| MAIN | CONCEPT-1 | PEOPLE | RESOURCES |
The COVID-19 Crisis: Planning & Imperatives for Bangladesh
| Professor Dr. M. Kamal Uddin | Senior Advisor (Policy) Centre for Policy Research, Bangladesh |
| & Former Director (Head), Institute of Appropriate Technology (IAT), Bangladesh University of Engineering and Technology, Dhaka |
Introduction: Since first attack of COVID-19 pandemic in Wuhan in December 2019, by now in April, 2020, serious havoc has flown through the whole world. More than 210 countries are struck by the virus having total death toll more than 109,000 persons as of today. Bangladesh is facing a situation of unprecedented severity due to this virus attack, whose impact is far-reaching.
In addition to the immediate concern about the very real impact on human lives, there is fear about the severe economic downturn in Bangladesh that may result from a prolonged battle with the novel coronavirus. Businesses are being shuttered and people are losing their jobs. In this serious circumstance, an effective rescue plan is required to be devised to bailout Bangladesh from this crisis. It is apprehensible that the present crisis and the measures taken to contend it will have far-reaching effects on practically every sector of the country. In fact, given our economic reality in Bangladesh, there will not be a single sector that will not require government assistance. It is, therefore, crucial for the government to devise a well-thought-out, comprehensive and strategic rescue plan that must be multi-sectoral in approach. This means the emergency plan must prioritize certain sectors such as health, business, employment (formal and informal), education, MSMEs (micro, small and medium enterprises) and all marginalized groups.
Management of`Resources: Most recently government has deployed its huge resources to combat the COVID-19 crisis. No other country has declared such big incentive/grant so far. PM’s BDT 5,000 crore (agriculture sector) & BDT 72,750 crore stimulus packages have been declared for industries & other sectors and to address the wage and food insecurity of people when the entire country under partial lock-down. Next task is to use this resource in a very prudent way. It is imperative that this bailout plan should be implemented in the most effective and efficient way so that there is no waste of resources or irregularities in distribution or allocation. No doubt this is a massive task and a huge challenge is in front for our government in such an overwhelming crisis. This is why the government must mobilize all the resources at hand and all the players who can contribute to implementing this rescue plan. Already we are seeing how businesses, NGOs, law enforcing agents, army, media, individuals and volunteer groups are trying to contribute in their own way. But all these efforts and programs should reach every sector and be sustainable; these must be done in a coordinated manner. The need of the hour is thus to formulate this all-encompassing, strategic plan and implement it with efficiency and determination.
Present Critical Needs: In Bangladesh, the present critical needs with respect to COVID-19 crisis are preparedness and response, including the provision of vital medical equipment, health system capacity-building, and support to establish treatment centers. It is required to provide immediate support to put in place containment strategies, train medical staff and provide equipment to ensure rapid case detection and contact tracing.
Continuous training program is to be articulated in the national health system in Bangladesh. The training service will include: training for emergency care doctors, nurses, and paramedics; purchase medical and laboratory equipment and supplies; rehabilitate health care facilities; and strengthen the country’s capacity to respond to health crises. Initiatives to be taken to establish laboratories and isolation and treatment centers in referral hospitals and equip them with essential medical and testing supplies in all 64 districts.
In all the districts of Bangladesh, it is required to expand intensive care capacity through equipment, supplies, and training, as well as supporting coordination with the public. At this moment, it is very important to boost the capacity of rapid-response teams, hospitals and laboratories by providing medical and laboratory supplies, ICU equipment, and preparedness accessories for hospitals and clinics.
Throughout Bangladesh, it is required to minimize COVID-19 transmission through more testing for early detection and rapid response teams to help contain outbreaks. Mobilization of additional health staff and supply of equipment will be needed to improve patient care. Medical supplies for COVID-19 cases and equip a greater number of intensive care units and isolation rooms will be required as well. The national communication strategy and dissemination of prevention and protection messages in the short and medium term will be needed.
Management System to be Improved: Presently, critical situation of health sector is prevailing in Bangladesh. The intrusion of virus attack in Bangladesh was not entirely unforeseen, given the rapid spread of the virus in other countries. But it would not be fair to say that the administration was not prepared to face the situation. The “National Preparedness and Response Plan for COVID-19” issued by the DG Health in March this year, which lays down in very great detail what the four likely ways that virus will find its way into our country, and how to deal with those, is an evidence of the government anticipatory work, at least conceptualization of the course of action. The health issue has to be tackled with urgency under elaborate action plans.
National Preparedness and Response Plan: National Committee Development of Comprehensive Strategy: The National Preparedness and Response Plan for the COVID-19—well formulated and drawn from the WHO guidelines published in February 2020—addresses only the health aspect of the issue. In spite of the best intention of the government, its efforts to implement the action plan to a lower level have gone a bit skewed at places. Under the plan there is the National Committee for Prevention and Control of COVID-19 headed by the health minister and National Coordination Committee for Prevention and Control of COVID-19 headed by the PM’s Chief Physician who himself is a medical specialist. And there are committees down to upazilla level including rapid response teams. And that calls for working out a comprehensive strategy to deal with the several problems both now and the future. COVID-19 plan requires addressing a few other likely outcomes that the pandemic will leave in its wake.
Phasing of Front Fighters: Doctors, Nurse and Other Health Associates and Development of a Volunteer Group: The suggestion is: front fighters’ human resources for COVID patient’s treatment (such as doctors, nurse and other health associates) are to be subdivided into two groups who will provide services in turn. One group will work in hospital for two weeks while other group will receive training or go for incentive holiday or if required to be placed in quarantine/ isolation. Hotel accommodation & transport of the duty doctors will be provided by the hospital. Retired doctors, nurses and other health associates are to be invited to entail them so that they can render their noble services to the country. In the meanwhile, a volunteer group is to be made ready through training. Both Rapid Test and PCR test facilities to be articulated all over the country and will be applied as per requirement.
Hospitals, Clinics, ICU Centers, Diagnostic Centers are to be Assigned into the COVID and Non-COVID Entity: The suggestion is: all the private hospitals, clinics, diagnostic centers are to be encompassed along with those of government entities in the battle against COVID-19. In the strategy planning, first task is to make a comprehensive list of all hospitals, clinics, diagnostic centers (government and non-government) of the country. Then it is required to subdivide and assign these into the COVID and Non-COVID entity. COVID and Non-COVID hospitals/ clinics,ICU centers, diagnostic centers, etc., should always be different and should not be amalgamated. In almost all countries of the world, they have made COVID hospitals/ clinics/ ICU centers/ diagnostic center separately in different building and even in tent.
Protective Equipment for all Health Work-forces: As long as the risk of infection remains, protective equipment is essential for anyone who works in hospital, clinics, diagnostic centers, etc. Without waiting for the expanded system of tests to come online, we should set ambitious goal- protective equipment for all health workforce must arrive within shortest possible time.
Strategy Planning of COVID-19: Infection Life Cycle Trajectory Prediction:: Using technology forecasting technique, infection life cycle trajectory is to be predicted using general parameters/ determinants of other countries and indigenous variant parameters/ determinants of Bangladesh. Peak is to be determined and necessary action to be taken. Here to note that 1st case COVID patient was identified on 8th March where the infection life cycle trajectory begins.
Creation of a National Council: A multi-pronged approach is required under a comprehensive strategy which makes imperative of creation of a council at the national level headed by the Prime Minister. The modality is to work continuously, to coordinate, supervise, guide, and provide the overall direction of the operation for the implementation of the directives more efficiently under the national strategy. For example, although the policy paper spells out the four ways the virus can spread, the first being from the categories of people arriving from contaminated countries, and lays down the courses of action, the on-ground work were inadequate. Vital actions in some instances were a little late in coming, ostensibly due to lack of decision; the consequences were evident. All instructions and announcement must come from the proposed national council. That would help avoid unwarranted situations, the kind of which the RMG workers faced. In a situation like this the decision to keep the RMG factories open or closed cannot be left to individual owners, as the trade minister has suggested. That decision should be for the government to take.
One feels that the preparatory action in anticipation of return of our citizens, particularly from those countries infected with COVID, could have been better planned and more efficiently laid out. The quarantine station for the incoming Bangladeshi may be ok for haj pilgrims in transit for a day or two, but for families to be quarantined in such a condition for not one, two or three days but a least fourteen is unbearable. Lack of coordination will lead to wastage of resources and duplication of effort and lack of strict supervision will result in pilferage, as was evident. What we face today is a kind of war, and like war it must be faced. In this regard it is imperative that a national council be established immediately. Apart from the PM, the Council may consist of home, health, finance, foreign, trade & commerce, overseas employment, transport and labor minsters, PM’s Security Advisor, the heads of services, PSO, AFD, cabinet Secretary, PM’s Principal Secretary, IGP, senior virologist, epidemiologist and public health experts. The national council should vet the comprehensive strategy and direct the implementation of it in totality during the ongoing pandemic and after it has ended. The nodal point should be the national council. Centralized planning and clear-cut directives and coordination, and decentralized implementation at the ground level would ensure more efficient application of the strategy and efficient use of resources. Policy decisions should come centrally and not from any individual ministers, that too from those who are not directly related to the issue.
Supply Chain Management should be Strengthened: The Covid-19 pandemic has had a profound impact on the supply chain and demand for the all sectors. Daily consumable commodities are being exhausted and becoming stock out. It seems that soon there will be crisis of consumable items against the huge demand of this populous country. In apparel sector, top exporters like Bangladesh have started feeling the heat due to raw material sourcing challenges and cancelled orders.
MSMEs and RMG sector: The COVID-19 has great impact on all industrial sectors especially on MSMEs and RMG sectors. There is great role of micro, small and medium enterprises (MSMEs) as major tool of poverty reduction in Bangladesh. Government of Bangladesh has given emphasis for developing MSMEs as a thrust sector for balanced and sustainable industrial development in the country to help deal with the challenges of free market economy and globalization. MSMEs covers 98% share of the industrial sector. On the other hand, the performance of the RMG sector is more critical in the economy of Bangladesh, since apparel contributes 84% of the country’s export, employing close to 3.5 million people. While gauging the possible impact of the pandemic on the apparel sector, it is imperative to look into the demand side scenario by analyzing the European, US and the emerging markets for apparel export. Due to large scale closure of stores owing to the lock-down enforced by different governments, apparel sales for Bangladesh have plummeted, leading to brands postponing or cancelling orders. Bangladesh Garments Manufacturers and Exporters’ Association (BGMEA) have claimed that USD 1.5 billion worth of orders have already been cancelled or put on hold by the buyers.
Bangladesh’s Fast Moving Consumer Goods (FMCG) Industry: The FMCG Industry has been one of the largest industry serving domestic consumer needs. The country’s middle-class population combined with rising per capita income has been a strong propagator for the growth of the industry. The middle and affluent class (MAC) population of Bangladesh is expected to reach a total of 34 million within the next 5 years. In the long run, until global supply chain stabilizes, the industry will remain turbulent but not dead if certain interventions are taken as preventive measures. The major FMCG companies also need to start planning for the long-term forgoing short-term gains in order to survive. If the global lock down subsides in a few months and the spread of the virus flattens, the industry will be able to pick up given the right remedial initiatives taken now.
Imperatives for Economic Recovery: Apart from the health issue, Bangladesh will have to face other problems long after the virus has taken its last toll, most importantly the economic problem. The intensity of impact due to COVID-19 will be far-reaching in a populous country Bangladesh; it is predicted that there will be serious economic turmoil after post COVID situation. It is perceived that we will not face the same trauma health disaster as some countries are facing, but we cannot escape the consequences of the pandemic on the world economy which unlike the 2008 meltdown will have a cascading effect on us. And unless all issues are addressed and preparatory action taken for what might come in the future, the consequences might be more severe in terms of human lives and last long after the virus is defeated. And this requires a multi-pronged approach under a comprehensive strategy.
A set of COVID-19 measures are to be taken so that these can help Bangladesh respond to immediate health consequences of the pandemic and bolster economic recovery. The broader economic program to be formulated which will aim to shorten the time to recovery, create conditions for growth, support micro, small and medium enterprises (MSMEs), and help protect the poor and vulnerable. There should be a strong poverty focus in these operations, with an emphasis on policy-based financing, and protecting the poorest households and the environment. All sectors of the economy of Bangladesh should be encompassed to strengthen developing nations’ ability to respond to the COVID-19 pandemic and shorten the time to economic and social recovery. The poorest and most vulnerable section of the economy will likely be hit the hardest, and the stronger part public & private around the nation should remain focused on sector level and having solutions to address the ongoing crisis. Responding to widespread supply chain disruptions, the government and relevant ministries should arrange access critically needed medical supplies by reaching out to suppliers. The operations should be coordinated at a national level to ensure best practice is quickly shared, including approaches to strengthen national health systems and prepare for potential follow-on waves of this devastating virus. The following measures are to be taken:
- Recapitalize health and epidemiological systems;
- Mobilize all micro-economic levers: monetary, fiscal, and structural policies ;
- Lift existing trade restrictions especially on much needed medical supplies;
- Provide support to vulnerable low income stratum and MSMEs;
- Share and implement best practices to support workers and all individuals, employed- particularly the most vulnerable;
- Keep businesses afloat, such as all industrial sectors, (especially RMG, MSMEs), agriculture sector, with special support packages in hardest hit sectors .
Need of Research Endeavors: A series of research initiatives are required to be undertaken at this moment which includes, strategy planning; mapping; development of comprehensive strategy; policy formulation; action plan development; procurement of relevant technology; training modules preparations, health system capacity-building and so on.
Conclusions: As coronavirus disease (COVID-19) is spreading across Bangladesh, the health sector and the community at large must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and hemodynamics is the key. Doctors, ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of re-purposed and experimental therapies. Collaboration at the local, regional, national and international level offers the best chance of survival for the critically ill. The COVID-19 programs should focus on immediate needs and response to the pandemic, while helping strengthen health systems across the country. To slow and limit the spread of COVID-19 through enhanced detection, surveillance, and laboratory systems, as well as strengthening essential health care delivery and intensive care system. In Bangladesh, emergency program is required for better screening, contact tracing, and laboratory diagnostics; procure personal protective equipment; and set up new isolation wards. Preparedness and emergency response is required in the health sector and include social protection and education measures to help the poor and vulnerable cope with the immediate impacts of the pandemic.
Enormous challenges are being posed to health systems and economic system by COVID-19. Indeed the sudden emergence of a new disease reveals that new health threats can at any time develop into emergencies; that no one, rich or poor, is exempt; that research has a key role to play in effective response. On the other hand, it is required to identify and prioritize essential research activities to be undertaken. Among many others, these include better understanding of how the disease is transmitted; the creation of speedier diagnostic tools; the development of candidate vaccines and treatments; and the full integration of social science research in outbreak response. People’s attitudes, beliefs and behaviors play a critical role in how diseases spread. Research that engages seriously with these social aspects of epidemic transmission and control is going to be essential both in gaining the necessary understanding, and in ensuring that response measures are appropriate for Bangladesh.