DeLisle Worrell: Strengthening Health Systems to Tame Pandemics


Reproduced with permission, the text of Dr. Delisle Worrell – former Governor of the Central Bank of Barbados – August 2020 economic letter:

Strengthening Health Systems to Tame Pandemics

On July 13, McKinsey & Company, one of the agencies of the famous global consultancy, issued a report entitled “Not the last pandemic: Investing now to reimagine public health systems”. The lesson of the Covid-19 pandemic is that there are basic flaws in the health systems of many of the world’s richest countries, countries that boast the most sophisticated medical facilities. Their clinics, hospitals and equipment are the best and most advanced, and they are staffed by the world’s leading experts, but the system which delivers health services has serious weaknesses. As a result, the Covid-19 pandemic has had devastating consequences for some of the world’s richest countries. The McKinsey study identifies five areas that were crucial for those health systems that were most effective in saving lives in the face of the pandemic.

The first feature of the successful response systems is that they are always alert for the emergence of contagious diseases, and ready to spring into action at a moment’s notice. The contrast is with systems that have to be mobilized afresh for each new event. Health systems in Uganda that had coped with the Ebola virus, or in Hong Kong that had been effective for SARS, were more successful in suppressing surges of Covid-19 infections.

A second useful health system characteristic identified is a strengthening of mechanisms to detect infectious diseases, at the global, national and local levels. Health workers in clinics and hospitals around the world should be equipped and trained to identify infections from their early symptoms, and there should be swift and reliable systems of reporting, to national and regional centres for disease control, and to the World Health Organisation. The countries where the incidence of Covid-related deaths are lowest are the ones where the detection, reporting and coordination mechanisms were in place and working, as soon as the virus was identified.

Thirdly, the McKinsey study notes the value of administering existing vaccines more widely, taking special protection measures in areas where there is risk of animal-to-human transmission, and other preventive measures. The report states “Recent outbreaks of measles, for example, show that places with lower vaccination rates are more susceptible to diseases that vaccines can prevent. Achieving full global coverage of all the vaccines in our arsenal would save millions of lives in the coming decades.”

The fourth insight is that the most effective health care systems are those that are designed so that personnel, equipment and facilities can be rapidly provided for a surge in infections, without compromising essential health services. These systems have invested in training, equipment and facilities for epidemic preparedness, to enable the creation of temporary care facilities, field hospitals and the like.

Fifthly, there needs to be a large boost to research and development on infectious diseases. Medical research is conducted through global networks of collaboration, as has been demonstrated in the trials being conducted in the search for a Covid-19 vaccine. There are opportunities for all health systems, including our own, to take part in this research.

In addition to these health system features, the strength and cohesion of local community and neighbourhood organisations is important in supporting effective emergency measures to suppress surges in infections. Media reports have shown the important work of community volunteers in delivering food and necessities to persons at risk and people in self-quarantine, in cities as widely dispersed as Sao Paulo, Brazil, Denver, Colorado and Wuhan, China. In Cuba, the effectiveness of their community-oriented health system is demonstrated by the health care teams seen touring neighbourhoods on foot, to check the status of everyone in their homes. This aspect of Cuban health care is unique, in a world where health care in the home is mostly unavailable.

As our countries beef up health systems to help us to overcome the Covid pandemic, our Governments should invest with a view to incorporating all five of the desirable features identified by McKinsey & Company: emergency responses that are always at the ready, early detection systems, measures to reduce the risk of pandemics, standby staff, equipment and facilities, and participation in global trials and research. At the same time, we should all recognise the value of getting to know our neighbours, and of participating in and strengthening community networks. They can prove invaluable in an emergency.