When Inside Philanthropy covered COVID-19’s rise in Africa two and a half months ago, the case count had recently jumped to 300,000. Now, the continent’s CDC dashboard shows nearly 1 million more cases, drawing wide red circles around South Africa, Egypt, Morocco, Nigeria and Ethiopia. Thirty thousand people have lost their lives.
Initial models predicted lower viral transmission rates in Africa than in other places, due to factors like a population that skews younger, and communities spread across vast rural areas. Government interventions were early and aggressive. But the rise was predictable: The virus has a disproportionate impact on places of extreme poverty, and all but one of the poorest countries in the world are situated within sub-Saharan Africa.
Major systemic weaknesses compound the problem. Forty-seven African nations count only nine ICU beds per million citizens. And common Western mitigation measures like social distancing and handwashing bump up against the realities of informal employment, intergenerational living environments, and water scarcity that affects one in three people.
Front-line workers are especially at risk. Infections among Africa’s doctors and nurses have rocketed by 203 percent since May. In mid-July, WHO Africa Regional Director Dr. Matshidiso Moeti announced that 10,000 health workers in 40 countries had been infected in the course of their work. A strained infrastructure and lack of personal protective equipment (PPE) were cited as key contributing factors.
In response, in early August, a coalition of more than 30 partners launched the COVID-19 Action Fund, the largest single effort so far to mobilize private resources to equip Africa’s essential front-line workers with PPE. The fund aims to raise more than $100 million to equip community health workers in 24 countries with the protection they need for up to a year.
On the Front Lines
Africa’s community health workers (CHWs) have always been on the front lines of African healthcare. Recruited from the communities they serve, their work ordinarily expands the reach of formal primary healthcare systems. They visit people in their homes, manage casework, and address health priority areas like maternal and child health and immunizations during prior outbreaks like Ebola. We’ve reported in the past on philanthropic efforts to strengthen local African health systems and invest in CHWs, such as Co-Impact’s investment in Liberia’s National Community Health Assistant Program. But private funds for these efforts comprise a drop in the bucket relative to the scale of the challenge—systemic shortcomings that have been laid bare by the coronavirus pandemic.
Explaining the need in human terms, Euniter Adoyo, community health worker supervisor of the Lwala Community Alliance and Kenya Ministry of Health in Kenya, says, “We visit households. We advise women to take their children for immunizations. We manage other cases, like malaria. We need PPE just like any other health worker so we can protect ourselves and our community.”
A Global Gap
Even high-income countries (HICs) have struggled to provide their front-line health workers with PPE as travel restrictions limit the flow from producing countries, and lockdowns restrict suppliers. But in an environment of global shortages, HICs stand ready to pay more, stripping supply. UNICEF estimates that prices for some items have reached 20 times historic levels, citing an “unprecedented” market for face masks, N95 respirators and medical clothing.
Low- and middle-income countries in general, and community health workers in particular, appear to be bearing the brunt of the resulting inequities.
The COVID-19 Action Fund
Anchored with a $10 million commitment from the humanitarian aid organization Direct Relief and leadership from Chicago-based Crown Family Philanthropies—which prioritizes community health in sub-Saharan Africa in its global health program—the COVID-19 Action Fund works in partnership with Africa’s Ministries of Health to meet the critical protective needs of CHWs.
Work is collectively advanced by Direct Relief and the Community Health Acceleration Partnership, the Community Health Impact Coalition and the Pandemic Action Network. Dr. Madeleine Ballard, executive director of the Community Health Impact Coalition, reports that the fund has already reached the first of four fundraising benchmarks, which will allow it to provide PPE to 12 countries for at least three months. Much of the total raised is expected to come in the form of in-kind giving, like the World Food Programme’s donation of more than $1 million in freight and logistics support.
The fund’s first round of mobilization airlifted nine 747 cargo loads of PPE for distribution. Supplies have already reached four countries, Lesotho, Liberia, Sierra Leone and Zimbabwe, and are en route to eight more: Côte d’Ivoire, the Democratic Republic of Congo, Malawi, Mali, Mozambique, Rwanda, Togo and Uganda. Rounding out the 24 countries expected to receive support are Angola, Benin, Burkina Faso, Ethiopia, Ghana, Kenya, Niger, Nigeria, Madagascar, Senegal, Tanzania and Zambia.
Allocations are based on verified needs as identified by ministries of health in each receiving country. Based on their reports, the fund has already purchased in excess of 25 million surgical masks, 35 million gloves, and nearly 825,000 face shields and 1 million isolation gowns. Local partners will transfer the PPE from ports of entry in each country and deliver it to healthcare workers in concert with health ministries. All told, the fund expects to supply more than 1 million workers with the surgical masks, gloves, eye protective wear and gowns they need to serve roughly 400 million people during the pandemic.