COVID-19: Africa needs unprecedented attention to strengthen community health systems

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus and is infectious among asymptomatic carriers.4 SARS-CoV-2 differs from Ebola virus in terms of the reproduction number (SARS-CoV-2 5·7 vs Ebola 1·5–1·9),5,6 incubation period (2–14 days vs 8–10 days on average),7,8 and case fatality rate (this varies for SARS-CoV-2 but average is estimated at 4·7% as of July 7, 2020, vs up to 90% for Ebola).9,10 COVID-19 is easier to transmit, harder to diagnose, and can quickly spread in communities. The stakes are high for people's health if there is any reduction in care-seeking behaviour for preventable diseases.19 To its credit, Liberia, scarred from the Ebola outbreak, has been training its National Community Health Assistants to prevent, detect, and respond to COVID-19 while maintaining essential services and is in the process of procuring PPE for CHWs.20 COVID-19 is the new public health backdrop and we cannot wait to strengthen community health systems. CHWs matter because they are trusted members of the community who are often the most accessible point of care, particularly for vulnerable populations—eg, in Sierra Leone, CHWs outnumber doctors 95 to one.21 Indeed, the Africa Centres for Disease Control and Prevention is planning to recruit 1 million community health volunteers to support contact tracing across sub-Saharan Africa,22 relying on existing CHW cadres.