Since the start of the pandemic, critical data gaps and inconsistencies in reporting related to testing, case numbers and mortality records have all impacted the ability of African governments to tailor their responses to the scale and speed of the crisis – and craft the most effective policies for managing it.
The World Health Organisation’s COVID-19 Weekly Epidemiological Update for the African region on 17 August begins by stating that data for the week is “incomplete due to reporting delays” and therefore “trends should be interpreted with caution.” Although such gaps in data and reporting are not new issues for the region, they are especially alarming in the context of responding to an ongoing global public-health emergency.
Testing and Case Counts
Africa has among the lowest Covid-19 testing rates in the world. South Africa, one of the top performers in testing on the continent, has conducted 270 tests per 1,000 people cumulatively, a figure that is six times lower than the US and 13 times lower than the UK. However, most countries in Africa are not even publishing national testing statistics. Lack of widespread testing and reliable reporting means that the true number of Covid-19 cases and size of the outbreak in Africa is unknown.
Limited data on Covid-19 testing in Africa signifies an incomplete picture of the size of the outbreak
Our World in Data
Without a clear picture of total cases, it is impossible to account for the true number of deaths. This is because Covid-19 can only be determined as the cause of death if the deceased has been tested for the virus. Consequently, in countries with low testing rates, both cases and deaths are undercounted.
Accurate mortality figures are further obstructed by inadequate or non-existent civil registration and vital statistics (CRVS) systems. According to the WHO, international standards for a “well-functioning” CRVS system involve the registration of all deaths (and births), including the issuance of death certificates, recording of cause of death, and the compilation and dissemination of CRVS statistics.
A 2017 Economic Commission of Africa survey found that only 18 African countries record and report on annual deaths. Within those 18 countries, only one in three deaths was officially registered and just four of the countries met international standards for CRVS, including documenting cause of death. A recent WHO assessment of health-information systems estimates that, overall, just 10% of deaths are officially registered in Africa, compared to 98% in Europe. And most countries still collect death records in paper form, which do not get digitised and so cannot be shared and aggregated at the national level.
WHO Health-Information Systems Assessment: count of births, deaths and causes of death
In summary, with just one in ten deaths officially registered and low testing rates among the population, it is highly likely that Covid-19 mortality figures in Africa are vastly undercounted.
In May, the Economist modelled the true global death toll to be nearly three times more than the official count. Yet, in sub-Saharan Africa, the death count was estimated to be 14 times higher than the official figure. If the estimate is accurate, it would mean that total mortality to date in sub-Saharan Africa could be closer to 1.8 million, not 200,000.
Importance of Real-Time, Comprehensive Data
These data gaps directly impact the ability of governments to make evidence-based policy decisions. As we pointed out earlier this year at the Institute, “you can’t manage what you can’t measure.”
Policymakers need to know the true prevalence and severity of Covid-19 in their communities to inform the implementation of public-health and social measures, such as indiscriminate versus targeted restrictions on movement, and to understand how an outbreak may be affecting certain demographic groups differently than others. Real-time, comprehensive data can assist countries in identifying priority populations for vaccinations, determining allocation of limited resources and appealing for donor funding.
Without reliable data, governments cannot craft evidence-based policies – or measure their effectiveness.
Testing must be ramped up across the continent to ensure that governments have a more complete picture of transmission. Increased testing will provide more accurate case and death counts. However, in the absence of sufficient testing, seroprevalence surveys that determine the number of people in the population with Covid-19 antibodies can help to fill the data gap.
Governments should resist political incentives that keep Covid-19 data hidden from the public. Transparency in reporting will serve to improve crisis-response efforts, including by earning public trust.
Strengthening health information and CRVS systems should be a priority for African governments. This ranges from the digitalisation of data-collection processes to compulsory registration of deaths and their cause. Investments in more robust routine data information and reporting systems now will not only improve Covid-19 policy outcomes today, but also ensure countries are prepared for the health emergencies of the future.