Disaster Resilience–the ability of countries, communities and households to manage change, by maintaining or transforming living standards in the face of shocks or stresses without compromising their long-term prospects, is somewhat limited when applied to the COVID-19 experience because of the underlying assumption of` bouncing back’ or `recovery’ to a status that what was there before. The COVID-19 pandemic is so severe and profound in effect that there really will be very limited instances of returning to the status that existed before. The pandemic will require societies to be radically transformed to a new culture of existence.
This First Advisory to Heads State or Government describes the type of resilience that countries must prepare for, therefore, is one that builds the capacity for re-invention and re-designing the fabric and structures of society.
Africa faces specific challenges in tackling coronavirus. In a paper titled ‘Why Sub-Saharan Africa needs a unique response to COVID-19’, Neema Kaseje, Founder, Surgical Systems Research Group, lists the following, among others, as major challenges:
- Health systems in Africa have limited capacity to absorb the pandemic; and
- The strategic approach should focus on containment and aggressive preventive measures.
- Challenges to Health Systems
There are two major health system factors that will make the COVID-19 response in Africa more challenging. Firstly, the continent is experiencing the double burden of diseases: in addition to dealing with these endemic infectious diseases, health systems in Africa are facing non-communicable diseases, including injury, and cancer. As a result, the health systems are stretched thin to begin with, and there is very little room to absorb the COVID-19 pandemic.
Secondly, the capacity to provide critical care is the lowest in the world. Severe forms of COVID-19 lead to respiratory failure requiring ventilation support. The ability to treat severe forms of COVID-19 will depend on the availability of ventilators, electricity, and oxygen. A recent analysis of countries with the highest numbers of intensive care beds per capita does not include any country from Africa. In Liberia for example, there are no intensive care units (ICU) with ventilators. Uganda has 0.1 ICU bed/100,000 population. In contrast, the United States has 34.7 beds/100,000 population.
Lessons learnt in the US, Italy and China are extremely valuable. However, they cannot be extrapolated directly to Africa because of these differences in demographics and health systems.
Because health systems in Africa are strained to begin with and have very limited capacity to absorb the pandemic, the overall strategic approach should focus on containment and aggressive preventive measures.
Early and aggressive physical distancing and frequent handwashing will prevail as the most effective and affordable interventions for the continent, with parallel testing, contact tracing, and isolation of cases. For aggressive preventive measures to work, there will be need for full support of populations. Full support of populations can only be achieved with community engagement and strong health leadership.
Furthermore, given the youth of the continent, youth leadership and engagement will be critical for prevention and containment activities. And lastly, given the priority given to religious services, religious leaders will need to participate actively in the COVID-19 response. At the health system level, operating rooms and teams could be reorganized and repurposed to build critical care capacity in district hospitals.
The African context is unique. There are population structure differences, high prevalence of endemic diseases and the double burden of disease, with health systems that are stretched thin with minimal critical care capacity.
A robust COVID-19 response for the continent will need to take these factors into account and include community engagement, health leadership, and involvement of youth and religious leaders to drive containment. At the health system level, temporary repurposing and reorganizing of the system will be key to increasing critical care capacity during the response, focusing on what we have as we move forward.
- Design of the African Response
African countries can consider themselves somehow `fortunate’ since they have experienced considerable disease disasters and henceposses vast amounts of data and information that can inform their learning, not only on COVID-19, but also on other epidemics such as the 1918 pandemic influenza, Ebola, Dengue, Zika, West Nile etc. in addition to endemic diseases such as TB, Malaria, HIV etc. It is now time to draw parallels, comparisons, contrasts, and think about education, science advocacy, lessons learned, potential projects and formulating policy advisement for governments in Africa.
In formulating an African response to COVID-19, there is need to consider radical transformations in the following broad areas. First, is the management of the commons; Second, is addressing Climate Change and Climate Variability; Third, is the management of food supply chains; Fourth, is the management of mental illnesses; and Fifth, is the provision of strong and effective leadership able to offer crisis management. These areas are elaborated below:
- Re-designing the management of the Commons—The term “commons” is taken to mean any shared and unregulated resource such as atmosphere, oceans, rivers, fish stocks, roads and highways, riparian lands etc. The notion of a“tragedy of the commons” is a description of situations of shared-resource systems where individual users, acting independently according to their own self-interest, behave contrary to the common good of all users by depleting or spoiling the shared resource through their collective action. It is the mismanagement and over exploitation of the commons that has resulted, more than anything else, directly or indirectly, to the global spread of COVID-19. We cannot therefore hope to formulate a resilience response if we do not put into place a different protocol and culture of management of resources provided by the commons for the post-COVID-19 era. That is true for Africa as it is true for the rest of the world.
- Addressing Climate Change and Climate Variability—Africa has one of the fragile commons which has been severely degraded by external and internal inhabitants. The emissions of Greenhouse gases, deforestation of our prime forests, expansion of agriculture to the hilltops have resulted in the increased changes in patterns of rainfall and temperatures commonly known as “Climate Change and Climate Variability” whose devastating impacts is greater than “Coronavirus “impacts so far. Some statistics illustrate the statement. It is estimated that today, May 7,2020, 265,238 deaths from Coronavirus has occurred globally https://www.bloomberg.com/graphics/2020-coronavirus-cases-world-map/. However, between 1980 and 2008 there were 1,699 disaster risk events which caused 708,712 deaths or 25,311 deaths per year in Africa, with an economic loss of US$ 832,449,000 https://www.preventionweb.net/about/privacy . Today, we have floods and landslides which has killed 196 Kenyans while Coronavirus has killed 26 Kenyans https://www.nation.co.ke/news/Heavy-rains-kill-194-Kenyans/1056-5544130-2bkd9fz/index.html.
The cause of all these tragedies arise from the destruction of the common goods. Coronavirus arose from the food source of some people that transmitted it from animals to humans. The Climate change effects arise from human destruction of the atmosphere by emitting greenhouse gases to the atmosphere, deforesting our prime forests and cultivating and building houses on trees depleted hill sides. Our future now depends on restoring the depleted and damaged nature. We need to restore the forests, debunk the rivers so that overflow may be a thing of the past. We need to plant trees and grass in our low-lying grounds.
The revitalization of the African economy will be achieved through mobilizing the people to work on the damaged commons. Above all, we need to enhance investments in the education of the youth, developing infrastructures for health, research facilities and facilities that serve the common man and woman. Borrowing money to invest in projects that continue to create differential wealth for the rich will create more poverty differences in the citizens and leave investments in the commons unattended. The next disaster will have a more devastating impacts than the present.
- Re-designing the management of food supply chains—The coronavirus will ravage and massively disrupt the existing systems of food production and supply. African farmers tend to be older in age than average. The continent has a youthful population, but young people tend to be less interested in agriculture and more likely to migrate to urban areas. This leaves a slightly older farming population that could be more vulnerable to the coronavirus. The question of where to buy food is also uncertain. While supermarkets have advanced in some cities. Many people in urban areas depend on small shops and open-air markets. These outlets are especially important to those who can only afford to buy in small quantities. Efforts to close markets for public health reasons will compromise people’s ability to buy food as well as curtailing the livelihoods of producers and vendors, with knock-on consequences for their own food security. While such actions may become necessary to combat the pandemic, creating alternatives for people will be important. Another very important consideration is food quality. How do we ensure that post the pandemic, food systems will be better managed, and that food quality will be better assured, especially in the various transaction points of the food supply chain right from the farm to the table?
- Enhancing the management of mental conditions—During the COVID-19 pandemic individuals within communities and within their respective countries need to remain optimistic, both physically and mentally healthy, as this will be key to the psychological resilience in overcoming this challenge united. Alisha Moopen, deputy managing director, Aster DM Healthcare says: `The novel coronavirus has stirred some very strong emotions in us: fear, trauma, grief and anxiety. The COVID-19 outbreak in several countries and with the news related to the disease, there is a strong likelihood of a dip in the mental health of the people at large. There are plenty of reasons for this mass panic — loss of lives and livelihoods; economic slowdown, rising health care costs; uncertainty; misinformation, over-information and also lack of appropriate information; isolation and separation from loved ones, and so forth.’
Indeed, according to Alisha, `challenges around mental health cannot be addressed in a piecemeal manner but requires concerted efforts from the civil society, policymakers and health care practitioners. The good trend we are seeing is that the millennials and young generation are not afraid to talk about it. What we need is the government to include these in policies and to allow our population to not suffer in despair but with hope for recovery. India took a giant leap in this direction by decriminalizing suicide attempt by someone with the notification of the Mental Healthcare Act 2017. It states that any person who attempts to commit suicide “shall be presumed, unless proved otherwise, to have severe stress” and that the government will be duty bound to provide care, treatment and rehabilitation to the person who attempts suicide, so that he or she doesn’t make such an attempt in future. Similarly, in January 2020 Singapore also amended its Penal Code to decriminalize attempted suicide.’
The issue is even more dire in Africa, facing each and every one of us on how we manage and react to stressful situations unfolding so rapidly in our lives and communities. It is vital that we can draw on the remarkable powers of strength, resilience and cooperation that we as humans fortunately possess. It is therefore essential that we address the public mental health challenges over the coming weeks and months in Africa and beyond. WHO proposes that we can achieve this by:
- Distributing timely, understandable and reliable information from the youngest to the older members of our society;
- Providing psychological support to front-line workers and bereaved families;
- Continuing care and treatment of people with cognitive, mental and psychosocial disabilities; and
- Protecting human rights, especially of those whose rights are often overlooked or violated, including migrants and refugees, prisoners, residents in other closed settings such as mental hospitals or social care institutions, and people with disabilities.
- Provision of strong and effective leadership able to communicate effectively and manages crisis— There is no easy route through the COVID-19 crisis. Besides the obvious problem of selecting the correct path to take, leaders also face the monumental task of reassuring the public and persuading them to follow through on government decisions – even when measures such as social distancing – with its knock-on effect on employment – come at great personal cost. A wrong move could erode trust and unleash unrest that exacerbates the existing dangers. Is the leadership class in Africa, both political and corporate, have the required capacity to enable them with the appropriate response to steer our countries through the pandemic?
There is ample research that leadership makes the greatest difference when the world around us is uncertain, when we are unsure about what lies ahead. We also know that the impact will be greatest when it comes not only from the apex but also from the middle ranks and front lines. Thinking strategically, communicating persuasively, and acting decisively are the hallmarks of good leadership in times of crisis such as this pandemic.
Two researchers inform the best strategies requited to develop effective leadership. Political scientist Arjen Boin, at Leiden University in the Netherlands, has studied the most successful and unsuccessful responses during previous emergencies There is much more to a leader’s responses than his or her speeches. Boin has identified many of the steps necessary for an effective response. Leaders should, for instance, offer a rapid recognition of the danger and, ideally, the necessary infrastructure and procedures should already be in place to quickly gather data once the crisis has hit (the so-called “sense making”). Boin has found that “Effective crisis leadership cannot be brought about by simply doing the right thing’ on the ground…” Instead, the leaders need to craft a good narrative that helps clarify the problem and unite the population if they are to attain the “permissive consensus” that is essential to be able to make decisions and formulate policies.
During the COVID-19 journey, around the world, including Africa there has been examples of great and of dismal leadership, characterized by poor planning, inability of learning from leaders elsewhere. No wonder that on 17th April, 2020, dozens of prominent intellectuals, writers and academics from across Africa co-signed an open letter addressed to the continent’s leaders, asking them to use the crisis caused by the coronavirus pandemic as an opportunity to spur “radical change” in direction.
“In the call, we urge African leaders to also think beyond the current crisis as a symptom of deep structural problems Africa has to confront if it is to become one day sovereign and an actor that contributes to the new global order,” Amy Niang, one of the academics behind the initiative, told Al Jazeera. “We are calling for a second independence.” Their statement went further, saying “African leaders can and should propose to their societies a new political idea of Africa. For this is a question of survival, fundamentally, and not a matter of rhetorical flourish. Serious reflections are needed on the functioning of state institutions, on the function of a state and the place of juridical norms in the distribution and the balancing of power. This is best achieved on the basis of ideas adapted to realities across the continent. The realization of the second wave of our political independence will depend on political creativity as well as our capacity to take charge of our common destiny. Once again, various isolated efforts are already bearing fruit. They deserve to be heeded, debated and amply encouraged…”
More recently other prominent thinkers have made a case for repositioning the continents position in face of the threat posed by the pandemic. Professor John F. E. Ohiorhenuan is one of these and in his recent moving piece titled “Cry the Beloved Continent” he says:
‘..The exceptional vulnerability of African countries is undeniable. For a majority of Africans livelihoods remain very fragile. Sub-Saharan Africa has less than 15 percent of the global population, yet it accounts for more than half of number of people globally who live in extreme poverty (less than $1.90 a day). More than one third of employed workers in sub-Saharan Africa live on less than $1.90 a day. Two thirds of the world’s maternal deaths occur in sub-Saharan Africa. The proportion of people with access to safely managed sources of drinking water in sub-Saharan Africa is about 28 percent. Thirty-four percent of sub-Saharan Africans live in slums or informal settlements, accounting for almost one quarter of the global slum population. At the best of times their situation is precarious…’
Peyton Fleming is much more optimistic. Writing in Gazettenet.com, Fleming poses: Can Africa escape COVID-19 that is ravaging the West? He sees advantages for Africa by saying:
‘…Africa is a young continent facing a virus that mainly kills the old. Africa’s median age is 20 and only 3 percent of the population in Sub-Saharan Africa is over 65 years of age. Hard-hit countries in Europe, by comparison, are significantly older, making them more vulnerable to serious illness; nearly a quarter of Italy’s population is over 65.
Africa has also had extra time to watch and learn from other countries. Sub-Saharan Africa confirmed its first positive case on Feb. 27, fully a month after Europe and the United States began seeing positive cases and more than two months after COVID-19 clusters were first reported in China.
As a result, governments responses were extraordinarily quick compared to most Western countries. Within days of the first COVID-19 death on March 9 in Egypt, Nigeria and dozens of other countries had imposed travel restrictions, school closings and bans on public gatherings. In the case of Uganda, schools were closed before it had any confirmed infections. South Africa’s lockdown was announced 10 days before Florida’s, though Florida had 12 times as many known cases and exponentially more fatalities..’
So, how and what issues should Africans discuss and build consensus on defining that elusive future? Among the priority, I would wish to see:
- Identifying, nurturing and retaining of national leadership that can be relied upon to effectively manage crisis;
- Nudging citizens to vote for such leaders;
- Develop leadership competence at the county level and helping them to find ways of overcoming the non-technical obstacles to service delivery; and
- Implementing programmes and approaches of resilience and crisis management that builds a vision of `shared prosperity’ at the national level.
The above are some of the major over riding concerns for building capacity of an African resilience response to the COVID-19 disaster. However, other related issues need to be also addressed as well. These include:
- How does a country, urgently and quickly, establish a rapid response initiative capable of providing real time, evidence-based information to inform both policy and practice?
- What would you tell our leaders and those who are charged in making decisions if you were asked to provide innovative solutions of the first actions towards building a resilient resource?
- What type of organizations and institutions need to be re-crafted or re-designed for the future capable of dealing with such global catastrophic events, which seemingly are going to be more commonplace?
- How would you suggest we reinvent how we better and efficiently spent time doing work, structures of governance, innovative ways of communication that does not rely on physical presence?
- The spatial dimension and use of the design of our cities need definite rethinking. I am not sure we have designed a working model of health system that caters for all, especially for such pandemic times.
- How best do we re-craft the management of the scientific research enterprise to respond and be of service at times such as these?
- How do we turn-around innovative virtual-conferencing as a pathway of exchange of research ideas and dissemination?
- How do we place our universities and think-tanks to be able to turn around ideas and offer well thought out solutions?
- How do we better use the defence machinery such as the military so that it is at the forefront of providing tactile security responses to enemies such as those are being posed by viruses?
- How do we rebuild confidence in the many Kenyan youth educated and talented as we rebuild the economy?
- How do we restore the degraded natural resources through mobilization of the less endowed Kenyans?
The ideas discussed in this paper are a result of discussions held with several senior colleagues. I wish to particularly recognize the input of Prof. Shem Wandiga, University of Nairobi; Kigara Kamweru, Chairman of ProPerArt Trust as well as Mike Eldon, founder chairman and lead consultant of The DEPOT (The Dan Eldon Place of Tomorrow), a management consultancy that focuses on leadership, strategy, culture strengthening, performance management and coaching.
- The Impacts of Climate Change in Africa. J.C. Nkomo, A.O. Nyong, K.Kulindwa. Chapter 5, The Stern Review on the economics of Climate Change, 1-52.
- Climate Change and Variability in Sub-Saharan Africa: A review of current and future trends and impacts on Agriculture and Food Security. Julius H. Korir. In: Environment Development and Sustainability (2011) 13: 587-605.
- Can Africa escape COVID-19 that is ravaging the West? Peyton Fleming, Gazettenet.com 2020
- The reason why some people don’t wash their hands
- Does One Size Fit All? Realistic Alternatives for COVID-19 Response in Low-Income Countries Amanda Glassman, Kalipso Chalkidou and Richard Sullivan
- It’s Your Leadership Moment Michael Useem, faculty director of the Leadership Center and McNulty Leadership Program at the Wharton School of the University of Pennsylvania. https://knowledge.wharton.upenn.edu/article/its-your-leadership-moment/
- Three reasons why Jacinda Ardern’s coronavirus response has been a masterclass in crisis leadership. Suze Wilson, Senior Lecturer, Executive Development, Massey University
- Open letter from African intellectuals to leaders over COVID-19. https://www.aljazeera.com/indepth/features/open-letter-african-intellectuals-leaders-covid-19-200417140154396.html