Covid-19 calls for capacity assessment of public health system

The coronavirus (Covid-19) has overwhelmed medical facilities around the world, and in some cases, health care systems are handicapped with paucity of essentials.

We are also seeing nonsensical comments and suggestions on potential vaccines or personalized solutions to the problem coming from people in very responsible positions. Meanwhile, our knowledge and experience of the disease will help us devise appropriate policies to fight a battle like Covid-19 in the future.

When the world ultimately announces the pandemic is over and as the countries open up, in addition to rebuilding the economies, we will probably need to assess the capacities of different countries' public health systems to fight future health crises.    

As we analyze the last couple of months, developed countries, such as the US, France, Italy, Spain and the UK have all experienced deficiencies of doctors, ventilators and personal protective equipment (PPE).

At the same time, the quality of public health system is largely uneven, particularly in some developing countries and most least-developed countries (LDCs). In some countries, public hospitals are overwhelmed during normal time and the situation has worsened with a sudden spike in admissions during this corona crisis.

In the absence of a vaccine, it is being advised to maintain physical distancing and wash hands regularly to reduce the spread of Covid-19. But many families in developing countries and LDCs live in single-room homes and lack running water to wash hands frequently. Needless to say, lack of infrastructure and crowded conditions put these communities at an even higher risk.   

As things stand, we are living with incomplete information and/or misinformation. Some recommended that people can avoid using masks if they are not infected. However, there are cases where people carry the virus without showing symptoms, meaning they can spread the virus before realizing that they are infected. Wearing a mask in public, under such circumstances, can help keep the infected person from spreading infectious droplets.

One of the plausible reasons behind the advice for people to not wear masks until they are sick could be the scarcity of masks and to make them available to the people who need them most, i.e., doctors, health workers, patients and others.

On the other hand, the World Health Organization and other agencies have pointed out that, wearing a mask, people may feel a false sense of security that may undermine other preventive measures. If only we could stick to specific guidelines, instead of moving in different directions, surely things would have been far easier.

While many countries cannot hospitalize people in numbers like China and some developed nations did, the potential damage minimization approach is to detect the infected promptly so as to contain the spread of the virus, suggest the patients with milder infections to take appropriate measures at home and admit the critical ones.

For that to happen, it's imperative to enhance the testing facilities to help prevent more waves of illness and to ensure that the pandemic is really under control. Korea, for instance, had tested so extensively that the rate of samples turning out to be positive was even less than 3%.

In the US case, the rate, as reported in electronic media, is even in the range of 24% to 31% in some states. For Bangladesh, the rate is hovering around 12% to 13%. This percentage needs to be lowered but lack of test kits and manpower is seriously hindering the process.

Just take a moment of your time and ponder on the statement of US President Trump - coronavirus patients could be injected with disinfectants as a remedy. Moreover, Trump seems to have been advocating for hydroxychloroquine, an anti-malarial drug, as a cure to Covid-19 albeit no scientific basis for that as of now.

A top US doctor, as reported in the media, has been relieved of his responsibilities as a consequence of his resistance to the US president's wish to apply hydroxychloroquine for treating Covid-19 patients.

Be that as it may, it is my gut feeling that we need to shore up capacities on health preparedness, both at country and global level. One has to know one's limitations and the realities on the ground.

Therefore, once the pandemic subsides, it would be imperative to follow a systematic approach, starting with a thorough capacity needs assessment to shed light on the gaps present in terms of knowledge, skills, weaknesses, assets and other elements required in our healthcare system to manage a pandemic in a better way.  

At the country level, for instance, the assessment should gauge as to whether a public health system has all the cutting-edge technologies at the laboratories with balanced distribution of the same throughout the country.

It would be crucial to look into the number of doctors, nurses and emergency beds per hundred or thousand people and other essentials and to what extent these numbers shall be increased.

Among other things, the assessment shall substantiate the requirement of capacity development measures for the doctors and nurses, with communication and coordination strategies etc. All these, of course, belong to policy discourse on investment.

The high social cost of Covid-19, as we have been exposed to, validates the increased expenditure on health care system. The coronavirus is yet another reminder that health care is a public good and therefore, no one should be excluded from the service.

At international level, it is essential to look into cooperation and meaningful spending on research. If we want to address a crisis like Covid-19 properly and effectively in future, all countries must have a clear understanding of the issues at stake.

The author is a Humboldt Scholar and a Senior Advisor in an International Development Agency