Bad policy or wrong priority: Why public health policy fails?

An imaginary conversation; really? "Fancy a newpa [new policy approach]?" Someone from the expert panel with transcontinental experience suggests a new-found approach in the new Covid-19 response project appraisal meeting.

"Oh, I'd love that. It's fascinating!" replies one team leader of the government delegates, having cuppa [a cup of tea], who oversees fighting the ongoing pandemic response.

A bit later, the suggested approach is included as a part of the response policy without further discussion.

This is probably a trivial version of a hypothetical conversation between the experts and policymakers actively working for Bangladesh's government, but certainly not out of context.

What are the facts? Only conventional wisdom? The fact is that the government is always seeking policy suggestions from national and international experts. These experts hardly consider possible implications for indirect concerns except their main areas of expertise. This is very expected, of course, and nothing unusual.

It is, however, unusual when a policymaker just accepts suggested policies without thinking of two basic concerns: the approach may be good, but why should I consider?

And if I consider, do I have the required administrative and operational spaces, and political competitiveness and value for this?

Health sector in crisis. Photo: Mumit M

If someone disregard these concerns, they are either wilfully ignorant or serving themselves, neglecting their commitments to the government and the country at the most challenging time.

Sounds like a good plan, but it is not a good plan. Backed by loans from international financial institutions, a few Covid-19 response approaches designed for the poor and vulnerable are well-intentioned, but have an administrative illusion, technological, and participatory drawbacks.

For example, recent small area-based (e.g., ward, road, or apartment building) lockdowns will be found ineffective as we have experienced a complete failure during the first phase of lockdown.

Off and on, several reopenings of garment factories were also an administrative failure, and the promised benefits and protections from the garment owners for workers are still unclear.

In addition, a mobile phone-based tracing and warning system has its limitations and is highly user-dependent. Also, developing high-priced websites instead of free ones (e.g., Google site) is another rent-seeking act.

Establishing several isolation and treatment centres without the necessary equipment and professionals indicated low-level policy design, and is still causing coronavirus patient suffering.

An overwhelmed media presence with quasi-truths is another pressing concern.

As Bangladesh has been historically known for its public health-related research internationally, these umbrella policies – blindly following other countries – are surprisingly heart-breaking.

So, what should we prioritize instead of trying every possible approach, which costs us time, money, and the lives of our loved ones?

Prioritizing two big basics is needed, as micromanagement is unmanageable. Existing Covid-19 response policies are not entirely non-functional; however, we need to put them in context.

Resource reallocation and relocation considering constraints are much needed to prioritize two basic policies.

First, fully functional coronavirus isolation centres and treatment hospitals are almost non-existent, with an increasing number of patients. Therefore, building district-level isolation centres, each with at least 500 functional beds and division-level treatment centres, each with at least 1000 fully equipped beds, should be the priority.

Other non-functional centres should be decommissioned to save money. Lodging and food are must-have services for the employees working for these centres and hospitals.

Moreover, the government should plan to establish a new specialized pandemic treatment hospital instead of leasing private hospitals and clinics. Also, professional ambulance and funeral services are essential requirements.

Additionally, emergency medical supplies (e.g., personal protective equipment) need to be produced locally to lower the high import dependency.

Second, different small-scale lockdown strategies are not working as common people are not complying for various reasons. Complete lockdown is urgent, if required, by deploying defence forces to curb the spread of coronavirus.

Supplementary concerns regarding economic activities need careful planning and need to work with affected people.

Why could some policies be a failure? Because of the new normal or the biases of policymakers? Preparing and adjusting public health policies because of the ongoing Covid-19 pandemic is a new normal across the world. The countries that adjust their policy based on emergency priorities are more successful than those who keep running practically ineffective response policies.

If government agencies continue to invest in less-prioritized health initiatives instead of emergency necessities, it will significantly undermine the ongoing Covid-19 response effort, and common people will suffer the most.

Perhaps the most pressing concern is whether experts and policymakers are influenced by their professional interest-based (e.g., technology "savvy" or not) and social and cultural biases (e.g., education, social values, work environments, affiliations) when making choices for public health policies.

Sometimes they might present a confirmation bias problem, as people often defend their views by using favourable information and neglecting opposite or alternative views when selecting policy approaches.

Any way out? Most probably, no, but at least we can try. Most of the time, a whole new team combining policymakers, administrative personnel, and multidisciplinary researchers could bring new synergies to the pandemic response team while ensuring successful implementation of Covid-19 responses with expected outcomes.

We, the common people, sincerely hope that ongoing administrative reform activities replacing leaderships, high-ranked officials, and spokespersons of public health–affiliated departments will be pivotal to serve essential public health interests and to earn public trust.

The author is a postdoctoral researcher at the University of Nebraska-Lincoln, USA.