If anything, the COVID-19 pandemic opened our eyes and taught us many lessons. Reflecting on the last two years, health experts unpacked the good and the bad and, most importantly, the state of healthcare systems in low and middle-income countries.

In partnership with the South African Public Health Preventive Medicine Association, Africa Health is hosting the 6th Public Health Conference. The three-day event ends today and is being held at the Gallagher Convention Centre in Johannesburg. Its theme is Population and public health beyond the pandemic.

Dr Edward Ngwenya, a Plastic and Reconstructive Surgeon, painted a picture of the critical state of the public healthcare system. In the future, he emphasised how important it is to prepare the healthcare system for future pandemics. 

The global shortage of healthcare workers

“There is a global shortage of healthcare workers. The World Health Organisation (WHO) says we should expect a deficit of 80 million by 2030. Low and middle-income countries are already experiencing the largest shortage. Resource shortages in public hospitals have widened. We are sitting at 0.7% of doctors available per 1000 people,” said Ngwenya.

He stated that the country has a problem and how the health system is run. 

“While the aforementioned is a factor contributing to health inequity, we cannot forget – to make advancements – we have to be true to addressing issues of corruption in public health management, political agenda advancements, inefficiencies and a bloated managerial structure that are not serving us well,” Ngwenya said.

However, it is not all doom and gloom. Ngwenya emphasised the need for conferences like these to come together and bring solutions to the identified problems. 

Ngwenya added: “We are here to address problems. Be honest and bring solutions to the challenges we have seen before and after the COVID-19 pandemic.” 

The future of healthcare  

Health equity can be understood as the ability to fulfil human potential in all aspects of health and well-being.

In his keynote presentation, Hannes van de Merwe from Deloitte, whose focus is on Life Sciences and Healthcare Clients, defined health equity as an addition to primary care, which includes social determinants of health – financial, mental, social, emotional, and spiritual health – all contributing to well-being.

Van de Merwe said that COVID-19 had highlighted many of these components and global battles. Africa is said to have been significantly one of the continents that have been the most affected.

Climate change impact

“Climate change is the 21st century’s greatest threat to public health, and the health costs related to climate change and pollution are estimated at USD 820 billion a year, according to a recent report,” said van der Merwe.

He added that climate change also impacts health systems’ infrastructure and workforce. 

“Understanding the likely impact of climate-related disasters on healthcare workers is a vital part of any planning and risk mitigation for the future of public health,” he said.

Van de Merwe noted that COVID-19 taught us how to collaborate while putting the healthcare delivery system under intensifying pressure and scrutiny. He said that the partnerships between private and public have to be leveraged and stronger. 

“Some of the biggest concerns are the shortage of healthcare workers. We have seen how the number of patients can skyrocket, so we need to prepare a ready workforce. Utilise partnerships and prepare for employee burnout and workforce shortages,” said van der Merwe.

Challenges and opportunities

He added that the supply chain is still facing disruptive challenges. 

“We are also still seeing this through transport strikes, war, and fuel supply. There should always be consideration around supply chain challenges. Infrastructure concerns also include the availability of intensive care beds, ventilators, and personal protective equipment,” he noted.

Digital transformation in health care will be a step forward toward improving service delivery. 

Van de Merwe continued: “Bold plays in digital can help health systems solve a range of clinical and operational challenges. It can also unwrap opportunities to move them along the path to reimagining public health for the future.” 

Van de Merwe recommends using the “three-prong approach”:

• Use what you have
• Partner with what you need to know; and
• Automate repetitive processes. 

Visitation policies

Dr Moselene Du-Plessis, Senior Lecturer from the University of Pretoria’s Department of Nursing Science, focused on the no visitation policy during the pandemic in her study. She spoke to caregivers, patients and family members to find out how this contributed to the mental instability of patients.   

The policy in hospitals was intended to reduce the spread of the virus. 

Du-Plessis said that this was a measure devoid of the ubuntu concept. When you visit someone sick, it’s an example of ubuntu. This African philosophy’s defining principles are caregiving, kindness and mutual respect.  

“Mental health is supported by visiting families. The absence of this has been shown to have caused anxiety in patients without their family members due to the fear of the unknown. This also led to mental instability for patients,” said Du-Plessis.

Du Plessis explained that feelings of loneliness and depression were common among patients who did not have the support of their family members. The erosion of trust in healthcare practitioners by family members was also an impact of this.  

She noted that visitation was significant to overall patient care, and using the Ubuntu philosophy to guide this is imperative.  

COVID-19 vaccines

Dr Amilcar Juggernath, the Public Health Medicine Registrar, presented a rapid review of the experiences and explanation of public sector healthcare services on integrating COVID-19 vaccination into existing services in the  Ekurhuleni Health District. 

Juggernath has compiled recommendations on how to improve the integration of COVID-19 vaccination. 

The results show that staff members in the Ekurhuleni District experienced COVID-19 vaccinations as a highly complex process. Facilities also experienced staff shortages, and there was limited infrastructure and space. 

Other shortages included vaccine fridges, medical consumables like cotton wool and sanitisers, furniture, and electricity. 

Staff in the district clinics said they experienced a poor uptake of COVID-19 vaccines caused by long waiting times and social myths. 

In his study, Juggernath recommends that the early involvement of stakeholders from staff and the community is essential. 

“Developing a guide at the district level must have a comprehensive framework and allow for flexible implementation,” said Juggernath.

He concluded that it was necessary to “start now!” 

Desirable consequences 

Prof Sogo France Matlala, Associate Professor at the University of Limpopo, said that the SA population continues to reap the benefits of COVID-19 restrictions and mitigative measures. 

Restrictions characterised the pandemic’s beginning to curb the spread of COVID-19. Lockdown and stay-at-home directives, wearing face masks in public spaces, social distancing and restricted movement were just some of the enforced measures. Limited access to alcohol and cigarettes was also included in the more arduous lockdown period. 

Matlala said there is a need to assess how the measures adopted benefited the Population and the public health system. 

His findings show that people seem to have an increased awareness of how infections are transmitted since the beginning of the pandemic. 

Unintended benefits

“There is also an adoption of preventative measures such as hand hygiene and the avoidance of crowds. These measures forced people to make healthy lifestyle choices such as smoking cessation, limiting the intake of alcohol, and regular exercise,” said Matlala.

Increased mask acceptance is an additional benefit even after the hard mask-wearing regulations. 

“It is important for the health system to build on these unintended benefits to improve population health and maybe even prevent future pandemics,” said Matlala. – Health-e News