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Health Policy in Low/Middle Income Countries after COVID-19

If COVID-19 has taught us anything, it is that our health and safety depend on collective action and that a strong public healthcare system is the best guarantor of good health. Even if the rate of transmission of COVID-19 in low/middle income countries to date seems to be slower than that in Europe, the United States and China. Yet, these rates can rapidly shift upwards if social distancing measures are not properly enforced in low/middle income countries (LMIC).

One of the direct consequences of the disruptive pandemic of COVID-19 in LMIC countries appears to be the increased awareness that there is a need to rapidly expand their healthcare systems, immediately and permanently improve the availability of diagnostics for their population, effectively boost the capacity of response of the healthcare system and access to critical healthcare supplies.

Another aspect which is also deemed of critical importance and currently subject to active debates is how global supply chains of (medical goods) are viewed in terms of the trade-offs between cost-effective efficiency and resilience.

In this paper, we will roll out four (4) proposals which are intended to be thought-provoking and are by no means exhaustive. Our focus here is mainly on the expected shift in public health policy in LMIC.

Universal access to healthcare is a human right. Yet it will not protect populations from the next pandemic.

Public health is a key component of the social contract. And the modernization of the public health system is essential while simultaneously pursuing universal health coverage.

As a matter of fact, LMIC need to reinforce capabilities in the public healthcare sector and reduce disparities across national territories and communities, invest in human capital & equipment; the number of hospital beds per capita, number of doctors and nurses per capita, the number of beds in emergency rooms, achieve fair geographical distribution of highly specialized centres of excellence, modernize public health data infrastructure and promote public health strategic planning based on robust statistical data. These actions if well implemented will yield positive results in terms of a decrease in fatality rates from preventable infectious diseases in infants, children, and young workers as well as improvement of LMIC in the international healthcare index ranking.

The use of technology in global health is the new ‘normal’ in the 21st century

Imagine for a minute a system in which all public health entities within LMIC use the same cutting edge technology in laboratories and computers. This would include equipment that enables rapid diagnostic tests to be developed and deployed quickly, during a viral outbreak, for instance, accurate data on the magnitude of disease spread to be made available to epidemiologists and policymakers, high-risk communities to be identified at an early stage, and hospital capacity to be preserved.

We cannot emphasize enough the importance of leveraging existing platforms and reimagining the most appropriate design of new health digital platforms in order to create efficient networks among public health institutions. For instance, all public health hospitals should be equipped with patients’ electronic health records in the short and medium-term. During the COVID-19 pandemic, an entrepreneurial initiative has been taken by ENOVA R&T in Morocco to create an online digital platform “e-lab cloud.” This initiative aims to consolidate patients’ data labs who have been screened for COVID-19 at national public health hospitals. Similar “cloud” prototypes should be generalized across patients’ electronic health records following the COVID-19 crisis.

Most importantly, LMIC should anticipate the near worldwide deployment of 5G connectivity and complete any 5G associated infrastructure that is currently missing. One of the numerous applications of 5G in health is telemedicine, further empowered by 5G connection, which could be a huge opportunity for patients, in remote counties where specialized health institutions are lacking, to access high-quality healthcare.

The combination of leadership, planning, and cooperation between nations is paramount during pandemics.

LMIC should coordinate public health efforts in multi-country pandemic preparedness and risk mitigation approach. For instance, through data sharing to better track high-risk individuals and control disease spread or through the implementation of multi-centre clinical trials to define common testing methods and vaccination strategies.

On April 13th, three African heads of state from Senegal, the Ivory Coast, and Morocco established an operational framework in order to support each other in the different phases of their management of the pandemic. This pragmatic and action-oriented initiative allows the sharing of experiences and good practices, to cope with the health, economic, and social impact of the pandemic. Results of this first-in-kind cooperation are expected to reinforce existing partnerships and lay the ground for a more established framework for future collaboration in the area of pandemics and other strategic issues related to populations’ health in Africa.

Another area for cooperation to be considered by LMIC could be the collective ramp-up in manufacturing capabilities to produce medical goods, tests, and vaccines. This is critical as it would immediately address the supply chain vulnerability and/or disruption frequent during pandemics and ensure the availability of vaccines in real-time to the populations. Such up-scaling, however, remains dependent on the level of complexity in the manufacturing process but also on other aspects such as intellectual property and technology transfer.

Funding innovation in healthcare

LMIC are likely to experience delayed or reduced foreign direct investment as partners from other continents redirect capital. LMIC ought to do the same and fund the most innovative health technologies through local and regional capital. Yet, redirecting regional capital towards healthcare and technologies requires important fiscal reforms to effectively attract investors. Also, there is an urgent need for an ecosystem which brings together research and development, academia, and private capital and creates value while optimizing public health.

Finally, regional philanthropic organizations could emerge as key alternative players, alongside governments. Their mission could be for instance to fund social policy research in LMIC universities and facilitate the implementation of public health policies across the region. Collaborations with other philanthropic foundations such as the Bill & Melinda Gates Foundation and Jack Ma Foundation may be a good start.

Our message is clear, bold reforms in the public health sector are the only guarantor of populations’ health, safety, and welfare. The COVID-19 crisis has shown that we need more inclusive political, economic, and welfare models. In other words, preparedness, solidarity, and cooperation between LMIC and with other nations is a collective responsibility to contain pandemic threats to humanity.

Kaouthar Lbiati

Dr. Kaouthar Lbiati is Medical Doctor (MD) with a Master’s of science in International Policy and Health Economics from the London School of Economics (LSE), Health Policy Specialist at the Moroccan Institute of Strategic Intelligence (IMIS), and a Member of the Strategic Advisory Board of U.S. biotech CYTOVIA Therapeutics.