Covid-19 should not shift focus from key health issues – WHO

The World Health Organisation (WHO) has warned that, with all focus directed at containing Covid-19, more people are likely to die from the indirect effects of the pandemic.
When health systems are overwhelmed, the WHO notes that both direct mortality from an outbreak and indirect mortality from vaccine-preventable and treatable conditions increase “dramatically”.
One of the things that are likely to be affected is immunisation. The WHO says that, despite being an essential health service, immunisation is likely to be disrupted with more children being exposed to vaccine-preventable diseases such as measles.
“Immunisation is an essential health service which may be affected by the current pandemic,” the WHO said while issuing guidance on immunisation services during the pandemic.
According to the global agency, countries will need to make difficult decisions to balance the demands of responding directly to Covid-19 while simultaneously engaging in strategic planning and coordinated action to maintain essential health service delivery and mitigating the risk of system collapse.
In Kenya, funds from some projects like the Universal Health Coverage (UHC) have been redirected to handle the disease, prompting health experts to warn that such measures will negatively affect some crucial aspects of healthcare.
“We are so focused on Covid-19 that we are forgetting about other aspects of health like maternal and child health,” said Dr Richard Ayah, a health systems management and policy expert.
The Ministry of Health has directed counties to suspend all minor and elective surgeries in preparation for Covid-19 emergencies. A statement by acting director-general of health Patrick Amoth urged county directors of health to prioritise treatment of the pandemic.
“There is necessity to direct all our available resources towards combating further spread and prepare for intensive management of patients who may need critical care,” said Dr Amoth’s letter.
The letter also directed health facilities to cancel all elective surgical procedures except obstetric cases. The WHO’s interim operational guidance for maintaining essential health services during an outbreak calls on countries to establish simple governance and coordination mechanisms that will complement the response protocols put in place for Covid-19. It also advises governments to establish an effective patient flow at all levels. This is from screening to triage and targeted referrals.
The health agency further calls on countries to use their health ministries to identify mechanisms that will ensure and maintain the availability of essential medications, equipment, and supplies.
Many hospitals are already operating at or near 100 per cent capacity and are now taking drastic steps to prepare for Covid-19 patients. On Saturday, Health Cabinet Secretary Mutahi Kawe announced that Kenyatta University Teaching and Referral Hospital (KUTRH) would only be admitting Covid-19.
“The current patients will not be affected but no regular cases will be admitted there,” said Mr Kagwe.
For years, the default choice of hospitals operating at or above 100 per cent of capacity has been to expand and add more beds. But years of research on patient flow has shown that hospitals can manage their bed capacity far better than they often do, and in the process, reduce or eliminate the need to add more beds.
The knock-on negative healthcare outcomes such as disruption of normal medical care for non-Covid-19 patients, disruption of preventative activities like vaccine campaigns which will be worse if the Covid-19 epidemic is not well managed are already being felt. Last week the Nairobi Hospital has announced the closure of its satellite outpatient centres and recalled all staff to be based at the main facility in Kilimani in a bid to consolidate resources to fight Covid-19. The changes took effect on Thursday evening. The hospital also announced that it was setting up a 100 bed capacity residence to accommodate staff who may be required to stay close by to deal with Covid-19 patients. People are worried, especially now that hospitals are looking at cancelling non-emergency surgeries. Already, some patients have begun feeling the impact through delays in accessing their medications.
“As systems to mitigate spread of COVID-19 are being implemented in Kenya, the needs of persons living with NCDs should be prioritised. Persons living with NCDs need uninterrupted access to medicines, treatment, and care to manage their condition and prevent falling victim to COVID-19 and its deleterious effects,” said David Makumi, from the NCD Alliance of Kenya.
Rapidly re-distribute health workforce capacity by re-assigning some healthworkers and introducing task-sharing.
“A well-organized and prepared health system has the capacity to maintain equitable access to essential service delivery throughout an emergency, limiting direct mortality and avoiding increased indirect mortality,” the agency says.