Diffracting the Global: Exploring the Implementation of WHO’s COVID-19 Protocols in Sub-Saharan Africa

Abstract

The coronavirus disease 2019 (COVID-19) has impacted the world in unprecedented ways. To deal with the virus, countries across the world implemented COVID-19-related protocols that include social distancing, washing hands, wearing masks and restricting movements of people. While the literature on the impact of COVID-19 is emerging, it is still relatively unknown how the virus affected countries in sub-Saharan Africa. This article explores the impact of COVID-19 protocols in sub-Saharan Africa. The article broadly argues that an all-assuming and globalised approach of COVID-19 protocols is antithetical to the sub-Saharan African continent with its vast territories and unique populations. The article highlights that the African continent that houses the world’s poorest populations cannot be adequately served by COVID-19 protocols in similar ways to Western countries. It is further suggested that COVID-19 protocols that reify universalism may need to be adapted and domesticated to fit the African context. The article provides critical insights into the experience of COVID-19 protocols that has several policy implications for future pandemics and disease outbreaks in the African continent.

Introduction

The emergence of the coronavirus disease 2019 (COVID-19) transformed and impacted the world in significant ways. First reported in Wuhan, China in December 2019, the virus spread to almost all the nations of the world. The effects of the disease were felt in almost all corners of the earth. The grave nature of the virus was evident especially after the World Health Organization (WHO) officially declared COVID-19 a global pandemic on the 11th of March 2020. At the time of the declaration, COVID-19 was spreading rapidly across the world. To contain the spread of the virus and its imminent threat, WHO came up with some health protocols that countries could use to mitigate against the virus. These measures include social distancing, wearing masks, restricting movements of people and quarantining individuals who were diagnosed with the virus. Over and above these measures, some countries implemented curfews to further reduce movements in their populations.

The roll-out of COVID-19 protocols reignited debates about the concept of globalisation. As countries began implementing these protocols and enacting stay-at-home orders, controversies emerged about the impact of these measures on different populations. The concept of globalisation is polarising and usually evokes mixed responses from scholars. Views about globalisation are usually mixed and variegated. One prominent approach amongst globalisation studies especially in Western scholarship is that globalisation is ‘natural’ and cannot be easily escaped (Johnson 2002, 428; Tomohara and Takii 2011, 520). Scholars aligned to this pro-global view, point to the benefits that all countries accrue from being part of the ‘global village’. That is, the interconnectedness of countries has provided material and economic benefits to many countries especially those in the African continent (Yaya, Otu, and Labonte 2020, 2). The sharing of COVID-19 vaccines between wealthy countries to the rest of the world, for example, has been cited as a sign of the benefits of globalisation (Puyvallée and Storeng 2022, 2). The globalisation process facilitated vaccine sharing that resulted in lives being saved in recipient countries mostly those located in the Global South. On the other hand, critics of globalisation demur its Eurocentric and universalistic persuasions that treat countries and world territories as if they are the same (Ascione 2016, 319). Globalisation is denounced for its bias towards westernisation that has canonised ways of knowing and epistemes of knowledge. Critics further direct attention to the power imbalance and a recent surge in nationalist ideologies inherent in the global system where rich and powerful nations dictate terms. For example, they reference the increase in populism, nationalism and in some cases the nativism that resulted from COVID-19 (Ciravegna and Michailova 2022, 173). In the Global South, scholars usually snipe at the foundationalist nature of globalisation and its insensitivities to local cultures (Richards 2014). The homogenising and standardising nature of globalisation is questioned and rendered passé. The implementation of WHO’s COVID-19 protocols in sub-Saharan Africa brought in some challenges and dilemmas. How would a continent that has historically had a fair share of pandemics and disease outbreaks deal with another pandemic? How would the poorest populations of the world deal with yet another catastrophe that threatens their lives? More importantly, can COVID-19 protocols serve African populations and communities in similar ways as the rest of the world?

This article examined the impact of WHO’s COVID-19 protocols in sub- Saharan Africa in the context of globalisation. The sub-Saharan region of the continent of Africa with its vast territories, diverse populations and a history of dealing with disease outbreaks provides a unique and relevant context for understanding the dynamics of WHO’s COVID-19 protocols. The African continent is uniquely placed to illuminate the effects of COVID-19 protocols within a global framework. The first section of the article presents a critique of the concept of globalisation. What is it and who benefits from it? The second section then focuses on the impact of COVID-19 protocols with a specific focus on the continent of Africa. How did Africa fare with COVID-19 protocols? The third section zooms on the specific experiences of COVID-19 protocols with relevant examples across the African continent. The last section illuminates the key lessons from Africa’s experience with COVID-19 protocols and its implications for globalisation.

Globalisation: By Who? For Whom?

Globalisation is one of the most fiercely contested concepts that usually attracts mixed reactions. For some, globalisation is a positive development that cannot be avoided (Contractor 2022, 161). Scholars aligned to this view believe globalisation is a sign of progress that relies on the ineluctable power of technological and scientific advances. The infrastructure provided by computer networks and the internet has facilitated the process of globalisation (Aggarwal 2011, 52). Pro-globalists see it as a necessary development that benefits all countries who participate in it. In a view that mirrors modernisation theories, proponents of this view contend that least developed countries are better off in a globalised world as it is positively correlated with economic development in developing countries (Dong, Cai, and Shi 2021; Marsh 2014). Concepts like ‘global village’ are usually invoked to entrench doctrinal beliefs about the cogency of interconnectedness. On the other hand, critics of globalisation believe that it reinforces the power imbalance between wealthy countries and those in the developing world (Kanbur 2019, 434). Globalisation is seen as detrimental to countries without power due to its totalising and homogenising nature. Anti-globalists believe that in a globalised world, ‘the fittest survive’ while those with less economic and technological strength are at the behest of the rich and powerful. Most critics of globalisation especially scholars based in non-Western society call for a need to decolonise and disabuse globalisation of its all-assuming and universalistic orientations. In essence, global linear thinking castaway ‘ways of knowing and knowledge that do not bend to Western European and North Atlantic epistemic regulations that are now resurging in diverse levels, spheres and areas of experience’ (Mignolo 2021, 721). Nyamnjoh (2004) questions the dualism and boundaries inherent in the globalisation process that disenfranchises Africans. He argues that ‘ordinary Africans in their millions have the rawest deal: they are most likely to be excluded anywhere in the world, if they attempt to cross the boundaries of poverty, powerlessness and despair that confine them’ (Nyamnjoh 2004, 54). Within these variegated views are those who believe that globalisation can impact countries both negatively and positively. In this way, globalisation is seen as both beneficial and harmful to countries (Ogar and Ogar 2018; Raluca 2010). Kellner (2002) believes that globalisation is fraught with contradictions. He argues that ‘the disclosure of powerful anti-Western terrorist networks shows that globalization divides the world as it unifies, that it produces enemies as it incorporates participants’ (Kellner 2002, 290). While the global space provides some useful benefits, it is seen as a site of contest, struggle and power imbalances between countries.

The advent of COVID-19 recentred debates that mirrored the polarising nature of globalisation. Questions around the involvement and motive of the WHO in COVID-19 interventions were raised (Chan and Yuen 2020, 1063). For example, in the United States, COVID-19 interventions were resisted by some people, especially in Republican states. Controversy surrounded not just the source of these interventions but also how they were implemented as people thought they tampered with their freedoms (Roberts and Utych 2021, 2517). Some politicians even refused to institute stay-at-home orders and mask mandates in their states. In sub-Saharan Africa, the region that houses the world’s poorest populations, the controversy around the COVID-19 protocols was prominent. While some people accepted COVID-19 protocols and saw them as beneficial, others questioned how they would impact African populations who have suffered the brunt of prior pandemics (Kapiriri et al. 2022, 298). They questioned whether countries in Africa and other parts of the Global South could be served well by protocols from the WHO with their unipolar discourses. Furthermore, issues were raised about how a diverse continent like Africa with high unemployment rates, poor health systems and prior experience with other disease outbreaks would be impacted by COVID-19 (Lone and Ahmad 2020, 1301). More importantly, when vaccines were made available later, questions were raised about the unethical practices of ‘vaccine hogging’ by the rich and powerful nations at the expense of poor nations (Catling 2020). In questioning these ‘unglobal-like’ behaviours, some people like the South African President, Cyril Ramaphosa likened this greedy behaviour to ‘vaccine apartheid’ where people in poor countries were likely to die waiting for their shots while rich countries had surplus vaccines. Interrogating the nature and form of COVID-19 protocols and the behaviours of wealthy countries in stockpiling vaccines at the expense of poor countries challenged the immutable suppositions of globalisation. It destabilised notions of a pristine and flawless global process that benefits all countries. It reorientated the critical question of who benefits from global processes and interventions.

The Globalisation of WHO’s COVID-19 Safety Protocols

In the early days of the pandemic, COVID-19 protocols were critical measures when vaccines were not yet available. Championed by the WHO, these all-encompassing and universal interventions became the sine qua non of global COVID-19 interventions. These protocols were elevated to a seignorial status by governments across the world. For pro-globalists, cascading these protocols to the world-as-a-whole (Connell 2007, 368) was a sign of ‘good’ globalisation at work. It reified the strength of globalisation where scientific knowledge can be shared amongst, and within countries. The declaration of COVID-19 as a pandemic in March 2020 was a significant moment that set-in motion efforts to disseminate WHO’s protocols to the rest of the world. As earlier stated, some of the measures included washing hands frequently with soap, avoiding public gatherings and crowds, wearing masks, enforcing stay-at-home orders and isolating individuals who were diagnosed with the coronavirus. Countries across the world adopted these protocols and used them as a blueprint to frame their response to the pandemic. In essence, the adoption of the COVID-19 protocols ‘embody the dialectical quality of contemporary globalization’ (Yaya et al. 2020, 3).

For many countries in sub-Saharan Africa, implementing COVID-19 protocols was the right thing to do. Without a known efficacious vaccine at the time, these protocols provided a temporary and effective way to reduce the spread of the virus. Implementing lockdowns became a preferred approach to contain COVID-19, which was threatening to spiral out of control. Lockdown has been defined as a ‘set of measures aimed at reducing transmission of COVID-19 that are mandatory, applied indiscriminately to a general population and involve some restrictions on the established pattern of social and economic life’ (Haider et al. 2020, 2). Haider et al. (2020) further distinguish between three types of lockdowns such as geographic containment, home containment and prohibition of gatherings and closure of public establishments. In line with these protocols, many African countries implemented strict lockdowns to contain the spread of the virus. ‘Strict’ lockdowns are stringent lockdowns where people’s movements are severely curtailed and not allowed. Strict lockdowns are usually accompanied by heavy policing by law enforcement. Most African countries (except for Tanzania) preferred strict lockdowns, especially in the early days of the pandemic. This involved some restrictions on people’s movement outside their residential dwellings for a specific amount of time. Essential workers and services were exempted from these restrictions. Schools, churches, gyms, alcohol vends and other establishments that attract crowds were closed during strict lockdowns. Street vendors and informal markets that are popular across many African nations were closed and not allowed to trade (Wegerif 2020, 798–799). Some African countries chose this form of lockdown, especially after the WHO’s declaration of COVID-19 as a global pandemic. For example, the Botswana government imposed a strict lockdown on 28 March 2020, followed by a declaration of the State of Public Emergency on 2 April 2020. The state of emergency empowered the President to make emergency regulations to protect the nation against COVID-19. Similarly, South Africa implemented a 3-week lockdown from 26 March to 16 April 2020, to contain the spread of the coronavirus. At the time of the lockdown announcement, South Africa was experiencing a surge in COVID cases and had already declared a national state of disaster. Other African countries such as Nigeria, Uganda, Ghana, Namibia, Zambia and others announced lockdowns in the month of March to deal with the impeding danger posed by the coronavirus. As earlier stated, most of these lockdown measures were strictly enforced by the police and other law enforcement agencies across Africa.

It is evident from the African experience that WHO’s COVID-19 protocols were widely embraced by governments in sub-Saharan Africa. More specifically, many countries across the African continent chose ‘strict’ lockdowns and curfews in an effort to control the spread of the virus. While these measures were enacted differently by countries, they were nevertheless very popular across the African continent. The next section details the experiences of COVID-19 in Africa with a specific reference to a case study amongst South African townships. The aim is to demonstrate how the global protocols associated with COVID-19 might not be well suited to people living in extremely poor conditions.

COVID-19 in Africa: Dying of COVID, Dying with Hunger

The onset of COVID-19 exacerbated the already dire economic situation in many countries in Africa. Although these conditions varied by country, poor and marginalised populations across Africa were likely to feel the grave effects of the pandemic (Rutayisire et al. 2020, 268). These are people without access to basic amenities such as clean water, sanitation as well as electricity. The pandemic further demonstrated that some workers in the African continent could not work from home as they are mostly employed in the informal sector. An informal economy with low-skilled workers does not favour virtual work (Ujunwa, Ujunwa, and Okoyeuzu 2021, 2). Moreover, when the pandemic swept through the African continent, workers in the informal sector were likely to feel the effects of the virus. Due to the large informal sector and its underemployed workforce, ‘the structure of African economies and the primary stage of economic development predisposes the continent to risk’ (Ujunwa et al. 2021, 2).

The restriction of movements and public gatherings due to COVID-19 significantly affected the informal sector that is a mainstay of many African countries. These global interventions undermined the lives of ordinary people across the African continent. One of the impacts of COVID-19 was the job losses amongst informal workers. For instance, in South Africa, an estimated 2.2 million informal workers lost their jobs between April and June 2020 (Skinner et al. 2021). In some African countries, the informal sector is largely unregulated and operates in crowded spaces near metropolitan areas. Many traders in the informal sectors sell, and trade imported goods such as used clothes, shoes and food items (Makoni and Tichaawa 2021). Marketplaces in urban areas were temporarily shut down to reduce the spread of the coronavirus. This affected many people whose livelihoods depend on these marketplaces. Moreover, as governments closed down urban markets to contain the spread of COVID-19, it resulted in unintended consequences such as illegal transactions and price gorging of essential supplies. For example, there was an exponential price increase in food items by suppliers in marketplaces in Ghana (Asante and Mills 2020, 174). Poor Ghanaians were likely to suffer the consequences of these price increases. In Zimbabwe, lockdowns and restrictions of movements resulted in a lack of basic commodities in an economy that was already suffering from an economic meltdown (Makoni and Tichaawa 2021). Restricting trade in the informal sector due to the coronavirus, therefore, resulted in a black market where goods and other food items were smuggled from neighbouring South Africa. Temporarily shutting down the informal sector in Zimbabwe had negative ramifications as people resorted to smuggling food items from South Africa. The next section is a discussion of the South African experience with COVID-19 protocols amongst its poor populations in urban townships. This example demonstrates the impasse that occasioned poor people who had to navigate the risk of COVID-19 infection, social isolation and the threat of dying from hunger.

The Experience of COVID-19 Protocols in South African Townships: An Example

Existing evidence suggests that the devastating effects of the coronavirus were felt by the poor and socially estranged across various African countries. The urban poor usually live in areas that are characterised by squalid living conditions, overcrowding, unsanitary infrastructure and lack of basic services. In some countries, these areas are called ‘slums’ (Nigeria, Kenya), or ‘townships’ in South Africa. The experience of COVID-19 protocols in South African townships point towards the dilemma of implementing global interventions in predominantly poor areas in the continent of Africa.

The development of townships across South African towns can be traced to the apartheid era where separate locations were established for native African people. This separation was enacted through various legislative frameworks, such as the Urban Areas Act (1923) and Group Areas Act (1950), which created separate communities based on racial groups (Mbambo and Agbola 2020, 331). Historically, the apartheid government deprived townships of infrastructural resources and other amenities for native African people. Due to this blatant discrimination and deprivation, residential spaces in townships are usually smaller compared to those in white neighbourhoods (Mbambo and Agbola 2020, 331). This has resulted in the mushrooming of ‘shacks’ to deal with the lack of space. ‘Shacks’ are makeshift houses made from cheap materials such as corrugated iron. The long-term effect of this development is that townships across South Africa have remained overcrowded, unsanitary and dangerous places with high levels of crime (Lemanski 2004).

The implementation of COVID-19 protocols in South Africa posed unique challenges for individuals living in townships. Physical distancing was the greatest challenge for most township residents due to overcrowding and lack of proper house spacing. Nyashanu, Simbanegavi, and Gibson (2020) argue that the 1–2m physical distancing recommended by the WHO interventions was impossible to attain in townships due to lack of space. In their study based in informal settlements in Tshwane, South Africa, they found about 9,500 people living in 960 shacks. This translates to about 10 people living in a shack of 6–15 square meters. This situation makes physical distancing practically impossible. Similarly, in a study of informal settlements in Cape Town, Gibson and Rush (2020) conclude that implementing physical distancing was a challenge due to the population density. They argue that ‘to effectively maintain social distancing, residents would, in effect, be unable to leave their homes. This is impractical, given that many homes are not serviced and lack toilets and running water’ (Gibson and Rush 2020, 7). The structure and make-up of townships in South Africa, therefore, made it difficult to conform to WHO’s COVID-19 protocols. In other words, the homogenising COVID-19 protocols from the WHO were antithetical to the South African situation, especially for township dwellers.

Over and above the COVID-19 protocols being at odds with the lived experience of township residents, there were reports of constant violations of lockdown measures by residents of poor informal settlements. By the first week of April 2020, the Minister of Police in South Africa, Mr Bheki Cele had reported that over 2,000 people were arrested for flouting COVID-19 protocols. At this time, South Africa was the epicentre of COVID-19 in Southern Africa with over 1,000 daily cases. Most violators were from poor informal settlements. The harsh response to COVID violations by South African police and armed forces led to an outcry of human rights abuses. Many activists lamented the heavy-handedness and excessive use of force by security officers in dealing with COVID violations. For example, the Independent Police Investigative Directorate (IPID) reported a 32% increase in complaints against South African police during the early days of the hard lockdown in 2020 (Burger 2020). The report suggests that most cases (74%) were for alleged assault while about 2.6% were related to deaths associated with interaction with the police. This experience was not unique to South Africa as 18 people were reportedly killed and 33 tortured by security officers in Nigeria between 30 March and 15 April 2020 (Odigbo, Eze and Odigbo 2020, 3). These scenarios of police brutality in poor settlements were evident across all African countries that implemented strict lockdowns.

Enforcing COVID-19 protocols in South African townships demonstrates the peculiarity of dealing with poor populations across Africa. It points to the challenges of a universal approach that occludes the unique experiences of South Africans. Poor people with their idiosyncratic lived experiences bore the brunt of COVID-19 and its ramifications. The preponderance of global interventions might be inimical to the experiences of people in resource-poor settings. As seen in the cases of constant violations in South Africa and other countries, poor people might struggle with stay-at-home orders that confine them to homes with no means to survive. This forces people into making choices between working to sustain themselves and exposing themselves to the virus. More specifically, if poor people are mandated to ‘stay at home with no access to their major source of livelihood and no financial support from the state, the risk of food insecurity leading to hunger increases’ (Chirisa et al. 2020, 2). What are the lessons that can be learnt from implementing COVID-19 protocols in sub-Saharan Africa? How can these lessons inform how the continent deals with future pandemics? The next section discusses some of the lessons that could be learnt from the African experience with COVID-19 intervention measures.

One-Size-Fits-All Approach of COVID Protocols? What Lessons from Africa?

There are several lessons that can be learned from the COVID-19 experience in sub-Saharan Africa. One of the issues that was exposed by the coronavirus was the glaring inequalities across many African countries. As this article has demonstrated, the poor and marginalised were severely affected by the virus. As countries implemented strict lockdowns and limited movements, poor populations across Africa bore the brunt of these interventions. The constant disregard for COVID protocols by poor individuals was tactic to survive and deal with the devastating effects of the virus.

The most important lesson that can be learned from the implementation of the COVID-19 protocols in sub-Saharan Africa is that the ‘one-size-fits-all’ approach might not necessarily apply to countries and regions like sub-Saharan Africa. The taken-for-granted assumptions that underlie global interventions like lockdowns cannot uniformly apply to all regions of the world. A careful and deliberate consideration of the other and their lived experience is important not just to reimagine interventions but also to theorise about global phenomena (Richards 2014, 150). Clearly, strict lockdowns are not necessarily the best solution for areas with a high concentration of poor populations. Global protocols that prioritise strict prohibition might not be suited for poor populations. As this article has demonstrated, poor Africans were being constantly asked to choose between staying hungry or risk getting infected by the coronavirus. Evidently, many people chose to continue seeking means of sustaining themselves at the same time violating COVID protocols. These all-assuming and sweeping global interventions undermine the social situations of poor people. It does not fit contexts with poor populations. This does not mean that global interventions should be jettisoned and shunned. It does not mean that global measures should be completely abandoned in the Global South. Rather, it means that in some cases, global interventions may need to be adapted, modified and decolonised. The Ebola outbreak in West Africa taught us that interventions from WHO and other international organisations are usually not culturally sensitive and do not align with the needs of local people. Using imported tropes of knowledge is usually discordant with the lives of people, especially in places with limited resources. Ghana did not wholesomely adopt the WHO guidelines, rather, they adapted them to suit the context of their unique situation (Asante and Mills 2020). The President of Ghana reportedly did not ban gathering at the urban markets although they attract crowds. Rather, he allowed them to operate with strict conditions of hygiene as they are essential to the urban economy of Ghana. The lesson here is that international frameworks may need to be domesticated to better serve the unique situations of African countries. Adapting global protocols might also entail deploying culturally sensitive and linguistically concordant messaging (Kuy et al. 2020). This process might result in ‘buy-in’ from populations across the African continent. Implementing strict lockdowns and restricting people’s movements has severe consequences for the poor and marginalised especially in resource-poor settings. Kuy et al. (2020) have called for a patient-centred framework to protect vulnerable and poor populations. This approach facilitates dialogue with, and amongst vulnerable populations to seek the best possible ways to serve them.

Another lesson that aligns with adapting international health guidelines/frameworks is to leverage on existing community-based structures. The continent of Africa has enormous experience dealing with other disease outbreaks such as Ebola, malaria and HIV/AIDS. There exists a swathe of long-standing community structures that African governments leveraged on to deal with the onset of the coronavirus. Ajisegiri, Odusanya, and Joshi (2020, 5) advocate for the involvement of community workers who have previously served the continent well in previous pandemics. They argue that the involvement of community health workers is important as it brings in more manpower and, in the process, alleviates the burden on health systems during a health crisis. In many African countries, governments established COVID-19 taskforces that included traditional and religious leaders, people living with disabilities and youth who represented communities that are usually neglected in health programming. Although concern was raised about the underrepresentation of women in these taskforces, estimated at 19% in 69 taskforces in Africa (Pandey 2021), their constitution and outlook leveraged on past lessons dealing with other diseases. The key issue is that experience has been the best teacher in dealing with COVID-19 in Africa. Collaboration with communities could provide valuable inputs in dealing with disease outbreaks and pandemics like COVID-19. Community-based approaches allow governments to gain entrée into the lived experience of people and constitute a central aspect of health interventions.

In the quest to prepare for future pandemics and disease outbreaks, it is important for African countries to address the socio-economic disparities across and within their populations. As this article has demonstrated, poor people are likely to be severely affected by disease outbreaks. More efforts must be leveraged towards economic programs to uplift the poor so that they could be cushioned against pandemics and disease outbreaks. To deal with challenges in urban informal settlements across the continent, Van Belle et al. (2020) call for rethinking how governments engage with people in informal settlements. They argue that the COVID-19 pandemic has exposed how ‘governance, health and equity are intertwined, and demonstrates the fact that effective urban governance cannot be achieved without collaboration with and/or the engagement of residents and real governance actors’ (Van Belle 2020, 2). Rather than impose strict lockdowns in poor neighbourhoods and informal settlements, African governments could engage them about what measures best serves them. Additionally, Chirisa et al. (2020) suggest the rapid rollout of social protection programs amongst the poor and marginalised across sub-Saharan countries. They emphasise that ‘it is crucial for governments of sub-Saharan Africa to implement social protection programs, including cash transfers, food distribution and fee waivers, to support citizens, especially those in the informal sector’ (Chirisa et al. 2020, 11). These interventions might provide buffers against pandemics and disease outbreaks amongst Africa’s poor.

African health systems have been a focus of study for different sub-fields in the public health field. As COVID-19 engulfed the continent, several studies zoned on the weak health systems and their inability to deal with the effects of COVID-19 (Gebremeskel et al. 2021, 2–3; Paintsil 2020, 2742). In Nigeria for instance, Odukoya and Omeje (2020) suggest that the weak health systems in Kano State, the most populous state in Nigeria were ill-prepared to control the virus. They charge that there ‘were delays in setting up surveillance systems for the prompt identification of cases, isolation, testing, and contact tracing’ (Odukoya and Omeje 2020, 91). COVID messaging was also not adequately disseminated to citizens. They call for the strengthening of health systems that include better coordination and anticipatory planning to deal with future pandemics. The lesson learnt is that strengthening health systems is integral to reducing the spread of diseases in Africa. Strong health systems might also make it easier for African governments to implement global interventions. Moreover, well-functioning health systems might cushion poor people from pandemics. Strengthening health systems in Africa is about making them resilient, integrated and adaptive to various disease contexts (Ataguba 2020, 325). For African countries, this entails clearly specifying the roles of different stakeholders such as individuals, organisations and communities in combating the effects of the virus.

Conclusion

This article has examined the implementation of WHO’s COVID-19 protocols and their effects in sub-Saharan Africa. The article broadly called for a readjustment of WHO’S COVID-19 protocols in Africa to deal with its unique contexts. Global interventions with their homogenising and foundationalist agendas might not serve other contexts well. Global health frameworks and associated interventions are usually abstracted from the lived realities of people. The article has argued against the unipolarity that is inherent in globalisation. It challenged the ‘one-size-fits-all’ approach of COVID-19 health protocols and provided evidence that they undercut the agency and experiences of Africans. As Kaseje (2020, 4) rightly states, ‘the African context is unique. There are population structure differences, high prevalence of endemic diseases and the double burden of disease, with health systems that are stretched thin with minimal critical care capacity’. The idea that global interventions can be rolled out to the world as a whole in a similar way is untenable. The resistance and constant violation of COVID-19 protocols in South Africa and other parts of the Global South suggest that these measures might be discordant to the lives of people. The appeal for global interventions might lie in seeking out and understanding the lives of the other.

Overall, the analysis of the article suggests a need for African countries to be intentional about adapting global health frameworks to suit their local contexts. As stated throughout the article, this plan of action is particularly critical in sub-Saharan Africa, which houses the poorest populations of the world with unique life experiences. Efforts to adapt and re-engineer global health frameworks authorise African countries and others in the Global South to domesticate health interventions and make breakthroughs in reaching the most vulnerable people in their respective populations. Such a strategy might allow African countries to not only intensify their agency but also cushion their most vulnerable populations against the vagaries of diseases in the African continent.