CAF-Africa’s emergency response has made an important impact to date, but there is a large unmet need to get community health workers (CHWs) personal protective equipment (PPE) through the duration of the pandemic and beyond. More than a year into the pandemic, and in the face of surging COVID-19 cases around the world, routine access to the most basic commodities for a pandemic response remains a challenge. Given this landscape, CAF-Africa commissioned an independent strategic analysis in March 2021 from Krishna Jafa at Precision Global Health to analyze how the original assumptions on which CAF-Africa was based had changed and the implications for protecting and supplying CHWs in 2021 and beyond.
The Precision Global Health analysis highlighted the following:
- The need continues for gap-filling PPE supplies that are specifically earmarked for CHWs at least through 2021 and maybe beyond. This need can be filled through both funding and in-kind donations, although the latter will also need nontrivial funding for logistics and transportation. However, with each successive and worsening wave of infection, Ministries of Health-controlled supplies continue to be understandably prioritized for treatment and quarantine centers and facility-based health workers. While regional efforts like the African Medical Supplies Platform (AMSP) continue to mature, other sources like The Global Fund’s wambo.org platform are restricted to recipients of their funding. There is a lack of visibility into all sources of PPE funding for CHWs, and it is therefore challenging to determine if sufficient supplies are being delivered. Some key initial suppliers, such as the Jack Ma Foundation, have wound down their efforts.
- The current state of the pandemic calls for a stronger emphasis on country level support. In 2020, CAF-Africa focused on getting PPE to national capitals with the assumption this would be a stopgap arrangement, and CAF-Africa identified in-country partners to help distribute PPE to CHWs. Specific ongoing needs include technical assistance for PPE quantification, integration of CHW needs into supply planning beyond PPE, last mile distribution, and monitoring and verification of commodity distribution to intended end users.
- Regularly updated and reasonably accurate CHW estimates are often unavailable at the country level. While mixed levels of CHW professionalization and a lack of representation in decision-making are contributing factors, a lack of mechanisms for registering and monitoring the number and location of CHWs in the health system is an important root cause of variable and often inadequate inclusion of CHWs’ health commodity needs—including PPE. CHW registries are important for ongoing and future quantification and supply planning exercises, including for COVID-19 vaccine rollout, as well as to inform planning, training and deployment for future crises.
- More than one year into the pandemic, limited visibility into PPE needs at the country and global levels continues. There is no single regional body that quantifies cross-country PPE needs, tracks pipeline, and aggregates needs and gaps. The PPE market is fragmented: On the supply side, most PPE manufacturers are in Asia and require upfront cash payments and high volumes to secure low prices; on the demand side, buyers in LMICs are fragmented and forced to compete with better-resourced global players and countries—leading to inequitable distribution of PPE. Additionally, there are limited standards or support for PPE market access and distribution during an emergency. For example, while it’s recommended that goods are procured from a mix of local and international suppliers, there is little to no support for domestic manufacturers to go through the registration process and prepare for certification.
- Philanthropic support for PPE was fragmented and insufficient, and not many donors saw it as their specific priority. Many of the donors that CAF-Africa engaged with voiced that they recognized PPE was important but saw it as something that someone else was better positioned to support. As a result, the funding for PPE from both the philanthropic and institutional funding communities tended to be fragmented, with program-specific PPE written into some grants or investments, but without a comprehensive view on the full amount needed at all levels of the health system.
For more details on this analysis download the attached PDF.