Ever since its emergence late last year, the Coronavirus pandemic has cast spotlight on the vulnerabilities and challenges faced by the healthcare sector; the ever-increasing rate of daily confirmed cases worldwide is a sign that the curve is yet to flatten.
There are more than 17.7 million confirmed cases globally, with more than 679,000 deaths as of writing. In the face of this raging crisis, even developed countries are finding it tough to curb the virus’ spread with their healthcare systems. The US spends more on its healthcare system than any other country--more than 17 percent of its GDP-- and yet many citizens continue to suffer from a heavily privatized system. As for the least developed and developing countries, the situation is grimmer. Enforcing an ideal lockdown is tough, and so is utilizing the exhausted healthcare facilities.
The bleak state of the healthcare system in different countries
According to a recent healthcare report, India-- a country of 1.3billion people--spends only Rs 138 per person every month in healthcare. This means that the citizens mostly have to bear the additional healthcare costs on their own. Meanwhile, its neighbour Bangladesh spends about 3% of its GDP on the health sector, although government contribution remains about 1.1%.
Among the South Asian countries, India’s caseload rises to 4th largest globally, while Pakistan has been ranked among the top ten countries with rising COVID-19 cases by WHO. Bangladesh’s situation has been deemed the same as Pakistan’s with regard to high test positivity--which is 20%. Afghanistan, the poorest country in South Asia, also dangles over a precarious terrain. Its health sector is already overburdened from the tensions emerging out of violence. Its GDP is only around half of Nepal’s and one-third of Pakistan’s.
The aforementioned figures suggest that the healthcare systems across South Asia are not ideally equipped.
Even though South Asian countries were initially thought to be safe from the blows of Covid-19, the current scenario paints a different picture. In the wake of the pandemic, South Asian countries (the ones with mounting cases) are floundering in giving treatment to their patients.
Beyond South Asia, the countries with healthcare systems already in a poor, battered state before the pandemic now await a cruel fate. Yemen is one such example, a country ravaged by air-raids, conflicts, and military operations. Since 2015, many Yemenis have been denied some basic rights like healthcare and hygiene due to war. And now, that pre-existing condition, coupled with the pandemic, is likely to deal a double blow against Yemenis. Yemen is suffering the world’s worst humanitarian crisis. On top of that, the vulnerability of medics, collapsing health system, absence of a central government, and the rising grip of Houthi rebels over vast areas contribute to roughening up efforts to contain the virus.
Across Africa, the effects of a historical lack of political will to ensure proper investment in health systems and health-related industries are being laid bare by COVID-19. For instance, Nigeria only invested less than 4% of its annual budget to healthcare despite the pledge made to increase its annual health budget to 15% during the Abuja declaration in 2001. Limited funding allocated to the health sectors has led to the existence of understaffed and under-equipped public medical centers. There are about five-hundred ventilators per 400,000 persons and 350 ICU beds per 571,429 persons in the 23,640 public and private hospitals.
On the 17th of March, as coronavirus cases were rising, doctors in Abuja, the federal capital territory, reportedly went on strike due to the delay in salary and unsafe working conditions. The same trend has been pervasive in many African countries' healthcare systems, such as Kenya, Uganda, Niger, Sierra Leone, among others. Another major weakness in sub-Saharan African health systems is inadequate human resources. Africa is said to have less than one health worker per 1000 population compared to 10 per 1000 in Europe.
There has been a shortage of PPE (personal protective equipment) for health workers. The doctors are also facing heavy additional workloads as the cases surge, leaving them vulnerable to infection. Lack of transparency and political integrity remain the enduring constraints in fighting the Covid-19 pandemic in major African countries. For instance, in some states in Nigeria, many of the funds dedicated to healthcare emergency aid were being looted. According to Delia Ferreira Rubio, Chair of Transparency International, "the regulations of the money lobby needed an urgent address in order to tackle the pandemic in Africa.”
Besides Nigeria, cases of corruption in the wake of the pandemic have also been reported in Bangladesh. Recently, a man was arrested for selling fake negative certificates.
The Way Forward: Rethinking Healthcare Development During and Post-COVID
By the end of March, when the UK recorded more than 6500 cases and 330 deaths, New Zealand had only 102 cases and no record of death from the coronavirus. It is largely attributable to the fact that New Zealand imposed travel bans--as early as February-- on anyone coming from or via China, and subsequently extended the ban’s range to other hard-hit countries. The ban, coupled with a rigorous alert system and self-isolation measures, proved to be a successful story. However, after 17 days with no coronavirus cases, the country lifted the lockdown and eased movement for citizens. As a result, new cases started to emerge. Currently, the number of cases stand at 1553 with 22 deaths. The number of recovered patients remains 1506 as of July 19th.
While many assume that New Zealand’s isolated location and low population density may be the leading reasons that helped it control the virus in a better way than most countries, according to a Professor’s quotes in the BBC, the strategy applies to any country with a functioning government and infrastructure. However, the sad reality that looms over many countries in Asia and Africa is: The healthcare infrastructure is not as well equipped as New Zealand’s.
Conflicts and tensions have battered countries like Yemen, Afghanistan, Cameroon, and Congo. Financial hardships continue to stalk informal workers from developing countries like Bangladesh, Pakistan, Kenya and so on. Isolation is a privilege for many. Not maintaining proper quarantine measures has become the norm. Gloomy Covid-19 stories keep flooding the news, with no respite on the horizon.
If this condition persists, healthcare systems across the countries with poor or exhausted infrastructure will have to bear the brunt. Then in turn, the patients will suffer.
Through effective testing and isolation, the world could slide out of this grisly scenario. This includes a partial/full ban on international travelling as well. The economy has to be designed in such a way that quarantining and maintaining physical distance can deal no blow. Social safety net should also be introduced so that laid-off or isolated workers can sustain themselves without risking their own lives and others’. These measures can have a significant impact on easing the hardship faced by healthcare infrastructure, as seen from the New Zealand model.
In an ideal world, there would be united and concerted efforts when it comes to bettering the healthcare conditions of countries with poor facilities. But by taking the current world order into consideration, we can realize that the responsibility lies on each government to contain the virus’ spread. Until a vaccine is discovered, facilitating ideal isolation, social distancing measures and introducing health-sector , social safety friendly budgets remain some viable options.
According to a research done by Centre for Policy Dialogue, a think-tank based in Bangladesh, the Government of Bangladesh should take more effective measures to ease the strain on its healthcare infrastructure in the wake of this pandemic. Chief among the recommendations are: Enhanced budgetary allocation for the health sector, reduction of taxes on healthcare workers’ income, pharmacies, and other entities that may benefit the health sector, and the presence of necessary, tax-free funding for emergency medical facilities and equipment.
If a silver lining can be drawn from the spread of the pandemic – it will be that Leaders in the developing countries need to turn their ‘political will into political action’ by strengthening their healthcare infrastructures and policy. As Julius Mugwagwa wrote in his blog, “Africa governments must see this pandemic as an impetus towards achieving SDG3 (Health and Well-being).”
Additionally, training community-based health workers to ensure the timely delivery of treatment is also crucial to meet the shortage of health workforce. A good example of a country that has been practicing this is the Democratic Republic of Congo. During the outbreak of Ebola in 2014, the country trained thousands of community health workers to help prevent, detect, and respond to the Ebola-infected people. This community-based strategy is now being deployed to help strengthen the COVID-19 response in the country.