Yellow Pad

That all countries failing the test of beating COVID-19 is not an imagined fear. What we are seeing now is severe stress to the point of failure in all country health systems, regardless of preparedness.

But how prepared are we for the health emergency that is upon us?

The Global Health Security Index or the GHS Index gives us perspective. Published by the Center for Health Security, Johns Hopkins Bloomberg School of Public Health and Nuclear Threat Initiative in October 2019, the GSH ranks the Philippines and 194 other countries with regard to health security capabilities.

The publication’s finding is disturbing: “The Global Health Security (GHS) Index analysis finds no country is fully prepared for epidemics or pandemics. Collectively, international preparedness is weak. Many countries do not show evidence of the health security capacities and capabilities that are needed to prevent, detect and respond to significant infectious disease outbreaks.”

Overall, the Philippines is ranked 53rd, with a score of 47.6. The global average score is 40.2. The Philippines is thus categorized as a “more prepared country.”

Here are some indicators on how the Philippines fares, which have relevance to fighting COVID-19.

On the “rapid response to and mitigation of the spread of an epidemic,” the Philippines is ranked 69th, with a score 43.8 against the average score of 38.4 (more prepared).

On having a “sufficient and robust health system to treat the sick and protect health workers, the Philippines is ranked 47th, with a score of 38.2 against the global average score of 26.4.

And here is the most telling part: The GHS Index shows that all countries are failing when it comes to the key indicator that will save us from a severe pandemic: sufficient and robust health system to treat the sick and protect health workers. Out of a possible score of 100, even the top country, the US, has a score of 73.8. The Philippines is barely halfway with a score of 38.2. Worldwide, the average score is 26.4.

But as the GHS Index said, no country is fully prepared for a pandemic like COVID-19. Many countries, even those categorized by the GHS Index as prepared — including the US, which is in relative terms the most prepared — have been caught flatfooted. The GHS Index came out three months before the COVID-19 outbreak in Wuhan.

The Philippines was able to do early detection, but was overwhelmed by many constraints, both objective and subjective, in preparing for the COVID-19 onslaught.

It is still not too late for the Philippines to emulate what countries in this region have done to blunt the pandemic. But given the resources we have, we need to use our wits and optimize the resources of the health system we have which is neither resource-rich nor technically prepared.

The Philippines must use its best available tools to overcome the crisis.

Our major advantage is a large pool of health workers, not only in the Department of Health (DoH) and local governments, but also in other agencies outside the regular health system but who are already in government. These extra health workers need to be identified and enlisted now to address any need for a surge in health workers should the crisis worsen.

The private sector is another source of additional health workers and the DoH and health authorities in provincial and city governments have to start enlisting them as a health augmentation pool.

It is both a weakness and a strength that the country has a decentralized health system. But during an epidemic, the country needs one health authority for the entire system. It is important for the health authority to have a single command but with decentralized action at the provincial and city levels, much like the uniformed police and military.

They also face the challenge of blindly caring for all without having the luxury to analyze where the patients are coming from. This happens in a clustering of cases to which one must assign a team from the ESU (epidemiological surveillance unit) at provincial and city levels to limit the impact of the cluster event. These units can support hospitals by predicting where the next outbreak will be and conduct testing or act on information regarding new cases. Done consistently and properly this can reduce the current burden of hospitals.

Demographically, the enhanced community quarantine covers 100% of Metro Manila’s 13 million-population — confined to their households and communities, 24/7. Before quarantine, 60% of that population would be working and commuting half the day.

Without the relief brought by population mobility in daytime, surveillance systems need to ramp up their activities, and public health centers serving these communities should set up influenza or fever lanes to identify pockets of outbreaks early and deploy testing if needed. This to avoid communities from exhibiting a “cruise ship effect.”

Given the above, this is where a single health authority has to take hold of the system and start assigning tasks rationally. The DoH can use the Local Government Code’s Section 105 to take over province-wide and city-wide health surveillance systems to prepare for the coming surge of patients and allocate limited resources. Municipal and component city clinics will now report to the higher health authority.

In the same vein, now is actually the time to implement the province-wide and city-wide health systems, as mandated by the Universal Health Care law.

Further, the DoH and local health authorities can realign province-wide and city health systems to set up a wide net of surveillance for ILI and a secondary line for SARI (severe acute respiratory infection or atypical pneumonia). This can be set up at the level of the rural health unit/health center, out-patient department (OPD), or private clinic.

This system should identify communities where there is a large number of consultations for this type of illness in order to catch potential cases and treat those who do not have to be referred. This eases up the pressure on higher-level hospitals and maintains healthcare for the greatest number.

In addition, the DoH and local health authorities can call on the other government and private sectors to support the system and deputize them as public health workers.

This move will necessitate some easing up of the enhanced community quarantine: There is a potential danger that those with influenza-like illness and potential source of COVID-19 infection will stay at home until it is too late. We could be covering up the clusters of illness developing in our urban communities in particular, making it harder to flatten the curve.

Physical distancing or social distance should not limit or curtail one’s access to health services. Local health authorities with DoH supervision must make this clear to police and military authorities.

It must also be clear to us as a nation that we will stand alone for the major part of this crisis. All the houses are burning globally, and the fire trucks are nowhere to be found.


Juan Antonio Perez III is a friend and partner of Action for Economic Reforms, is a civil servant at the Commission on Population and Development, and a public health worker with experience in local health systems and health information systems.