27 July 2020, NIICE Commentary 5679
Pooja Sharma
In the era of globalization, the world is battling to save human lives owing to the deadly disease of COVID-19. Countries, irrespective of their level of development are struggling with the challenge of life and livelihood posed by the disease. Countries with one of the world’s best medical health facilities are failing miserably to save human lives, such as the US and Italy. Developing countries face several challenges on account of pandemics, both owing to a lack of health infrastructure and health disaster preparedness. The need for better preparedness to fight against influenza epidemics requires financial and medical infrastructure in strengthening pandemic preparedness and emphasis on the need to formulate effective and feasible strategies to mitigate the pandemic challenges. World Health Organization along with pharmaceutical industry and other stakeholders are constantly working on capacity building in developing nations, providing grants to developing countries and initiatives for influenza vaccine technology transfer in 2007. The developing countries are not able to access e-health applications owing to deficiency of financial assistance and technical resources, limited health care surveillance and health care resources.
Several studies have contributed to the factors instrumental in the preparedness of a Pandemic. The capability of potentially forecasting the risk of disease outbreak plays a significant role further reducing disaster losses and boosting level of development. Educational attainment reduces human fatalities as a result of the disaster, a larger population will increase the death toll, while a larger land area will reduce the disaster fatalities. Masozera et al. (2007) suggested that pre-existing socio-economic conditions play a significant role in the ability for a particular economic class to respond immediately to the disaster. The study concluded the policy recommendations to reduce social and economic vulnerabilities. Availability or access to an adequate amount of health infrastructure is the foremost and necessary requirement for constructing resilience for the health catastrophe like COVID-19. There is a massive difference in the access to health facilities across nations, between developed and developing nations and even across the developing nations.
The socio-economic factors constitute a significant component of inequality or Gini coefficient is a strong indicator of variations in the accessibility of health facilities and infrastructure across countries and within the nations. The Gini coefficient for the US is substantially high around 41.4 while for developing nations such as India it is 37.8, China 38.5. The low and middle-income Asian countries have responded to COVID-19 crises by expanding the existing social security programs by introducing new schemes. The magnitude of these fiscal responses ranges from 0.02 to 0.8 per cent of GDP. The Philippines provides a transfer at 75 percent poorest households across the country, Srilanka around 70 percent of households while Timor Leste is planning a universal transfer. India has announced 10 percent of GDP, with only 0.8 per cent of GDP allocated for social protection. The amount is very minimal in constituting effective economic stimulus packages to encounter the devastating effect of the well-being of a vulnerable population. The challenge of the threat of both life and livelihood has placed the socio-economic factors, health infrastructure and political stability also not to neglect food security as the core factors determining the preparedness of a country.
In this backdrop, the potential and the ability of countries to respond to the outbreak of COVID-19 largely depends on some of the crucial components. Availability or access to an adequate amount of health infrastructure is the foremost and necessary requirement for constructing resilience for the health catastrophe like COVID-19. The health Infrastructure which includes the availability of doctors, hospital beds, ICU beds and ventilators. Economic status is another crucial component as it reflects the financial strength or resilience to combat the health crises. The economic factors which largely incorporates health expenditure as a percentage of GDP, per capita income, agricultural productivity and fiscal deficit. Food security is another concern that should be addressed since food is the most crucial component for securing human life at the time of such catastrophe. Finally, the socio-economic factors include life expectancy, the density of population, migration and Gini coefficient. To evaluate the socio-economic-political and food security status, six countries are considered namely, Brazil, India, China, Bangladesh, Nepal and Srilanka.
Based on socio-economic, political factors and food security, the unforeseen health disaster resilience should be fabricated by countries. There is a huge variation across countries related to factors such as access to clean drinking water, sanitation, immunization, the number of hospital beds and physicians per 1000 people. In the case of the health component, China and Srilanka are better off in comparison to other countries. Brazil and China exhibit better economic condition than the other countries. India, China and Bangladesh are more food secure than others, while Bangladesh has a lower level of socio-factor. Brazil, China and Srilanka are politically better than the other countries. All these countries considered are insecure, Bangladesh, India and Nepal exhibiting lowest levels of health disaster resilience, with China reflecting highest security. Health Disaster Resilience Index (HDRI) is significantly positively related to health factors, economic factors, socio-factors and political factors. However, the resilience index for health disaster is significantly negatively related to food security. This indicates that stronger the health infrastructure, socio-economic factors as well as political factors, stronger is the resilience. Among these factors, the health infrastructure and political factors are more significantly related to resilience.
The food security component is a very crucial component of the vulnerability aspect of health resilience. However, it is observed that countries with greater food security have less resilience for health disaster. In other words, the countries which have a stronger agricultural base lack health infrastructure and perform poorly in terms of socio-economic and political stability. There exist several bottlenecks and shortcomings within the countries that become the most significant source of deterrence in achieving the overall health disaster resilience. Strengthening their weaknesses as well as bridging the existing gaps in their preparedness to encounter the challenge of health crises is an enormous challenge for developing nations. Regional cooperation would serve as a way forward for efficiently planning and preparing the developing countries that are trapped in the nexus of a multitude of socio-economic problems.
To ensure health security, a comprehensive framework consisting of four pillars is recommended, namely Health infrastructure, Technology, Policies and Environmental Sustainability. Within the scope of these four broad pillars, there are several potential layers of cooperation existing that can considerably enhance the status of health security in South Asia. Multilateral or bilateral cooperation in terms of availability of health infrastructure for informal and migrant labourers. Several technological collaborations and cooperation can exist for knowledge-sharing and innovation that can directly strengthen the health infrastructure base. Foreign policies related to medical tourism; policies related to pharmaceuticals can prove to be extremely beneficial for most of the developing countries. Further, the countries can also cooperate for attaining environmental sustainability which comprises of the spectrum of spheres to be explored for cooperation such as climate change, cutting carbon emissions, energy-efficient technologies along with renewable energy technologies, water recycling technologies.
It is evident that there is an immense need for countries with a better agricultural base to strengthen their health infrastructure accessibility in rural areas apart from the fact that all countries need to secure themselves in terms of food. However, this opens up the avenues for inter-regional cooperation in strengthening agriculture base. Owing to the acute need to achieve Sustainable Development Goals (SDGs), incorporating environmentally sustainable technologies constitutes as one of the strong pillars for cooperation.
