How much health financing does Sub-Saharan Africa need to fight COVID-19 (coronavirus)?
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The Sub-Saharan Africa region could potentially be hard hit by the coronavirus. A large number of people are at higher risk of infection because of medical preconditions: about 26 million live with HIV and 2.5 million fall ill from tuberculosis annually, while South Africa and Namibia report the highest mortality rates from noncommunicable diseases among upper-middle income countries. Estimates for the region suggest that between 110 million and 720 million people could become infected with COVID-19. More optimistic projections point to 80,000 infected and 3,000 deaths. Clearly, COVID-19 will result in a heavier strain on countries’ health systems.
Some countries in the region are ill-prepared to cope with pandemics. Countries battle with low levels of health spending and widespread shortages of health professionals and hospital beds. Currently, the share of total health expenditures compared with GDP ranges widely from 2.6 percent in the Democratic Republic of Congo to 11 percent in countries like Lesotho and Sierra Leone. Additional funding will be needed for prevention and treatment of COVID-19 patients, and for pandemic monitoring and evaluation.
Estimating financing needs
We considered two scenarios, each with estimated levels of preparedness and treatment. A suppression scenario assumes widescale, intensive social distancing leading to a 75 percent reduction in interpersonal contact across all ages. Meanwhile, under a social distancing scenario, social mixing would drop and high-risk groups would reduce their social contact rates by 60 percent. Under both scenarios, R0 (the basic reproduction number) equals 3.0 following the Imperial College model. The preparedness calculations use the World Health Organization’s Strategic Preparedness and Response Plan. Treatment costs are adjusted to African countries and estimated based on both the projected case numbers and the unit cost for malaria patients, amounting to US$3.65 for a mild case and US$15.56 for a hospitalized patient. We assumed that all severe and critical cases would receive treatment in hospitals.
How much additional funding is needed?
We estimated that the additional health financing needs to prepare, respond, and treat COVID-19 are between 1.5 and 3 percent of GDP in Sub-Saharan Africa covering a period of 250 days. In the suppression scenario, an additional US$23.54 billion would be needed for preparedness and treatment of COVID-19. Under the social distancing scenario, almost 720 million people would be affected, and US$53 billion would be needed (see illustration below). This is aligned with estimates from the UN Economic Commission for Africa, which posits that Africa needs US$100 billion to tackle COVID-19 across sectors, albeit at a considerably lower infection rate.
Table: Additional health financing for COVID-19 in Sub Saharan Africa for 250 days, in US$ billion
Effective implementation of additional health funds must be ensured
Increasing funding for health requires additional measures to ensure effective allocation. The World Bank is supporting health systems across the region in these areas. The following recommendations offer policymakers some options:
- Make public resources available to health facilities. When drafting legislation for additional budget funding, governments should allow flexibility and disburse priority funds in a timely manner. Adequate public financial management systems can accommodate this during emergency situations.
- Adjust regulatory frameworks. Regulations may need to be revised for faster responses. For example, health workforce planning should be adjusted by disease burden, workload, and population dynamics. Vacancies can be reduced through faster hiring processes.
- Invest in prevention and treatment. Invest in prevention and treatment of diseases that exacerbate COVID-19-related risk, such as HIV/AIDS, tuberculosis, respiratory diseases, and noncommunicable diseases.
- Procure efficiently. Use pre-existing framework contracts where possible. Allow single-sourcing from trusted suppliers to expedite procurement. Post all procurement requests on government portals to enhance transparency.
- Collaborate with the private sector. Demand for elective treatments will drop during pandemics, leading to extra capacity in the private sector. Governments should contract with private providers and reserve isolation wards and ICU beds for COVID-19 patients. Framework contracts could be prepared to be ready ahead of time for when crises occur.
- Coordinate with lower levels of government and with hospitals. Coordination could help identify the needs of providers so that funds may be transferred to help them meet service delivery requirements.
These investments help ensure that Africa’s health providers are well equipped. Still, the actual number of cases may be higher than reported. In the absence of reliable testing, a large number of COVID-19 patients may be misdiagnosed as malaria cases and not adequately treated. Poorer individuals might also go undiagnosed because they cannot afford to pay for treatment.
Governments in Sub-Saharan Africa have requested World Bank support for their COVID-19 response plans, which are primarily focused on short-term needs. Many plans do not contemplate significant community transmission and the subsequent implications for health systems, so their costs are likely to be significantly underestimated.
Better data would lead to better estimates of the unit cost for treating COVID-19 patients. More detailed analysis should account for different treatment capacity across countries, regions and health facilities, and estimate the effect of subsequent outbreaks, which are not included in our analysis.
Very valuable and timely blog