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Background The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. Methods We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O’Malley’s methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. Results Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. Conclusions The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised.
We conducted a scoping review since it allows us to capture the broad nature of the research question and range of health system preparedness measures, impacts of and responses implemented across Africa in different settings. We followed the methodological framework suggested by Arksey and O’Malley20 and further refined by Levac et al 21 which comprised of the following five steps: (a) identifying research questions, (b) identifying relevant studies, (c) selection of studies, (d) extraction and charting of data and (e) summarising and reporting results. The following questions guided the scoping review: (1) How well prepared were the existing health systems in responding to adverse impacts of COVID-19 infection? (2) What were the implications or consequences associated with COVID-19 on the healthcare system in Africa? (3) How did the health system respond in maintaining pre-pandemic health service needs, including providing essential healthcare services? To effectively answer these questions, we adopted the population, concept and context framework developed by the Joanna Briggs Institute,22 as described in table 1. Population concept context (PCC) framework for defining the eligibility of the studies for the primary research question GAT developed a comprehensive searching strategy and discussed with the research team, presented in online supplemental file 1. We searched peer-reviewed papers on PubMed, Scopus and CINAHL bibliographic databases for peer-reviewed articles. Since grey literature such as unpublished work, preprint articles and relevant government reports on COVID-19 have grown in number and significance, we also searched Google and Google Scholar and MedRxiv and Research Square websites. We considered studies that employed quantitative or qualitative methods and reported health systems more broadly or any essential health services. These studies reported the impact of COVID-19 on maternal and child health services, services for infectious diseases such as tuberculosis, malaria, HIV and antiretroviral treatment services, chronic care, cancer care, hypertension care and treatment, and mental health services. We included studies conducted between 1 December 2019 and 21 March 2021, at which time the comprehensive literature search was performed. bmjgh-2021-007179supp001.pdf We included any published, preprint or grey literature in English that explored a combination of the following three terms: ‘health system preparedness’, ‘the impact of’ and ‘responses for COVID-19 pandemic by the healthcare system’. Two investigators (GAT and FHT) searched and screened the studies by titles and abstracts and then reviewed the full texts of potential studies. Records were managed by EndNote X9.0 software. The reference lists of the included studies were screened for relevant studies. Any questions around study eligibility were resolved through consensus between the two investigators (GAT and FHT). However, we excluded articles that mainly focused on the clinical and biological conditions of the diseases without any contextual linkage into the health system or those investigating the perceived/anticipated health system impact of the COVID-19 pandemic. Editorials, commentaries and letters to the editor that did not involve primary data were also excluded. Two reviewers (GAT and FHT) initially developed a pre-determined electronic data-charting form that the research team later discussed and agreed on. Five reviewers (GAT, BAD, AGT, KG, DE) extracted data from included studies. The data extraction form had the year of publication, country name, article title, journal, study design, study setting and population. It also captured the key findings reported in the three core areas of health systems (ie, preparedness, impact and response) and limitations acknowledged in each study. We used a thematic content analysis using narrative descriptions of the extracted data, and organised the results under three main domains: preparedness, impacts and responses. We reported the review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines Extension for Scoping Review reporting standards (online supplemental file 2).23 bmjgh-2021-007179supp002.pdf The study did not involve patients or the general public. Their input was not sought in the systematic review design, interpretation of results, or drafting or editing this document. This study was a systematic review of publically avilable literature, and ethical approval was not required.
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