COVID and a fragile health system: A case for Universal Health Coverage

The team had set up a COVID-19 taskforce encompassing departments round the hospital, set up a screening system at the front gate, prepared the Infectious Diseases Unit (IDU) for the isolation of patients with an airborne respiratory pathogen, and held multiple trainings of frontline healthcare staff. Despite the small size of our clinical team — Emma Bailey, a nurse and our Clinical Lead, Dr Olivia Farrant, and Dr Dan Youkee, a seconded clinical research fellow — we supported the hospital to prepare for the expected wave of unwell patients who would soon arrive.

Disruption to Sierra Leone’s healthcare system

As we all know now, this disease threatened to overwhelm health systems in the wealthiest of nations, and in Sierra Leone, as we watched this happen in Europe and the US, we wondered how we would cope with the Covid-19 pandemic in the context of a fragile healthcare system. Although the epidemic in Sierra Leone did not result in the extremely high number of official deaths seen in other nations (Sierra Leone has recorded 74 deaths – correct as of 8^th December 2020¹), the pandemic resulted in enormous disruption to health service delivery across the country, with the closure of health facilities, absences of healthcare staff and late presentations of unwell patients. We do not yet know the extent of this disruption, but we do know that during the Ebola epidemic of 2014-2016, more people died of untreated malaria than of Ebola².

Our small team worked at national level and at facility level. We achieved an enormous amount working in close collaboration with members of the COVID-19 response – from frontline healthcare workers to leaders at national level. However, we were hampered by a lack of resources, both human and financial, and forces beyond our control that sometimes made it difficult to mount an effective response.

Universal Health Coverage: Health for All

Patients accessing care at a government facility need to pay out-of-pocket for everything from the cannula that delivers life-saving drugs, to the blood tests that guide the clinicians to make a diagnosis. This leads to unacceptable delays as relatives scramble to find the funds to buy the necessary medication and equipment and medical teams have to make impossible decisions about the priorities of care. This is unthinkable for those of us who have grown up with the safety net that the NHS provides.

The Covid-19 global pandemic has further highlighted the urgency for Universal Health Coverage (UHC). On UHC Day (12^th December) we are sharing the learning paper, Responding to Covid-19: Reflections from the King’s Sierra Leone Partnership. The paper provides key insights from the clinical team at Kings Sierra Leone Partnership during the COVID-19 epidemic. It outlines the events of the epidemic in Sierra Leone, viewed from the epicentre in Freetown where our team is based. We are sharing what we learnt, with the hope that this might inform future strategies both in times of crisis and in more normal times.

We hope that this will provide a platform for policy makers and practitioners to learn, as the themes that emerge are relevant to healthcare delivery more broadly, not just in a low-resource environment. Accelerating progress towards Universal Health Coverage is critical for the people of Sierra Leone, for their health, wellbeing and long-term prosperity. Resilient health systems and well-supported healthcare workers underpin this basic human right.

References

1. Sierra Leone Ministry of Health and Sanitation COVID-19 Situational Report 8^th December 2020. https://unsierraleone.files.wordpress.com/2020/12/sitrep-253_08.12.2020-final20594.pdf
2. Jain V, Brown CS, Johnson O. Sierra Leone: the forgotten mortality. Glob Health Action. 2015 Feb 9;8:26757. doi: 10.3402/gha.v8.26757. PMID: 25669239; PMCID: PMC4323409.