Transitioning the COVID-19 response in the WHO African region: a proposed framework for rethinking and rebuilding health systems

The onset of the pandemic revealed the health system inequities and inadequate preparedness, especially in the African continent. Over the past months, African countries have ensured optimum pandemic response. However, there is still a need to build further resilient health systems that enhance response and transition from the acute phase of the pandemic to the recovery interpandemic/preparedness phase. Guided by the lessons learnt in the response and plausible pandemic scenarios, the WHO Regional Office for Africa has envisioned a transition framework that will optimise the response and enhance preparedness for future public health emergencies. The framework encompasses maintaining and consolidating the current response capacity but with a view to learning and reshaping them by harnessing the power of science, data and digital technologies, and research innovations. In addition, the framework reorients the health system towards primary healthcare and integrates response into routine care based on best practices/health system interventions. These elements are significant in building a resilient health system capable of addressing more effectively and more effectively future public health crises, all while maintaining an optimal level of essential public health functions. The key elements of the framework are possible with countries following three principles: equity (the protection of all vulnerable populations with no one left behind), inclusiveness (full engagement, equal participation, leadership, decision-making and ownership of all stakeholders using a multisectoral and transdisciplinary, One Health approach), and coherence (to reduce the fragmentation, competition and duplication and promote logical, consistent programmes aligned with international instruments)

The Induction Team Member Training Course Fitted to the Scope and Background of the Participants: A Case Study of the African Setting

Background/Introduction: The Induction Team Member (ITM) course is compulsory training for teams setting up an EMT. It encapsulates elements around safety and security, protocols and procedures, and familiarization with equipment and should happen in countries that have undergone the awareness session.1 Tailoring the ITM course to fit different countries settings and professional backgrounds is imperative, particularly in Africa, because countries have heterogeneous characteristics. Objectives: To describe the changes to the ITM Course curriculum adapted to the different professional backgrounds and technical scopes of potential team members (TM) and African countries. Method/Description: This is an After-Action Review (AAR) of in-depth feedback (n = 10) received from participants in the five trainings that have been conducted at the WHO African Regional EMT Training Center (TC) since 2021 to date. All analyses were done thematically. Results/Outcomes: The training experiences in the region have shown the need for three imperative modifications to the ITM course based on the type of EMTs and the background of the participants. These include ITM courses focusing on health workers (Doctors and Nurses); team leads, security, and logistics officials; and support staff that can work during deployment and pre-deployment tasks. An interactive ten steps to building an operational national EMTs initiative developed to fit the context has been shown as significant. Conclusion: Conceptualizing ITM course training for EMTs based on teams' backgrounds, cultural circumstances, and political will is imperative for enhancing the capacity of regional countries' EMTs. A pragmatic modification to the training to fit the context that captures the countries' needs is key

A Systematic Literature Review of the Determinants of a Good National Civil-Military Partnership for Rapid Management and Response of Health Emergencies: Lessons for Africa

Background/Introduction: Civil-military collaboration in response to an epidemic or health crisis could strengthen countries’ capacities to provide adequate medical care and limit casualties. Many countries have received the support of military medical services during an emergency,1 guided by their multi-disciplinary human resources, with a strong background in rapid deployment, logistics and trauma management, and the civilian teams with a good capacity in epidemic management.1,2 Objectives: This study analyzes the determinants of a good civil-military partnership for rapid management of health emergencies on the African continent. Method/Description: We conducted a systematic review of literature from published (PUBMED, Hinari, and Google Scholar) and grey databases guided by the PRISMA guideline. Results/Outcomes: A good collaboration requires a formal agreement with a defined institutional anchor structure between the two institutions.1,3 The coordination should remain flexible with the co-leadership of each institution.1,3,4 The roles of all participating teams should be defined at the onset,1-5 and plans instituted based on the type of emergency to enhance cooperation. Both civilian and military teams need to know and understand the approved management protocols. Military health services are better experienced in trauma management, while civilians are more equipped to manage epidemics.1,4 Besides, there is a need for periodic evaluation of patient outcomes, resource management, challenges, and lessons learned after the response. Conclusion: Civil-military teams jointly responding to emergencies can be challenging but should be built around four defined pillars: collaboration, coordination, capacity building, and evaluation to capitalize on the teams’ strengths

A Policy Analysis of the Deployment of International EMT in the WHO African Region during the COVID-19 Pandemic

Background/Introduction: The COVID-19 pandemic, especially in Africa, has increased the need for EMTs for surge management, clinical care, and capacity-building support for establishing national EMTs. Objectives: To analyze the implementation of EMT's deployments in the AFRO Region during the COVID-19 pandemic. Method/Description: This is a retrospective policy analysis done from the perspective of the EMT policy implementor using Walt and Gilson’s policy triangle1 (capturing processes, the actors, the context, and the content). Data were collected through document reviews, key informant interviews, semi-structured in-depth interviews, and focus-group discussions. Analysis was done through a priori framework analysis. Results/Outcomes: Overall, 22 countries benefited from international EMT deployments since the onset of COVID-19, with deployment periods varying between six to 24 weeks. Development partners, governments, and local authorities supported deployments. Some deployments were hampered by inadequate knowledge of EMTs processes, bureaucratic and administrative barriers, and slow mobilization of resources. Other challenges were the lack of critical care equipment and teams facing resistance due to cultural differences. Some teams only worked in big cities rather than local regions with low capacity and high morbidities from COVID-19. Collaboration between international and national teams resulted in enhanced capacity building, optimistic volunteerism and resilience, and provision of clinical care in constraint settings to save lives. Conclusion: The deployments were critical in saving lives in under-resourced settings despite the challenges. COVID-19 has provided an impetus to strengthen national public health response by providing training opportunities, twinning or exchange programs, building health infrastructure, and prepositioning supplies and equipment to ensure national reliance and sustainability