Restoring Health Systems Disrupted by the Pandemic

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by Elmer S Soriano MD and Timothy Ting MD

As countries relax quarantine policies after months of lockdown, how can health program managers reactivate their teams and programs given the gaps created by the pandemic? Many program systems have been damaged, and there is a need for interventions to help restore program functions.

Here’s a list of gaps created by the lockdown:

1.program staff were transferred to contract tracing and other pandemic-response functions

2. program staff got exposed to COVID19 and this increased stress and risk to themselves and their households

4. clinics and other facilities were shut down or converted during the COVID19 response

5.supply of medicines and other medical supplies stopped due to cancellation of flights and other logistics gaps

6.treatment continuity for chronic patients was disrupted

7.budgets may have been reprogrammed resulting in  funding gaps

8. elective surgeries and other non-urgent medical procedures were postponed and clinics now face three months of backlog

9.authorization and political capital for non-COVID19 programs may have been diminished

We’ve interviewed several program managers trying to restart their programs and here are a few notes on what works. We use approaches adapted from the Problem-Driven Iterative Adaptation and Presencing methodologies.

Reconnect with Sense of Purpose 

Program managers and staff are having trouble recovering their sense of direction. Many are accustomed to years of rule-based programs where clear policies, procedures, and standards are given to them and their jobs are to execute the plans within stable environments.

These days, their higher-ups are devoting attention, political capital, and resources to the pandemic response and diverting resources away from non-COVID19 health programs.

What should a program manager do?

Take a deep breath. Recognize how the stress and tensions have a tendency to keep people’s brains in the fight,  flight, or freeze modes for many weeks.

Reconnecting with one’s personal sense of purpose helps the mind  transcend the rule-based program systems and reconnect with the higher values and principles public health as a vocation, and program outcomes. This helps one gain a sense of perspective beyond the daily urgency of pandemic response and rule compliance.

Sharing the sense of purpose with colleagues also helps restore a  sense of agency individually and collectively, helping the group go back to work tomorrow with a renewed sense of purpose and a bit more hopeful.

Reimagine the Pandemic’s Impacts on the Health System

The lockdown’s unintended effect was that most clinic services, transportation, logistics, medical supplies and other  elements in the  supply chain suddenly stopped functioning. Health personnel were pulled away from their posts into the pandemic response. Program managers need to recompute program targets, budgets, and gapsand think through best and worst case scenarios for the program assuming that the pandemic continues for the next two years.

They have to imagine scenarios where their programs actually benefit and improve their performance during this period, leveraging the changes in these sudden transitions in the health systems to benefit program clients.

Redesign Program Systems for Improved Outcomes within a Pandemic Setting 

We have to move past the emergency mindset. It’s time to assume that  COVID19 will be a public health concern among dozens of other public health concerns. Connect with teams through available channels and start practicing staff meetings, clinical consultations, case management, and patient education online.

Prototype and Iterate.

We’re all just figuring it out as we go along. Spend an hour searching for good practices around the world in restoring programs like yours, then try and iterate something within three days. The health systems are broken in different places, and solutions in other parts of the globe will not always work given the specific gaps in your health system.

Just  like testing a new recipe in your kitchen, cooking your first version of the dish will usually yield imperfect results, but you are much closer to an outcome that  you will be  happy with, than if you had not tried it at all. You will have to improvise using locally available ingredients, making substitutions for inputs and processes that are no longer available due to the pandemic.

Rebuild your Program’s Authorization

If your program funds were diverted to the COVID19 response, don’t despair. You may feel that the value of your program has been diminished, but it hasn’t. There is just a new disease that we need to control as well.

Controlling COVID19, as well as achieving your pre-pandemic target outcomes both still have public value. You just need to re-establish the importance of your health programs in the eyes of your authorizers. Help them appreciate that addressing diabetes or HIV or mental health are still important and they will understand, in general.

Prototype new methods in delivering your program services and engage your authorizers so that they know that you have reactivated that program. Help them understand that it is time to assume that COVID19 will be around for the next 1-2 years that the health system has to be reactivated amidst the COVID19 pandemic response.

 

Universal Health Care in a Low-touch Economy

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by Elmer S. Soriano MD MPA

With the low-touch economy likely to to stay for the next 12 months or more, how can Universal Health Care be sustained and evolved? The disruptions in health systems because of the COVID19 pandemic release the system partially from old mindsets and institutional constraints, and the discourse on social distancing and health inequities allow for a reframing and leapfrogging toward more equitable health systems. The term emancipatory catastrophism by Beck (2015) proposes that there are good side effects of bad events.

Here are a few strategies building upon concepts at the interesection of Universal Health Care and leadership.

  1. Give the work back to the people by increasing health literacy. Harness the discourse and narratives around COVID19 to increase health literacy. Establish household-centric programs to emphasize the role of individuals and households as the first line producers of health care.
  2. Promote digital health. The use of telemedicine and self-care apps will reduce exposure of people to crowds as well as increase human capital for health. Telemedicine will reduce the need for physical face-to-face interactions while personal health care apps will improve feedback loops and health education as individuals take on new behaviors and increase their understanding of personal health.
  3. Integrate multiple service packages into fewer physical touchpoints. Patients and health care providers will be exposed less if they have fewer interactions. Client-centered bundling of services will allow clients to benefit optimally from each physical interaction. A cost-benefit and risk-benefit analysis of such bundling will have to thought through using scenarios of variable quarantine and prevalence settings. Murray (2000) provides a good nomenclature of health systems.
  4. Organize design sprints to reimagine service delivery systems.

 

  1.  
  2. Reduce client travel by delivering services closer to home. Taking public transport to clinics and spending time in waiting rooms expose patients to crowded settings. Shorter travels reduce exposure of clients to
  3. tners Shorten physicr supply chains.

Methodologies to evolve low-touch health systems.

  1. Patient journey analysis will help identify the different touchpoints in the pre-COVID health system and allow health system designers to reconfigure processes
  2. touch points by adoptive Techniques

shorter supply chains

horizontal integration, unified touch points

task shifting

digital health

constant experimentation

 

Food Security Coupons amid COVID19 Disruptions

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Context

  1. Food supply chains have been disrupted by COVID19 quarantine affecting, supply, demand, and markets
  2. farmers and fisherfolk have difficulty selling their produce, urban poor communities lose their daily incomes, and government is spending resources to provide subsidies to support poor households
  3. the Woergl experiment demonstrated how municipal governments can create new mechanisms for exchanging value

Response: Provincial Food Security Coupons

Objectives:

  1. improve food security by re-establishing farm-to-fork supply chains enhanced by financial instruments
  2. engage stakeholders to co-create institutional arrangements that increase food security
  3. mobilize resources to support the incubation of new institutional arrangements for food security

Mechanisms:

  1. food producing Local Government Units (LGU) establish accounts in escrow to guarantee the coupons
  2. municipal governments purchase locally produced food products for redistribution within the  LGU or for sale to nearby LGUs
  3. purchasing LGUs send Letters of Credit to acquire food supplies from selling LGUs

 

 

 

References:

Mindanao Futures Lab – Food Highway

Marikina Eco-savers Vouchers

Quezon Health Vouchers

 

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