Red-gloved hands gently dip cotton swabs down nostrils and mouths of people taking turns to stand in front of a tall booth, masks lowered and head tilted backwards. Inside the booth to which the gloves are attached is a COVID-19 sample collector.

Set up by Nigerian health investment firm Flying Doctors in eight of the country’s worst-affected states, the mobile booths, which separate the sample collector from the people being tested, have boosted COVID-19 testing. Between 80 and 100 samples are collected per booth every day, although the number varies among states. Nigeria is conducting an average of 2500–3000 tests daily.

Flying Doctors founder, Dr Ola Brown, explains that at the start of the pandemic, Nigeria had few people trained to take COVID-19 test samples, and collectors would also visit people at homes to take samples, heightening infections risks through exposure.

“It [the sample collection booth] reduces to zero the number of infections on the people conducting the tests. Secondly, it also saves a lot of time compared [with] the people testing having to go to people’s houses to do the tests and thirdly, it saves money because people [are] not having to change their PPE [personal protective equipment]” frequently, says Dr Brown.

For Dr Walter Kazadi, World Health Organization (WHO) representative in Nigeria, “expanding access to services such as sample collection and diagnostic testing are critical for an effective response.” WHO continues to support Nigeria’s Centre for Disease Control and the national response system by providing resources for training and supplies for sample collection and testing.   

The COVID-19 response across Africa has propelled a raft of innovations. Across the continent, innovators have worked to create tools to help public health experts manage challenges ranging from contact tracing and clinical care to local production of equipment and supplies as well as laboratory and testing materials.

Many of the innovations were already existing but have had to be redirected or adapted to COVID-19 response. For example, Zipline, a California-based firm, repurposed its high-speed drones that were in use in both Ghana and Rwanda to deliver medical packages to clinics and hospitals to now identify COVID-19 hotspots and collect samples. In anticipation of new treatments and vaccines that may become available, the company is poised to help with distribution.

In Kenya, to support contact tracing in public transport, a mobile phone-based application, mSafari, was launched in March by its developers in collaboration with the ministries of Health and Transport.

Most of the innovations are homegrown. The mobile booths in Nigeria are made locally. In all there are 14 booths in Abuja, Kano, Kaduna, Lagos, Ogun, Oyo, Rivers and Zamfara states. Flying Doctors also has transformed one vehicle into a mobile laboratory. In total, the organization has three laboratories. It has trained more than 100 molecular laboratory scientists to carry out COVID-19 testing.  

Working with various foundations, the organization has made its testing free to encourage people to turn up. COVID-19 testing in Africa still lags other regions of the world. The World Health Organization Regional Office for Africa recommends 10 tests per 10 000 people per week in the region. Just 12 countries recently surpassed the threshold.

While Africa has recorded relatively fewer COVID-19 infections compared with other regions, the decline in cases seen between July and September has plateaued, with spikes in cases reported in some countries. Dr Brown stressed the criticality of testing and maintenance of vigilance on COVID-19.

“I think [that] one of the things that has really impacted the focus on testing is the fact that not many people have died in Africa compared [with] Europe or America. When people aren't dying and when people aren't getting horrifically sick and we're not seeing those numbers of course it [testing] gets deprioritized especially in a country that has limited resources,” she says.

“It’s important for everybody to remain vigilant … and continue to really keep our guard up.”