Virus, health, and budget

Monday 2nd November 2020

The government has been compelled to extend quarantine curfews as COVID-19 is ripping through the country in what looks like an unceasing wave. Perhaps, it may have to resort to much more stringent measures to curb the spread of the virus in spite of the socio-economic costs they will entail. Several other countries have also chosen to do so, unable to beat the virus.

Three key health officials engaged in the country’s battle against COVID-19, in an interview with Derana TV, over the weekend, discussed the current pandemic situation here, the steps the health authorities, the military, the police et al had taken to curb the transmission of the virus, facilities available at the state-run health institutions and what needed to be done to break the back of the problem. They were Health Secretary Maj. Gen. Dr. Sanjeewa Munasinghe, Director General of Health Services Dr. Asela Gunawardena and Dr. Samantha Ginige of the Epidemiology Unit of the Health Ministry. Moderator was Chathura Alwis. The discussion was very insightful. Insisting that the pandemic was still at the cluster stage, the three doctors stressed the need for an all-out effort to prevent it reaching the community transmission level. They sounded reassuring and stated that the national healthcare system was not overwhelmed, and it was ready to face any eventuality.

The current wave of infections has made institutional quarantine an uphill task. The success of home quarantine hinges on public cooperation, which is sadly lacking in this country if how people behaved in the virus-hit Atolugama, etc., some moons ago, is any indication. A large number of people are reported to have left the Western Province to avoid the curfew currently in force there to prevent infections from fanning out to other areas. Hence, the health authorities prefer institutional quarantine, which is far more effective yet very expensive. However, the country will be left with no alternative but to place suspected COVID-19 patients under self-quarantine if push comes to shove.  There’s the rub.

Thankfully, the ICUs are far from overwhelmed, according to the Director General of Health. But the situation is likely to change for the worse sooner than expected. The number of infections has already exceeded 10,000 and is expected to rise exponentially within the next few weeks. The country has only 641 hospitals with 84,728 beds (3.9 beds per 1,000 persons), according to the Medical Statistics Unit, and most of them were overflowing with patients even before the COVID-19 outbreak. They usually have patients lying under beds and in corridors. There are only 91 medical officers per 100,000 persons (or one medical officer per 1,099 persons). The number of nurses per 100,000 persons is about 212. These numbers are not sufficient. Frontline health workers are burnt out, and some of them have even contracted COVID-19. Those serving in the hospitals where COVID-19 patients are treated have not seen their families for weeks. How bad the situation will be in the event of a community transmission of the virus is not difficult to imagine.

The most important take-away from the aforesaid television discussion was that Sri Lanka has benefited tremendously from its free healthcare system, which, however, has not found favour with the international lending institutions. Healthcare accounts for only 5.92% of the total government expenditure, according to the latest Health Ministry statistics. What would have befallen the country if there had not been a well-established public healthcare system is anybody’s guess. Among the critics of the free healthcare system are some captains of industry. They do not seem to have realised that the state investment in free healthcare has helped keep the cost of production low.

The instrumentality of public healthcare systems in the battle against coronavirus has not only had great appeal the world over but also shown that government expenditure on healthcare has to be increased. In the US, President Donald Trump has made an election pledge to make the COVID-19 vaccine available to all Americans free of charge! A few years ago, whoever would have thought that the GOP, which went all out to scrap Obamacare, would have to make such a promise?

It is hoped that Sri Lanka will minimise waste, curtail expenditure on mega projects, which can wait, and make more budgetary allocations for the health sector. Unfortunately, health does not seem to figure very high on the government’s agenda if what is reported of the next Budget to be presented to Parliament is anything to go by. Lessons learnt during crises must not be forgotten.