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.
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Putting the public back into public health: Communities organising solidarity responses to Covid-19
Whyle E; van Ryneveld M; Brady L; Loewenson R: Maverick Citizen, December 2020
What do we know about COVID-19 spread in Africa?
Daraja Press, 5 February 2021
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.
'We are subjects, not objects in health’: Communities taking action on COVID-19
Loewenson R; Colvin C; Rome N; Nolan E; et al: Training and Research Support Centre in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) and Shaping Health, September 2020
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.
Using evidence and analysis for an adaptive health system response to COVID-19 in Uganda in 2020
Kadowa I: EQUINET Case study paper, Ministry of Health Uganda, TARSC: EQUINET: Harare, 2020
Uganda reported its first confirmed case of COVID-19 on 21 March 2020. The country has since implemented a series of public health measures to limit the spread of the virus. The pandemic has progressed from imported cases through sporadic community cases to stage four, with widespread community transmission. This paper documents how evidence and analysis were used to support decision-making for an adaptive health system response to COVID-19 in Uganda in 2020. A desk review was thus implemented using published and grey literature covering the period from February to October 2020 to document the nature and organisation of different data and related evidence used to support projections, planning and decision-making on the surveillance, prevention, care and health system response to COVID-19. The desk review also looked at how evidence was used and communicated across different actors to support adaptive responses. While there have been challenges, Uganda’s response to COVID-19is reported to have been dynamic, responding to different sources of evidence, and through different institutional channels and actions, with the latter generating evidence and experience that feeds back to the response.
Brief: COVID-19 in East and Southern Africa: developments in the pandemic, July 2020
EQUINET and ECSA HC: Mimeo, 2020
This information sheet is the second presenting work summarising evidence as of July 17 2020 from official and scientific population data across countries in east and southern Africa (ESA) on the COVID-19 pandemic, the responses to it and the relationship with other indicators of population health, health systems and health determinants. The information sheet aims to address four questions: What is happening with COVID-19 testing and detection? How and where is the epidemic progressing over time? How has the health system responded? What are the implications for wider vulnerability? In terms of the epidemic profile, increased testing has improved case detection, although still at low levels for an effective public health response. The pandemic continued to take different forms in different ESA countries. In terms of the health system response, the evidence in July indicated continued constraints in accessing diagnostics, limiting case detection, despite reasonable surveillance capacities. In terms of wider vulnerability, the slower, sustained increase in cases in the ESA region were noted to raise concern on the effects of sustained implementation of measures such as school and workplace closures.
COVID-19 in East and Southern Africa: Rebuilding Differently and Better Must Start Now
Loewenson R: MEDICC Review 22(3), doi: https://doi.org/10.37757/MR2020.V22.N3.13, 2020
This paper outlines how for ESA countries, COVID-19 has exposed the weakness in being dependent on research and production outside the region of commodities that are needed in good time for communities and services across the region. This not only relates to current demand, like test kits. It forewarns that African countries will be last in the queue when COVID-19 treatments and vaccines are approved. Tariff reductions and reduced protections for domestic industry have suited a global strategy of ‘lowest-cost-production’ but leave ESA countries vulnerable in the global competition for products. The author also notes that COVID-19 has pointed to resources in the region that could play a more significant role in public health. The Ebola experience showed that an effective response demands collaborative work that involves communities and is supported by professionals, governments and accessible, capable public services. This is the same lesson learned from the gains made in health by applying primary health care strategies in the region, despite their being weakened by underfunding of public services. In contrast, the response to COVID-19 has often generated a self-protective response across countries in global trade and a command-and-control response within countries. Yet neither are effective strategies for a global pandemic that demands distributed local capacities and action. Noting the UN call to use COVID-19 as an opportunity “to rebuild differently and better, the author observes that this begins with how we respond to COVID-19 today, and raises what this implies.
Trends in climate, extractives and health equity in the east and southern Africa
Zimbabwe Environmental Law Association for the Regional Network for Equity in Health in East and Southern Africa (EQUINET), 2020
This paper presents the current situation and projected trends related to climate change in east and southern Africa (ESA); the implications for the health of current and future generations of these trends and; the policy choices and alternatives to respond to them. ESA contributes the least of any world region to global greenhouse gas emissions yet will be more vulnerable to the impacts of climate change than any other region. Extractive sectors exacerbate climate change through deforestation and high emission levels of greenhouse gases. Climate change is expected to cause reduced rainfall and a greater frequency of extreme events in the region, and ESA countries will be vulnerable due to their economic reliance on rainfed agriculture and water resources.The region faces resource and other constraints to implement adaptation policies, or for key areas such as the development and production of green technologies.
Trends in extraction of biodiversity and genetic resources in east and southern Africa
Mayet M, Mentz-Lagrange S, African Centre for Biodiversity: EQUINET, 2020
This paper presents the current situation and projected trends related to biodiversity and genetic resources in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The biodiversity, genetic diversity of plants, animals and forests in ESA countries are declining at alarming rates, risking the health and wellbeing of populations in the region. Losses of biodiversity and genetic resources have led to poorer diets, poorer living conditions, encroachment on areas with animal populations and an erosion of wild foods and medicinal plants that raise the risk of chronic and zoonotic diseases and pandemics. Current policies have not reversed these trends, nor met the targets of the Convention on Biodiversity (CBD). The authors argue that this calls for an urgent paradigm shift from industrial agriculture to diversified agro-ecological systems and a one health approach, that recognise the complex, intergenerational interconnections between human and animal health, plants and a shared environment. The authors call for a movement to defend genetic diversity as a common good, not something that can be extracted and privately profited from.
Trends in extraction of mineral resources in east and southern Africa
Caramento A: EQUINET, 2020
This paper presents the current situation and projected trends related to extraction of mineral resources in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The author notes several changes in the coming decades that have numerous implications for health and wellbeing in ESA, including as a result of land displacement and precarious jobs. A demand for greater and wider health and developmental benefits from current and future mineral extraction has led to resource nationalism. The paper notes that it means effectively projecting, monitoring and preventing the impacts of mineral extraction on health and environments; adopting financial transparency and accountability measures and employing strategies and responses that are built from bottom-up through consultation with small scale miners, communities, workers and the wider public.
Trends in water resources in east and southern Africa
Loewenson R, Training and Research Support Centre: EQUINET, 2020
This paper presents the current situation and projected trends related to water in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. Maldistribution and water scarcity and stress are predicted to intensify in coming decades. Southern countries will become significantly drier and east Africa will have higher rainfall. Climate change will amplify existing variability but may be less critical than growing demand for water. A growing, urbanised population, expanded enterprise and agriculture will deplete and can pollute water resources, with lowest income households least served. Water scarcity contributes to ill health, food insecurity, poverty and increases women’s burdens. There is a potential for vicious or virtuous cycles between these impacts and water resources, depending on the policy choices made. Inequality and stress is not inevitable. There is potentially adequate water to meet the basic needs of all in the region and for sustaining ecosystems if managed through co-operation, paying attention to equity, interdependence and long-term outcomes. The dividends from investments in water systems thus need to be made more visible as well as the harms of competitive, short term choices.