The global spread of COVID-19 posed unprecedented challenges to health systems worldwide. Yet, the magnitude and consequences of the pandemic varied considerably across countries, largely reflecting disparities in institutional capacity and health infrastructure. In low-income countries, the pandemic acted as a stress test, revealing systemic weaknesses – but also highlighting opportunities for innovation, decentralized governance, and community engagement. Kerus Consulting International has conducted an in-depth review of COVID-19 response strategies in these contexts to extract actionable lessons for future health preparedness.
Context: pre-existing structural vulnerabilities
Fragile health systems
Prior to the pandemic, most low-income countries operated with structurally weak health systems characterized by limited diagnostic infrastructure, low healthcare worker density, under-resourced hospitals, and insufficient public funding. According to WHO (2022), Africa has an average of only 1.3 physicians per 10,000 people, compared to 34 per 10,000 in Europe reflecting a critical imbalance in care capacity, particularly for intensive and emergency services.
External dependence and vaccine inequity
The distribution of COVID-19 vaccines underscored longstanding asymmetries in global health governance. Despite mechanisms such as COVAX, many low-income countries experienced delayed and insufficient vaccine access. By early 2022, less than 20% of their populations had received a first vaccine dose, compared to over 70% in high-income countries—further highlighting dependency on external aid and limited procurement power.
Economic pressures and informality
A significant portion of the population in these countries depends on the informal economy and lacks access to social protection. Lockdown measures led to immediate economic hardship, threatening food security and livelihoods. The World Bank estimated in 2020 that 88–115 million additional people could fall into extreme poverty as a result of the pandemic’s economic effects.
Strategic and contextual responses
Community-based and decentralized governance
Several governments adopted decentralized models by delegating authority to local leaders, religious institutions, and community-based organizations. This approach proved essential in communicating preventive measures and encouraging compliance. In Senegal, neighborhood matriarchs (Bajenu Gox) were instrumental in promoting mask usage, handwashing, and vaccination in underserved areas.
Use of appropriate technological solutions
Technological adaptability was evident in countries like Rwanda, where drones were used to disseminate public health messages. In Uganda, SMS-based platforms were leveraged for remote communication of COVID-19 symptoms and guidance. These low-cost, high-impact solutions effectively supplemented the limited reach of traditional infrastructure.
Public-private and civil society partnerships
Crisis response frameworks increasingly included non-state actors – universities, start-ups, cooperatives, and NGOs. The Noguchi Memorial Institute in Ghana contributed to diagnostic training and validation. Countries such as Ethiopia, Benin, and Togo partnered with local artisans to produce face masks, reinforcing local value chains and reducing dependence on imports.
Lessons for future health emergencies
Strengthen monitoring and evaluation (M&E) systems
The absence of robust M&E mechanisms hampered real-time response and evidence-based decision-making in many countries. Investing in functional health information systems is critical for early outbreak detection, resource tracking, and timely policy adjustments. Centralized digital platforms for testing and vaccination data, for instance, improved crisis coordination and strategic oversight.
Institutionalize community health models
Responses rooted in local knowledge, trust, and social cohesion proved more effective than top-down approaches. Strengthening community health systems – including training local health workers and involving traditional authorities – will enhance future response capacities and improve public health literacy.
Diversify medical supply chains
The over-reliance on imported medical goods exposed the fragility of global supply chains. Encouraging local pharmaceutical manufacturing and establishing regional procurement partnerships can improve self-sufficiency and resilience to global shocks.
Position public health as a development imperative
COVID-19 reinforced the notion that health security underpins economic and political stability. Countries that had invested in public health infrastructure, workforce development, and preventive strategies fared better. Low-income countries must now structurally increase health budgets and integrate health priorities into broader development agendas.
Conclusion
While the COVID-19 pandemic amplified long-standing structural deficiencies in low-income countries’ health systems, it also demonstrated these countries’ capacity for innovation, adaptability, and social mobilization. The lessons derived from their pandemic responses offer a blueprint for building stronger, more equitable, and more resilient health systems. At Kerus Consulting International, we work alongside governments, NGOs, and international institutions to develop robust monitoring and evaluation frameworks tailored to local contexts and aligned with international standards. Our goal is to help co-create durable solutions in health governance, public health, and emergency preparedness. Contact us to strengthen your health policy systems and enhance preparedness for future global health threats.
References
- 50,000 Interviews on COVID-19 Vaccination in Sub-Saharan Africa: Key Learnings (2022)
- Identifying Priority Challenges and Solutions for COVID-19 Vaccine Delivery in LMICs: A Modified Delphi Study
- The Impact of COVID-19 and National Responses on Health Service Utilization in Seven LMICs
- Learning from COVID-19 to Strengthen Pandemic Preparedness in Low- and Middle-Income Countries
