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Journal Pre-proof
Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan
Africa – A Situation Analysis of the Disruptions and Impact of the
COVID-19 Pandemic
Pascalina Chanda-Kapata , Francine Ntoumi , Nathan Kapata ,
Patrick Lungu , Luchenga Adam Mucheleng’anga ,
Jeremiah Chakaya , John Tembo , Cordelia Himwaze ,
Rashid Ansumana , Danny Asogun , Sayoki Mfinanga ,
Peter Nyasulu , Peter Mwaba , Dorothy Yeboah-Manu ,
Alimuddin Zumla , Jean B. Nachega
PII: S1201-9712(22)00173-4
DOI: https://doi.org/10.1016/j.ijid.2022.03.033
Reference: IJID 6081
To appear in: International Journal of Infectious Diseases
Received date: 8 February 2022
Revised date: 16 March 2022
Accepted date: 17 March 2022
Please cite this article as: Pascalina Chanda-Kapata , Francine Ntoumi , Nathan Kapata ,
Patrick Lungu , Luchenga Adam Mucheleng’anga , Jeremiah Chakaya , John Tembo ,
Cordelia Himwaze , Rashid Ansumana , Danny Asogun , Sayoki Mfinanga , Peter Nyasulu ,
Peter Mwaba , Dorothy Yeboah-Manu , Alimuddin Zumla , Jean B. Nachega , Tuberculosis,
HIV/AIDS and Malaria Health Services in sub-Saharan Africa – A Situation Analysis of the Dis-
ruptions and Impact of the COVID-19 Pandemic, International Journal of Infectious Diseases (2022),
doi: https://doi.org/10.1016/j.ijid.2022.03.033
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©2022 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
1
Highlights
The COVID-19 pandemic has impacted negatively on Africa’s health systems
COVID-19 disruptions on TB and other health services need to be urgently addressed
Strengthening health systems will require visionary political leadership
Innovations in service delivery and technological adaptations remain critical
Beyond modeling, actual country-level data is required to guide decision making
2
Invited Viewpoint article for IJID - World TB Day Issue 2022
Title:
Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa – A
Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic
Authors:
Pascalina Chanda-Kapata *, Francine Ntoumi, Nathan Kapata, Patrick Lungu,
Luchenga Adam Mucheleng'anga, Jeremiah Chakaya, John Tembo, Cordelia
Himwaze, Rashid Ansumana, Danny Asogun, Sayoki Mfinanga, Peter Nyasulu,
Peter Mwaba, Dorothy Yeboah-Manu, Alimuddin Zumla and Jean B.Nachega
Institutional affiliations:
Pascalina Chanda-Kapata: Ministry of Health, Lusaka, Zambia. Electronic address:
pascykapata@gmail.com.
Francine Ntoumi: Fondation Congolaise pour la Recherche Médicale (FCRM),
Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen,
Germany. Electronic address: fntoumi@fcrm-congo.com
Nathan Kapata: National Public Health Institute, Ministry of Health, and UNZA-UCLMS
Research and Training Program, Lusaka, Zambia. Electronic address:
nkapata@gmail.com
Patrick S Lungu: University of Zambia, School of Medicine, Department Internal
Medicine, Lusaka, Zambia. Electronic address: lungupatrick99@gmail.com
3
Luchenga Adam Mucheleng’anga: Ministry of Home Affairs, Office of the State
Forensic Pathologist, and UNZA-UCLMS Research and Training Program, University
Teaching Hospital, Lusaka, Zambia. Electronic address: luchengam@gmail.com.
Jeremiah Chakaya: Department of Medicine, Therapeutics, Dermatology and
Psychiatry, Kenyatta University, Nairobi, Kenya. Electronic address:
chakaya.jm@gmail.com
John Tembo: HERPEZ and UNZA-UCLMS Research and Training Program, University
Teaching Hospital, Lusaka, Zambia. Electronic address: john.tembo@gmail.com
Cordelia Himwaze: University Teaching Hospital, Department of Pathology and
Microbiology; and UNZA-UCLMS Research and Training Program, University Teaching
Hospital, Lusaka, Zambia. Electronic address: cordeliahimwaze@gmail.com.
Rashid Ansumana: Mercy Hospital Research Laboratory, Bo, Freetown, Sierra Leone.
Electronic address: rashidansumana@gmail.com
Danny Asogun: Ambrose Alli University, Ekpoma and Irrua Specialist Teaching
Hospital, Nigeria. Electronic address: asogun2001@yahoo.com
Sayoki Mfinanga: Muhimbili Medical Research Centre National Institute for Medical
Research, Dar es Salaam, Tanzania. Electronic address: gsmfinanga@yahoo.com.
Peter Nyasulu: Division of Epidemiology & Biostatistics, Faculty of Medicine; Health
Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address:
pnyasulu@sun.ac.za
4
Peter Mwaba: Lusaka Apex Medical University, Faculty of Medicine, and UNZA-
UCLMS Research and Training Project, Lusaka, Zambia. Electronic address:
pbmwaba2000@gmail.com.
Dorothy Yeboah-Manu: Noguchi Memorial Institute for Medical Research, University of
Ghana, Legon, Ghana. Electronic address: Dyeboah-Manu@noguchi.ug.edu.gh.
Alimuddin Zumla: Center for Clinical Microbiology, Division of Infection and Immunity,
University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS
Foundation Trust, London, United Kingdom.; UNZA-UCLMS Research and Training
Program Program, Lusaka, Zambia. Electronic address: a.zumla@ucl.ac.uk
Jean B Nachega: Department of Medicine and Division of Infectious Diseases,
Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South
Africa; Depts of Epidemiology and International Health, Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland, USA; and Depts of Epidemiology,
Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of
Public Health, Pittsburgh, Pennsylvania, USA. Electronic address: jbn16@pitt.edu.
Correspondence to: Dr Pascalina Chanda-Kapata: Ministry of Health, Lusaka, Zambia.
Electronic address: pascykapata@gmail.com. Mobile phone: +260977879101
Author declarations:
All authors have a specialist interest in global epidemics of COVID-19, TB, HIV and
malaria and One Health. All authors declare no conflicts of interest. The views
expressed in this article are entirely those of the authors and do not reflect the views of
their respective institutions.
5
Abstract
Background: The unprecedented and ongoing COVID-19 pandemic has exposed
weaknesses in African countries’ health systems. The impact of shifted focus on COVID-
19 for the past 2 years on routine health services, especially those for the epidemics of
Tuberculosis, HIV/AIDS and Malaria, have been dramatic in both quantity and quality.
Methods: In this article, we reflect on the COVID-19 related disruptions on the
Tuberculosis, HIV/AIDS and Malaria routine health services across Africa.
Results: The COVID-19 pandemic resulted in disruptions of routine health services and
diversion of already limited available resources in sub-Saharan Africa. As a result,
disease programs like TB, malaria and HIV have recorded gaps in prevention and
treatment with the prospects of reversing gains made towards meeting global targets.
The extent of the disruption is yet to be fully quantified at country level as most data
available is from modelling estimates before and during the pandemic.
Conclusions: Accurate country-level data is required to convince donors and
governments to invest more into revamping these health services and help prepare for
managing future pandemics without disruption of routine services. Increasing government
expenditure on health is a critical part of Africa’s economic policy. Strengthening health
systems at various levels to overcome the negative impacts of COVID-19, and preparing
for future epidemics will require strong visionary political leadership. Innovations in
service delivery and technological adaptations are required as countries aim to limit
disruptions to routine services.
Keywords: Tuberculosis, HIV/AIDs, Malaria, COVID-19, impact, Africa, Health
services
6
Introduction
The ongoing unprecedented and devastating COVID-19 pandemic continues to claim
lives, disrupt and divert resources from health systems and have a negative impact on
the mental and physical health of peoples across the world. As of 7th February 2022,
COVID-19 accounted for 396,254,535 cases and 5,759, 785 deaths globally, with Africa
reporting 11,196,707 cases and 241,826 deaths (Worldometers, 2022). Since the
beginning of the COVID-19 pandemic two years ago, African countries had to divert
resources from other competing priorities to tackle this new WHO declared global public
health emergency of international concern (WHO, 2020a; Ivers and Walton, 2020). The
COVID-19 pandemic has also exposed weaknesses in health systems such as
inadequate infrastructure, low numbers of health care workers, inadequate community
engagement and gaps in health system leadership (Chapman and Veras-Estévez, 2021).
Routine health services in Africa, especially those for other killer infectious diseases such
as Tuberculosis (TB), HIV/AIDS and Malaria, were affected greatly, resulting in slowing
progress in achieving control programs targets (Ivers and Walton, 2020). In this article,
we reflect on some of the COVID-19 related disruptions on TB, HIV/AIDS and Malaria
routine health services in Africa, and on gaps in health systems and lessons learnt.
Tuberculosis
The pandemic response measures such as lockdowns reduced access to key health
services like TB diagnosis and treatment. Globally, COVID-19 led to a 29 % decline in the
TB detection rates in 2020 (The Global Fund, 2021a). Reductions in sputum samples
7
received for TB diagnosis were in part due to people shunning health facilities and health
workers prioritised COVID-19 over other conditions (Afum et al, 2021; Alene et al, 2020).
Country level declines for TB notifications ranged from 41% in South Africa to 25% in
India, highlighting major disruptions in high TB burden countries (McQuaid et al, 2021).
The African region has 17 countries, which have the highest burden of TB. New TB
diagnosis notifications and screening programs declined in part due to a reduction in
numbers of health workers, limited access to facilities, and data reporting lapses thus
affecting treatment access. The World Health Organisation (WHO) states that in 2020,
of the 10 million people who developed TB, only 5.8 million cases were detected globally,
leaving 4.2 million undetected and a pool for further transmission in communities (WHO,
2021a). These cases of undetected TB will no doubt continue to rise in the near future.
Furthermore, the number of people dying from TB increased both among HIV negative
(from 1.2 Million in 2019 to 1.3 Million in 2020) and among HIV positive (from 209,000 in
2019 to 214,000 in 2020) individuals (WHO, 2021a). The underlying determinants of TB
are poverty, undernutrition and stress and numbers of TB cases will rise further in Africa
while untreated TB could kill more than half of those with disease (Tiemersma et al, 2011).
Additionally, TB/COVID-19 coinfection appears to triple mortality compared with TB mono
infection (Tamuzi et al, 2020; Kouapaei et al, 2021). The poor and malnourished are likely
to have undiagnosed TB because of health services disruptions and stigma due to
COVID-19, this has further led to an increase in TB incidence and mortality which is
disproportionately higher among the low-income communities (Saunders and Evans,
2020). However, how many African countries have data on TB and COVID-19 infection?
Larger cross-continental studies are required to define accurately the trends of
8
undiagnosed and new TB cases, MDR-/XDR-TB and impact of TB/COVID-19 co-
infections on management outcomes. Associated risk factors for mortality also need to
be defined (Matos et al, 2021). The disruptions to pharmaceutical supply chains and
national TB programs require urgent attention (Inzaule et al, 2021).
HIV/AIDS
According to Global Fund, the world recorded a 41% reduction in HIV testing, 37% decline
in referrals for diagnosis and treatment in 2020 versus 2019 (The Global Fund, 2021a).
Modelling estimates by Jewell and colleagues (2020) showed that disruptions in the
supply of antiretroviral drugs (ART) would lead to negative impacts on HIV/AIDS trends.
Disruptions in the supply of condoms among 50% of the population were projected to
increase new infections by 1.19 times, general disruption to services would lead to a 1.06-
fold increase in HIV deaths (Jewell, 2020). Information from simulation models also
predicted an additional 0.002 -0.15 COVID-19 deaths per 10,000 clients if HIV services
were maintained while averting 19-146 HIV deaths per 10,000 clients, showing that it was
beneficial to continue HIV services (Stover et al, 2021). COVID-19 has resulted in
disruptions of services both for those needing ART and for prevention activities (Holtzman
et al, 2022). However, in South Africa, the impact of the 2020 national COVID-19
lockdown on HIV testing and treatment in KwaZulu-Natal, where 1·7 million people are
living with HIV, showed that ART treatment provision was generally maintained during the
lockdown, but HIV testing and ART initiations were heavily impacted (Dorward et al,
2021). The lessons learned from maintenance of ART provision which can be extended
to other areas of service delivery include prioritising essential health services at all times,
9
integrated health service delivery, multi-month prescriptions for chronic medications and
ongoing sensitisation of patients and care givers. National HIV programs in collaboration
with WHO and local non-governmental organization need to make pivotal health system
changes to help maintain essential health services, including expanding testing and
treatment initiation during ongoing COVID 19 surges in low- and middle-income countries.
Malaria
The World Health Organisation (WHO) estimated that 241 million malaria cases and
627,000 malaria deaths occurred globally in 2020, an increase of 14 million cases and
69,000 deaths compared to 2019, with 47,000 deaths specifically due to COVID-19
related disruptions of malaria prevention, diagnosis, and treatment services (WHO,
2021b). In the African region, death increased by 12% between 2019 and 2020 (WHO,
2021b). Models project a grim picture for Africa, and anticipate that the 2021 situation
may not be any better (WHO, 2021b; Weiss et al, 2021). While the scale up of
Artemisinin-based combination therapy (ACTs) and Rapid Diagnostic Tests (RDTs)
improved testing and treatment for malaria, the emergence of pyrethroid resistance
stagnated malaria prevention efforts leading to WHO recommending use of nets
containing the synergist piperonyl butoxide PBO nets (Churcher et al, 2016; Lindsay et
al, 2021). Additionally, climate change factors and mobility are expected to re-introduce
malaria to areas known to be malaria free (Cella et al, 2019). Late health seeking due to
distance to health facilities impedes early access to appropriate treatment (Bannister-
Tyrrell et al, 2017). Thus, the stagnation in malaria indicators requires further exploration
(Lindsay et al 2021). The COVID-19 pandemic started while progress in malaria control
and elimination had plateaued. COVID-19 exacerbated a trend that began about 2015,
10
with improvements in other regions, but progress against malaria stalled in Africa where
the malaria incidence is off track by 40% for cases and 42% for mortality rate (WHO,
2021b). The biggest increases in burden caused by disruptions due to COVID-19
occurred in the moderate and high malaria transmission countries in Africa.
Worst-case scenarios projected that the COVID-19-related disruptions to malaria control
in Africa could double malaria deaths from 2020 and much more thereafter (Weiss et al,
2021). It has also been shown that even moderate service disruption to malaria services
(diagnosis, treatment bed-nets distributions, chemo-prevention for pregnant women and
children living in sahelian areas) may have dramatic consequences (WHO, 2021b). For
countries in Africa, there are cross-country variations in the COVID-19 related impact. For
example, Uganda reported a slight decline in patients tested for malaria because of
disruptions in the global supply chain while the case load remained similar to pre-COVID
times (Namuganga et al, 2021). In Zimbabwe, however, both malaria cases and deaths
increased when comparing 2019 and 2020 using data from all public and private health
facilities (Gavi et al, 2021). However, the data sources were different making it difficult for
cross country comparisons. Countries need to take on the challenge of tailoring the
response to infectious diseases using locally generated data to be on course to attain the
2030 global malaria targets (WHO, 2021b). The need for more resources is key as some
of the reported reduction in funding levels was due to diversion of local and external
resources to respond to the COVID-19 pandemic. Malaria service disruptions in the early
days of the pandemic, though moderate, were anticipated to cause more deaths (WHO,
2020b).
11
Re-invigorating Health Systems Disruptions by COVID-19
COVID-19 has resulted in variable disruptions on health systems, social services, and
economic activity (UNSDG, 2020) [Table 1]. Furthermore, global disruptions to the
supply chains affected the availability of essential medicines and supplies amidst a
limping global health system (Amimo et al, 2021). Disruptions in sub-Saharan Africa are
expected to be disproportionately higher than other world regions due to relatively weak
health service infrastructures, low clinician to population ratio, limited laboratory capacity,
and a higher burden of other infectious diseases (El-Sadr and Justman, 2020). With the
advent of COVID-19 however, even the available equipment and staff were repurposed
as countries had to respond to the pandemic (Nyaruhirira et al. 2022, Ivers and Walton,
2020). As a result, outpatient consultations declined, childhood immunisations were
disrupted, infectious disease programs limped, and the global burden and mortality
estimates for both COVID-19 and other conditions have continued to soar (Shapira et al,
2021; Weiss et al, 2020; Holtzman et al, 2022 ). Mathematical models predicted higher
mortalities in high TB burden countries with major disruptions to provision of antiretroviral
treatment (Hogan et al, 2020). Model projections showed that assuming a 75% disruption
in malaria control interventions could lead to reduced testing rates and consequently
declined numbers of those on treatment (Weiss et al, 2021). Weaknesses in the quality
and scope of pediatric and critical care services in Africa have resulted in a high in-
hospital mortality (8.3%) among African children with COVID-19, contrasting with about
1% in high-income countries (1%) (Nachega et al, 2022). The COVID-19 pandemic will
continue to negatively affect the HIV, TB and Malaria Control Programs until such a time
12
that the pandemic is contained (Holtzman et al 2022; Weiss et al 2021). The Global Fund
to fight AIDS, Tuberculosis and Malaria (GFATM) has indicated that COVID-19 will likely
reverse decades of progress made in mitigating the impact of TB, HIV and Malaria (The
Global Fund, 2021b). Further research is required to establish the impact of COVID-19
preventive measures on infectious disease transmission patterns in Africa and beyond.
The COVID-19 pandemic associated economic recession has negatively affected each
individual household through reduction of income and rise in unemployment rates
(Gondwe, 2020). Underscoring the need for countries to strengthen social security
systems as part of safeguarding the well-being of citizens. Unfortunately, at
macroeconomic level, most African countries had to divert resources from essential
services and acquired more debt in order respond to the COVID-19 fight, coupled with a
shrinking fiscal space due to slowed economic activities, there are limited options to
finance an ever growing health and social security need (Gondwe, 2020; Holtzman et al,
2022). Global solidarity is thus required to enable sustainable, rights-based approach to
investments for the fight against TB, HIV and Malaria, amidst health security threats.
Given the foregoing COVID-19 pandemic, policy makers should align their plans in such
a manner as to ensure that additional resource allocation and investment go into health
system strengthening. Cross-country studies are required to generate granular country
level surveillance data as well as on comorbidities, outcomes and costing to guide current
and future COVID-19 related investments. National and international funding agencies
should prioritise activities that will provide epidemiological, molecular diagnostics and
surveillance programs to strengthen the countries early warning systems. Frontline health
workers should utilise the point of care tests to guide their clinical management decision-
13
making to optimise appropriate COVID-19 care. The inequities in COVID-19 vaccine
rollout has taught the world that urgent investment in vaccine manufacturing hubs in Africa
must be a priority and expanded to prepare for the current and future pandemics (Inzaule
et al, 2021; Loembé and Nkengasong, 2021; Nachega et al 2021). When it appeared that
the COVID-19 was somewhat contained, the ‘leaving behind’ of those needing routine
services has regressed progress made and it is anticipated that countries will have to
innovate and collaborate more to get back on track.
Therefore, innovations, collaborations, human rights, and science are critical now more
than ever. Improvements in domestic and external investments are required to ensure
uninterrupted access to a wide range of services for all (WHO, 2020b). Innovations are
also key in-service delivery including use of technological approaches to improve data or
information flow, deliver essential medical supplies, e-learning, disease surveillance and
supportive supervision (Maharana et al, 2021). As an example, the novel RTS,S which
was found to save 1 life for every 200 children vaccinated, reduction of malaria cases by
40% and significant reduction in deadly severe malaria can be delivered through the
existing platform for childhood vaccination that reaches more than 80% of children (WHO,
2021b). Practical recommendations to help maintain access to high quality HIV and TB
health services in the COVID-19 era include embracing community-based differentiated
service delivery models, less frequent visits to a health facility with less frequent
medication pick-ups, expansion of mental health strategies, offering opportunities to build
back better, and an improved focus on people centered care.
In HIV, innovative examples of home delivery models exist from Africa (Nigeria,
Indonesia, Laos, Nepal, and) where ART was delivered using existing community
14
networks or private courier to avoid interrupted service delivery during the pandemic
(Hoke et al, 2021). Another good example of utilising the local context to ensure
continued supply of essential medicines for PLHIV. The future pandemics should find a
more just, prepared, and strong health system if the lives are to be saved by prioritizing
the continuity of essential services amid the COVID-19 pandemic remains crucial (Gavi
et al, 2021). The One Health approach provides valuable platform to effectively prepare
and respond to zoonotic health threats through a multisectoral human-environmental-
animal health approach (Ung et al, 2021; Zumla et al, 2016). It is important that other
infectious diseases which also impact a high burden on health services in Africa are not
sidelined by COVID-19 epidemic (Kapata et al, 2020).
Furthermore, innovations in financing are key to improve financing levels to support full
implementation of prioritised activities. For example, The GFATM has used different
innovations to raise up to US$50 billion as of June 2021 to support both programs and
health system strengthening (The Global Fund, 2021b). The GFATM has also made
available funding for both country and regional grants, increased the role of both domestic
and private sources of financing while maintain transparency and accountability. The
Fund continues to be responsive to emerging needs by providing ‘above allocation’
funding either to support country attainment of strategic targets or pandemic related
responsive mechanism to avoid disruption to TB, HIV and malaria services (The Global
Fund, 2021b).
In conclusion, the ongoing COVID-19 pandemic has disrupted health services generally
and led to diversion of resources away from tuberculosis, HIV and malaria services at
various levels. There is an urgent need to address this by strengthening health systems,
15
providing needed financial resources, renewed political leadership and foster
collaborations. Evidence-based cost-effective interventions need to be scaled-up and
include community-based differentiated service delivery models, less frequent visits to a
health facility with less frequent medication pick-ups, expansion of mental health
strategies, offering opportunities to build back better, and an improved focus on people
centered care. Finally, innovations in service delivery and technological adaptations
remain critical as countries aim to limit disruptions to routine services.
Author Contributions
PC-K, FN, NK and AZ conceptualised and drafted the manuscript. PSL, LAM, JC, JT, CH,
RA, DA, SM, PN and PM contributed to discussions and provided further inputs in writing
the manuscript.
Acknowledgements
P C-K, FN, NK, AZ are co-Investigators or collaborators on the Pan-African Network on
Emerging and Re-Emerging Infections (PANDORA-ID-NET – https://www.pandora-
id.net/) funded by the European and Developing Countries Clinical Trials Partnership
the EU Horizon 2020 Framework Programme. AZ, FN, TV and TMC acknowledge
support from EDCTP CANTAM-3. Sir Zumla is a Mahathir Science Award and EU-
EDCTP Pascoal Mocumbi Prize Laureate. FN is coordinator of the Central Africa
Clinical research Network, CANTAM (www.cantam.org). PSN is an Investigator on the
COVID-19 Africa Rapid Grant Fund. J.B.N. is an infectious disease internist and
epidemiologist and Principal Investigator of NIH/FIC grant numbers 1R25TW011217-01;
1R21TW011706-01 435 and 1D43TW010937-01A1. He is also Chairman of the
16
AFREhealth Research Committee, served on the scientific program committee of the
American Society of Tropical Medicine and 437 Hygiene (ASTMH), and is a senior
fellow alumnus of the European Developing Countries Clinical Trial Partnership
(EDCTP).
Conflict of Interest
All authors have no conflicts of interest to declare.
Funding Source
The authors did not receive any funding for this work.
Ethical Approval Statement
Ethics clearance was not required as the information contained in this Viewpoint was
accessed from publicly available information using online searches.
Declaration of interests
☒ The authors declare that they have no known competing financial interests or personal relationships
that could have appeared to influence the work reported in this paper.
☐The authors declare the following financial interests/personal relationships which may be considered
as potential competing interests:
17
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24
Table 1: Selected COVID-19 impacts, actual and projections
Issue
COVID-19 related impact
Projections for
2021/2022
Tuberculosis -global
(WHO, 2021a)
>100,000 TB deaths among
HIV negative (+100000) and
HIV positive (+5000)
Malaria - global
(WHO, 2021b)
14 million more cases in 2020
compared to 2019
69,000 more deaths; 47
000/69,000 malaria were
linked to disruptions in the
provision of malaria
prevention, diagnosis and
treatment during the
pandemic.
HIV/AIDS – Model estimates
(Jewell et al, 2020)
Assuming disruption for 50%
of the population over a 1
year period:
o 1·06 times increase in
HIV-related deaths;
o 1·19 times increase in
new HIV infections
Financing/resources – Foreign and
domestic
Diverted and redirected to
COVID-19 response
Economic performance – Africa
(Gondwe, 2020
https://unctad.org/system/files/official-
document/aldcmisc2020d3_en.pdf )
Overall 1.4% decline in GDP
o Smaller economies
facing contraction of
up to 7.8%
Health services utilisation -Africa
(Tessema et al, 2021)
Reduced service utilisation
Repurposing of services and
facilities
Health service disruptions – Selected
African countries
(Shapira et al, 2021)
>= 1 month, OPD 10-25%
decline,
Variations in patterns of
service disruptions across
countries
?
?
