COVID-19 Response Slippages: Shall We Tell The President?
Eid Mubarak! I pray that Allah (SWT) continue to guide you in delivering the best for the smiling coast of Africa.
Mr. President, it’s exactly 70 days since the Gambia registered its first COVID-19 case on the 17th of March, 2020. I am aware of your government’s restrictive measures; the closing of schools, suspension of public gatherings, closure of all non-essential public places, restriction on number of passengers on public transport, etc., in delaying the peaking of the event to help better curb the spike/surge of cases.
Mr. President, I appreciate your government’s effort in appointing Mr. Alasan Senghore as the national coordinator (my friends will joke to say – the Chief Minister of Health) for covid-19 preparedness and response to provide technical assistance to the Ministry of Health. Well, I believe you will agree with me that there has recently been a lot of distractions at the ministry which is sadly frustrating response efforts.
Your Excellency, I sometimes get a little bothered with issues dear to my heart, and I wish to discuss them to you. Well, this is what “The Greatness Guide” by Robin Sharma taught me.
First, the Ministry of Health is faced with challenges in mobilizing both capabilities and resources to help frontliners reduce the impact of this pandemic. Significantly, the pandemic has also revealed the fragility of the country’s health power. The ministry struggles with weak institutional and human capacity. There is a gross shortage of indigenous skill due to high attrition rate among trained and skilled staff, high dependency on expatriates, uneven distribution of health workers, a remuneration package which does not match the cost of living, lack of clear guideline for staff promotion, posting guideline, and so on and so forth.
Second, because of the weak governance on the state health institutions and community mistrust of government in the fight against this pandemic, we will face a double burden in the fight against COVID-19. The 58th national situation report of the country dated 21st May, 2020 indicated gaps in the response efforts including the inability to provide a policy on the use of face masks and delay in setting up an e-surveillance system that would ensure the availability of real-time response data as well as inadequate border patrol throughout the country border line communities. Coupled with this, we still do not have long term health investment strategies towards bolstering health service post COVID-19, and these significantly makes response efforts more challenging.
Sir, for the country to flatten the COVID-19 curve, we have only one option; aggressive prevention. Ultimately, we need to adjust the restrictive measures to our local realities. Let’s do pool testing for hotspots, increase capacity for border surveillance, and fine-tune restrictive measures for markets, churches and mosques. Let us tailor all interventions into local contexts. Activate a pragmatic strategy to support border communities through a cross border surveillance with Senegal. Shared vulnerability requires shared responsibility!
Sir, the updates of the 59th national situation report (SITREP) dated 24th May, 2020 has indicated that about 64% of the cumulative confirmed cases are all imported. It is sad to read on this report that currently there are no motor cycles at Fatoto Health Centre and Nyamanarr border post to support response efforts. Infact, Kartong border post and other border posts are yet to be supplied with motorbikes to ease mobility. What is wrong with the system?
Mr President, third, there is an urgent need to repurpose service delivery. Health workers across the board should strengthen preventive care services to minimize or prevent interruptions on routine public health services. Service disruptions could lead to several preventable deaths as a result of decline for service utilization. The country has a poor triage system in many public health facilities which are not ideal for infectious disease triaging to accommodate both COVID-19 cases and other patients at the same time. Well I know there is no readymade plan for case surges. Are we seriously prepared?
Mr. President, next on policy matters, let me use this opportunity to remind you that both the National Health Policy 2012 – 2020 (Acceleration of quality health services and universal coverage) and the Gambia National Health Strategic Plan 2014 – 2020 are due for expiry. Its high time you advise the Minister of Health to engage on serious and critical policy evaluation on the said documents and get us a more realistic blue print for the way forward.
Sir, the country has a poor health financing strategy. Health spending in the country is heavenly dependent on external partner sources. Nearly half of the total health spending is donor-driven. Poor countries like ours requires supportive health financing policies. It’s high time you institutionalize a National Health Financing Committee to conduct a situational analysis which provides an outline of the issues a comprehensive health financing strategy should address in terms of revenue raising; moving towards a predominant reliance on public/compulsory funding sources and pooling revenues with a redistributive capacity of available prepaid funds for strictly public health emergencies. You must learn your lessons to next time avoid open-ended financial commitments such as payment of allowances for responders, etc.
Finally, Sir, please know that the results of unnecessary delay and political distractions in response activities will activate greater disease spread, more people been affected, and more lives lost. If resources are not available, it offers the responders minimum response capabilities needed to arrest the outbreak. Resources delayed, response denied!
Dr. Martin Luther King Jr once said in a speech: ‘The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.”
Sheikh Omar Sillah
MSc © Epidemiology and Health Statistics
Tongji Medical College
Huazhong University of Science and Technology, Wuhan.