Opinion: In pandemic times

COVID-19 screening and testing. Picture: FILE

Healthcare remains a basic human and constitutional right, globally. Diverse resource limitations in the wide spectrum of healthcare-delivery remains a challenging issue especially in low- and middle- income countries, even in normal times.

In crisis like wars, and pandemics even robust healthcare systems fault as demonstrated during the current COVID-19 pandemic.

The persistent challenge to the providers of all State and private healthcare is to proactively continue providing equitable healthcare, especially in times of humanitarian crisis.

Pandemics adversely affect service delivery especially in countries with fragile healthcare systems, like Fiji.

Constant attention to the wide range of preventive care, screening, health delivery and palliation to address national development as verbalised in the Universal Health Coverage documents and of the Sustainable Development Agenda (2015 – 2030) remain paramount even within the parameters of this crisis. The additional healthcare delivery strains created by the pandemic need to be addressed as it is of an existential nature. The sum total efforts must remain multipronged.

This can be a diffi cult exercise with fi scal and human resource constraints overburdening the health bureaucracy looking down the double barrel. A review of health policies, strategies and re-operationalisation of programs need closer attention in Fiji, now more than ever.

This narrative looks at Fiji, a middle-income island state coming out of the ravages of a COVID-19 2nd wave and the need to address healthcare delivery based on established World Health Organization (WHO) principles whilst our fragile healthcare system remains on the brink of collapse as the politicians and their bureaucrats had opted for a sequential approach to the containment and mitigation phases of the pandemic rather than establish a concurrent plan to mitigate the deep waters of COVID-19 in two phases from the outset using international standards.

The WHO framework has a six ‘Building Block’ profi led matrix to provide support to member states, such as Fiji.

This Building Block profi le addresses Executive Governance & Leadership, Workforce, Service delivery, Financing, Technology and the Pharmaceutical and Medical Consumable supply chain challenges. Alignment to this framework will ensure synchronised healthcare development support (technical and fi scal) to lift the Fijian State’s healthcare system into robustness.

Reviewing Fiji’s Basic Statistics & Demography will assist in determining our Healthcare fragility indices;

 Population 864,000;

 Indigenous population— 62 per cent, Fijians of Indians descent — 34 per cent, other ethnicities — 4 per cent;

 Mean age of population — 28 years;

 Urban population — 56 per cent, rural/maritime — 44 per cent;

 10 per cent live in squatter settlement (nationally). Suva — 20 per cent in squatter settlements;

 Health /GDP 2.8 per cent (WHO regional criteria) — 6.6 per cent;

 Health/ total government expenditure — 9 per cent (WHO regional criteria — 14 per cent);

 National lifespan: males — 64 years, females — 70 years — 60 years (8 per cent) > 16 per cent by 2030.

 30 per cent population living below poverty line pre-COVID-19 (Fiji Bureau of Statistics, 2021). Communicable Diseases: Endemic: Typhoid, Leptospirosis, Dengue still prevalent

 Non-Communicable Diseases: Responsible for 80 per cent premature deaths. (WHO Step Surveys); amd

 DFAT Structural Reform Reviews: Health in Transition reports undertaken to 2014: (Collating this data indicates our healthcare fragilities). The serial impact of COVID-19 on Fiji’s Healthcare System;

 First wave (2020) two case fatalities-imported delta variant (India) returning patients;

 Second wave (April 2021 — current November 22, 2021);

 50,855 cases positive cases; swabbing now selectively undertaken;

 Deaths (Direct: 695) & (Associated: 598) COVID- 19 deaths. Total deaths —1293. (MOHMS press release 22nd November 2021)

Vaccinations Strategies.

The slow start to vaccination was a direct result of the international vaccine diplomacy surrounding it’s availabilities. Fortunately, Australian keenness in keeping its own borders safe, provided AstraZeneca- twin doses within our ‘Vuvale’ relationship. Obviously, with vested geo-political interests to counter Chinese offers of support tipped the balance.

Even Japan’s offer was taken up but China’s offer of Sinopharm was diplomatically shunned, even for the expatriate & local Chinese who preferred their own, understandably.

Strange politically motivated decisions, indeed in the high circles of governance.

With our sheltered tropical isolation, the cutoff from international travel has been breath-taking to see the targeted population agree to responsible double dosed vaccinations now at over 90 per cent. Indeed, a mammoth task for the health teams in general and the fear of No Jab, No Job, No Entry worked without the need for Mandatory vaccination by regulations to the Public Health Act of 1935 and its amendments of late.

The writings are on the wall — a third wave is possible and social distancing, continued masking and adolescent vaccinations must be followed through, stringently. The current resolving health crisis needs to remain in focus.

Preparations to address a mutating viral genome must remain on the drawing board as importation of the virus may only be one way to another resurgence apart from local mutations. Delta variant can change its colours locally too.

As the governance thrust is on economic recovery, ensuring that the tourism basket is not the only one in future must be factored in. Think innovative ways in agricultural and oceanic resources to address national assets within our ecologically sustainable development.

All this must remain within the parameters of universal health coverage into the second decade of our 21st century as the pandemic challenges remain. The 2020 checkered time-lined healthcare systems strategies are tabulated;

 Containment initially. Mitigation phase followed;

 Public Health Vs Macroeconomic weighin;

 Quarantine: Dedicated and progressive home centered;

 Screening, swabbing curtailed;

 Contact tracing, Care Fiji app: data not in use- possibly benefi cial if a 3rd wave strikes;

 Isolation, Social distancing, masking;

 Short term Locked-down strategies (72 hours). Virus wins; and

 Food Security an issue.


The Unfolding Challenges in the Pandemic. 

The sequential approach was determined by healthcare professionals but the fragilities of our system at containment resulted in community spread by super-spreader events, unfortunately.

In hindsight, as note such decisions were to a new virulent virus and the pandemic scenario new with even the best academics, epidemiologists, medical strategists, armchair philosophers and social-media key board warriors procrastinated.

Public awareness was slow in forthcoming and a rather ‘all of government’ approach had its limitations and could have been strengthened with an ‘All of Society’ engagement.

Even the vibrant private sector in public health was waylaid till much had transpired with disease and health infi rmity escalates;

 Containment > Mitigation;

 State party fi scal restraints;

 Budget reductions in 2009;

 Loss of employment, livelihoods and earning capacity. Cost of living escalating;

 Utilisation of personal retirement funds — loss of long term $ security;

 Private Sector, NGO, Civil Society not party to State party efforts;

 Private/ public health system not called up to support healthcare effort; and

 Continued international vaccine diplomacy — slow uptake initially. (Vaccine-hesitancy).

The Future Challenges to this and any other Pandemic can be projected on current knowledge.

Non -Communicable Disease are the leading cause of morbidity and mortality in Fiji. That remains the undeniable fact, today.

Our fragile healthcare system must review and undertake an audit of services, technology and human resource capabilities to strengthen our systems. Based on this fi scal measures to optimise the outcomes needs balancing and prioritising. We cannot wait for handouts in these economically pressured times.

The greatest dents of COVID-19 are within healthcare delivery systems and the unfolding educational sectors. Unnerving to predict, but the next six to eight months will demonstrate its impacts if the virus reseeds and excess deaths resurfaces with more COVID-19 related deaths;

 Urgent Healthcare Strengthening of facilities, supply chain management, technology operational and upgraded et Human resource optimisation;

 Health Literacy & increased Public Awareness;

 Addressing Micro-economics- Food security, wellness and livelihoods;

 Booster Dosing – Adult population;

 Vaccination strategies for 16-17year old’s in 2021-22;

 Children vaccination (11-17);

 Future general and health educational measures;

 Scaling up Healthcare et Social Services funding; and

 Excess death analysis needs to be undertaken.

 DR NEIL SHARMA is a former health minister The views expressed are the authors and not of this newspaper.

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