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How COVID-19 exposes healthcare shortfalls in Africa and what can be done about it

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The Covid-19 pandemic has exposed gaps in health services that require urgent attention in many African countries, Human Rights Watch said on Monday.  

Amnesty called on African governments to urgently address healthcare deficiencies to meet the demands of the Covid-19 pandemic and ongoing healthcare needs of their populations. They should act to ensure everyone’s right to health is in line with international human rights law, including the African Charter on Human and Peoples’ Rights.

“The current global health crisis from the spread of the novel coronavirus has brought to the fore the need for African Union (AU) member states to carefully analyze the current state of their healthcare infrastructure and make meaningful investments to improve access to quality health care,” said Carine Kaneza Nantulya, Africa advocacy director at Human Rights Watch.

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In April and May 2020, Human Rights Watch interviewed African health experts, including pathologists, epidemiologists, and public health officials. They said that inadequacies in resources are due to insufficient government investment in health, which in turn affects the ability of health workers to fulfill their duties, especially during the pandemic.

The health experts and representatives of human rights organizations interviewed said a chronic lack of investment in healthcare infrastructure and equipment has made it harder for African nations to retain skilled healthcare workers, provide essential medicines, and reduce the mortality rates of perennial diseases like malaria.

According to the World Health Organization (WHO), as of June 8, 187,875 cases of Covid-19 had been reported across 54 African countries. The global health agency warned on May 7 that up to 190,000 people could die on the continent and up to 44 million could become infected, if the disease is not contained.

Lack of access to testing is hampering efforts to save lives, some experts told Human Rights Watch. While many African countries have responded swiftly by enacting measures to slow the spread of the pandemic, many also lack the capacity to test for Covid-19, isolate people with confirmed or suspected cases, trace contacts, and treat those with severe illness.

In 2001, African leaders signed the Abuja Declaration, voluntarily pledging to allocate a minimum of 15 percent of each country’s national budget to health. Nineteen years later, there have only been modest increases in the health budgets of a few African countries. In 2011, WHO reported that 27 countries had increased the proportion of total government expenditures allocated to health since 2001.

According to a subsequent report released in 2013, only three countries had attained the percentage pledged: Botswana (17 percent), Rwanda (20 percent), and Zambia (16 percent). In 2019, the Pan-African Parliament and the WHO Regional Office for Africa said that African governments should ensure the right to health for all and increase domestic resources for HIV prevention and treatment and overall health.

Norman Matara, a Zimbabwean doctor, told Human Rights Watch that African governments need to take the Abuja Declaration seriously. “When you look at the defense budget, they buy state-of-the-art military equipment, so this is not about poverty; it is about genuine political commitment,” he said. “Our health sector is poor…. This is not something that will change overnight. But if we continuously invest, we will see progressive, then full, realization of the right to health.”

Recent studies have highlighted deficiencies in health systems across the continent. A May survey report by Reuters found that there is less than 1 intensive care bed per 100,000 people across Africa, while an April report by the United Nations Economic Commission for Africa (UNECA) concluded that healthcare systems across the continent are under-resourced, with lower proportions of available hospital beds, intensive care units, and health professionals than other regions of the world.

Lack of consistent planning for healthcare infrastructure and inadequate funds allocation, compounded by budgetary cuts, have left public health sectors in some countries ill-prepared to deal with the novel coronavirus in Africa.

Solomon Dersso, chairperson of the African Commission on Human and Peoples’ Rights (ACHPR), the primary AU human rights entity tasked with promoting and protecting human rights on the continent, said the Covid-19 pandemic underscores the fact that health is a fundamental human right and that its realization and fulfillment is not just for the health of individuals but for the society as a whole: “Ultimately, the right to health is a policy choice,” he told Human Rights Watch. “Governments have the primary responsibility to be at the forefront of preventive and palliative measures.” He said African nations should pause and reflect during the current crisis.

In a March 24 statement, the ACHPR said that governments should provide health workers with the necessary protective equipment and establish treatment protocols to ensure that they are protected from exposure to infection. The commission also highlighted the importance of integrating human rights within the continental response to the pandemic in a May letter to the AU chairperson, President Cyril Ramaphosa of South Africa.

The right to health is a fundamental right under international human rights law. It is also a critical component of the UN Sustainable Development Goals (SDGs) and is recognized in at least 115 constitutions across the world, including the 55 AU member states. A key goal of the AU’s Agenda 2063, the institution’s master plan for democratic governance and sustainable development, is to ensure that citizens are healthy and that adequate investment is made to expand access to quality health care.

Article 16 of the African Charter on Human and Peoples’ Rights guarantees the right of every individual to enjoy the best attainable state of physical and mental health. The charter says that AU member states should take the necessary measures to protect the health of their people and to ensure that medical services, goods, and facilities are available, accessible, and of good quality.

“Beyond the current pandemic, African governments should bring the right to health front and center in their policies and programs to improve people’s lives,” said Kaneza Nantulya. “They should engage African human rights institutions like the ACHPR as key partners to fulfill their obligations under the African Charter.”

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