Africa and Coronavirus - in Kenya, the Private Sector Is Taking Action

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Although the number of people infected with Covid-19 remains lower than in other African States, it is nonetheless rising rapidly in Kenya (179 confirmed cases to date). The country recorded its first case of coronavirus on Friday, March 13, and Kenyan President Uhuru Kenyatta announced a few days later the first measures of social distancing. They have since intensified their measures with the introduction of a curfew on Friday, March 27. How can the health situation evolve? Which measures have been implemented? Is the country's healthcare system able to cope with the crisis? What are the economic consequences? Yvonne Mburu, immunologist, founder and CEO of Nexakili, answers our questions.

What is the current health situation in Kenya? How might it evolve in the coming weeks?

In Kenya, we now have 179 confirmed cases, 9 recovered and 6 dead. In addition, several hundred people are under quarantine, and are being monitored through a contact-tracing process. Nevertheless, as is the case in other countries, the figures are most likely underestimated. We know, at this stage, that the coronavirus is spreading by community transmission, and that Kenya needs to considerably increase its capacity to test the population on a massive scale, in order to allow for more up-to-date monitoring. Most importantly, this would allow for more realistic projections of what needs to be anticipated.

One reassuring factor, however, is that the population is beginning to realize the seriousness of the situation and the need to follow the recommended hygiene instructions.

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

Since mid-March, the country has been in partial lockdown, with several measures implemented to maintain social distancing:

on one hand, social gatherings, such as religious ceremonies, weddings and funerals, are limited. Working from home is strongly encouraged;
on the other hand, in public places such as public transportation(trains and minibuses), supermarkets and shopping centres, a limited number of people are allowed to go in at once, so as to maintain an occupancy rate of less than 60% of the capacity of the premises. Other public places such as schools, restaurants and bars are closed.

Furthermore, prevention messages aimed at the population are regularly issued, particularly about the symptoms of Covid-19, the way it spreads, and the hygiene rules to adopt in order to limit its spread (not shaking hands, using hydro-alcoholic gel, wearing a mask, etc.). Finally, the country eventually closed its borders on March 25 and introduced a curfew two days later, which lasts from 7 pm to 5 am.

It is estimated that the epidemic will become truly widespread throughout the country within the next two to four weeks.

Is the healthcare system resilient enough to deal with the epidemic?

The experience of European countries has demonstrated that no healthcare system is immune to the increasing demand for intensive care related to Covid-19. This is all the more worrying for African countries, where healthcare systems are fragile.

In Kenya, the government needs to rapidly increase its hospital capacity, especially regarding intensive care. It is estimated that the epidemic will become truly widespread throughout the country within the next two to four weeks. Urgent general mobilization is therefore needed, both from the government, but also from the private sector, manufacturers, the informal sector, IT specialists, etc., so as to prepare the country and the healthcare system for this wave. In addition to the healthcare system, actions must also be implemented to ensure that the country's essential services are maintained, so as to guarantee its proper functioning in facing the epidemic.

What role can new technologies play in the healthcare sector to cope more efficiently with the pandemic?

First of all, in Kenya, there is a widespread microfinance and mobile phone money transfer system, the M-Pesa, which constitutes a barrier to the virus in itself, as it reinforces social distancing compared to cash payments.

Then, new technologies are used to track people who have come into contact with infected individuals (contact tracing). This is achieved in part through the use of telecom data triangulation technologies. It provides a warning of a potential exposure to a patient with Covid-19 in order to encourage contact persons to quarantine themselves, while monitoring the appearance of possible symptoms. As an example, two young computer engineers have developed an application to help the government track down people who have come into contact with infected individuals on public transportation.

In addition, Ushahidi, the Kenyan text messaging crowdsourcing platform, is already being used since 2008 in cases of crisis or disaster. It is now used worldwide to support professional and civic action against the pandemic, by collecting information on where Covid-19 cases are high, particularly to report cases of vulnerable and isolated people. This allows communities to organize themselves in order to target their resources and provide assistance to those most in need.

Finally, Kenyan researchers are using machine learning to analyse mega-data from social networks and assess the level of information (or misinformation) about Covid-19 among Internet users. This enables better targeting of communication campaigns and helps dealing with fake news.

What lessons could the authorities draw from the crisis in order to rethink the Kenyan healthcare system after the pandemic?

Kenya has not met the WHO recommendations concerning health personnel of 1 doctor for 1,000 inhabitants (in Kenya there is 1 doctor per 17,000 inhabitants), a weakness exposed by the current crisis. The pandemic is an opportunity to prioritize the training of health workers and the optimization of tasks. In the future, we must also fight against inequalities in access to care and against medical deserts, since the majority of health workers are concentrated in large cities. It is therefore important to build an equitable health system.

Kenya has not met the WHO recommendations concerning health personnel of 1 doctor for 1,000 inhabitants (in Kenya there is 1 doctor per 17,000 inhabitants).

Furthermore, in Kenya, there is a high risk of falling into poverty because of healthcare spending. Therefore, massive investment is needed to improve the supply and quality of care in public hospitals (which are cheaper than private hospitals) in order to accommodate the largest number of patients. This must be accompanied by an extension of social security, particularly to the informal sector, in order to achieve universal health coverage.

This crisis reminds us - if need be - that health is a public good, and that the government has a fundamental role to play in providing quality care, in federating an ecosystem of actors, and in fighting inequalities. In Africa, the rhetoric of recent years that praised the involvement of the private sector in the health sector has, unfortunately, led many to forget that the government’s role is to provide basic minimums and establish equity within the health system. If there is one crucial lesson to be learned from the Covid-19 pandemic, it is this one.

What will be the economic impact of the coronavirus in Kenya?

About 80% of employment in Kenya pertains to the informal sector. These workers are particularly impacted by lockdown measures that are slowing down the economy, because they subsist from day to day. There is therefore a significant risk that a large part of the Kenyan population will fall into poverty.

In the formal sector, many workers have already been laid off or placed on unpaid leave, given that almost all sectors of the economy - particularly tourism and horticulture, Kenya's main sources of foreign exchange - have been heavily impacted. This requires careful consideration of the support needed to enable workers to get through this period.

There is also a real risk that many companies, especially SMEs whose turnover will have fallen drastically, will collapse with an inevitable recession.

What are your recommendations to decision-makers and the Kenyan people?

Our goal is to produce insights from the available data in order to model and predict the probable evolution of the epidemic in African countries.

For Kenya, my recommendations will echo those of the WHO General Director: "test, test, test". Indeed, it is absolutely essential to get ahead of the virus through planning, and this means investing in testing platforms throughout the country, in order to assess the extent of the epidemic and to put in place appropriate suppression measures. This fight does not concern only the public sector, and I commend the initiatives of the Kenyan private informal sector (known for their dynamism), for being proactive in finding solutions.

Indeed, they already offered to provide drinking water in certain housing areas, communication channels with the public, mutual support for the most deprived of our fellow citizens, etc. It is clear that everyone should ask themselves what contribution they can make as citizens to this fight.

At the continental level, African policy-makers and governments need to realize the importance of sharing detailed and up-to-date anonymous data on the number of confirmed cases, suspected cases, demographics, comorbidities, presentation of patient cases, etc.

I am currently working with a team of researchers (mathematicians, epidemiologists, data scientists, experts in infectious diseases, etc.) and our goal is to produce insights from the available data in order to model and predict the probable evolution of the epidemic in African countries. Unsurprisingly, however, our biggest concern is the lack of "open source" data available in Africa. This hinders research and, more importantly, prevents the creation of a knowledge ecosystem that would benefit from our collective intelligence to propose solutions in the African context.