COVID-19 The Litmus Test for Ethiopia’s Health System

The strength of a country’s health system will be tested when emergencies like the outbreak of a pandemic occur. To identify a country’s health care system strong, it has to fulfill at least four basic elements. First, it has to improve public health. Then when people get sick and go to health centers, they have to get proper services. The third element is that the health service provided to people should be affordable. That means with reasonable cost, everyone should get good medical services. The final element is that the system has to ensure the safety of health professionals. Analyzing Ethiopia’s health system from these vantage points would lead one to conclude that it is fragile. Despite the poor ratings, a lot has been done in disease prevention, curbing maternal and child mortality, and controlling the community spread of various diseases. With these positive steps in mind, it is possible to say that there are improvements with regard to public health.

If we compare the current situation of the health care system with its status 40 years ago, it is clear that there have been significant changes. With regard to individual access to quality medical service, however, the sector lags far behind. Therefore, it still needs more attention. The problem is mainly related to medicine stock outs, shortage of medicines in the market, problem of accessibility of laboratory services and not enough visits from health professionals to patients as the doctors to population ratio is very small. In addition, access to medical services is costly. Hospitals also provide similar services. If some of them provided specialized services instead, it would be much better as the duplication of efforts and capital would be used in some other service. Moreover, the majority of Ethiopians are dependent on out of pocket money to access health service instead of relying on health insurance. Health professionals serve for extended hours and the amount they get paid is not enough to make ends meet. The condition has affected the morale of health professionals especially nurses, laboratory professionals, pharmacists, and junior medical doctors. Lack of motivation has its own impact on service provision. On top of these challenges, the country is now facing the Coronavirus pandemic.

A collaborative effort is being made by everyone to curb the spread of the pandemic and flatten the curve. One of the silver linings of the Coronavirus pandemic is that it has raised the attention accorded to the Ethiopian health sector. Such efforts are plausible since the virus has the potential to break the already weak health system unless the spread falls under control through strict adherence to mitigative measures. Under its current capacity, the country can only work on prevention as a significant discovery of cases every day can easily overwhelm the system.

However, while fighting and preventing the Coronavirus pandemic, other aspects of health service shouldn’t be neglected. If the status of other health problems was to be reported just like the daily Coronavirus report by the Ministry of Health and the Ethiopian Public Health Institute, it would be shocking. A lot of people die every day because of HIV, malaria, traffic accident and other communicable and non-communicable diseases. These health problems have the possibility of recovery under proper diagnosis and medication. Yet they claim the lives of many people as the Coronavirus pandemic has come to enjoy the primary attention of the health system, leaving the others in the back burner. Actually, focusing on pandemics is a common trend around the world. Under such conditions, other patients maybe be neglected and that might lead to their death.

Various reasons might lead to death under such conditions. The first reason is difficulty to get medical services since priority is given to the pandemic. Refraining from going to hospital in fear of acquiring the virus is another factor that has detrimental impact on other health problems. Furthermore, health care professionals responsible for treating COVID-19 patients do not see other patients to avoid contamination. Health professionals may also be required to quarantine themselves in relation with the pandemic, making it harder for patients of other diseases to get professional help. All these things create additional burden on the health system and affect people who have permanent health problems. So, parallel with tackling the Coronavirus pandemic, it is very important to give enough attention to other health problems. Otherwise, a large number of people with a big chance of survival under normal conditions might die. Besides, providing proper medical services for permanent patients would make the process of fighting the pandemic easier as people who have diabetes, pneumonia, heart problem and other permanent diseases are the most vulnerable part of society.

The number of patients who go to hospitals for treatment of other diseases has drastically fallen since the first Coronavirus patient was found in Ethiopia. There were also places where patients were told not to go to hospitals. That was wrong and it has been rectified. Providing medical services while maintaining physical distancing is an alternative while telemedicine services have also commenced. For instance, 80Pct of the Black Lion Hospital patients have started to benefit from telemedicine. However, telehealth is by no means substituting normal medical services. It is, however, a viable supportive system. People who need diagnosis still come and get the service they need.

Before the outbreak of the Coronavirus pandemic, Black Lion hospital provided service for up to 200 patients a day. Hospitals like Black Lion are referral centers. Although the number of people who visit Black Lion has plummeted since the launch of telemedicine service, patients sent to referral hospitals such as Black Lion still get access to medical services. However, other patients who don’t want to go to hospitals physically can use telemedicine services.

With all their negative impacts, pandemics test the strength and weakness of a country’s health system. A strong health care system has to fulfill three things. First, it has to be flexible enough to stride out of the usual procedures and still manage to handle emergencies like pandemics, war and flood. Towards that end, the responsibility of organizations should be clearly known ahead of time. Clear policies, rules and regulations have to be prepared on how to respond to emergencies. The third point has to do with the presence of health professionals who are ready and have enough awareness on how to tackle emergencies like pandemics.

The current situation in Ethiopia is marred with confusions on clear cut responsibilities of organizations. Some organizations carryout health related activities and make health related decisions even though they normally have nothing to do with matters of health. The inverse is also true in some cases. I hope our experience in handling the Coronavirus pandemic will help the country figure out these problems and tackle them. Post-Corona, I hope we will have a strong health care system with the clear policies and legislation needed to handle emergencies without any confusion. The pandemic has also underscored the importance of health professionals in society.

Health is a priority for everyone. The status of health has a significant bearing on societal productivity. The Coronavirus pandemic has emphasized that point and laid it out for everyone to understand. As a result, the government has started giving more attention to health professionals. If such trends continue after the eradication of the Coronavirus, the health system will have more inspired and dedicated doctors, nurses, laboratory technicians, and pharmacists.

Commendable prevention efforts have been exerted so far. People have also adapted quickly to preventive activities such as frequent hand washing, using hand sanitizer and face mask. However, I have witnessed communication problems with regard to preventive measures taken so far. Economic problems are generally believed to have made it impossible for Ethiopia to impose total lockdown. However, staying at home is recommended by the authorities as a key preventive measure. Such recommendations, on the other hand, do not clearly indicate who should stay at home. Instead of expecting individuals to take it up on themselves to stay at home, such directives should clearly identify the social segment that is expected to stay home and instruct them to do so.

As Ethiopia’s weak health system could easily be overwhelmed, the country should focus on preventive measures that help people avoid contracting the virus. Pandemics will disappear sooner or later. It is just a matter of time. So, delaying the spread will help save many lives.

In general, it is a difficult time for health professionals. They might contract the virus and spread it to their loved ones in the process of helping others. If it gets to the point where hospitals would be overwhelmed with patients, health professionals would be obliged to choose among patients and prioritize some over others. The morale question that arises from favoring one over the other for not clearly identified reasons makes health professionals susceptible to psychological problems. To avoid such type of undesirable consequences, it is very important to protect health professionals from contracting the virus. Moreover, additional trainings are needed to make them psychologically ready and they need to be provided with proper treatment to avoid psychological problems.

9th Year • August 1 – 15 2020 • No. 89

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