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Supporting ECOWAS and Nepal in fighting COVID-19

Budhanilkantha Health Post, Kathmandu

First-hand perspectives from two German-supported health programmes

Supporting partner countries’ epidemic preparedness has been a core part of German-supported health programming for decades. In times of COVID-19, this work is gaining in urgency. German advisors are actively coordinating with other partners whilst pushing for a speedy and comprehensive response. What does this look like in practice?

‘In situations like this, the most important thing is good coordination: making sure that every agency focuses on what it does best’, says Paul Rückert, team leader of the project Support to Health Sector Programme (S2HSP), which GIZ implements on behalf of BMZ in Nepal. ‘We take a deep breath, coordinate with others and then delve in. My team is great at this: earthquakes, floods, disease outbreaks – each emergency presents opportunities to strengthen the health system. That’s how we see it and that’s what we do.’

How do German-supported health projects support responses to COVID-19?
On Healthy DEvelopments, we want to share experiences and lessons learned as German technical and financial cooperation projects support partner countries in tackling the COVID-19 pandemic. Would you like to share how your project contributes? Contact

Supporting countries’ epidemic preparedness and response is what German-supported health programmes have done for decades. What’s happening all around us right now, however, is different. The COVID-19 pandemic is spreading at unprecedented speed and has gripped all continents (except Antarctica) and their populations’ daily routines with a momentum that leaves even weathered epidemiologists and public health experts stunned.

Were we ready for this epidemic?

Back in 2015, as Guinea, Liberia and Sierra Leone began to emerge from their battle against the deadly Ebola outbreak, Bill Gates said in a TED talk that ‘if anything kills over 10 million people in the next few decades it is most likely to be a highly infectious virus, not a war’. Globally, the COVID-19 pandemic’s death toll currently stands far from 10 million. However, the figures reported daily from Asia, and now also Europe, the Americas, Pacific nations and Africa, show clearly that for many, if not most, countries the core message of Gates’ prophecy is still spot-on: ‘We’re not ready for the next epidemic.’

Given that changing this is a priority for many German-supported health programmes, including those in the ECOWAS region and in Nepal, Healthy DEvelopments has asked their team leaders, Sabine Ablefoni in Nigeria and Paul Rückert in Nepal:

  • how it is changing the focus of their projects’ work, and 
  • whether it presents any new opportunities for the nature of their bilateral cooperation and partnership. 

COVID-19 in the daily lives of development practitioners

Since the start of the COVID-19 outbreak in China both team leaders have spent even more time than usual in coordination meetings with all local stakeholders and development partners. However, both regard this as important and worthwhile. ‘We preach coordination wherever and whenever we can’, says Rückert. Ablefoni agrees: ‘WAHO (the West African Health Organisation for the ECOWAS region), our partner, has been organising regular calls for COVID-19-related information sharing and coordination amongst its 15 member states. Everybody is keen on being part of these exchanges. Our focus on strengthening WAHO as coordinating body for disease surveillance and epidemic response is exactly what’s needed at this point in time.’

COVID-19 underscores the relevance of the two projects’ work

‘Strengthening pandemic preparedness and the control of infectious diseases in the ECOWAS region has been the focus of our project from the start’, says Ablefoni. ‘So COVID-19 has not changed what we’re doing. On the contrary: it’s just proving to all involved how very relevant it is. We are getting additional funding now, but even before that we used project funds for COVID-19-related risk communication. A COVID-19 module was added to the SORMAS software our project supports (see box 1) and Nigeria and Ghana are both using it for their COVID-19 responses.’

A Community Health Extension Worker in Nigeria uses a tablet to enter a potential new case into the SORMAS application
A Community Health Extension Worker in Nigeria uses a tablet to enter a potential new case into the SORMAS application

The SORMAS (Surveillance, Outbreak Response Management and Analysis System) software
SORMAS was designed to improve the efficiency and timeliness of infectious disease control measures. It operates as a business process management tool: the entry of a suspected or confirmed case by a health worker at any level of the system automatically triggers a series of actions to ensure that it is managed quickly and efficiently. Multidirectional information flows allow the different actors in the national surveillance and response system to receive information from other network users – such as updates on the status of a patient – and to post new information which is then immediately accessible to all those who need to see it, providing real-time data on current outbreaks as well as the data needed case management. Its flexible, modular design allows for the addition of new diseases, such as COVID-19, and new functionalities, keeping pace with the constantly evolving medical and epidemiological state of the art in surveillance and outbreak management.

‘Because of COVID-19 we’re getting extra funds and extra work’, says Rückert. ‘Our project’s focus is on health system digitalisation and – on specific request by our partners – on the responsible management of healthcare waste (see box 2). Both are very much needed in times of COVID-19.’

Safe handling of potentially infectious waste from plane returning to Nepal from Hubei province
Safe handling of potentially infectious waste from plane returning to Nepal from Hubei province

COVID-19 evacuation: a new healthcare waste management challenge
In February 2020, the Government of Nepal decided to evacuate 175 Nepali students from Huwei Province in China and to quarantine them upon arrival in Kathmandu. As plans were drawn up, the containment of potential cases of COVID-19 acute respiratory disease within Nepal was the top priority. Officials at the Ministry of Health and Population recognised the need for clear protocols for the collection, transport and treatment of potentially infectious waste from the plane. They worked quickly to develop and pass guidelines for the management of waste potentially infected with the coronavirus and, in accordance with the WHO guideline Safe management of wastes from health-care activities, established a special waste treatment center at the quarantine site. The German health programme supported this effort with technical advice, as well as with equipment and logistics for the collection, segregation and treatment of waste.

What can we learn from this crisis?

‘One thing this pandemic shows very clearly is how important it is for any country – not just low- and lower-middle-income countries – to have a resilient health system that can handle such shocks’ says Rückert. He points out that this requires the right infrastructure and equipment, as well as a sufficient number of qualified human resources at the right places to provide preventive and curative services. Helping Nepal to digitalise its health system relates to all these aspects. ‘A real-time health information system which covers all facilities and links to lab services and surveillance is the only way to identify and quickly respond to problems that emerge in a country. Vertical programming cannot tackle these issues. But, with their focus on systems strengthening, our bilateral projects can.’

‘COVID-19 has put pandemic preparedness and global health security high on the international agenda’, says Ablefoni. Rückert remembers the motto of Nepal’s reconstruction efforts following the earthquake in 2015: Build back better. It is a good motto for everyone working on health systems strengthening in times of COVID-19.

March 2020

© GIZ/Umong Shah
© Mahesh Nakarmi, HECAF
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