Key COVID Lessons: Nuture Healthworkers and Build Primary Care
Dr Raquel Child Goldenberg, Director of the Office of International Relations and Cooperation in Chile’s Ministry of Health

Strong primary health care, nurturing the health workforce and legal flexibility emerged as key COVID-19 lessons at a high-level roundtable at the Fifth Global Forum for Human Resources for Health, which opened on Monday.

Chile gave its healthworkers life insurance, more holidays and extra pay during the pandemic, said Chilean health official Dr Raquel Child Goldenberg.

“It was really important to have measures to protect health workers. They were stressed, and they had a hard workload,” explained Goldenberg, Director of the Office of International Relations and Cooperation in the Ministry of Health.

“The government proposed different measures and legislation to take care of health workers. For instance, if health workers faell sick with COVID-19, that was declared a profession-related disease and there were different kinds of treatment and measures to protect them.”

The Chilean government also empowered the health ministry to employ healthworkers not authorised to work in the country.

Building community health 

Dr Atul Gawande, Assistant Administrator of Global Health at the US Agency for International Development

Dr Atul Gawande, Assistant Administrator of Global Health at the US Agency for International Development stressed that a country’s strength in any pandemic response “is only as good as the health system that you’ve built”.

“And therefore our investment at this time in protecting that frontline primary health care workforce is absolutely critical,” said Gawande. 

“We’ve come through the first global reduction in life expectancy since World War Two and in order and that damage did not come just because of the direct damage of the virus. It became because we had diverted resources from health workers. It came because the financial landscape for health has changed dramatically. And the prioritisation of the primary health care workforce is critical.”

Gawande conceded that the US “did not have a strong, broad commitment to community health work”, and needed to undergo “reverse innovation” during COVID-19 “when tens of thousands of community health workers were brought in”.

“We heard the lesson that you have to hire and train people from the community. And many of the communities where the lowest rates of vaccination and the highest rates of deaths were occurring were the lowest income, least provided for. So those places became the places to invest in raising those community health workers and creating that outreach capability.”

Tapping into informal networks

Dr Lino Tom, Papua New Guinea’s health minister.

At the other end of the wealth spectrum from the US, Papua New Guinea had no choice but to use an “informal system where we asked the community leaders to actually identify people which they can send to our health facilities to help,” said Dr Lino Tom, the country’s health minister.

Initially, his country could not even process COVID-19 tests.

As a result of these glaring shortcomings, Papua New Guinea is establishing a stand-alone medical university and a national laboratory. 

But, lamented Tom, “we’ve seen a lot of brain drain and it’s quite difficult when you don’t have the resources to retain people you have within your system”.

Mozambique’s health minister, Dr Armindo Tiago, said that his country had to adopt a flexible approach to health workers during the pandemic in light of the dire shortage. In addition, the country was so short of personal protective equipment (PPE) it had to ration it to the most at-risk workers.

“Mozambique is still in different emergencies,” added Tiago. “We went out of COVID but then we went into polio. Then we went into cholera, and we have terrorists in the north of Mozambique. We need to still mobilise resources to respond to current emergencies.”

Mozambique’s health minister, Dr Armindo Tiago,

Non-partisan approach

Portuguese MP Dr Ricardo Baptista Leite stressed that the issue of richer countries poaching healthworkers away from lower-income countries had to be addressed, possibly by the pandemic treaty currently being negotiated.

“We need to have regional planning and we have to have regional commitments. One country in a region benefiting from the health workforce and all the others not benefiting will lead to huge problems. we need to do this in a way of a common good approach,” Leite stressed. 

“We also need to use digitization for healthcare system reform, and stronger monitoring mechanisms in terms of health care, workers satisfaction, and also using compassionate care indicators,” added Leite, who used the forum to announce that he was leaving parliament to become the new CEO of the International Digital Health and Artificial Intelligence Research Collaborative, I-DAIR.

Leite said that Portugal had been so successful in addressing COVID-19 because the main political parties took a non-partisan approach and stood together. 

Parliament declared a state of emergency, and during this phase, chronic patients were able to get electronic prescriptions for three to six months’ supply which were delivered by community pharmacies.

“People trust institutions and trust health institutions,” he added. “Many people ask me how was Portugal successful in vaccination. When neighbouring countries in the European Union were below 60%, Portugal was over 90% vaccination. And it’s because, especially after the 1974 revolution, the public health structure invested tremendously in health literacy.

Primary healthcare family doctors, who are paid according to health outcomes, played a critical part during COVID, and so did community pharmacies, he added.

Oman’s Dr Fatma Al Ajmi, Undersecretary for Financial and Administrative Affairs

 Oman’s Dr Fatma Al Ajmi, Undersecretary for Financial and Administrative Affairs, said that primary health care is “very solid” in her country, and this had enabled it to contain the impact of COVID-19.

“From the initial stage, factor one was the focus was on the protection of healthcare worker and the public,” said Al Ajmi. 

A mental health hotline was established to support healthcare workers, and committees were activated in each hospital where psychologists and psychiatrists were available to offer support.

It solved its shortage of PPE by encouraging local manufacturers to produce it, she added.

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