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How to Help Developing Countries Respond to the Coronavirus

Low-income countries have 7x fewer ventilators per person than the US. Here’s how to help nonprofits save lives in countries where health systems were stretched well before the pandemic.

As American hospitals scramble to find enough ventilators to keep coronavirus (COVID-19) patients alive, there are still seven times fewer ventilators per person in low-income countries like Nepal — and no General Motors or federal stockpiles to tap. Though the vast majority of known cases of COVID-19 have so far been in affluent countries, the case count elsewhere is rising: 16,588 confirmed cases and over 600 deaths in low- and lower-middle-income countries as of April 2nd. And the true figures could be far higher in countries in Sub-Saharan Africa, for example, leading experts to call the spread through poor countries a “ticking time bomb.”

Hospital capacity

Just how prepared are low-income countries to handle the coronavirus?

Based on World Health Organization (WHO) data, there is just one hospital bed and fewer than one physician for every 1,000 people in low-income countries.

The WHO also scores countries on a scale of 0 to 100 on their population’s access to essential health services. By this measure, people living in low-income countries have half the level of access to health care of people in affluent countries.

Ventilators

In the most severe cases of COVID-19, patients need more than a doctor and a bed. They need to be under intensive care and given a mechanical ventilator to breathe. In the US, where fewer than 100 confirmed cases on March 1st exploded into 243,500 a month later, a mad dash for ventilators has begun. The Institute for Health Metrics and Evaluation projects a nationwide need for up to 55,000 ventilators on a single day in mid-April. Compare that to just 77,000 produced worldwide over a year in 2019.

To meet skyrocketing demand, President Trump invoked the Defense Production Act last week, ordering General Motors to produce ventilators. The automaker plans to build 10,000 a month. Ford and General Electric have committed to tens of thousands more.

But what would the ventilator shortage look like in poor countries, which don’t have manufacturing giants to rally and never had enough machines to begin with? In a systematic review of ICU capacity in 15 low-income countries, fewer than half of the individual ICUs studied had mechanical ventilators on record.1One survey estimated just 7.2 ICU beds with ventilators per 100,000 people in Kathmandu, Nepal, as of 2011 — a rate seven times lower than the 54 ventilators available per 100,000 people in the U.S.2 In Uganda, there were only 33 fully equipped ICU beds with a ventilator in 2009.3 In a country of 33 million at the time, that’s just one fully equipped ICU bed per million people.

Handwashing and social distancing

Low-income countries also face a serious disadvantage when it comes to preventing community spread. In many communities, the WHO's top two pieces of advice — frequent handwashing and social distancing — will be all but impossible to heed. Data from the WHO and UNICEF show that less than half the population has access to basic handwashing facilities in Sub-Saharan Africa. Over 76 percent have no handwashing facilities at all in the Middle Africa region.

Worldwide, over 1 billion people are living in slums, with most concentrated in low-income countries. In South Sudan, slums are home to a whopping 95 percent of the entire urban population. Characterized by their extreme overcrowding, substanding housing structures and inadequate water and sanitation, slums are the perfect breeding ground for viruses like COVID-19.

A stark tradeoff

But measures that work in wealthy nations may not be enough for poor ones. If low-income countries follow the path of the U.S., Italy and China, they could face a stark tradeoff between saving coronavirus patients or saving the lives of refugees and malnourished children.

World leaders and nonprofits on the ground alike have raised warnings about facing such tradeoffs if action is not taken now. Last week, UN Secretary General Antonio Guterres appealed to the G20 — made up of 19 industrialized countries and the EU — to funnel trillions of dollars to developing countries. Doing so would avoid dipping into existing humanitarian funds that are currently keeping vulnerable populations fed, sheltered and safe from persecution.

The Community Health Impact Coalition, a group of 14 nonprofits on the frontlines, says that a “massive loss of life” resulted from neglecting existing illnesses during past outbreaks. The 2014 Ebola epidemic halved access to health care services, dramatically increasing deaths from malaria, HIV/AIDS and tuberculosis. This time around, those nonprofits believe Community Health Workers (CHWs) — community members trained to provide basic health services — can help countries avoid repeating history. In poor countries, where the pinch of the global health-worker shortage is felt most, CHWs can “maintain existing health services while surging their capacity.”

How you can help

Nonprofits need immediate funds to purchase essentials like masks and gloves so CHWs can stay safe as they work. They are also fundraising for COVID-19 tests that can be used in non-clinical settings and educational materials to ensure families have accurate information about the virus — among other funding needs. Donations will help nonprofits afford these necessities and allow CHWs to save lives in some of the world’s most hard-to-reach places.

The Coalition counts among its members three of ImpactMatters’ Top Health Nonprofits of 2019: Integrate Health (Togo), Living Goods (Kenya, Uganda and Myanmar) and Possible (Nepal). It also includes Amani Global Works (DRC), Last Mile Health (Liberia), Lwala Community Alliance (Kenya), Medic Mobile (14 countries in Africa and Asia), Muso (Mali, Cote d’Ivoire), Partners In Health (10 countries around the world), Pivot (Madagascar), Praekelt (54 countries around the world), VillageReach (six countries in Africa), Vital Pakistan (Pakistan) and Wuqu’ Kawoq (Guatemala).

1 Seventeen out of 36 individual ICUs had data showing the presence of ventilators.

2 The Center for Public Integrity reported 160,000 ventilators in U.S. hospitals as of March 24th, and a further 16,600 in the Strategic National Stockpile. With 327.2 million people in the country, that’s 54 ventilators per 100,000 population.

3 A fully equipped ICU bed is defined here as one with a pulse oximeter, mechanical ventilator, suction machine and an anaesthesia provider in the vicinity.


Nonprofits fighting COVID-19 in developing countries

Integrate Health 
 Top Health Nonprofit
integratehealth.org
Integrate Health works to expand access to health care for all individuals through community driven initiatives in partnership with the public sector in Togo, West Africa.

Living Goods 
 Top Health Nonprofit    Impact Audited
livinggoods.org
Living Goods saves lives at scale by supporting digitally empowered community health workers who deliver care on call – making it easy for families in need to get the care they need. To achieve this, we leverage smart mobile technology and real-time data to optimize outcomes, performance, and accountability. We work closely with governments and partners to strengthen national community health systems. We ensure health workers are effectively compensated, supervised and equipped. We nimbly innovate to deliver the greatest health outcomes at the least cost. And we always aim for national scale, co-creating financing solutions to make universal health coverage a reality.

Possible 
 Top Health Nonprofit
possiblehealth.org
Possible, a US-based non-profit, and Nyaya Health Nepal, a Nepal-based NGO, have partnered over the last decade to provide quality, accessible care to underserved communities in Nepal. Currently, we work in two districts in Nepal: Achham in the Far-West and Dolakha, which was devastated by the 2015 earthquakes. Our more than 350 staff provide integrated care from home to hospital to over 200,000 community members, provide over 150,000 hospital visits, and conduct over 8,000 surgical procedures annually.

Amani Global Health
amaniglobalworks.org
Amani Global Works’ mission is to Care, Cure and Make Whole by providing healthcare to the most impoverished and forgotten areas of Africa.

Last Mile Health
lastmilehealth.org
Founded by survivors of Liberia's civil war and American health workers, Last Mile Health’s mission is to save lives in the world's most remote communities. The organization specializes in working with governments to develop and manage national networks of professional community health workers who bridge the gap between a country’s public sector health system and remote communities, bringing lifesaving health care to the doorsteps of people who would otherwise be out-of-reach. Last Mile Health’s vision is global: a health worker within reach of everyone, everywhere.

Lwala Community Alliance
lwalacommunityalliance.org
To build the capacity of the people of North Kamagambo, Kenya to advance their own comprehensive well-being.

Medic Mobile
medicmobile.org
Medic Mobile's mission is to improve health in hard-to-reach communities. The organization builds mobile and web tools that help health workers provide better care that reaches everyone.

Muso
musohealth.org
Muso’s mission is to eliminate preventable deaths rooted in poverty. We envision a world in which no one dies waiting for health care.

Partners In Health
pih.org
Our mission is a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring benefits of modern medical science to those most in need of them and to serve as an antidote to despair.

Pivot
pivotworks.org
In partnership with communities in resource-poor areas, PIVOT combines accessible and comprehensive health care services with rigorous scientific research to save lives and break cycles of poverty and disease. This mission is based on a fundamental belief in the worth of all people and a moral responsibility to address the needs of the destitute. Our goal is to create a model health system of universal access to to quality health care for Madagascar via comprehensive health system strengthening in a region near Ranomafana National Park. PIVOT takes a highly rigorous approach, carefully monitoring and evaluating costs and impacts, and engaging in relevant scientific research.

Praekelt
praekelt.org
Praekelt.org leverages mobile technology to solve some of the world's largest social problems. We deliver essential information and vital services to improve the health and wellbeing of more than 100 million people in over 65 countries. Partnering with governments, NGOs and social enterprises, we provide our users with information, inspiration, and access.

VillageReach
villagereach.org
Save lives and improve health by increasing access to quality healthcare for the most underserved communities.

Vital Pakistan
vitalpakistan.org.pk
Saving lives and improving health of women and children in Pakistan

Wuqu’ Kawoq
wuqukawoq.org
Wuqu' Kawoq is a non-governmental organization dedicated to improving the health of Mayan communities in Guatemala. We believe that everyone – no matter where they were born or what language they speak–should have the highest quality health care.