How the private sector coming together to support the COVID-19 response in Africa
The lack of funding and infrastructure for health in Africa was well-documented coming into 2020.
The COVID-19 pandemic has added significant stress to regional health systems that were already short of funding, infrastructure and personnel. Faced with such an urgent task, raising funds for immediate interventions and procurement of medical supplies became paramount.
In addition, there is the need for ventilators, PPE, masks and other supplies that every country in the world is also facing. There are also additional knock-on effects of COVID-19 on national budgets, such as those relating to reduced exports and tourism, which exacerbate the lack of available funding.
Partnerships are needed more than ever to catalyze funding and supplement the COVID-19 response from national governments. The private sector, through internal initiatives and public-private partnerships (PPPs), has been essential to supplementing private funding for healthcare in Africa, both before and during the COVID-19 pandemic.
We reviewed some national COVID-19 partnerships across Africa to identify shared principles for addressing this pandemic. And it starts and ends with what is perhaps the key principle of this whole crisis – solidarity.
Lack of health funding & infrastructure in Africa As of 2018, Africa accounted for approximately 26% of global population and 36% of global disease burden while accounting for less than 2% of global health expenditure. The average physician density in sub-Saharan Africa stands at 0.2 doctors per thousand people. UNECA in April called for $15 billion to fix the gaping need for additional resources to support Africa’s health systems”.
COVID-19 is inherently a problem that requires a whole-of-society response, partly because everyone around the world must undertake various actions (like social distancing and wearing masks) in order to help solve the collective problem.
These issues take on a special significance in Africa because, as UNECA stated, “the measures being taken in Asia, Europe and North America such as distancing and regular hand washing are a particular challenge for countries with limited internet connectivity, dense populations, unequal access to water and limited social safety nets.”
To foster solidarity in the COVID-19 response in Africa, it’s necessary to account for these particular challenges that are especially significant in the region. For example, there needs to be solidarity between the fight against COVID-19 and the fights against the other epidemics affecting the region. Global Fund Executive Director Peter Sands said:
We are acutely conscious of the interaction between the challenges of COVID-19 and the ongoing challenges of the [HIV, TB and malaria]… The big challenge for Africa is that… lockdowns are difficult to sustain in countries where households live on the income they earn each day… Where people live in very close proximity to each other, social distancing is very difficult to achieve, [and] clinical care ICU capacity in many African countries is extremely limited… Africa is going to have to leapfrog to the most sophisticated strategies around massive testing, tracking, and tracing if it’s to control COVID-19, not just to save people dying of COVID-19 but to save people dying of the knock-on impact on other diseases, because I think it is far from implausible that the true cost of COVID will be its impact on other diseases… To fight HIV, TB and malaria we have to fight COVID because if COVID overwhelms the health systems, if it makes health workers sick or incapacitated, it will have this massive impact on HIV TB and malaria.
Of course, the principle of solidarity applies to governments, organizations and institutions as much as it does to individuals. Solidarity is such a key concept that the word is in the name of numerous funds and partnerships addressing the COVID-19 response: the COVID-19 Solidarity Response Fund for WHO, the South African Solidarity Fund (SASF), the Nigeria Solidarity Support Fund (NSSF), and many more.
“COVID-19 affects us all and threatens our collective health – economic, social, psychological and physical wellbeing; hence, the urgent need to work together to beat this common enemy… The task ahead is daunting and bigger than any one organization. To win this battle, it is critical we all come together as one,” said Aliko Dangote, Dangote Group Chairman, whose philanthropic endeavor – Aliko Dangote Foundation (ADF) – is co-leading the Coalition Against COVID-19 (CACOVID), a private sector task force working in partnership with the government of Nigeria, WHO and the Nigeria CDC to combat COVID-19 in Nigeria.
Sherwin Charles, CEO and co-founder of Goodbye Malaria and Global Fund Board Member for the Private Sector Constituency, spoke to GBCHealth about the importance of solidarity during the pandemic, and how to achieve it in a situation where each country is, out of necessity, prioritizing the health and wellbeing of its own citizens. He described the role of partnerships in fostering solidarity by alleviating some of this international competition through equitable procurement and distribution of medical supplies. Solving procurement bottlenecks through regional coordination allows for equitable allocation of resources while harnessing the logistical networks, capabilities and relationships of existing partnerships.
For example, a recent article from The Lancet about the ethics and politics of access to COVID-19 medical supplies for African countries suggests that:
Pooling regional procurement is needed, which can be improved through cooperation between Africa CDC and the WHO-led UN Supply Chain Taskforce, the Global Fund, and other organizations… African governments must mobilize domestic funds, while bilateral and multilateral aid must be increased—with resources flowing in weeks, not months. External funding streams could be channeled through existing mechanisms like the Global Fund, which opened a new mechanism to receive and distribute funds for COVID-19.
Build Back Better
Much of what is needed to fight COVID-19 – health systems and infrastructure, health workers, public health communications capabilities, etc. – is what’s needed to build a stronger African health system to withstand the duration of this pandemic and to face future health threats.
“While finding ways to battle the current pandemic may be daunting, it also presents an opportunity to focus on the strengthening of Africa’s health systems by adopting a comprehensive and integrated approach based on each country’s individual needs,” noted Babatunde Omilola, the manager for the Public Health, Security and Nutrition division at the African Development Bank (AfDB).
CACOVID has been focusing largely on infrastructure, having provided and equipped medical facilities for COVID-19 testing, isolation and treatment in each of the six geopolitical zones of Nigeria. The coalition is also focusing on supplies, having sourced test kits and other health equipment. They are also working with the government to enhance lab capacity.
The principle of long-term sustainability is also part of the core mandate of the NSSF; to “re-skill and retool a new Nigeria and sustainably tackle the pandemic.” Discussing the Fund during its launch, Nigeria’s Vice President, Prof. Yemi Osinbajo, said “[COVID-19] helps us to develop a comprehensive social and critical response. The move to re-engineer and rethink our health system is key; these efforts are commendable.” He also specified that the Fund will work to supplement the government’s Social Investment Program (SIP).
Part of settling into a ‘new normal’ may require rethinking the value of local production of certain commodities, added Mr. Charles. These commodities might be better viewed in the context of health security, viewed as strategic assets and manufactured locally to avoid possible future issues relating to supply chain and multinational bidding wars on health goods like we are seeing today. The local private sector may have an important role in this process of a shift to more localized production.
Harness Private Competencies
The role of private partners of course goes beyond simply providing funds as individual companies. For example, CACOVID is a private sector task force working in partnership with the Nigeria CDC, and has been tasked by the government to pull resources across industries to provide technical and operational support while providing funding and building advocacy through aggressive awareness drives.
The SASF not only represents a way for business to mobilize resources, but assists with government procurement and other activities. Funds such as the SASF can complement governments efforts via the ability to be more agile, catalytic and opportunistic in the current tough procurement environment where every country is bidding for the same medical supplies.
As the world’s richest countries vie to bid on vital supplies, the private sector can help countries increase bidding power. Countries must utilize every possible route, relationship, bit of trade know-how, and other asset at their disposal in order to secure supplies, and the private sector can help with many aspects of this. Additionally, the private sector may operate logistical systems within a given country, which can be vital for the distribution of these resources.
Of course, actors in the African private sector are making individual efforts to fight COVID-19, in addition to working on partnerships. “Africa’s private sector and its youth have responded with entrepreneurialism and ingenuity to the crisis,” said UNECA Executive Secretary Vera Songwe. “Companies have repurposed their manufacturing lines to produce essential COVID-19 products like sanitizers, face masks, and personal protective equipment. The private sector stayed open in many countries to help keep jobs going and businesses have adopted a number of effective measures to mitigate the effects of operating in the COVID-19 environment. These include adopting technology, working remotely and using ecommerce to drive trade.”
Community Engagement & Action
Community ownership is vital to ensure that social distancing and stay-at-home measures are effective. It will continue to be vital throughout the process of reopening societies, while societies balance returning to business as usual with the aspects of these measures that will need to be maintained to stop the potential spread of COVID-19.
A big part of engaging communities is addressing the pandemic not only as a health issue but one that extends to food security, economic and social wellbeing, and other non-health concerns. It’s important to communicate to the public in ways that will foster community ownership and engagement. Due to the isolation caused by stay-at-home measures, social media and other forms of online interactions have become important out of necessity to spread vital messages and keep communities connected.
“It’s important that [the COVID-19 response is] not just government owned, but that it’s whole of society owned,” Githinji Gitahi, CEO of Amref, said in a discussion of the COVID-19 response in Kenya and the National Business Compact on Coronavirus (NBCC). “The community needs to drive the response and see it as their own, so they hold each other accountable.” The NBCC is working to share best practices, “create a unified communications strategy to amplify the government’s messaging on how to stay safe and limit the spread of the virus… scale up the distribution of hygiene facilities,” and “create a flexible funding mechanism to quickly respond to the government’s needs as the crisis evolves.” The NBCC has published best practices and lessons learnt from its work on hygiene, behavior change, and related measures.
Herbert Wigwe, Group Managing Director of Access Bank – which is spearheading CACOVID along with ADF – noted that “while several measures are being taken to stop the spread, including lockdowns, restriction, social distancing, there is the need to address the hunger. How do we cater for the feeding needs of the people if these measures are to be effective?” Part of CACOVID’s efforts focuses on food relief efforts for local governments.
The SASF also recognizes that this is not just a health challenge. Humanitarian efforts and a solidarity campaign (an advocacy/behavior change campaign) are pillars of its work, on equal footing with health. The Fund is “continuously engaging with multiple civil society groups and government partners to understand where the country’s most pressing needs are for intervention.” More on the Fund’s work with civil society and government to distribute food parcels can be found here (scroll to “Support”).
The SASF has also focused on the importance of getting individuals to understand why hygiene and social distancing are important, emphasizing the context of how they relate to ending the pandemic. Their goal goes beyond messages about hygiene, but aims to get positive messages into communities, and to replace fear, distress and panic with positive hope.
Many countries (not only in Africa but throughout the world) cannot afford to sustain their citizens through an extended lockdown period by providing food and other financial offsets to ameliorate the impact of lost work due to the pandemic, again reinforcing the importance of working together to raise funds and help at this vital moment.
To foster community ownership, it’s critical to ensure the public understands why their governments are imposing strict measures, and that the government is respecting the significant consequences to the wellbeing and livelihood of many people posed by the pandemic. For example, South Africa President Cyril Ramaphosa said in an address to the nation, “we have closed our borders to the world, our children are not in school, businesses have closed their operations, many have lost their income, and our economy has ground to a halt… You have done so because you have understood the devastating effect that this disease will have on the health and well-being of all South Africans unless we take drastic measures.”
Alignment, Accountability and Transparency
COVID-19 initiatives are prioritizing transparency and working to demonstrate responsible management of funds. Good governance is key to ensure that funds are being used efficiently and appropriately. Equally important for the success of any partnership is to align with local government efforts to maximize efficiency and impact. Programs need to be aligned with government strategy from inception, and need to adapt to changing circumstances alongside local government and other local actors.
For example, the NSSF highlights its partnership with the Nigeria Sovereign Investment Authority (NSIA) as part of its governance. NSIA Chairman Jide Zeitlin said collaborations such as the NSSF are key to helping mobilize funds and other support for the COVID-19 response, and added “we are committed to bring good governance to the fund management.” Also speaking at the NSSF launch, Nigerian Minster of Finance, Mrs. Zainab Shamsuna Ahmed, noted that “NSIA is a credible government agency, and the partnership will help to provide the right vehicle for funds management.”
The SASF has a Board led by the private sector, but with two of the members being government Ministers. Additionally, the Board reports to a national council set up and chaired by President Ramaphosa. And, in each of the workstreams there are connections made to relevant government groups to ensure the Fund and the government are complementing and synergizing with each other’s work, which is especially important for example in the procurement of medical supplies.
The funds raised by the SASF are managed by an independent pro bono asset manager, and the fund has a full set of audit, compliance, and risk frameworks overseen by Board committees, as well as a disbursement committee which focuses on where money is spent, ensuring impact. The Fund has even made an overview of its governance framework available online for maximum transparency.
These are just a few of the common principles shared between COVID-19 partnerships in Africa. Of course, funding from multilateral development banks and international financing institutions will also have an important role to play in supplementing funding for African governments’ COVID-19 response. We will continue to share the latest on PPPs and health financing for COVID-19, Africa, and other pandemics and endemics in future editions of our newsletter.
For more information on these partnerships, including info about all the local and regional partners each organization is working with, visit their websites: