The COVID-19 pandemic has strained the already stretched health systems in East and Southern Africa (ESA) countries, and was affected by previous levels of public leadership and engagement with the private sector. The response involved a range of collaborations between the public and private sectors. Country plans were public sector-led, in co-operation with international development partners, with partnerships between the public and private sectors in the response both in and beyond the health sector. This desk review commissioned by EQUINET presents evidence from online materials and EQUINET steering committee key informants on features of the public and private sector health system roles in the response to COVID-19. The work differentiates the private for-profit sector from the private not-for-profit sector. The review explores the equity implications of these responses, and suggests implications for (re)investing in strengthened public health system preparedness and functioning and private sector co-ordination in ESA countries.
Latest Equinet Updates
This desk review reports available published information relating to youth mental health in east and southern Africa (ESA). It was implemented within and informs collaborative work on youth mental health in the region in EQUINET between Training and Research Support Centre (TARSC), the International Working Group for Health Systems Strengthening (IWGHSS) and the pra4equity and PAROnline network, specifically Country Minders for Peoples Development (CMPD), Malawi, and the Centre for Youth Driven Development Initiative (CFYDDI), Uganda. The desk review explored patterns and determinants of youth mental health in the region; how the coronavirus (COVID-19) pandemic and responses to it have affected this; where youth seek and obtain support for mental health needs and the perceived challenges and gaps. It presents recommendations for improving the responses to mental health challenges. The COVID-19 lockdown and social distancing measures led to difficulties, with online learning and loss of work and rising costs intensifying some factors and increasing mental stress, as well as suicidal ideas and substance and alcohol abuse among youth. Youth mental health is a pertinent issue for the ESA region, more so due to the impact of the pandemic, but is not well recognised by formal services and policy. The review evidence points to a need, intensified by COVID-19, to co-create with young people strategies for preventing and responding to youth mental illness and its drivers and consequences.
The first East and Southern Africa Regional People’s Health University (ESA RPHU) jointly convened by PHM and EQUINET is being held virtually between July 29 and November 12 2021 with 10 weeks of interactive sessions to build and share evidence, experience, analysis and knowledge on health equity to support regional co-operation and joint engagement, from local to global level, on shared priorities. The course programme is at https://www.equinetafrica.org/rphu/rphu-programme with different issues affecting health equity in the region and learning from COVID-19. Open access online dissemination of plenary presentations and resources is available on the RPHU resources page. It currently includes video clips of a panel discussion moderated by Dr Rene Loewenson TARSC/EQUINET with Dr Firoze Manji, Daraja Press and Professor Patrick Bond, University of Western Cape, explored the Political Economy of Health in East and Southern Africa; David van Wyk from Benchmarks Foundation on a case study of health equity in mining in South Africa; Mariam Mayet, Executive Director of the African Centre for Biodiversity on global and corporate activities in industrial agriculture and gene technologies in relation to malaria; Thusang Butale BFTU and Danny Gotto I4Dev on experiences of extractive activities in Botswana and Uganda; Masuma Mamdani, EQUINET on social determinants of health; Shakira Choonora on an Intersectional lens to health inequities; Sue Godt on Emerging commercial determinants of health and the reality in the region and Peter Binyaruka, Ifakara Health Institute (IHI), Tanzania presentation on co-financing to address social determinants of health equity. The Resources page is being updated with new content as the course progresses.
The first East and Southern Africa Regional People’s Health University (ESA RPHU) jointly convened by PHM and EQUINET is being held virtually between 29 July and 12 November with the theme ‘Past, present and future struggles for Health equity’. The course aims to build and share evidence, experience, analysis and knowledge on the drivers of health equity to support efforts and activism within countries, as new and existing members of PHM and EQUINET, and in regional co-operation and joint engagement, from local to global level, on shared priorities. The course aims to link key areas of evidence and knowledge to practical experiences and action to share insights and build learning from action. We invite applicants based / working in the east and southern Africa region in state, non-state, community-based institutions involved in health-related work, from health and other sectors and disciplines that have an impact on health equity. See the website link for further details on the course, features for applicant eligibility, and for the online application form. Applicant forms must be received by 25 June 2021. Applicants will be informed by 12 July.
Access to health technologies (vaccines, medicines, diagnostics, PPE, ventilators etc) depends on distributed local production. Nationalism and protectionism on these technologies has implied a sustained struggle to get sufficient access to meet population needs, and global measures such as CTAP (for voluntary patent pooling) and COVAX (for vaccine and technology pooling) have not had the support that matches need. One of the barriers is the patent protection in the TRIPS agreement. In this interview, Firoze Manji speaks with Leslie London, Professor of Public Health in the School of Public Health and Family Medicine University at the Cape Town (and an EQUINET steering committee member), and Jens Pedersen from Medicins Sans Frontiers on the issues of access.
The ability of African countries to mount effective and equitable responses to COVID-19 reflects in part the access that countries have to reliable, sustained, distributed supplies of diagnostics, medicines, vaccines and other health technologies. By 2021 significant inequality in access to vaccines has become clearly evident, a situation that the World Health Organisation director-general called a “catastrophic moral failure” in January 2021. While noting that vaccine roll out in East and Southern Africa (ESA) is a dynamic situation, this brief discusses the different vaccines and the distribution of vaccines in the region and issues involved in the development and production of vaccines and other health technologies in the region. It raises areas where regional co-operation is taking place and suggests where it could be strengthened.
This fifth information sheet in the COVID-19 series summarises information on how COVID-19 has affected working people in the ESA region, and the response by workers, unions, states and others, with recommendations for how to better address the impacts. Nearly a million African workers are estimated to have had COVID-19 in 2020, probably more given the low level of testing. Health workers (HWs), those in crowded or poorly protected workplaces or in crowded accommodation, those in common contact with the public and those in caring roles may be more at risk. Informal, migrant, young, disabled and female workers may be more vulnerable to COVID-related disease. Lockdowns and blocks in supply chains have disrupted key areas of employment, affecting working people’s livelihoods, jobs and mental health, and leading to stigma and social insecurity and falling remittances from African migrants and revenues for social protection. Possible responses include public health measures, including now equitable access and vaccines; workplace infection control; social protection to prevent impoverishment; protection of jobs and wage subsidies. Workers and unions have contributed to these responses, despite the pandemic undermining union operations. The brief outlines recommendations to protect workers and their rights at work, noting that not implementing such measures makes the whole of society vulnerable.
This oped draws on EQUINETs 42 case studies of community action on Covid-19 that collectively show innovative and solidarity-based approaches to prevent and care for Covid-19, to address social needs and hold states accountable, and in more detail on the experience with the Community Action Networks in South Africa.
This interview between Firoze Manji Daraja press and Dr Rene Loewenson, Training and Research Support Centre explores evidence and knowledge gaps on COVID-19 in east and southern Africa, drawing on EQUINET information briefs and other sources. The interview identifies positive examples of state and public proactive responses to the pandemic in the region, the challenges faced and what learning that brings for equity in responding to pandemics.
This document provides evidence of practical and affirmative options of people-centred, participatory forms of community organising and engagement in diverse areas of prevention, care and wider social protection in responding to COVID-19. The 42 case studies from different regions intend to inspire, inform and support. They report the creative development and use of social media platforms for action across all areas of response, connecting people within and across communities and countries, giving voice and visibility to community experiences and linking people to key resources and services. They demonstrate that a compassionate society enhances public health. Many build on histories, ideologies, structures, organisation and relationships that began long before the pandemic, enabling a relatively rapid response to new challenges posed by COVID-19 and with an intention to sustain relevant innovations after the pandemic. They reach to socio-economically disadvantaged groups within communities, strengthening collective organisation, investing in capacities and leadership and making links with more powerful groups to address local priorities and negotiate delivery on state obligations. They build new relationships between communities and producers and between communities and health workers, and solidarity interactions with international agencies and diaspora communities. The challenges presented by the pandemic are creating demand and space for innovation, and in many settings communities are rising to that demand. The mobilization of affirmative community effort and creativity needs to be recognised in the story of the 2020 pandemic.