Joyce Makasi, a young woman in Kambiti village, Kitui County, Kenya, went into labor with her second child one afternoon in December 2020. She had just enough money to hire a motorbike to take her to nearby Waita health center. At the facility, the clinical officer and nurse told her she would need a cesarean delivery. It wouldn’t be her first cesarean, but COVID-19 presented new obstacles.

Africa was predicted to be hardest hit by the COVID-19 pandemic, given its poor health systems. However, this outcome has not been the case. Despite the U.S. being the highest spender on health care globally, COVID-19 has shown that its primary care infrastructure is in much need of strengthening. But we should not mistake COVID-19 as the biggest pandemic of our time. If anything, it is only a dry run, with other epidemics brewing on the horizon. Therefore, if the global community is serious about epidemic preparedness, global health security, and protecting the most vulnerable, we need to redesign health systems for resilience. Africa’s lessons from the COVID-19 pandemic, as well as from concurrent outbreaks of cholera, Ebola virus disease, yellow fever, and chikungunya, could provide a roadmap.

When Mwanahamisi Abdallah’s mother announced plans to marry her off to a stranger, the 14-year-old Tanzanian girl burst into tears. She had no desire to marry—especially after learning the man already had three wives. Remembering advice from a teacher, she phoned authorities to intervene. They blocked the wedding and eventually delivered Mwanahamisi from her village in southeastern Lindi region to a girls’ shelter in Dar es Salaam.

“If there’s one message, it’s health systems need to be resilient, agile, and equitable,” said Uzma Alam, a researcher at the Africa Institute for Health Policy Foundation and Senior Program Officer of the Africa Academy of Sciences. “No one person, no one community, no one minority can be left behind. After all, your health system is as agile, as resilient as your weakest link.” She spoke at a recent Wilson Center event co-sponsored with the Population Institute, “Lessons from Africa: Building Resilience through Community-Based Health Systems.” The event focused on how locally led interventions improved the resilience and responsiveness of health systems in sub-Saharan Africa. 

The coronavirus pandemic has people throughout the world pondering how humankind should respond to a public health crisis. While individual countries are managing the crisis with varying degrees of success, we can all agree that the Covid-19 pandemic is commanding the international community’s attention. By contrast, it is much harder to get the world to care about the long-term public health crisis unfolding in the West African Sahel.

In Kenya, primary and secondary school students take courses called Life Skills Education. So do students in Malawi, Mozambique, Namibia, and Swaziland. South Sudan adds “peace-building” to the subject title. Lesotho, Madagascar, Rwanda, Tanzania, Uganda, and Zambia are more direct. These countries add the word “sexuality” to the course name.