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Coronavirus and Africa - in Senegal, Communication and Prevention are the Key Words

ARTICLES - 8 April 2020

With 237 registered cases, of which 105 have been cured and 129 are being treated, on April 7, Senegal is one of the African countries most affected by Covid-19. The first citizen to be infected with the virus was reported on March 2, nearly three months after the pandemic erupted in China. 20 days later, President Macky Sall declared a state of health emergency in the country. How might the health situation evolve? Which measures have been implemented? Will the country's health system be able to cope with the crisis? What will the economic consequences be? How will cooperation with neighbouring states look like? Gilles Yabi, founder and president of Wathi, a West African citizen think tank, answers our questions.

What is the current healthcare situation in Senegal? How could it evolve in the coming weeks?

The Senegalese authorities have played a commendable role in providing information. Every day, they monitor and analyze the number of contaminated people and the number of recoveries, which is crucial. We only know of two deaths due to Covid-19 in Senegal, including that of the Olympique de Marseille’s former President, Pape Diouf, who passed away on March 31st. To date, the care received by infected patients has been remarkable. But the number of positive cases continues to increase on a daily and regular basis, although there is still no indication of an outbreak. The population remains deeply concerned, which is legitimate insofar as there is a lot of uncertainty over the official figures of reported cases in the absence of large-scale testing. Tests are only carried out on people identified as being at high risk of contamination. In all countries of the world where testing is not carried out on a large enough scale, it cannot be ruled out that the number of people infected is in fact much higher than official numbers suggest.

What is the country's strategy to resist the epidemic?

In most West African countries, measures have been set halfway between freedom of movement and total lockdown. In Senegal, President Macky Sall declared a state of health emergency on March 23: a curfew is imposed between 8 pm and 6 am, during which the population is forbidden to roam the streets.

In most West African countries, measures have been set halfway between freedom of movement and total lockdown.

The lockdown is therefore limited to certain hours. In addition, social distancing measures have been taken during the day, such as a ban on all gatherings, the imposition of a minimum distance of one metre in public transports, and the closure of many markets and all public spaces, among others. The government hopes to take measures gradually as the situation evolves. Communications on the threat posed by Covid-19 were initiated fairly quickly. In this respect, the fact that the epidemic spread to Europe after China gave African countries some time to anticipate the virus’ arrival. It is also the first pandemic of this magnitude to have been the subject of exceptional media coverage, in the age of social media.

At first, the country realized that most cases were coming from Europe and thus closed its borders to these countries, albeit after a few days of hesitation, which attracted criticism. Senegal is deeply connected, particularly through its diaspora, with several African countries, as well as with France and Italy, the epicentre of the epidemic in Europe for weeks. People in contact with infected individuals flying in from Europe were tracked and isolated. While the scheme worked rather well, it is not certain that it was able to identify all contact points effectively – it is necessary to identify both direct and indirect contacts with the virus. If even a few are missed, the virus will continue to spread from one place to another.

With the global spread of the pandemic and an increasingly strict lockdown imposed in many European countries, the Senegalese government could adopt more radical measures. It is not impossible that we will move to a total lockdown, or at least closer to it, in the coming days. However, French or South African-style lockdown measures could only be laboriously implemented in a country where economic and social conditions are such that a large share of the population needs to move about on a daily basis in order to earn money, survive and support other family members.

Not all Senegalese citizens, even in cities, have access to a refrigerator, a continuous electricity supply or the financial means to stock up food and other essential goods. Under these conditions, total lockdown simply cannot be applied. This is the case in many other African countries, but it is not limited to the continent. What about India, for instance, where it is reported that millions of people are fleeing from cities to the countryside where they believe they can more easily feed themselves and survive the indefinite period of confinement? In any case, the context differs greatly from that of European countries or the United States.

Does the population support the measures adopted by the government?

Yes, the population is largely mobilized to fight against the Covid-19. Everyone understands that communication stressing prevention is the only viable option, given the limits of the healthcare system to cope with serious cases requiring hospital care in the event of an outbreak of the epidemic in Senegal, and across several regions at the same time. People understand the magnitude of the threat and do what they can to contribute to the fight through prevention and well-known barrier gestures, starting with regular hand washing. The fact that the West African region experienced the terrible threat of the Ebola virus a few years ago has also helped raise awareness of the importance of prevention gestures such as hand washing.

Is the health system resilient enough to cope with the epidemic?

Senegal’s health system is on average better than that of many countries in the West African region. But of course, everything is relative. Health indicators have been improving steadily for years but still remain below what would be expected and what is achievable. Shortfalls are glaring in terms of numbers of health workers, with a ratio of less than two doctors per 10,000 inhabitants according to World Health Organization (WHO) figures, and the geographical distribution of the workforce is highly uneven, as is the case almost everywhere in the region.

Senegal is also facing medical equipment shortages. There had already been scandals in Dakar’s major hospitals due to equipment breakdowns, but all the more so in the present case where patients developing the virus’ most serious symptoms require respiratory assistance. As of April 1, Senegal would count 56 resuscitation beds, with 40 additional beds being set up. It is imperative to increase the number of beds available for patients with Covid-19 within a few weeks. As long as numbers do not explode, the health system will be able to cope. It really is a matter of scale.

The crisis we are currently experiencing is particularly challenging, but weaknesses of the West African countries’ healthcare systems and the urgent need for structural reforms pre-existed the crisis, as we examined in a report published by Wathi in February this year. Too many people, and especially children and young people, are still dying from diseases that can be cured in all the countries around the region.

Senegalese people – like many others – initially found it difficult to grapple with why it was so important to mobilize against the coronavirus to this scale, when there are so many other more lethal diseases. Analytically, it was not so simple to understand the extent of the global concern surrounding the coronavirus, especially in contexts where we are perhaps more accustomed than Europe to dealing with adversity, as well as with our "unbearable lightness" as human beings. Over and above the ambitious reform of healthcare systems, one of the main takeaways from this crisis is the importance of continuing to work on improving public services, and thus strengthening state capacity to anticipate, organise, rationalize and to do so for the benefit of the greatest number.

The crisis we are currently experiencing is particularly challenging, but weaknesses of the West African countries’ healthcare systems and the urgent need for structural reforms pre-existed the crisis.

What will the coronavirus’ economic impact in Senegal be?

As with the health crisis, this will depend on the State’s capacity to take measures and effectively implement them. In his speech on March 23rd, President Macky Sall also announced economic measures. A special fund endowed with 1,000 billion CFA Francs was declared. The private sector and all forms of domestic and external contributions are being called upon to supply this fund. There are proposals for supporting sectors most affected by the dramatic downturn and providing assistance to the most vulnerable households.

Transfers to households could, for example, take the form of food distribution, especially if lockdown measures become more drastic in the coming weeks. In addition, the existing family grant scheme could, despite existing limitations, be useful and help identify the poorest households. There are also many ideas and proposals for innovative measures tapping into new technologies’ potential being discussed in various circles. It is interesting to observe efforts to mobilize collective intelligence in responding to a crisis that is almost making us forget everything else.

Is there any form of cooperation with neighbouring states?

At this stage, we are not perceiving any real cooperation at the regional level. On the health front, an emergency meeting was held on February 14 in Bamako bringing together all the Health Ministers of the Economic Community of West African States (ECOWAS) and the West African Health Organization (WAHO). One of the recommendations put forward by Wathi in a report published before the crisis was to strengthen WAHO’s role so it could act as a "small WHO" at the regional level with the capacity to pool resources in key areas such as research, international partnerships negotiation and, precisely, epidemic response. Despite this encouraging meeting, decisions were taken by each at the state level, without clear principles being established at the regional level. Admittedly, all over the world, and even in the European Union, states are obviously taking measures on their own before having been able to develop a common vision of what an adequate response should be, but in my view, we must continue with our initiatives of closer regional integration in Africa – realistically and pragmatically – because there lies our collective interest.

Among countries of the West African Economic and Monetary Union (WAEMU, which brings together West African countries whose currency is the CFA franc), measures have been announced by the Central Bank of West African States (BCEAO) to enable banks to continue operating and, in particular, to protect companies with loan repayment schedules and to maintain the financing of economic activity. Further measures are expected to be taken depending on the severity of the looming economic and financial crisis. Unfortunately, even if the health crisis does not turn into a disaster, negative economic consequences are already a certainty.

What are your recommendations for decision-making bodies and the population in Senegal?

The priority must therefore remain prevention. It is very important to be educational and pedagogic.

Since the field of action for Wathi is regional, and in view of what I said above about the imperative of regional integration, including in the field of health, my recommendations do not only address the Senegalese authorities and population. If all countries are not equally successful in avoiding an explosion in the number of cases, by the time travel resumes in a hopefully not too distant future, every country will be exposed again.

The priority must therefore remain prevention. It is very important to be educational and pedagogic, raising awareness on why this degree of mobilization and exceptional measures are necessary. I have already explained why this is not necessarily obvious to the population. Nevertheless, the government is conducting an effective communication and prevention campaign, relayed by many voices from civil society, artists and public personalities. Citizens now seem to be accepting that only the recommended preventive attitudes will prevent a multiplication of cases that could not adequately be dealt with. At the same time, it is also necessary to keep on increasing the capacity to receive and treat patients who may be infected and, of course, to pay close attention to the protection of health workers, the key resource we must protect if the community is to be preserved.

It is also necessary to anticipate the pandemic’s disastrous, and also lethal, economic consequences, which are certain and far-reaching, focusing on the sectors and the populations most affected by the drop in economic activity.

Finally, this crisis should highlight to the authorities that structural reforms are needed to improve health systems in Senegal, throughout West Africa and on the continent as a whole. The African Union has also set up a health crisis management centre, which is very useful, and has helped raise awareness of the need to increase coronavirus testing capacity on the continent. Subsidiarity is essential here: that WAHO plays an important role in West Africa, that regional organizations elsewhere on the continent play a similarly important role, and that arrangements at the African Union level focus on coordinating efforts across the region’s economic communities.

 

Copyright : Seyllou / AFP

 

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