Leveraging Community Health Workers for COVID-19 Response in Democratic Republic of Congo, Nigeria, Senegal, and Uganda: Roles, Barriers, and Facilitators (preprint)

Background: The COVID-19 pandemic overwhelmed health systems and disrupted the delivery of health services globally. Community health workers (CHWs) play a critical role in linking communities to health systems, supporting the prevention and control of diseases in many low- and middle-income countries. However, their roles, barriers, and facilitators in the response and control of the COVID-19 pandemic have not been well documented. We described the roles of CHWs in the COVID-19 response including the barriers, and facilitators. Methods: We assessed the COVID-19 response in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This involved key informant interviews with CHWs, and review of documents on the COVID-19 response, and engagement of community health workers. We searched Google, Google Scholar, and PubMed for published and grey literature. Data from the selected documents were extracted into a Google master matrix in MS Excel and analyzed thematically. Results: In COVID-19 Control, CHWs supported community-based surveillance, contact tracing, risk communication, community mobilization, and home-based care. To support the continuity of other non-COVID-19 services, the CHWs conducted community mobilization, sensitizations, outreaches, referrals, and patient follow-ups. CHWs were challenged by movement restrictions, especially in the initial stages of the lockdown, inadequate PPE, increased workload, low allowances, and motivation. CHW were facilitated by trainings, the development of guidelines, development partners’ support/funding, provision of personal protective equipment (PPE) and tools. Conclusion: CHWs supported both the COVID-19 control and continuity of non-COVID-19 health care during the COVID-19 pandemic. CHWs are a critical resource that must be adequately supported to build resilient health systems.

Strategies for rapid scale up of laboratory capacity in a public health emergency in a resource-constrained setting: the SARS-CoV-2 Nigeria response experience (preprint)

Introduction: Sufficient laboratory capacity is vital to containing infectious diseases outbreaks. This study was conducted to assess SARS-CoV-2 testing performance, the strategies adopted to scale up laboratory testing capacity, and to highlight challenges and lessons learnt in Nigeria’s response to COVID-19 pandemic regarding testing strategies.Methods This cross-sectional descriptive study adopted a mixed method approach including desk reviews and key informant interviews (KIIs). The KIIs were conducted among actors of the COVID-19 response teams in states (SMoH) and the Federal Ministry of Health (FMoH) in Nigeria. Data extraction tools were populated from the relevant online resources and documents of the FMoH, SMoH and the Nigeria Centre for Disease Control.Results At the beginning of the pandemic in Nigeria, testing performance was poor, but this improved over time. To manage the demand for testing, Nigeria adopted targeted testing with a focus on symptomatic contacts and alerts, returning travelers from high-risk countries who were symptomatic during the quarantine period, among others groups. Strategies to enhance laboratory capacity and improve the turnaround time for results included leveraging on existing tuberculosis laboratory network or building new laboratories where none existed; decentralization of sample collection and testing; staff health workers repurposing and hiring of volunteers; training and retraining of laboratory personnel; adoption of rapid diagnostic testing; and strengthening public-private partnerships to leverage the private sector testing. From an initial three laboratories with capacity to test for SARS-CoV-2 in February, 2020, the number of laboratories increased to 158 by March, 2022. Although laboratory capacity increased, logistics and supply chain disruption was still a challenge.Conclusion Investment in local manufacturing capacities of laboratory consumables such as RDTs and reagents would promote self-reliance and sustainability for a country as populous as Nigeria.

Improving testing capacity for COVID-19: Experiences and lessons from Senegal, Uganda, Nigeria and the Democratic Republic of Congo (preprint)

Background: African countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria and the Democratic Republic of Congo (DRC). Methods: The four countries’ testing strategies were studied using a mixed-methods approach. Desk research on COVID-19 testing strategies was conducted and complemented by interviewing key informants. The findings were synthesized to demonstrate learning outcomes across the four countries. Results: The four countries demonstrated severely limited testing capacities at the onset of the pandemic. These countries decentralized COVID-19 testing services by leveraging preexisting laboratory systems such as polymerase chain reaction (PCR) and GeneXpert used for the diagnosis of tuberculosis (TB) to address this gap and the related inequities, engaging the private sector, establishing new laboratories, and using rapid diagnostic tests (RDTs) to expand testing capacity and reduce the turnaround time (TAT). The use of digital platforms improved the TAT. Testing supplies were sourced through partners, although access to global markets was challenging. Case detection remainssuboptimal due to high costs, restrictive testing strategies, testing access challenges, and misinformation, which hinder thedemand for testing. The TAT for PCR remained a challenge, while RDT use was underreported, although Senegal manufactured RDTs locally. Key findings indicate that regionally coordinated procurement and manufacturing mechanisms are required, that testing modalities must be simplified for improved access, and that the risk-based testing strategy limits comprehensive understanding of the disease burden. Conclusions: Although testing capacities improved significantly during the pandemic, case detection and access to testing remained suboptimal. The four countries could benefit from further simplification of testing modalities and cost reduction. Local manufacturing and pooled procurement mechanisms for diagnostics are needed for optimal pandemic preparedness and response.

Unintended consequences of implementing non-pharmaceutical interventions for the COVID-19 response in Africa: experiences from DRC, Nigeria, Senegal, and Uganda (preprint)

Introduction: The coronavirus (COVID 19) pandemic is one of the most terrifying disasters of the 21st century. The non-pharmaceutical interventions (NPIs) implemented to control the spread of the disease had numerous positive consequences. However, there were also unintended consequences—positively or negatively related to the nature of the interventions, the target, the level and duration of implementation. This article describes the unintended economic, Psychosocial and environmental consequences of NPIs in four African countries. Methods: We conducted a mixed-methods study in Uganda, the Democratic Republic of Congo (DRC), Nigeria and Senegal. A comprehensive conceptual framework, supported by a clear theory of change was adopted to encompass both systemic and non-systemic interventions. The data collection approaches included: (i) review of literature; (ii) analysis of secondary data for selected indicators; and (ii) key informant interviews with policy makers, civil society, local leaders, and law enforcement staff. The results were synthesized around thematic areas. Results:Over the first six to nine months of the pandemic, NPIs especially lockdowns, travel restrictions, curfews, school closures, and prohibition of mass gathering resulted into both positive and negative unintended consequences cutting across economic, psychological, and environmental platforms. DRC, Nigeria, and Uganda observed reduced crime rates and road traffic accidents, while Uganda also reported reduced air pollution. In addition, hygiene practices have improved through health promotion measures that have been promoted for the response to the pandemic. All countries experienced economic slowdown, job losses heavily impacting women and poor households, increased sexual and gender-based violence, teenage pregnancies, and early marriages, increased poor mental health conditions, increased waste generation with poor disposal, among others. Conclusion: Despite achieving pandemic control, the stringent NPIs had several negative and few positive unintended consequences. Governments need to balance the negative and positive consequences of NPIs by anticipating and instituting measures that will support and protect vulnerable groups especially the poor, the elderly, women, and children. Noticeable efforts, including measures to avoid forced into marriage, increasing inequities, economic support to urban poor; those living with disabilities, migrant workers, and refugees, had been conducted to mitigate the negative effects of the NIPs.

Private Sector Engagement in the COVID-19 Response Experiences and Lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda (preprint)

Background: Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response. We conducted a study to document the public and private sector partnerships and engagements to inform current and future responses to public health emergencies. Methods This was a multi-country cross-sectional study conducted in the Democratic Republic of Congo, Nigeria, Senegal and Uganda to assess responses to the COVID-19 pandemic. We conducted a scoping literature review and key informant interviews (KIIs) with private and public health sector stakeholders. The literature reviewed included COVID-19 country guidelines and response plans, program reports, websites and peer-reviewed and non-peer-reviewed publications. KIIs elicited information on country approaches and response strategies specifically the engagement of the private sector in any of the strategic response operations. Results Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. In the DRC and Nigeria, private entities supported contact tracing and surveillance activities. Across the 4 countries, the private sector supported expansion of access to testing services through establishing partnerships with the public health sector to provide COVID-19 testing albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. The private sector also contributed to treatment and management of COVID-19 cases. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in the provision of services. Conclusions The private sector greatly contributed to the COVID-19 response through engagement in COVID-19 surveillance and testing, management of COVID-19 cases, and health promotion to maintain health access. There is a need to develop regulatory frameworks that support sustainable public-private engagements including regulation of pricing, quality assurance and alignment with national plans, strategies and priorities during response to epidemics.