Access to Care in this Pandemic Part 1

According to the World Bank (2014), economic growth (as driven by rising investment in natural resources and infrastructure, and strong household spending) in Sub-Saharan Africa was forecasted to rise from 4.7 percent in 2013 to 5.2 percent in 2014. In 2019, the annual GDP growth of Sub-Saharan Africa was recorded to be 2.3 % (The World Bank, 2021). Recently, World Bank (2020) has also mentioned that Sub-Saharan Africa’s natural and human resources can alleviate poverty and enable it to create healthier and more prosperous lives. However, it is quite unfortunate that due to the pandemic, economic growth in Sub-Saharan Africa is moving backwards and was predicted to fall to -3.3% in 2020, pushing the region into its first recession in 25 years.

The focus of today’s article is healthcare access status in Sub-Saharan Africa during this COVID 19 pandemic. Lying south of the Sahara, Sub-Saharan Africa is the region that comprises all African countries and territories that are fully or partially south of the Sahara. Expectedly, access to care in this pandemic has ranged from excellent to quite poor in various countries.  However, due to this pandemic, we do see public health infrastructure crippling and collapsing even in developed countries (Lal et al., 2021, p. 61). Imagine how worse it has become in countries in the developing world!

The rise in economic growth that we saw in Sub-Saharan Africa before the pandemic is applaudable. But it has also led to the rise in non-communicable diseases (NCD). Why is that? This is because the rise in economic growth has led to westernization (adoption of Western culture), urbanization, consumption of unhealthy food, a sedentary lifestyle and a rise in tobacco use (Owopetu et al., 2021, p. 1). Studies reveal some alarming statistics such as that stroke incidence has increased from 0.07 to 0.3%, hypertension from 6 to 48%, obesity from 0.4 to 43%, diabetes mellitus from 0 to 16%, and tobacco use from 0.4 to 71% (Dalal et al., 2011, p. 885). Alarming enough, by 2030, NCDs are attributed to be the leading reason behind rising in mortality in Sub-Saharan Africa and it exceeds all the other reasons behind mortality like communicable, maternal, neonatal, and nutritional diseases (Owopetu et al., 2021, p. 1). It also needs to be noted that the poor healthcare system in Sub-Saharan Africa does not have the capability to sustain this burden of increasing rates of NCDs (Juma et al., 2018, p. 1). This was the case prior to the pandemic and imagine how worse the situation has gotten with the widespread COVID 19 pandemic!!!!!

As the COVID 19 pandemic has been predicted to be worsening in Sub-Saharan Africa, healthcare resources have been diverted towards combatting the pandemic. This resource diversion is further crippling the already weakened healthcare system that supports patients with NCDs (Owopetu et al., 2021, p. 2). People with pre-existing conditions (such as cardiovascular diseases, hypertension, diabetes, respiratory diseases) are more susceptible to develop severe complications from COVID 19 virus (World Health Organization, 2020). In regard to cardiovascular diseases, a meta-analysis showed that hypertension, cardiovascular and cerebrovascular disease increased the propensity of severe COVID-19 complications by 2.3, 2.9 and 3.9 times, respectively. Additionally, another meta-analysis indicated that hypertension increased the risk of mortality from COVID-19 by 3.5 times. It was also found that people with diabetes were up to three times more likely to have severe symptoms or die from COVID-19, and the situation is likely to be worse for people with uncontrolled diabetes. In regard to respiratory diseases, one study shows that the presence of respiratory disease, including asthma, increased patients’ risk of mortality from COVID-19. Also, in a meta-analysis, it was found that patients with chronic obstructive pulmonary disease (COPD) were at increased risk of severe complications or death from COVID-19 (World Health Organization and United Nations Development Programme, 2020).

Just to give an example of the poor healthcare system in Sub-Saharan Africa, a country like Nigeria, situated in West Africa, is the most populous not only in the Sub-Saharan region but in the continent of Africa. Nigeria has an inadequate number of ICU beds and healthcare workers. For 200 million people there are only 350 ICU beds (Ogundipe, 2020; Akande & Akande, 2020, p. 4). A little detailed statistic shows an alarming state that even before the pandemic there were 0.4 physicians per 1000 people, 1.2 nurses and midwives per 1000 people and 1.4 specialists surgical workforce per 100,000 population. This was inadequate then and so this healthcare system is incapable of sustaining the increased burden of NCD rates in this pandemic especially with resources now being diverted for COVID 19 patients (Akande & Akande, 2020, p. 4). Not only in Nigeria but NCD patients in many other countries in Sub-Saharan Africa are also suffering from a lack of healthcare support (Owopetu et al., 2021, p. 2). NCD patients require continued support and, in this pandemic given the poor healthcare system, are we heading towards a far more increased rate of NCDs in the region instead of moving forward?

Well, globally, in many developed countries, the health care system is surviving somehow in this pandemic with the support of telehealth. But this is also not possible in Sub-Saharan Africa. Telemedicine could not flourish in most countries of Sub-Saharan Africa because of inadequate ICT infrastructure. We see some progress in this arena for countries such as Ethiopia and South Africa whereas other countries such as Nigeria and Burkina Faso are lagging behind. Lack of political support has been cited behind this. But this would have been the last resort for tackling the rising rates of NCDs in this region, especially given the pandemic and the already fragile and crippling healthcare system (Wamala & Augustine, 2013, p. 1). Owopetu et al. (2021, p. 2), also mentioned that due to the pandemic, drug pick-ups and routine clinic services has become inaccessible for NCD patients and with lockdowns and stay-at-home orders, only telehealth could have been the way out to save lives and support NCD patients. But that is also not an option that most in the region can exercise. So, what could be the way forward?

In our next feature, which will be the second part of this feature, we will discuss some strategies that could help the region in supporting NCD patients in this pandemic and thereby not further contribute to the rising rates of NCDs. There is light at the end of the tunnel and what is required is a bit of innovation and robustness in our healthcare strategies. With this, we end here today. Please check-in for the second part of this feature which follows soon.

REFERENCES

Akande, O., & Akande, T. (2020). COVID-19 pandemic: A global health burden. Nigerian Postgraduate Medical Journal, 27(3), 147. https://link.gale.com/apps/doc/A630027066/EAIM?u=yorku_main&sid=EAIM&xid=2da25502

Dalal et al. (2011). Non-communicable diseases in sub-Saharan Africa: what we know now. International Journal of Epidemiology, 40 (4), 885–901. https://doi-org.ezproxy.library.yorku.ca/10.1093/ije/dyr050

Juma et al. (2018). Non-communicable disease prevention policy process in five African countries authors. BMC Public Health, 18(Suppl 1). https://link.gale.com/apps/doc/A553923087/AONE?u=yorku_main&sid=AONE&xid=fcb03f01

Lal et al. (2021). Fragmented health systems in COVID-19: rectifying the misalignment between   global health security and universal health coverage. The Lancet, 397 (10268), 61-67. https://doi.org/10.1016/S0140-6736(20)32228-5

Owopetu et al. (2021). COVID-19: implications for NCDs and the continuity of care in Sub-Saharan Africa. Global Health Promotion, 1-4. https://doi.org/10.1177/1757975921992693

Ogundipe, S. (2020). Coronavirus: Nigeria has 350 ICU beds for 200 million people. Premium Times.https://www.premiumtimesng.com/news/headlines/384840-coronavirus-nigeria-has-350-icu-beds-for-200-million-people.html

The World Bank. (2014). Africa’s Growth Set to Reach 5.2 percent in 2014 With Strong Investment Growth and Household Spending. https://www.worldbank.org/en/news/press-release/2014/04/07/africas-growth-set-to-reach-52-percent-in-2014-with-strong-investment-growth-and-household-spending

The World Bank. (2020). Overview. https://www.worldbank.org/en/region/afr/overview#:~:text=Driven%20by%20the%20economic%20fallout,first%20recession%20in%2025%20years.

The World Bank. (2021). GDP growth (annual %) - Sub-Saharan Africa. https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG?locations=ZG

World Health Organization and the United Nations Development Programme. (2020). COVID-19 and NCD risk factors. https://www.who.int/docs/default-source/ncds/un-interagency-task-force-on-ncds/uniatf-policy-brief-ncds-and-covid-030920-poster.pdf?ua=1

World Health Organization. (2020). Information Note: COVID-19 and NCDs. https://www.who.int/publications/m/item/covid-19-and-ncds

Wamala, D., & Augustine, K. (2013). A meta-analysis of telemedicine success in Africa. Journal of Pathology Informatics, 4(1), 6–6. https://doi.org/10.4103/2153-3539.112686