Global Health Security Index and how we fare

Published June 24, 2020, 12:00 AM

by manilabulletin_admin

OF SUBSTANCE AND SPIRIT

By DIWA C. GUINIGUNDO

Diwa C. Guinigundo
Diwa C. Guinigundo

In last week’s column, we wrote that “our disjointed and uncoordinated public health mitigation system”  is the single biggest headwind to our efforts to get our economy to bounce back.

Many health and management experts, including our friend, former Health Secretary Manolet Dayrit, have confirmed this assessment.

While concerned and conscientious segments of society should persist in their efforts to restore economic normalcy and regain the pace of our economic growth, we should prioritize health reforms.

Rationalizing and modernizing our transport system is critical. Reordering our supply chains is timely. And the success of the Balik Probinsiya program first requires shaping up our towns and provinces’ economic capacities. It will never prosper unless we establish agricultural and industrial infrastructure and increase economic opportunities within an integrated regional dispersal strategy.  But as we push in this direction, we should put health reforms as the foremost immediate goal.

Addressing this pressing health issue can reduce the drag of the headwind. eadiwnd  Headwind is not something we need when taking off as in an economic recovery.

Without doubt, the state of our health care system forced us into a series of lockdowns. Our public hospitals continue to be ill-equipped, and have long suffered neglect despite budgetary allocations from  past and present administrations.

US Treasury Secretary Larry Summers had argued that for economic activities to thrive,  people must trust in the future and have confidence that they are safe. To achieve this, public resources should be concentrated on mitigating the pandemic and flattening the epidemiological curve.

These goals of stalling the viral spread and halting infections were not actually lost on our civil society.

Understanding that our health system was overwhelmed, private corporates, schools, churches, fraternities and sororities, rich and poor individuals and families donated millions of masks and protective personal gear and even testing kits. The private sector helped in testing for the virus. Others set up extension wings in both public and private hospitals to accommodate possible overflows from regular wards. Some provided lodging spaces to our medical frontliners who faced logistic difficulties because public transport was banned. Some cooked meals and distributed them to hospital staff. We all attempted to soften the headwind.

But our best efforts were not good enough.

Infections and deaths continue to haunt the Philippines and the world. So we had this succession of community quarantine.

Where should health reforms begin?

Last October, 2019, a few months before the viral outbreak, the Johns Hopkins Bloomberg School of Public Health, the Nuclear Threat Initiative, and the Intelligence Unit of The Economist presented a comprehensive diagnosis of the health care system preparedness of 195 countries.  The study measured “Global Health Security Index.” The goal was to better understand and measure “on a transparent, global and recurring basis—the state of international capability for preventing, detecting, and rapidly responding to epidemic and pandemic threats.”

The study was supported by an international advisory panel of 21 experts from 13 countries.  It utilized a framework consisting of 140 questions organized into 6 categories, 34 indicators and 85 sub-indicators.  Six parameters were employed namely,  prevention; detection and reporting; rapid response; health system; compliance with international norms; and risk environment.

The study concluded that no country in the world is fully prepared for either epidemics or pandemics. International preparedness is rather weak. In many countries, capacities needed to prevent, detect and respond to significant surges in infectious diseases are sorely lacking.

With the highest score at 100, the global average for 195 countries stood at only 40.2 percent. Even 60 high-income countries garnered only 51.9 percent. Of the 195 countries, 116 countries failed to hurdle 50 percent.

The general picture highlights severe gaps in health care;  and vulnerabilities to political, socioeconomic and environmental risks that can complicate outbreak preparedness and response. The study also found a noticeable lack of adherence to international practices.

From the index, we get a good idea of how our own health infra system compares with those of other countries.  Consider the following table:

Global Health Security Index, October 2019

Score
Rank Global 40.2
1 US 83.5
2 UK 77.9
3 Netherlands 75.6
4 Australia 75.5
5 Canada 75.3
6 Thailand 73.2
9 South Korea 70.2
18 Malaysia 62.2
24 Singapore 58.7
30 Indonesia 56.6
50 Vietnam 49.1
53 Philippines 47.6

The Philippines scored the lowest among the ASEAN 6 which now includes Vietnam.

Anecdotally, I remember when this was not the case.  Some 26 years ago when I was assigned as head of economic research of the South-East Asian Central Banks Center for Research and Training in Kuala Lumpur, my youngest son sustained a deep wound on his forehead.  We brought him to upper tier Pantai Hospital in Bangsar, KL. I observed that my son was treated splendidly well, but the facilities of our modern Manila hospitals were rather comparable then.

In this present-day chart, Malaysia even surpasses Singapore!

How did we score in specific metrics?

Philippines: GHSI, October 2019

Criteria Rank Score
Prevention 71 38.5
Detection and reporting 41 63.6
Rapid response 68 43.8
Health system 47 38.2
Compliance with global norms 84 49.8
Risk environment 124 50.3
Overall 53 47.6

The Philippines ranked lowest in risk environment metric at 124th with a score of 50.3 percent. This was lower than the average score of 55 percent for all 195 countries. In terms of the sub-components, we were lower than the global averages in three metrics namely:  political and security risks, infrastructure adequacy and public health vulnerabilities.

Although our scores were higher than the global averages, compliance with international norms and prevention of any disease outbreak were also serious weaknesses.  In this area, we were 84th and 71st, respectively, out of 195 countries.

In terms of the first metric of adherence, we scored lower than the global averages in reporting compliance and disaster risk reduction as well as in cross-border agreements on public and animal health emergency responses.

In preventing disease outbreak, we scored 38.5 percent, higher than the global average. But we scored 0 in both biosafety and dual-use research and culture of responsible science.

The last metric confirms why our health care system was unprepared and overwhelmed by the viral pandemic. While we scored higher than the global averages and relative to the other countries, we still lagged behind. In delivering a rapid response, we were 68th.

In detection and reporting, we scored decently at 41st, our highest ranking with a score of 63.6 percent. All the sub-metrics were higher than the global averages but in epidemiological workforce, we scored only 25 percent, much lower than the global average of 42.3 percent. It is not surprising therefore that we wasted 100 days of lockdown failing to test for COVID-19 and tracing for possible community transmissions.  Some good progress has been made but we simply do not have enough people and supplies.

We implore Congress and the palace to address these crucial issues. While there are many other important economic and political concerns,  addressing the direct health effects of the pandemic should be the priority. First for our people, next for our economy.

We are running a race against mortality. In this race, we must lay aside every weight that could slow us down.

 
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