On June 17, 2020, the Regional Bureau for Arab States kicked off its AHDR Webinar Series 2020, focusing on Human Development in the Arab States in the time of COVID-19. The first of the series looked at Public Health in the Arab Region. Participants discussed morbidity and mortality rates related to COVID-19; unique vulnerabilities at community and state levels, linked to the particular conditions of the region; and the risks, successes and recommendations for effective COVID-19 responses with the goal of decreasing inequities.
Moderator: Rima Afifi, Professor and Interim Head, Director of Graduate Studies, Director, Prevention Research Center for Rural Health at the University of Iowa
Panelists:
- Fadi El-Jardali, American University in Beirut, Associate Professor of Health Policy and Systems; Director of the Knowledge to Policy (K2P) Center
- Ali Mokdad, Director of Middle Eastern Initiatives and Professor of Global Health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington
- Nicola Jones, Gender and Adolescence: Global Evidence (GAGE) Director and Principal Research Fellow, Gender, Equality and Social Inclusion, Overseas Development Institute (ODI)
Key messages
Investing in public health capacities and resilience:
- Capacities in public health systems vary across the region. Many countries and governments in the region have underinvested in public health infrastructure, which had repercussions during this crisis, as those that did invest were quicker to react.
- Not many countries in the region are resilient when it comes to facing health and economic shocks. The crisis has exposed many dysfunctions about the lack of coordination across sectors.
- Public health preparedness is not just about ensuring that the system is better prepared to respond to health crises; it’s about harnessing the strength of all other sectors to respond in effective and coordinated ways.
- This is a great opportunity for the public health community, political scientists and academics to reshape the narrative around public health. Having underinvested in public health, many countries can make the case that public health investment is the most effective and needed investment.
Data concerns and the need for evidence-based interventions:
- The region needs better health information systems. Country averages hide disparities and subnational data is often lacking. With respect to key data points such as infection rate, capacity of providers, and number of deaths, there are issues of data transparency and accessibility.
- There is a major confidence gap between people and government, which was heightened during the crisis and was evident in the lack of trust people had in the data that was released.
- Good community-level coordination, organization and data reporting is key to overcoming COVID-19. Credible, quality data is needed to design effective responses.
- Governments need to invest in digital technologies. Many hospitals have no electronic records and poorly coded death registries. But digital health and mobile applications have been effective in reaching communities and changing behaviour.
Impact on communities facing multiple vulnerabilities:
- COVID-19 came to the region amidst existing challenges, including communicable and infectious diseases, conflict and war.
- In communities with already fraught relationships between refugee and host communities, the underlying issues have been exacerbated by the pandemic. For instance, Syrian youth are reporting feeling afraid to leave their communities to access services, for fear of being beaten by authorities or host community.
- There is a huge gap around mental health provision. Before COVID-19, referral systems for those suffering from mental health challenges were already limited and fragmented. There are critical issues related to stigma in accessing treatment. There is also an intersection between gender vulnerabilities and mental health.
- A broader package of social protection services is needed, yet we have seen little evidence of rapid scaling up of social protection systems for vulnerable populations. There may be one-off payments like the winterization payments, but no significant shift to address economic and food insecurity, which are rising. Agriculture-importing countries need to consider implications for food security, including transportation.
- COVID-19 responses tend to focus on biological risk factors, such as age, pre-existing or immunocompromised conditions. But social risk factors play a role as well. There is a need to ensure that the most vulnerable are consulted and involved in the design of responses.
- Finally, important to consider is support for youth with physical and visual disabilities, who may lack access to online education.
Turning a crisis into an opportunity – achieving health equity:
- This is an opportunity to put in place rebuilding plans that prioritize health system resilience for future outbreaks. The public health community, political scientists and academics must all participate in reshaping the narrative around public health.
- It is time to institutionalize the relationship between public health experts and policymakers by involving public health experts and officials in designing infrastructure.
- The pandemic has exposed many inefficiencies in the region. In adapting to the post-pandemic reality, public health systems should strengthen their institutional muscle memory for what’s working, rather than go back to business as usual.
- How countries respond to COVID-19 will shape regional cooperation and coordination around shared challenges for many years to come.
