Opinion: The anti-virus to global epidemics? Strengthen the health systems

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Health workers wait for patients in a tent erected to test for COVID-19, outside a clinic in Kuala Lumpur, Malaysia. Photo by: REUTERS / Lim Huey Teng

Three months into the COVID-19 outbreak, we are starting to see history repeat itself. Just as the Ebola outbreak in 2014-16 took an enormous toll on Liberia, Sierra Leone, and Guinea, where more than 11,000 lives were lost, this new disease is quickly spreading around the world.

The Ebola outbreak in West Africa was significant, not only due to deaths from the disease but because it exacted harm to the health system’s ability to respond to even the most basic of needs within the country, with a huge loss in the health care workforce. Today we have seen similar breakdowns of health systems due to COVID-19 beyond treatment of the disease.

It has become clearer now more than ever that global health is truly the responsibility of each one of us.

In China, in late February, hospitals were reportedly turning away pregnant women with complications and had shortages of essential HIV drugs, while in Italy, due to current overcapacity, routine procedures have been canceled.

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As COVID-19 starts to appear in sub-Saharan Africa, we must seriously reflect on the predictable consequences of failing to learn from mistakes of our past. We need to invest in our most fragile health systems. We will only be able to effectively combat epidemics if we are thinking about health systems holistically, especially in resource-limited settings.

While we cannot expect to fully build and strengthen health systems in the midst of the COVID-19 pandemic, we can start laying the foundation through response and prevention efforts. These must be guided by principles of equity, collaboration, and a commitment to leaving no one behind.

Firstly, we need to have systems with the right staff, space, and stuff — resources — to provide quality services, all while providing support for the most vulnerable. Rather than only bringing in external technical assistance, epidemiologists, and outside clinical providers, we must prepare the doctors, nurses, and government health workers within these countries to respond. This starts before epidemics — through training and preparedness exercises, for example — and continues during an outbreak with a collaborative approach, such as through international and local health practitioners working side by side.

Second, we should ensure that temporary structures built to treat patients can be later integrated into the health system to expand treatment for care as well as preparedness to the future outbreaks. Supplies such as personal protective equipment should be provided, but supply chains for other essential medications and vaccines also need to be maintained.

For instance, the global health nonprofit Partners in Health has continued its work strengthening health systems in the countries it operates in, while supporting COVID-19 containment and control and ensuring all patients, especially the most vulnerable are provided with high-quality care.

And finally, we need to prioritize care beyond the confines of the clinical setting by investing in social services at the community level. Such investments include helping to ensure adequate nutrition and basic primary care — such as that provided by community health workers — so that particularly remote and vulnerable populations are served comprehensively and given a fighting chance to recover.

We must all think about where we can step up. Only then can we feel more secure in our collective ability to manage outbreaks such as COVID-19 and those that lie ahead.

For some, like our University of Global Health Equity students, faculty, and staff, this means volunteering to serve where needed to support Rwanda’s national response. For others, especially those of us who are young, healthy, and not as likely to be most impacted, we must ensure that we play our part in remaining positive, educating with accurate information, dispelling myths and misinformation, helping to break chains of transmission, and taking the necessary measures to protect those among us who are most vulnerable.

It has become clearer now more than ever that global health is truly the responsibility of each one of us.

We must work together to ensure that we emerge from this crisis with the least damage to our systems and to each other. We cannot anticipate what the next public health emergency will be. Whenever it does occur, however, we know that our best chance at mitigating its impact is to have health systems that are resilient and truly comprehensive.

For this to be a reality we need to come together as a global community to build them.

Editor’s note: This article was updated on March 26 to more accurately reflect the length of the Ebola outbreak.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the authors

  • Alice Bayingana

    Alice Bayingana is a research associate to Dr. Agnes Binagwaho, vice chancellor of the University of Global Health Equity. Prior to joining the UGHE team, Alice worked as a research fellow for Partners In Health through the Global Health Corps fellowship program and later on as a mixed-methods research associate. Alice is passionate about access to health care especially as it relates to young people accessing sexual and reproductive health and mental health services.
  • Miriam Frisch

    Miriam Frisch is a research associate to Dr. Agnes Binagwaho, vice chancellor of the University of Global Health Equity. Prior to joining UGHE, Miriam worked for Partners in Health in Liberia and in Boston in clinical supply chain and operations, and for the Ministry of Health in Rwanda, as a Global Health Corps fellow, providing technical assistance in monitoring and evaluation for a nutrition program. Miriam is passionate about strengthening health systems, with attention to infectious disease prevention and response.