A decade for public health
Today, 30th July 2020, marks the 141st day since the death of ‘Patient Zero’ on 11th March. Today, we remember the twenty citizens who have died from symptoms associated with the coronavirus (Covid-19) disease.
Today will be etched in Guyana’s medical memory as the day when we demonstrated our determination to defeat this deadly disease in this country not for a day, or a year, but for the coming decade and beyond. We have, today, made an irreversible decision to employ our personnel and deploy our resources to protect our population from disease and to promote public health.
Today, life on earth is confronted with one of humanity’s gravest health challenges for more than one hundred years. The COVID-19 pandemic – an event which no country anticipated and for which few could pretend to have been adequately prepared – has brought the death and disease completely unanticipated to millions of persons in every continent.
The establishment of this infectious diseases’ hospital represents an essential and urgent investment in safeguarding our people’s health, not just against the coronavirus pandemic but also against future communicable epidemics.
The world, over the last two decades, has reeled from the adverse impacts of communicable diseases:
∙ 2003, Severe Acute Respiratory Syndrome (SARS) affected 8,098 in 26 countries and resulted in 774 deaths;
∙ 2009, H1N1 influenza (swine flu) affected 59 million persons in the Americas and may have caused between 150, 000 and 475,000 deaths;
∙ 2013, Chikungunya affected more than two million persons;
∙ Ebola discovered since 1976, recurred 2015-2016, resulting in 11, 310 deaths;
∙ 2014-2016, Zika is suspected to have affected millions in more than 86 countries;
∙ 2020, the COVID-19 coronavirus has infected 16.8 million persons and caused 662,503 deaths as at 28th July 2020;
∙ Dengue is estimated to infect 50-100 million new persons and result in 20,000 deaths each year; and,
∙ Human Immunodeficiency Virus (HIV) have led to complications which have killed more than 55 million persons since the virus was first identified.
The inescapable interconnection and interdependence of human societies increase the risks of epidemic, pandemics and global health emergencies. International travel, legal or illegal, formal or informal, will increase the risk of transmission of human and vector-borne diseases. Epidemics are now more likely to become pandemics.
The Ministry of Public Health immediately designated three quarantine facilities and:
– assessed the readiness of our health facilities to meet the anticipated increase in demand on services;
– developed local capacity to test for the COVID-19, with training provided by the Pan-American Health Organization;
– trained, and continues to train, health-care providers and first-responders and heightened active surveillance; and
– continued to fill existing gaps, including with respect of additional supplies and equipment.
These efforts are supported by a communications campaign to keep the population updated on the virus and its impacts and oversight provided by the Health Emergency Operations Centre. The National Emergency Operations Centre (EOC) was activated to provide support to the public health sector.
Your Government, within hours of the death of ‘Patient Zero’, established the National Coronavirus Task Force (NCTF). We published an extraordinary issue of the Official Gazette on 16th March and promulgated a menu of measures based on the Public Health Ordinance for the enforcement of protective measures.
This was supplemented, on 3rd April, by the promulgation of Emergency Measures which included the imposition of a curfew, the closure of our airspace and borders and other restrictions. A draft National Action Plan was promulgated in the form of a ‘White Paper.’ We have been active over the last 20 weeks or so.
Every Ministry has been responding to the pandemic through carefully coordinated action plans – Rural Entrepreneurial Action Plan (REAP); Coordinating Agency for Small Enterprise (CASE); Mobile Emergency Enforcement Teams (MEETS); National Implementation Scheme for Interconnectivity (NISI); Public Education Remote Learning-Teaching Scheme (PERLS); Social, Cultural and Arts Renewal Scheme (SCARS); Social Protection Implementation Measures (SPIM) and others.
The enforcement arms of the state have adopted the four Es – engage, explain, encourage and enforce – in their interaction with the public in urban, rural and hinterland districts.
Communicable diseases exact a huge toll on human life, the economy and on social development. The COVID-19 coronavirus pandemic is expected to result in the contraction of the global economy by 5.2 per cent this year – the deepest recession recorded in over eight decades, according to the World Bank.
The economy of Latin America and the Caribbean is expected to contract by 7.2 per cent in 2020. The pandemic, also, is projected to retard long-term economic growth, reduce living standards and shrink investments, constrain international trade and increase public health expenditures.
Sickness and deaths – consequences of pandemics – impact adversely on human capital and, particularly, on unemployment and labour productivity. The vulnerable – aged, very young and poor – are affected disproportionately, also.
This is a dark and a difficult period. Social life has been constrained; sport has been curtailed; employment has shrunk; education has been restricted; business has contracted.
Communicable diseases have the potential to cause major disruptions to our way of life. Our citizens have been subjected to social restrictions over the past four months. These restrictions are only now being relaxed in a phased manner.
The situation, however, is still evolving. Forty-four new cases were recorded from 25th July to 28th July and the total number of cases stood at 398 as at Thursday 30th July.
Your Government has recognized the public health threat posed by communicable diseases even prior to the outbreak of the COVID-19 pandemic. Attention, in recent years, has been focused on reducing the incidence and improving treatments for communicable diseases. The public health system is being made more resilient and responsive to the threats posed by communicable diseases.
Public health services are mandated by the Constitution of the Cooperative Republic of Guyana. The Constitution at [Article 24] states: “Every citizen has the right to free medical attention and also to social care in the case of old age or disability.”
I noted, on 30th May 2018, that: “Public health services are a public good; their enjoyment by one citizen does not deprive others of their value. They are aimed at promoting the common good and at ensuring that everyone could enjoy ‘a good life.’”
The responsibility for providing public health services is vested, principally, in the Ministry of Public Health which, in accordance with the Health Act of 2005, is required: “… to deliver and, where necessary, oversee the delivery of health care throughout Guyana and to effect plans and policies, monitor quality and evaluate [health] outcomes.” Its mandate includes ensuring health services which are accessible, acceptable, affordable and appropriate within its means.
Your Government has made substantial investments in the public health sector. Expenditure moved from 3.19 per cent of nominal GDP in 2014 before this Government entered office to 4.10 per cent in 2019 and, for the corresponding period, from 9.6 per cent of total public sector expenditure to 11.32 per cent.
Decade of Development
The Decade of Development: 2020-2029 will continue to see your Government improving public health services. These efforts will be consistent with the approaches outlined in our Guyana’s Green State Development Strategy: Vision 2040 which identifies communicable diseases as a challenge to public health and public well-being.
The Decade of Development will see public health expenditure achieve or surpass the PAHO-WHO target of 6 per cent of GDP. This will allow for the continued protection of the country’s most valued resource – our people.
The Decade of Development will witness the establishment of a more inclusive public health system. Among the priorities will be the augmentation of resources to address infectious diseases.
Investments will ensure a robust health system to safeguard the populace from communicable and non-communicable diseases, strengthen surveillance and treatment of communicable diseases, such as Human Immunodeficiency Virus (HIV), tuberculosis, malaria and dengue as well as transnational health threats.
The Decade of Development will witness continuous efforts to provide improved incentives – including emoluments and conditions of work – for health professionals. We have committed to ensuring that there are sufficient doctors, nurses and other medical personnel so that every public health facility is adequately staffed and every worker is appropriately remunerated.
The resilience of the public health system, however, depends on the quality of the health personnel within the public health system. Medical personnel – including doctors, nurses, pharmacists, technologists and therapists – constitute the sinews of any public health system.
Guyana’s doctors, nurses and other health personnel have been on the frontlines of the local efforts to combat the COVID-19 threat. The nation owes these courageous men and women a debt of gratitude for their professionalism and humanity during this very difficult period.
This Government’s objective of universal health care is all the more important given the present situation. The global pandemic has tested public health systems everywhere. The new reality requires that public health systems increase and strengthen their capacity to address sudden and unexpected outbreaks of communicable diseases by providing more hospital beds, improved protective gear for medical personnel, better communicable diseases surveillance and specialized hospitals, such as this institution, devoted exclusively to infectious diseases.
Your Government has crafted a national response to the pandemic. This institution is an essential element of the emergency response. Government recognised the urgency of having an institution which could be dedicated exclusively to providing treatment to coronavirus patients. The model which we developed in the early days of the pandemic requires us to have the capacity and the capability to achieve accommodation of 197 ICU patients at any one time.
This institution is strategic. It will be used primarily for COVID-19 patients but, eventually, will become a fully-specialized communicable disease hospital. It is an important step forward towards protecting our people from epidemic disease. It is always preferable for infectious patients to be isolated away from the general hospital population so as to reduce the risk of transmission and to ensure a better environment for treatment and recuperation.
Your Government continues to urge everyone to practice personal measures – avoid leaving home; avoid gatherings of more than five persons; avoid visiting sick persons; avoid coughing and sneezing in the presence of other persons; avoid touching other persons; avoid touching parts of your own faces; and adopt the habit of washing of hands frequently and thoroughly. We must continue to observe the rules of social distancing, by wearing face masks and practicing good hand hygiene.
We will win the fight against the COVID-19 and other communicable diseases. Exercising personal and social responsibility will help keep our people safe.
Human lives are our most precious resource. Human health is being threatened by the increasing incidence of transnational infectious diseases. These diseases, unfortunately, are not expected to disappear completely. The country’s public health systems, therefore, must never be found deficit in responding to emerging communicable diseases.
Citizens have had to make personal sacrifices in order to contribute to the national effort to suppress the spread of the pandemic. I thank all Guyanese everywhere for the sacrifices which they have made.
Guyanese can be assured that no effort will be spared, now or in the future, to protect the nation’s health. Every life matters.
I thank the Ministry of Public Health and all of those who have worked to have this institution ready to treat patients. I look forward to the institution helping patients to have their health restored.
I look forward to the proper management of this institution, built with public funds and to serve a public purpose. It is my pleasure – in keeping with the new reality – to declare open this infectious disease Centre. I thank you.