Risk Communication and Community Engagement Strategies, Surveillance Systems and Laboratory Testing Capacity for COVID-19: A Comparison of 13 WHO-Prioritized African Countries

1. Project background, context and needs addressed The Director-General of the World Health Organization (WHO) declared the novel coronavirus outbreak (also called COVID-19, or 2019-nCoV, or SARS-CoV-2) as pandemic on 11 March 2020, after it was previously declared a global health emergency. African countries are not spared from the threat and the impact of this pandemic on global health security, which currently seems to have originated from China. The WHO has prioritized 13 African countries (Algeria, Angola, Côte d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia) due to their direct links or high volume of travel to and from China. These countries were warned to be more vigilant to ensure effective containment of COVID-19. In response, these 13 countries have set up measures to respond to COVID-19 pandemic. Their efforts have not been without challenges, such as weak healthcare systems and double burden of communicable and non-communicable diseases among others. In 2019, the Johns Hopkins Center for Health Security reported the African continent as least prepared to respond to health emergencies, treat the sick and protect health care workers. The weak healthcare systems and high prevalence of malnutrition, malaria, HIV/AIDS, and tuberculosis are further challenges facing the continent. Thus, this global pandemic serves to create unique challenges that will test the emergency responsiveness of health systems in these countries. This calls for the need for this study. We would like to compare the public health responses to COVID-19, across the 13-WHO-prioritized African countries, focusing on risk communication and community engagement strategies, surveillance systems and laboratory testing capacity. In addition, we will derive lessons from their responses for future public health decision and policy making and epidemic preparedness. 2. Aim of the research project The project aims to compare public health responses to the COVID-19 pandemic, with a focus on risk communication and community engagement strategies, surveillance systems and laboratory testing capacity across the 13 WHO-prioritized African countries. Specifically, we would like to: a. Describe pre-existing physical infrastructure, equipment, and health policies relating to pandemics present in these countries prior to the COVID-19 pandemic b. Enumerate the initial strategies deployed for COVID-19 risk communication and community engagement, surveillance and laboratory testing across the WHO-prioritized African countries. c. Identify and describe the challenges encountered in the implementation of the aforementioned strategies from a health systems perspective. d. Catalogue how each country has circumvented the unique challenges they have faced in implementing the aforementioned strategies.   3. Study Design This is a descriptive study aimed at comparing public health responses to the COVID-19 pandemic among the 13 WHO-Prioritized African countries, focusing on risk communication and community engagement strategies, surveillance systems and laboratory testing capacity. The 13 WHO-prioritized African countries are: (in alphabetical order) 1. Algeria 2. Angola 3. Côte d'Ivoire 4. Democratic Republic of the Congo 5. Ethiopia 6. Ghana 7. Kenya 8. Mauritius 9. Nigeria 10. South Africa 11. Tanzania 12. Uganda 13. Zambia A questionnaire shall be developed to cover the domains to be examined in this study. These domains are: -Risk communication strategies -Community engagement strategies -Surveillance systems -Laboratory testing capacity In order to create this questionnaire, a systematic literature review for parameters to be included in each of the above domains will be conducted. The systematic literature review will be conducted using online databases, including PubMed, Medline, Google Scholar, The Cochrane Library, Popline, Web of Science, Science Direct and WHO Library Database. Search terms and strategy will be agreed upon by the team and will be documented. The questionnaire shall then collate the parameters pulled from the systematic literature review and shall be designed for use by the study team. The parameters will be examined in the following subdivisions: 1. Pre-existing infrastructure, equipment, personnel, and health policies relating to pandemic response present in these countries prior to the COVID-19 pandemic. 2. Initial strategies relating to infrastructure, equipment, personnel and health policies deployed as response to COVID-19. 3. The variety, difficulty and sectoral involvement of the challenges encountered in the implementation of the initial strategies 4. Solutions to the challenges faced in implementing the initial strategies It will be placed online through Google Forms, selected for its time stamp feature, ease of access across different countries, and low internet bandwidth requirement which is ideal for settings where the internet is not accessible or difficult to access. This questionnaire shall be validated through experts in global and public health, health policy, and methodological research. It will be piloted in Nigeria by 2 independent researchers and compared for consistency. Nigeria was selected as the pilot country due to the proximity of the researcher to this country. Responses to the questionnaire shall be collated through examination of a variety of sources, including: -Government websites of each respective country -Publicly available documents in the health ministries of each country -Broadcast media -Social media -Online databases: PubMed, Medline, Google Scholar, The Cochrane Library, Popline, Web of Science, Science Direct and WHO Library Database The sources of the responses to the questionnaire shall be documented and referenced clearly. These sources shall be supplemented by individual online interviews with key individuals from each of the 13 countries. These individuals shall be selected based on their involvement in public health, health policy, and government response to COVID-19, such as membership in their national COVID-19 task force, local public health body, or local centre for disease control. A minimum of 2 individuals per country shall be interviewed. The consent of the interviewees shall be procured and their responses shall be anonymized in the final research output should the interviewees request this. Meetings shall be set-up online due to the social distancing restrictions in place to COVID-19 and will involve 2 interviewers. These meetings shall use the questionnaire as a discussion guide, although interviewers will be permitted to ask probing questions to further elucidate information from unclear responses. In addition, the initial responses to the questions as taken from the online review shall be validated during each interview. The meetings will be transcribed, with results documented using Google documents. After each meeting, interviewers will triangulate findings with each other and document the agreed responses in the questionnaire response form. Once all data has been collected, the researchers shall collate responses into the previously stated domains, parameters, and subdivisions per country. Tabulation of these responses to summarize findings across countries shall likewise be performed. 4. Approach used to maximize the impact of research outputs, to improve health and the research community -The findings of the study will be published in a reputable public health journal. -A focused group discussion shall be formed with the interviewees from each country to present the findings of the study. Plans for larger engagement shall utilize Global Health Focus and its network, which includes trainees and graduates of different health professions, as well as academics and policy makers from Asia-Pacific, Africa, Europe and North America. Efforts shall be made to coordinate with the Africa Centres for Diseases Control, WHO African Region Office and other non-government and civil society organizations for public health decision, policy making and in preparation towards possible future pandemic. -Policy and infrastructure suggestions shall be collated and re-disseminated in a subsequent paper. -For public engagement, findings from the study will also be shared through blogs and news outlets. Due credit will be given to Royal Society of Tropical Medicine and Hygiene for the funding support in all publications. 5. Expected outcomes With this study, we hope to expand knowledge base, identify research gaps and provide clear understanding of public health responses concerning risk communication and community engagement strategies, surveillance systems and laboratory testing capacity for effective containment of COVID-19 in the WHO-prioritized countries. It will also provide the opportunity for other African countries to learn from the WHO-prioritized countries which strategies are likely to work given the unique challenges. In addition, findings from this study have potential impact for future public health preparedness and policy making towards pandemic and other outbreaks including other diseases afflicting the region. 6. Your role in the project As principal investigator, I will be in charge of managing the methodology of the study and will be allocating resources across the study group. I will lead the communication of the study participants, and function as one of the literature reviewers and interviewers in the study. I will likewise resolve any potential conflicts and issues that arise when it comes to study implementation. 7. Project Supervisor Adrian Paul J. Rabe, MSc, MD, FRSPH, Managing Director, Global Health Focus