The Impact of COVID-19 on Global Health Systems
1. Introduction
Many health systems have struggled with optimal allocation of virtual care services and testing capacity for COVID-19 and further implementing governing public health interventions. In resource-limited communities, the basic and most affordable personal protective equipment such as masks and gloves have been short in supply in healthcare systems. Despite the facts that these dynamics needed for effectively managing the outbreak were reported, for example in critical care and in virtual care, countries have been understandably utilizing differing care models and hence implementing different governing policies. Physicians have been left to weigh on which of the two patients: patient A who has been hospitalized due to COVID-19 and requires intensive care that is now out of capacity or patient B who has life-threatening non-COVID-19 ailment but has the compliant capacity is more deserving of critical care resources. The battle to manage this pandemic asks healthcare systems and governments to reflect on growing public scrutiny on the practices deployed to deliver care and the role of global collaborations on COVID-19 response.
The outbreak of coronavirus disease 2019 (COVID-19) and its rapid spread across the globe have raised the alarm for a public health emergency of international concern and have reunited nations to control the infection and save lives. In countries managing this pandemic, healthcare systems and healthcare workers fall under immense and unprecedented suffering ranging from moral dilemma, fatigue, out-of-stock critical care supplies, and overall system overload due to the growth in critically ill COVID-19 cases. At this stage, the entire human race is dreading compassionate leadership and effective, genuine, and strategic operations of healthcare systems globally. This pandemic calls for unity in the way healthcare capacity, health policies, and clinical guidelines are promoted and executed, more especially in optics of their strengths and shortfalls across resource settings. In doing this, our decisions and choices should be solidly grounded on the existing scientific evidence and best practices and need to be regularly reviewed in the context of our global experience in managing COVID-19.
2. Challenges Faced by Global Health Systems
The number of patients presenting with symptomatic disease is likely to be much higher during a pandemic than the daily numbers reported by clinical laboratories, potentially straining even the strongest of health care systems. Even if the actual number of patients seeking medical attention during a pandemic is only a fraction of the population affected, the surge in patients requiring hospital-based care could easily overwhelm the health care system. Patients affected may require other services as well, such as drug treatment of their disease and more typical primary and specialist care. Clinics, hospitals, specialty care facilities, and even long-term care facilities and home health assistance must be prepared to meet these challenges, especially for patients with severe respiratory illness and those at high risk of complications or transmission to others.
Challenges confront health care systems all the time, but pandemic influenza represents a uniquely severe threat to health care systems. If current clinical attack rates occur during an influenza pandemic, health care systems would be overwhelmed, creating a need for rapid decision-making and solutions for systemic problems. Inadequate pandemic planning and preparedness have left health care institutions facing large numbers of ill patients and shortages of staff, medical supplies, and hospital beds. This study outlines lessons learned from pandemic planning efforts and makes recommendations for improving the ability of health care facilities to respond to and withstand such an event.
3. Strategies to Mitigate the Impact
In some health structures, patients’ meetings had been restricted to less than 20 persons; those patients were provided with hand sanitizers, handwashing facilities, and masks. Other related healthcare services had been transferred to the care of other health structures, including home-based care and adherence support of TB patients. In Cameroon, the national TB program planned to continue distributing the tuberculosis drugs for two months during the COVID-19 pandemic. HIV/AIDS antiretroviral drugs’ distribution points were increased in time to reduce the high density of patients in health facilities. There were also announcements made to dissuade patients who may not be potential COVID cases from attending health facilities. Community-based closing tuberculosis identification and the closing tuberculosis treatment was recommended as means of minimizing contacts. In Ghana, the health sector established a policy to mitigate the impact of COVID-19 on the epidemiological patterns of diseases (malaria, diarrheal, and respiratory infections) through the setting up of COVID centers, thus limiting the circulation of potential COVID-19 patients. These patients were instead monitored by phone calls. In Uganda, the Ministry of Health advised general hospitals and district hospitals to give refills to TB and HIV/AIDS patients.
The COVID-19 pandemic has impacted health systems and structures around the world, affecting the delivery and quality of healthcare services. So, as a means of mitigating this pandemic, strategies have been developed and implemented by health structures. In Nigeria, for instance, telemedicine and teleconferencing were recommended as means of alternative care so that routine care could continue. Health dwellers resorted to using chloroquine and other antimalarials to treat COVID-19. Affected by these changes are the HIV/AIDS, TB, and family planning services. The use of HIV drugs has been threatened. Only 28% of countries reported that antiretrovirals were available in their health structures, and related services were interrupted, especially for lower-level facilities. These problems could be largely associated with the fact that many health facilities were converted to COVID-19 treatment facilities in many countries. Health workers were redirected to work in these facilities, wherein absentees of health managers continue to hamper the primary healthcare services.
4. Lessons Learned for Future Preparedness
Healthcare systems were able to quickly adapt to the situation and prioritize. All formal integrated health system bodies surveyed reported abolishing activities that could be postponed and canceled other investments and non-urgent technical facilities. Moreover, shifts in resource allocation to help patients and healthcare workers afflicted with COVID were common, and nearly all IHS bodies reported securing the personal protective equipment (PPE) and medical supplies. Additionally, around three-quarters or more of healthcare providers increased access to telemedicine or virtual care, postponed elective surgeries, and primary care activities. These changes and the other measures implemented to respond to COVID affected all the dimensions GAIA had originally identified as important for health system performance and decision-making, particularly those related to priorities and benefits, fueling existing inequalities in health and wellness, as well as utilities and processes that had flexible and agile capabilities.
Although the majority of high-income countries responded promptly to reduce the transmission of COVID and protect their healthcare systems by introducing measures such as lockdowns, quarantines, social and physical distancing, and heightened public hygiene, healthcare system readiness and the ability to cope with the pandemic varied significantly across countries. Many healthcare systems faced challenges in scaling up the required personnel, equipment, and facilities, and while critical care capacity was often increased, progress in testing capabilities was slow in several countries. Resource reallocation, particularly human resources, was widely implemented during the crisis in most high-income countries. However, changes in areas such as remote provision of care, expansion of telemedicine grants, and the introduction of diagnostic testing were still implemented in under half of surveyed healthcare systems.
5. Conclusion
Africa and Nigeria in particular, standing at the peak of the pandemic, proved to be scientifically and technically resilient. The opportunity now should be transformed into sustainable development. COVID-19 has exposed the fissures in the investment in health and the excessive dependence of the rich nations in the pursuit of “vaccine sovereignty”. Over the past years, the bombing of drugs against other communicable diseases has focused on non-communicable diseases while Africa struggles with the burden of communicable diseases. The COVID-19 vaccine provides an avenue for the continent to exponentially expand its capacity for vaccine production for the diverse vaccines that Africa needs, to escape the vaccine out of Africa justified by the tragedy of the 2009 introduction of the pandemic H1N1 vaccine and the devastated 1991 meningococcal meningitis vaccine at suboptimal quality levels. The vaccine out of Africa is a potential source of business opportunities in the continent, as noted by Schellekens (2021). We know the challenges, and we should be assured in our capacity to resolve the issues that confront us. In fact, more than anyone else, African scientists are capable of addressing African challenges.
The COVID-19 pandemic has taught us important lessons that require us to change our approach in dealing with global public health challenges. The first and most important lesson is how to prepare better for global health emergencies. Timely communication to the relevant institutions in order to prevent the spread of diseases should be encouraged in order to avoid unnecessary panic. The second is the power of teamwork. In the global environment with advanced technology and flow of human resource, no country could survive alone. Common international efforts and cooperation must be established to combat the menace of pandemics.
