthcare workers. Studies from South Africa, Kenya and Uganda revealed burnout, stress and anxiety among frontline workers, with little to no institutional mental health support. These issues contribute to workforce depletion, brain drain and declining morale across health systems.
Strengthening Early Warning Systems
One of the brightest aspects of Africa’s response was the emphasis on improving early warning systems and surveillance. Regional collaboration, particularly through the Africa Centres for Disease Control and Prevention (Africa CDC) and WHO’s Africa Regional Office (WHO AFRO), helped address the pandemic’s evolving threat.
The Africa CDC’s Event-Based Surveillance (EBS) framework improved the continent’s ability to detect emerging threats by aggregating data from diverse sources such as media reports, facility data and community feedback. Initially developed for diseases like Ebola, the system was adapted for COVID-19, leading to calls for its broader application to other public health threats.
The use of digital technologies also expanded rapidly. In South Africa, the COVID Alert SA app enabled exposure notifications through contact tracing, while Rwanda used its digital infrastructure for real-time monitoring. These innovations provided a model for others to follow.
However, challenges remain. In rural and remote communities, the use of digital tools was limited due to insufficient internet access and low smartphone penetration. Effective early warning systems must therefore be tailored to the specific needs of underserved populations.
Lessons from the Frontlines
Nigeria: Drawing on its experience with the Ebola outbreak, Nigeria responded proactively. The country expanded laboratory testing from a handful of centres in early 2020 to over 100 by the year’s end. The NCDC launched mass contact tracing efforts, deploying thousands of trained community health workers. As of 2023, Nigeria had tested over 7 million people, achieving one of Africa’s highest population-adjusted testing rates. This experience underscores the importance of scaling diagnostics and community engagement during epidemics.
Mozambique: Mozambique strengthened its pandemic response by integrating multiple surveillance systems. The National Institute of Health (INS) employed both traditional and digital platforms to monitor outbreaks. This led to an 80% improvement in early case detection compared to the 2014 Ebola outbreak, highlighting the value of coordinated surveillance in complex health environments.
South Africa: As the continent’s COVID-19 epicentre, South Africa faced unique challenges but showed notable resilience. Mass testing, effective public health messaging and strict lockdowns helped curb early transmission. Still, the healthcare system came under immense pressure as case numbers rose. South Africa’s experience highlights the need for robust infrastructure and flexible surge capacity.
Strategies for Enhanced Preparedness
The lessons from COVID-19 must shape Africa’s future pandemic preparedness. First and foremost, investment in healthcare infrastructure is critical. Governments must prioritise expanding diagnostic capabilities, improving supply chains and increasing ICU capacity.
A well-supported healthcare workforce is equally vital. To prevent brain drain, African nations should offer competitive pay, incentives and mental health support. Retaining skilled personnel is as important as building physical infrastructure.
Digital technology must become central to health planning. Investment in mobile health tools, e-health platforms and telemedicine will enhance data collection and service delivery, even in remote areas.
Regional cooperation via bodies like the African Union and Africa CDC should be deepened. Shared resources and coordinated planning can help address disparities. Sustainable financing models such as public-private partnerships and global collaborations must also be pursued.
Lastly, public trust is crucial. Governments must continue investing in health education and transparent communication. Combatting misinformation and fostering community cooperation will determine the success of future interventions.
Africa’s journey through COVID-19 was difficult but also instructive. The pandemic exposed long-standing weaknesses, yet it also revealed the continent’s capacity for innovation and collective action. By addressing infrastructure gaps, enhancing surveillance and strengthening partnerships, Africa can face future health crises with greater confidence.
The time to invest in Africa’s health systems is now. As the world anticipates future pandemics and health emergencies, the continent has a clear path forward, built on resilience, adaptability and collaboration. Pandemic preparedness in Africa must not be viewed as a reaction to COVID-19 but as a lasting commitment to building a stronger, more sustainable healthcare future.
