Covid-19 Pandemic: a priority amongst other global health priorities!
Why ensuring business continuity in existing responses and health programs is imperative to avoid millions of deaths worldwide.
The Coronavirus pandemic has been steadily spreading globally and the last few weeks have seen the eye of the storm moving from China, to Europe and North America. Coming right behind, Latin America, Africa and the rest of the world also see their numbers rapidly increasing.
As we all witness countries shutting down in confinement in an effort to stop the progression of the pandemic, questions remain around the implications of such measures on the most vulnerable, especially in low-income countries.
Public health measures considerations
Basic preventative measures by individuals and communities remain the most powerful tool to prevent the spread of the virus according to the World Health Organisation (WHO), even in low and middle-income countries. Hand wash, social distancing and other non-pharmaceutical measures are our best weapons until a vaccine or treatment is discovered, which could take months.
But, how do you wash your hands when you don’t have access to clean water? How do you stay away from people when you live in an overcrowded refugee camp? How do you not leave your home when you are the sole breadwinner of an entire family and working from home is not even a concept where you are? How do you apply confinement measures when you have to run away for your life? These are questions for over 168 million people worldwide.
In addition to these concerns, the social and economic impacts (short and long term) of either suppression or mitigation strategies are significant, even for high-income countries. We are already seeing the damages of the current situation on income security and economic growth across the globe. In lower income settings, these could be considerably worse, besides a higher human cost.
Redefining the “high risk” group
We know that the COVID-19 virus can infect anyone, and some groups are at higher risk of severe illness or death. High-risk groups include people 70 and older. It also includes people with underlying health conditions and comorbidities. In lower-income settings, although the life expectancy is lower and the proportion of the population over 70 may be smaller, underlying health conditions are very common in the whole population, including children.
Sub-Saharan Africa is particularly of great concern. Endemic malnutrition, high infectious diseases prevalence and an increasing double burden of disease with non-communicable diseases (NCDs) on the rise may completely change the risk profile of the populations there. Weak health systems, political instability, high number of refugees and internally displaced people (IDPs), lack of social protection etc., further compromise the chances of a low-mortality/fast recovery response scenario.
Many countries across the world also share similar health profiles, socio-political and economic realities. In such settings, the recommended measures to fight this pandemic may not be sufficient, if at all contextually realistic. Maintaining lifesaving health programs therefore becomes even more crucial to support vulnerable populations in places where barriers to accessing health care are high. However, it is also more difficult to keep operations running in these circumstances.
A challenging time to deliver, but the worst moment to stop
Many countries have closed their borders and restricted travel, making it extremely complicated to deploy staff or commodities where it is needed most. Strict movement restrictions within countries also affect people on the ground.
Health system strengthening activities, including capacity building, medical procurement and essential service delivery could be highly impacted. This would further weaken the capacity of health workers to provide business as usual health services to the general population and to respond to the epidemic. The impact on WASH programs and health promotion activities may increase further the chances of infection transmission in the population.
With schools closing, education programs will have to be adapted to distance learning. Yet again a challenge depending on pre-existing digital capacity (access to internet, computer or smartphone etc.). Most importantly, from a health perspective, the most vulnerable children now out of school may potentially lose their only guarantee of a decent meal for the day among other benefits of school Health and Nutrition programs.
Should livelihood support programs also be affected, food insecurity would massively increase, especially in places where most people have informal occupational activities, as in many of these countries. Labour shortages, transport interruptions, and quarantine measures could also affect staple food production and availability similar to the Ebola crisis in 2014, this time on a much broader scale.
The way forward?
The challenge is certainly vast and complex. While experts’ worldwide are working tirelessly to put forward viable strategies to avoid a catastrophic scenario, one consensus remains: we must ensure the continuity of lifesaving programs as we respond to this new emergency.
Providing safe and effective health care through existing services should remain a priority. We should continue to strengthen medical service delivery, by equipping countries with the right tools and create strong frameworks as foundation on which to rely if (when) things get worse. Ensuring access to quality medicines and other medical commodities, delivering essential health services and protecting socio-determinants of health (through WASH, nutrition, education, livelihood protection etc.) is vital.
Of course, responses should be revised and adapted to address the additional needs of the pandemic. “Time is everything” and to ensure effective programs adaptation, situation needs and monitoring activities must be scaled-up and strengthened. Strong partnerships (with involvement of local partners and communities) and financial sustainability and resilience strategies will now more than ever be of paramount importance to increase our chances of success and prevent us from diverging resources from ongoing operations.
A call for action…
The current coronavirus pandemic is yet another wakeup call, reminding us that in the globalised world we live in, Universal Health Coverage is not an option or a vague idealistic dream. It is an urgent priority and as António Guterres said, “The world is only as strong as the weakest health system”.
