Health Systems and COVID 19, what lessons are there for the road safety community?
The COVID 19 pandemic has exposed the fragility of health systems in almost every country around the world. More than a third of the world’s population has experienced some level of lockdown. This has caused economic chaos globally. But the alternative would be the collapse of health care systems and an unprecedented loss of life – more so than we can probably currently envisage.
The pandemic has therefore made many people more aware of the importance of robust and resilient health care systems and has also put the issue high on the political agenda.
What does this mean for us in the road safety community?
First and foremost, better health care systems mean improved capacity for post-crash response and trauma care. If put into place effectively, this could in itself reduce the number of road fatalities by up to 50%. This is why Pillar 5 of the Global Road Safety Action Plan is so vital.
However, as countries begin shifting focus on re-building their economies, how can we encourage governments and major donors to keep focus on health systems and continue to build their capacity – particularly in low and middle income countries where resources are limited and where there will be many competing demands for investment? Can we, as a road safety community, do more to collaborate with health care professionals to achieve our mission?
These are some of the questions we put to a panel of experts last month when we facilitated an online session on Health Systems and COVID 19 hosted by the Global Alliance of NGOs for Road Safety.
The panelists were Dr. Olive Kobusingye, a Senior Research Fellow, heading up the Trauma, Injury, & Disability Project, in the School of Public Health at Makerere University in Uganda; Dr. Pryanka Relan, Technical Officer, COVID-19 Health Systems and Services Response Team and COVID-19 Clinical Management Response Team at the World Health Organisation; and Dr. Erkin Checheibaev, EASST Expertise consultant and Former Minister of Health in the Kyrgyz Republic.
During the session, they each spoke about their experiences of the pandemic, the lessons learned in terms of the impact on health systems, and how they see things changing as a result.
Erkin highlighted how the pandemic has exposed the weakest parts of the health system in Kyrgyzstan. Years of reforms to make the health system economically cost-effective has left it vulnerable. Whole medical centres have had to close because the doctors have become sick, and, in hospitals, medical students have been drafted onto the frontlines. Locally, this has mobilised communities who want to support the health system but they unsure of how to do so. The role of NGOs should be to channel this support in to effective and meaningful action. Erkin also emphasised that while delivering treatment is important, prevention is critical – noting that in Kyrgyzstan there is little investment or attention given to non-communicable diseases, including road safety. He urged donors to think about non-communicable disease prevention as a priority in the post-COVID era. In doing so, the burden on health systems can be somewhat alleviated so that when needed they can operate a maximum capacity. Non-communicable diseases are not on the political agenda right now, but once COVID has passed, these issues will still be there and the whole health system will need to be ready.
As a clinician, Pryanka discussed the need for the road safety community to partner with other health programmes. She cited the fact that whether a patient enters the health system as a road crash victim or as a patient with COVID-19, the systemic care they receive is the same. From this perspective, ensuring hospitals have adequate intensive care capacity is undoubtedly important, but focusing investment on the 95 per cent of patients who require basic emergency care can go a long way towards leveraging road safety, COVID 19 and many other health issues. To achieve this, more joined up advocacy work is needed.
Referencing the in-equitability of many health care systems, Olive also highlighted the need for more investment in basic care and frontline training. Globally, a lot of resources have been put into high-end care in hospitals, but for many people – particularly in rural and low-income areas – a lack of access to basic health care is the main challenge. In the EASST region, data from Ukraine suggests that 78% of road crash casualties die at the side of the road because there is inadequate emergency response to get them to a hospital on time. Olive therefore called on us all to begin at the bottom, making the case for basic access to health care for the most vulnerable and isolated in society. She argues that only once these foundational systems are in place can we begin to look at bigger issues.
Building the resilience of emergency services and improving post-crash care has been central to EASST’s work since 2014 when we co-founded FIRE AID and International Development specifically to address Pillar 5. Today, FIRE AID works to build the resilience of emergency services globally to respond to road traffic crashes and improve post-crash response, as well as other emergencies. You can find out more about our work on post-crash response and our partnership with FIRE AID here.
Thank you to all the speakers and to the Global Alliance for hosting this session. We are hopeful that one positive outcome of this crisis will be a renewed focus and energy on the issues around Pillar 5. The session is available to watch on YouTube via Global Alliance channel here.