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Coronavirus: Which African countries are ahead on testing? Coronavirus: Are African countries struggling to increase testing?
(12 days later)
Testing plays a major role in the response to the coronavirus, as it helps us understand how far the disease has spread. African countries have started to lift lockdown restrictions, raising fears that coronavirus infections could rise.
The Africa Centres for Disease Control and Prevention, which co-ordinates pandemic responses across the continent, says there is a large gap in testing rates between nations. The World Health Organization has said countries should consider their ability to test and trace before lifting lockdown.
So which countries are succeeding in testing, and which are lagging behind? The continent has so far conducted 1.2 million tests since the start of the epidemic.
Who is testing most and least? But is that enough?
Some of Africa's smaller nations have achieved significantly better rates of testing than their larger neighbours. Nigeria - a very low testing rate
Mauritius and Djibouti, for example, have both achieved high rates of testing per capita. Africa's most populous nation has now begun to relax some of its lockdown measures despite having one of the lowest testing rates on the continent,
Ghana has also been praised for its level of testing, which its government says will help contain the spread of the virus once the lockdown is lifted. It's is a major challenge in country of 200 million people, and there are a limited number of laboratories able to process tests.
South Africa has also pursued a relatively aggressive testing strategy, and has so far managed over 200,000 tests. That's much less than in South Korea, Italy and Germany. Chikwe Ihekweazu, director general for the Nigeria Centre for Disease Control, said in late April: "I would rather go a little bit slower and get it right than speed into a situation that we will end up regretting."
However, those countries have been far ahead of many others, including the UK and the US who were slower to ramp up their testing. The Nigerian government says it's focused on clusters of outbreaks rather than mass testing of the population.
There are concerns that Africa's most populous country, Nigeria, is not testing nearly enough - although the government insists it's focusing on "clusters" of positive cases. The commercial capital Lagos and northern state Kano are the worst-hit areas - and these regions do have the most laboratories for processing tests.
The BBC's Nigeria-based correspondent Chi Chi Izundu says the authorities are scaling up testing. However, the Nigerian Medical Association has expressed concern that the low rate of testing means the real incidence of the virus remains unknown in the country.
"The aim is to be at 5,000 a day - but they've not even got to 1,000." South Africa - high testing but hitting constraints
It's worth adding that there are some countries on the continent where testing data is not available, such as Eritrea and Algeria. South Africa has enforced one of the strictest lockdowns anywhere on the continent and has achieved a relatively high level of testing.
Some don't have testing capacity, while others for various reasons won't give out data. The number of tests being carried out - around 16,000 a day - is considerably higher than other African country, but still a long way short of European levels.
For example, President Magufuli of Tanzania has said releasing such data creates fear. His country has only released information intermittently, sometimes just giving out the numbers of people who have recovered from the virus. Health Minister Zweli Mkhize has raised concerns over the country's ability to scale up testing.
What are the obstacles to more testing? "In relation to the issue of tests, I've called around both public and private laboratories - they are all suffering from the constraints of the availability of test kits,"
Getting hold of the chemical reagents needed to process tests can be difficult, as African countries don't produce their own and need to compete for limited global supplies. Ghana - emphasis on test and trace
John Nkengasong of Africa's Centres for Disease Control says "the collapse of global co-operation and a failure of international solidarity has shoved Africa out of the diagnostics market". The West African nation has put a great deal of emphasis on testing and tracing Covid-19, choosing not to implement harsh lockdown measures to protect the economy.
He says African countries might have funds, but "70 countries imposing restrictions on exports of medical materials" has made it difficult to buy necessary goods. President Nana Akufo-Addo has eased Ghana's lockdown measures and emphasised the need to test, track and trace coronavirus cases, instead of keeping people at home. The country, much smaller than its neighbour Nigeria, has 11 testing centres, compared with 24 in Nigeria.
There are also other barriers to increasing testing, including the lockdown measures to restrict movement, which can make it difficult for people to get to test sites. The government is using a "pool testing" approach which involves combining a group of samples and testing them together. Only if that produces a positive result will individual samples be tested.
However, Ngozi Erondu, an associate fellow at the Centre for Universal Health, Chatham House, says the bigger issue is the equipment. Using this method, Ghana has one of the highest testing rates on the continent, with just over five per thousand of the population - a total of around 160,000 tests.
"It is not having enough kits and reagents," says Dr Erondu. However, a recent incident at a fish factory, where one worker infected 533 others, has raised concerns about rising infections.
Nigeria's Centre for Disease Control currently has 18 testing laboratories which can process tests that tell you if you have the disease. But it has put out an urgent plea for essential testing equipment. East Africa - shortages of testing materials
Kenya has also admitted to facing challenges in getting testing kits, swabs and reagents, and its overall testing figure has fallen recently as a result. Kenya has been criticised for its lack of testing. The government says that a global shortage of testing supplies has affected the country's ability to conduct tests.
The head of one of Kenya's regional governments said recently that there were only 5,000 testing kits in the country, and that they were expecting 24,000 more. Tanzania hasn't released testing data since the end of April. President John Magufuli has said that imported tests have been faulty, claiming that samples from a goat and a fruit tested positive for the virus.
There are concerns that Tanzania, which has chosen not to enforce strict lockdown measures, could be facing a very serious, but as yet unidentified, outbreak. The US government recently warned that the coronavirus threat in Dar es Salaam, Tanzania's main city, is "extremely high".
Uganda has carried out just over 60,000 tests, but the Uganda Virus Research Institute has said they are facing shortages of testing supplies. The government says it's because of the need for increased testing on truck drivers (a suspected source of virus transmission across the region), limited supplies from abroad and delays in delivery.
Two of the Africa's smaller nations, Mauritius and Djibouti, have achieved the highest testing rates on the continent.
Pan-African initiative
Getting hold of kits and the chemical reagents needed to process tests is proving difficult, as African countries don't produce their own and need to compete for limited global supplies.
Some countries also have weak, underfunded health systems, and have been slow to allocate money and resources to tackle the pandemic.
The African Union and the Africa Centres for Disease Control and Prevention (CDC) have launched an initiative, the Partnership to Accelerate Covid-19 Testing (PACT), which focuses on tracking, testing and tracing.
The organisations plan to roll out about one million tests across the continent, and 10 million within the next six months.
Dr John Nkengasong, director of Africa CDC, says the agency has so far distributed 250,000 kits from a depot in Senegal, and will be finalising the distribution of 500,000 kits received from the Jack Ma Foundation to countries over the next few days.
There are also other social and political factors which could be barriers to greater testing.There are also other social and political factors which could be barriers to greater testing.
"In some communities there could be a stigma attached to having the coronavirus," says Ngozi Erondu. "It's also the case that local leaders may push back against testing if they are up for an election." "In some communities there could be a stigma attached to having the coronavirus," said Ngozi Erondu, an associate fellow at the Centre for Universal Health, Chatham House. "It's also the case that local leaders may push back against testing if they are up for an election."
The African Union and the Africa Centres for Disease Control have launched an initiative, the Partnership to Accelerate COVID-19 Testing (PACT), which focuses on tracking, testing and tracing. Acquiring testing kits in a competitive global market, getting tests to where they need to be and setting up the labs to process samples is not a simple task for countries with less economic clout and weaker healthcare systems.
The initiative aims to roll out about one million tests in four weeks across the whole continent.
The earlier coronavirus outbreaks in Asia and Europe gave African states time to consider their responses, and the experience of handling epidemics such as Ebola has also helped them.
But acquiring testing kits in a competitive global market, getting tests to where they need to be and setting up the labs to process samples is not a simple task for countries with less economic clout and weaker healthcare systems.
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