The COVID-19 pandemic: A focusing event to promote domestic investment for health systems strengthening in the WHO African Region

Abstract

Background

The COVID-19 pandemic has been framed as a catalytic occurrence that exposed the chronic underinvestment in health systems strengthening (HSS) in the WHO African Region as well as its potential to galvanize much-needed political attention towards the issue. This expectation aligns with the portrayal of COVID-19 as a ‘focusing event’ for HSS. This study analyzes whether COVID-19 met the criteria of a focusing event for HSS as set forth by John Kingdon, and then, if as a focusing event, it generated political attention towards policy making and implementation for HSS and whether there could be prospects for sustaining such momentum in the post COVID-19 era.

Methods

We carried out a scoping review of available literature using the O’Malley and Arksey method (2005).

Results

The COVID-19 pandemic presented an unprecedented crisis that drew attention to the problem of weak health systems in the WHO African region, a problem that had long been acknowledged but largely ignored. This study has also shown that COVID-19 had a profound personal experience on policy makers since it severely limited their opportunity to seek medical care abroad and forced them to personally witness the weak state of domestic health systems. These attributes suit the criteria of COVID-19 as a focusing event according to Kingdon, which helped to stimulate governmental action on HSS.

Conclusion

The COVID-19 pandemic can indeed be leveraged as a salient focusing event to generate political attention for HSS in the WHO African Region. However, such attention cannot be guaranteed in the long-term, due to the differential dynamics between policy making and implementation in crises and non-crisis situations. By casting light on a plausible but rarely examined mechanism for driving policy change –the personal experience of policy makers, we conclude that lack of financial resources does not sufficiently explain the lack of domestic investments for HSS. This calls for attention towards other reasons of inaction towards HSS, including the insulation of the elite from facing the weak health systems.