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Ideas & Debate

Seven things countries must get right in their Covid-19 response plans

Joy Phumaphi, co-chair of the UN
Joy Phumaphi, co-chair of the UN Secretary-General’s Independent Accountability Panel (IAP). PHOTO | COURTESY 

The UN Secretary-General’s Independent Accountability Panel (IAP) recently released a report estimating the impact of Covid-19 on mothers, newborns, young children and adolescents.

The experts expressed their fear on the enormity of disruption of children and maternal health services. These services include immunisation and lack of access to life-saving vaccines due to closures and movement restrictions.

Joy Phumaphi, co-chair of the Panel and former WHO Assistant Director-General, spoke to the Business Daily about the situation.

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WHAT IS THE MAGNITUDE OF COVID-19 DISRUPTIONS ON HEALTH SERVICES?

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All health and support service delivery is affected. The most vulnerable groups will suffer the worst effects of the disruptions to routine services.

For every three months of lockdown, 15 million more cases of gender-based violence are anticipated. With more women delivering without midwives or post-natal care and without access to emergency obstetric care, an additional 168,000 newborn deaths and 24,400 maternal deaths are estimated.

With disruptions in under 5 years child health care, over 400,000 additional deaths due to Covid-19-related disruptions are estimated. The stoppage of mass immunisation campaigns has led to 13.5 million children not being protected against disabling and life-threatening diseases.

WHAT DOES THE FUTURE LOOK LIKE, CONSIDERING THE NUMBER OF MOTHERS, ADOLESCENTS AND CHILDREN WHO HAVE BEEN AFFECTED?

With job losses and reduced agriculture and manufacturing production, and low economic activity, an estimated 42-66 million people could be pushed into extreme poverty, with women, children and adolescents disproportionately affected and lacking both financial and social protection. The gains that countries have made since the beginning of this century are currently threatened, and countries will take several years to recover.

CAN THE SITUATION BE RECTIFIED? WHAT SHOULD BE DONE?

There are essentially seven key areas where we are lagging, which we need to address.

The world needs an additional 18 million health workers. This gap needs to be addressed through quality training, effective deployment and structural support, as well as protection and appropriate remuneration. Health data in most countries is incomplete and surveillance is not IHR (international health regulations) compliant.

It is not surprising therefore that with limited information to inform decision making, the outcomes end up patchy. One in four births of children are not registered with any civil authority, and only 93 out of 193 countries are currently able to register more than 80 percent of adult deaths. This means that large portions of the population are invisible and not provided for in planning, budgets and programming. It also means that the root causes of mortality in parts of the population are unknown and therefore not addressed. Accountability is a must have for good governance, and not a nice to have.

It must be permanently embedded so that leaders, managers, implementers, and all stakeholders are committed to their roles and responsibilities and can justify their decisions and actions which are supported and explained on the basis of evidence, rights and the rule of law. It is important in implementing core accountability functions of monitor-review-remedy-action that are institutionalised and making continuous progress towards agreed goals and rights.

Underinvestment in common goods for health, such as legislation, regulation, health surveillance and information, population services and communication has been there. This lack of investment has shown up in the fault lines of the Covid-19 response, with millions of lives, health and livelihoods put at risk, especially mothers, newborns, young children and adolescents.

Universal health coverage and primary health care are currently limited to between one third and one half of the world’s population. The rest of the humanity is not covered by essential health services, including services for women, children and adolescents.

Progress across other sectors addressing the social determinants of health is equally important. Forty-five per cent of the global population is using safely managed sanitation services, whilst three billion people lack such services, and 1.4 billion have none at all. Access to potable water, communication, clean energy, and others are all equally important.

Inequities are a critical factor. There are huge gaps in access as well as in quality of care between the rich and poor, between races, between geographical regions, between ethnic groups, between religious groups. These inequities are worsening with Covid-19, compounded by lack of financial and social protection.

HOW MUCH IS NEEDED TO TAKE THE SERVICES BACK TO WHERE THEY WERE BEFORE PANDEMIC?

The Covid-19 pandemic continues to weaken health systems and it is difficult to predict what the extent of the damage will be by the time the crises ends.

Easily one of the smartest investments that countries can make is in primary health care.

Investing an additional $200 billion a year on scaling up health across low and middle income countries could save 60 million lives and increase life expectancy by 3.7 years by 2030, thus contributing significantly to socio-economic development.

WHY IS THIS REPORT IMPORTANT AT THIS TIME?

It must be embedded so that every leader and government is obliged to do what they say they will, with citizens fully able to participate and claim their rights. It is an opportunity for countries to address accountability, guaranteeing results for women children and adolescents once and for all.

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