Estimates of Critical Care Capacity in 54 African Countries
Since COVID-19 first appeared in late 2019, there have been over 4 million cumulative confirmed cases and nearly 300,000 deaths reported globally. Many countries have implemented measures to reduce COVID-19 transmission and to prevent health facilities from being overwhelmed by demand for hospital care, intensive care unit (ICU) beds, and ventilator therapies needed to treat severe infections. Despite these interventions, many well-equipped countries have faced shortages in health equipment and trained personnel.
Thus far, African countries have reported lower disease incidence with only 46,829 confirmed COVID-19 cases and 1,449 deaths across the continent as of 12 May 2020, according to the World Health Organization. Most African countries implemented airport closures, curfews, lockdowns, and other social distancing measures in March or April 2020. Projections of COVID-19 case burden predict that most African countries will experience an uptick in total and severe COVID-19 infections in the next one to three months.
Across Africa, critical care capacity is far below international norms and public health officials have suggested there is a severe lack of ICU beds and ventilators. However, it remains unclear what critical care capacity is available in many countries across the continent as there is no centralized database or capacity reporting mechanism at the local, national, or international levels.
To better understand critical care capacity across the continent, CDDEP compiled data on number of ICU beds, number of ventilators, and number of physician anesthesia providers (PAP) and non-PAP (i.e. nurses and other clinical care staff), among other datapoints, for 54 African countries. This database is intended to inform and assist policymakers and public health officials at the national, regional, and international levels in equipping and preparing African countries to tackle the COVID-19 pandemic.
Data and Methods
National critical care capacity datapoints relevant to COVID-19 treatment included in the database were number of ICU beds, number of ventilators, and number of PAP and non-PAP. The estimated numbers of ICU beds and ventilators were obtained from published government reports or statements, published scientific literature, reports or statements from aide and other non-governmental organizations, local and international media (in all major continental languages), and in-country informants including government or public health officials and other local researchers and healthcare workers. Where possible, we cross-checked ICU bed and ventilator estimates with multiple sources. The number of PAP and non-PAP was obtained from the World Federation of Societies of Anaesthesiologists Global Anesthesia Workforce Survey.
National demographic and economic information for the most recent year for which data were obtained from various World Bank databases. Population data, hospital beds per 1,000 people, and physicians per 1,000 people were obtained from the World Bank’s World Development Indicators database. Regional sub-groupings of African countries followed those of the United Nations Statistics Division; disputed and dependent territories were excluded. For comparisons across countries and regions, count data and data reported per 1,000 people was translated into rate data reported per 100,000 people.
Population and economic data including hospital beds per 100,000 people, and physicians per 100,00 people were available for over 90% of the 54 African countries.
Data on number of ICU beds were available for 49 (91%) countries and on number of ventilators for 46 (85%) countries. Data on physician anesthesia providers (PAP) and non- physician providers (non-PAP) was available for 47 (87%) and 37 (69%) countries, respectively.
Critical Care Capacity
Critical care capacity is summarized in Figures 1 and 2, below. Across the continent, there was an average of 135.19 hospital beds and 35.36 physicians per 100,000 people ranging from 67.39 beds and 9.57 physicians per 100,000 people in low-income countries to 302.50 beds and 115.24 physicians in upper-middle-income countries. The average number of hospital beds per 100,000 was highest in Southern Africa and lowest in West Africa while the average number of physicians per 100,000 was highest in North Africa and lowest in West and Middle Africa.
Across all 54 countries included in the analysis, there was an average of 3.10 ICU beds and 0.97 ventilators per 100,000 people. The average number of ICU beds per 100,000 people ranged from 0.53 in low-income countries to 8.59 in upper-middle countries and 33.07 in Seychelles, the sole high-income country included in this analysis. The average number of ventilators per 100,000 people ranged from 0.14 in low-income countries to 2.49 in upper-middle-income countries. The average number of ICU beds was lowest in West Africa with only 1.10 ICU bed per 100,000 people, and the average number of ventilators was lowest in East Africa with only 0.23 ventilators per 100,000 people.
Overall, there was an average of 2.42 total (physician and non-physician) anesthesia providers per 100,000 people ranging from 1.24 and 0.66 in low-income countries and in the Middle African region, respectively, to 6.91 and 6.64 providers per 100,000 in upper-middle-income countries and the North Africa region, respectively.
Discussion and Limitations
Overall, the availability of hospital beds, physicians, ICU beds, ventilators, and anesthesia providers in 54 African countries is far below the capacities of other countries where the demand from COVID-19 has exceeded existing resources. As expected, there is particularly limited critical care capacity in low and lower-middle-income African countries.
For most countries included in this analysis, there was a lack of verified data available from published scientific papers and reports, or from government Ministries of Health, or other equivalent national agencies. In addition, for several countries, we were unable to identify various datapoints. Despite these limitations, this database on African critical care capacity is the most comprehensive available to our knowledge, and alongside COVID-19 case burden projections, may be useful in guiding and informing national, regional, and continental outbreak preparedness and response.