Is our health system ready to face Omicron?
The emergence of the highly transmissible Omicron variant of the coronavirus reminds us how uncertain the world has become. Despite vaccination, the third wave of the pandemic indicates that Covid may continue to remain a part of our life. Experts have cautioned that the virus may not be wiped out fully and could continue to prevail and affect people, but over time it may become weaker and the fatality rate may decline. Omicron seems to signal the beginning of that phase. Hence, we have to prepare ourselves to navigate through its perils and learn how to survive.
In the face of the rapid surge of Omicron, several countries are reinstating strict measures including travel restrictions and quarantine of travellers. Citizens are being alerted to the dangers. Companies are revisiting their coping strategies. For example, a global financial company has made vaccination mandatory for its staff if they want to keep their jobs. Some companies have announced work-from-home policies for an indefinite period of time.
In Bangladesh, the government has announced some directives recently, while people have been asked to strictly follow health protocols. Further directives to control people's mobility are supposed to be announced soon.
However, some of the announced measures are inadequate. People traveling into Bangladesh will have to undertake an antigen test post-arrival. This is a very weak measure compared to what has been announced in India where travellers will have to undergo seven days of quarantine and an RT-PCR test on the eighth day. Antigen tests are not very reliable in detecting the coronavirus. That is why it is not accepted in most countries. The health ministry, therefore, should take stronger measures. We may recall that weak measures for international travellers in the early days of Covid-19 had been a reason for the fast spread of the virus in Bangladesh.
During the first and second waves, countries enforced lockdowns and border closures. However, that was not very successful. Of course, countries such as China could control the spread of the virus quite successfully, but have had to see their economy shrink. Indeed, the global economic output reduced significantly. Poorer countries were hit hard as they did not have enough fiscal space to support the poor and various economic sectors.
Like many countries, Bangladesh government had announced lockdowns in 2020 and 2021. Enforcing measures like countrywide shutdown, use of masks, and maintaining physical distance helped reduce the spread of the virus. The rollout of vaccination further helped reduce cases. However, there has been a lack of seriousness among the common people in following health protocols of late. A large number of people do not wear masks in public places. This highlights the need for constant efforts towards awareness-building through various platforms.
Almost two years into the pandemic, this is also a time for Bangladesh to reflect on how we have prepared ourselves in terms of healthcare facilities. The health sector has always been underfinanced. With an allocation of around one percent of Gross Domestic Product (GDP), the sector suffers from inadequate human resources, facilities and innovation. Unfortunately, even with only 5.8 percent allocation in the total Annual Development Programme in 2021-22 fiscal year, the Health Services Division could spend only 6.4 percent of its allocation during July-November of FY22. This is unfortunate since there is a need for higher spending on health services during the pandemic. The allocation for various ministries and divisions is determined by the ministry of finance on the basis of their capacity to spend. So, naturally, there will be lower allocation for the poor performers.
The capacity of the health system compared to the needs of patients even during normal periods is far too low. Since the outbreak of the pandemic, some capacity has been developed, but essential facilities such as ventilators, hospital beds, and intensive care units in the hospitals are still woefully inadequate. There is a need for higher allocation. But the quality of healthcare services and the inherent weaknesses in the system cannot be improved with higher allocation alone. The sector has to be revamped through reforms since much of the problem is linked to the governance of the sector. How government funds are used, who gets contracts, who oversees procurements, as well as the quality of the supplies are some of the issues that need to be scrutinised and streamlined. The number of healthcare professionals also have to be increased urgently.
While bigger investment by the government is needed to ensure affordable healthcare, the private sector also has to invest more. The private sector needs to increase and improve their services considering the high demand. Reputed international hospital chains may also be brought in to collaborate with local private investors. It's essential that the government ensures proper regulation and monitoring of these hospitals.
Overall, dealing with the coronavirus successfully will largely depend on a robust and affordable health system. Policymakers should utilise the lessons learnt in the past two years and be prepared for a possible third wave.
Dr Fahmida Khatun is the Executive Director at the Centre for Policy Dialogue. Views expressed in the article are the author's own.