The COVID-19 pandemic exposed the weaknesses of health systems in low-income countries. Discover the lessons learned from the responses to COVID-19.

Lessons learned from the evaluation of COVID-19 responses in low-income countries

In recent years, low-income countries have faced major challenges, including the covid-19 pandemic. Although no country was spared from the consequences of the pandemic, it is clear that the extent of its impact varied depending on each state’s ability to respond effectively. COVID-19 revealed significant weaknesses in health systems especially in developing countries such as limited access to medical resources, fragile infrastructure, and heavy reliance on external aid. However, despite these constraints, these countries showed remarkable resilience, offering valuable lessons for managing future health crises. In this article, kerus consulting international reviews key lessons drawn from the evaluation of covid-19 responses in low-income countries.

Health systems under strain even before the COVID-19 pandemic

Before evaluating the responses to the COVID-19 health crisis, it is important to establish the context. Certain structural realities shaped political decisions, interventions, and observed outcomes. Many countries, particularly in sub-saharan africa, south asia, and latin america, had to face this health emergency while already grappling with systemic vulnerabilities.

Fragile health systems

Prior to the covid-19 pandemic, most low-income countries were already dealing with fragile health systems. These weaknesses included a lack of modern laboratories, low density of medical personnel, under-equipped hospitals, and insufficient public health funding. For example, according to statistics published in 2022 by the world health organization (who), africa had an average of 1.3 physicians per 10,000 people, compared to 34 per 10,000 in europe. This imbalance translated into a limited capacity to handle surges in covid-19 patients, especially those requiring intensive care.

High dependence on foreign aid and unequal vaccine access

Inequities in vaccine access also highlighted another major issue the high dependence of developing countries on foreign aid. However, it is important to note that the multilateral COVAX initiative helped ensure more equitable access to covid-19 vaccines. While several low-income countries did receive initial vaccine doses, they often arrived late and in limited quantities. By the first quarter of 2022, less than 20% of the population in developing countries had received a first vaccine dose, compared to 70% in high-income countries.

Economic constraints

A large portion of the population in low-income countries depends on the informal sector for income, often without any form of social protection. Lockdown measures had an immediate and severe economic impact, threatening the daily survival of many families. The covid-19 pandemic led to an increase in global extreme poverty. In 2020, the world bank warned that between 88 and 115 million additional people could fall into extreme poverty due to the pandemic.

What were the responses to the COVID-19 pandemic ?

Despite structural constraints, low-income countries did not remain passive in the face of the COVID-19 pandemic. Most demonstrated responsiveness, pragmatism, and innovation making decisions that reflected their local realities.

Community mobilization and decentralized responses

Given the shortage of human resources, many governments quickly delegated responsibilities to local actors such as village chiefs, religious and community organizations, and traditional authorities. This approach made it easier to disseminate prevention messages, organize awareness campaigns, and build public trust in health measures. In senegal, for example, neighborhood godmothers known as bajenu gox played a critical role in promoting mask-wearing, handwashing, and vaccination.

Adoption of appropriate technological solutions

Some countries, like Rwanda, leveraged simple yet effective technologies to respond to the pandemic. The rwandan government used drones to broadcast prevention messages in hard-to-reach areas. In Uganda, sms platforms were used to share health information and symptom alerts remotely. These innovations helped compensate for the lack of traditional health and communication infrastructure.

Partnerships with non-state actors

Many local businesses, NGOS, universities, and start-ups were included in national response plans. For instance, the noguchi institute in Ghana contributed to training healthcare workers and validating diagnostic tests. Governments also worked with artisan cooperatives and tailors to locally produce masks—as seen in ETHIOPIA, BENIN, TOGO, and others. These public-private partnerships were essential, as states alone could not meet the scale of the health crisis.

What lessons can be drawn from evaluating COVID-19 responses in low-income countries ?

The responses of low-income countries to the COVID-19 pandemic offer crucial insights for strengthening health systems and improving global health governance. Here are the main lessons learned.

Invest in strengthening monitoring and evaluation (M&E) systems for health policies

A common shortcoming across many developing countries was the absence or inadequacy of robust M&E systems for health policies. This gap limited governments’ ability to rapidly adapt strategies, allocate resources effectively, and ensure accountability. With functional health information systems, epidemiologists could have detected outbreaks earlier, measured the impact of interventions, and adjusted strategies in real time. For example, centralized data on testing and vaccination via national digital platforms enables better strategic crisis management. Investing in stronger M&E systems is essential to support the collection, analysis, and dissemination of health data.

Rely on community-based and contextualized approaches

The COVID-19 crisis showed that the most effective responses often come from strong, culturally relevant community networks. Developing countries successfully leveraged social trust and community ties to relay health messages, encourage prevention, and promote vaccination. Strengthening community health systems by involving traditional leaders and community health workers in policy planning will be key to future resilience.

Diversify medical supply chains

The reliance on imports for medicines, equipment, and vaccines exposed the vulnerability of many health systems. Stimulating local production, even at a small scale, can help address health crises more effectively. Governments should support local pharmaceutical industries and form regional partnerships to pool resources and strengthen the resilience of health systems.

Invest in public health as a pillar of development

The COVID-19 pandemic reminded us that health is not just a medical issue—it is a central factor for social, economic, and political stability. Countries that invested in prevention, healthcare training, and health information systems were better able to weather the pandemic. Low-income country governments must structurally increase health budgets and integrate health risks into sustainable development strategies.

Conclusion

The COVID-19 pandemic revealed structural flaws in the health systems of developing countries but also highlighted their adaptability, innovation, and community mobilization. By learning from this crisis, these countries can build more resilient and equitable health systems. At Kerus Consulting International, we support governments, NGOS, and institutions in developing monitoring and evaluation frameworks for health policies that align with international standards and are tailored to local contexts. Contact us to build on progress made and co-create sustainable solutions in public health, health governance, and emergency response so we can better anticipate future crises.

References

• We’ve conducted 50,000 interviews across sub-saharan africa on COVID-19 vaccination since 2020 here’s what we’ve learned
• Identifying key challenges and solutions for vaccine distribution in low- and middle-income countries: a modified delphi study
• The impact of COVID-19 and national response strategies on healthcare service utilization in seven low- and middle-income countries
• Learning from the COVID-19 pandemic to strengthen preparedness in low- and middle-income countries for future global health threats