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Mobilizing Health Workforce Surge Capacity in Response to COVID-19: Lessons from the Asia Region

The Asia Pacific Action Alliance on Human Resources for Health (AAAH) Webinar Series kicked off on August 14, 2020. The webinar series was organized in lieu of AAAH’s traditional biennial meeting, originally scheduled for this month in Myanmar. Due to COVID-19, the in-person convening was transitioned to an online series of webinars, organized under the theme Addressing Health Care Workers’ Challenges in Response to COVID-19: sharing experiences and drawing on countries lessons. The series showcases the innovations and expertise of AAAH’s 18 member countries and their colleagues and partners from other regions as they battle this global pandemic. This blog summarizes four take-aways from the first webinar episode.

The challenges of health worker shortages, capacity, and morale were evident in many countries even before the COVID-19 outbreak. Since the global pandemic, these chronic challenges have been overshadowed by new ones starkly illuminated by the crisis: a lack of personal protective equipment (PPE), ineffective government support and leadership, and an inability to harness data for decision-making. But there are bright spots in how some countries have been mobilizing their health workforce to overcome these and other pandemic-related challenges. Recently, human resources for health experts from Pakistan, Singapore, and India’s Kerala state shared their challenges, practices, and lessons learned during these first seven months of the pandemic an online discussion, Mobilizing Surge Capacity of Health Care Workers in Response to the COVID-19 Pandemic.

From the beginning, the government structures in Pakistan, Singapore, and India’s Kerala state realized that the response to the pandemic would require a surge in the health workforce, and that all health workers were greatly at risk of infection. Eight months into the year, Pakistan, although it has done well compared to some other countries, with a total of 290,000 cumulative cases, lost 76 health professionals. Singapore, with a confirmed case count of 55,492 (as of August 14), has lost none. And in Kerala state, there have been no fatalities among its health workforce.

What are these countries doing right? How are they strengthening the workforce not only in numbers but with the skills and resources they need to deal with the crisis? Here are four lessons learned derived from the current practices in these three locations.

Controlling the outbreak alleviated the strain on human resources for health.

Early on, both Kerala state and Singapore recognized that controlling the outbreak was key to alleviating the strain on the health workforce. One could say that preparations for COVID-19 in Singapore date back to 2003 and the SARS pandemic. The country learned many lessons from that deadly virus, including that enforced isolation of cases is critical to maximizing health workforce efficiencies, stated Professor Yik-Ying Teo, Dean of Saw Swee Hock School of Public Health.

“Isolation has been crucial in preserving our hospital resources and our health care workforce to really manage the complications and those that are at a higher risk of mortality,” said Professor Teo. The country’s COVID-19 outbreak has been driven by migrant workers coming in from outside the country, living in dormitories that are similar to household settings. Once these were identified as “hot spots,” medical posts were established at all dormitories, effectively isolating the spread at its source. Although establishing these posts required moving health care workers from hospitals, because Singapore’s hospitals were never overwhelmed, not even at the peak of the infections in April and May, the workforce was available to concentrate on this high risk group and control the spread.

In Kerala, the first case was diagnosed on January 30, and the very next day, the state had identified the facilities that would handle the COVID cases. Ensuring home quarantine, institutional quarantine, and using frontline COVID treatment centers ensured that its health workforce could focus on the most critical cases in the designated hospitals.

Being open to many approaches achieved results—from the tried-and-true to new digital solutions.

Proven practices came into play in both countries and Kerala’s city-state. In Pakistan, a locum-based system helped to add public health specialists, physicians, nurses, pharmacists and others into the workforce on a per day remuneration system; medical students and interns helped to offload routine outpatient and elective treatments; and new health workers were recruited with emergency budget allocations.

Incentivizing the workforce, another tried and true approach, also worked. Pakistan’s federal and provincial governments provided COVID-19 allowances for the frontline health workers; medical staff were also provided with insurance coverage; and post-humous packages were arranged to care for beneficiaries of those health workers who had lost their lives. Singapore gave health workers financial bonuses to recognize their sacrifices during the peak spread.

Less tried-and-true, but used to good effect, was the recruitment of health professionals from other areas of medicine as part of the surge workforce. In Kerala, dentists, medical students, and practitioners of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) were tapped to aid with capacity building for contact tracing and case identification, for example, depending on their skill sets. In Singapore, the health system turned to another set of professionals completely outside the medical realm: With tourism virtually at a standstill, Singapore’s airline cabin crews were trained and repurposed within the healthcare framework to support nurses with non-clinical duties.

Today’s digital technologies were instrumental in the pandemic response. Telehealth—long promised as a solution to the health workforce challenges—is increasingly used to triage today’s coronavirus response, noted Dr. Assad Hafeez, Vice Chancellor, Health Services Academy University, in Islamabad, Pakistan.

“Telehealth has really helped us to reduce stress on health care workers,” said Dr. Hafeez. Many clinical practices, he said, had moved toward telemedicine visits, where patients called in to discuss symptoms with their provider, who then decided whether the patient needed to visit a hospital.

Mobilizing volunteers—enter the COVID Brigade, the Corona Tigers—also frees up medical personnel.

In Pakistan, more than one million young men and women are contributing to the coronavirus response as the “Corona Tigers,” providing administrative and non-medical support by bringing food and supplies to those isolating from the disease. Kerala has its “COVID Brigade,” a volunteer workforce, recognized with certificates and given risk allowances, that is helping to address non-clinical needs such as ensuring quarantine, temperature screenings, and delivering medicines. In Singapore, volunteers have been trained to support swab clinics, stepping up when the health workforce is stretched. Volunteers are most often recognized with non-cash incentives, such as the certificates or uniforms.

Tapping private sector engagement boosts capacity.

Singapore’s primary care system is largely serviced by the private sector—which provides 80 percent of all care. The government manages most of the acute tertiary hospitals. During the pandemic, the country in effect established a nationalized primary care system, standardizing payments that were subsidized by the government, allowing mild cases to be handled by the primary care system, so that hospitals’ health workforce could exclusively focus on high risk groups, severe cases, and those at greater risk of mortality.

Kerala state also engaged the private sector, starting with a series of meetings with private sector management and professional organizations, followed by local officials providing capacity building efforts to staff in private hospitals, ensuring proper treatment; the private sector facilities then provided both COVID and non-COVID care services to alleviate pressures on the hospitals that were caring for critical patients. The government helped the private sector by providing insurance options for these facilities to ensure they would be recompensed.

How to prepare for the road ahead

These lessons are bright spots in the long road ahead facing the health workforce. Beyond the physical challenges, easing the mental strain on the health workforce is imperative over these coming months, and has been largely ignored during COVID-19, said Professor Gabriel Leung, Dean of Medicine and Chair of Public Health Medicine at the University of Hong Kong, who provided a commentary during this first webinar. However, countries are starting to pay attention to this issue, noted two of the panelists. Pakistan is cascading down a series of virtual preventive trainings to help in this area and has established a 24/7 toll-free number for COVID care providers. Callers with mental health concerns are referred to a network of specialists. Kerala, too, has an established helpline ready to provide referrals, and has a cadre of counselors that is now actively offering support to those under strain.

Countries also need to begin thinking about vaccinations. When the COVID-19 vaccine does become available, countries must prioritize health workers as initial recipients. And how will countries—and the health workforce—deal with the anti-vaccine population? This is likely to put more strain on the health workforce which in many places has already not been able to sustain the rate of routine immunizations, and will now be faced with encouraging vaccinations or, even worse, dealing with shortages of vaccines.

When thinking ahead, “don’t ever let a catastrophe or a disaster, like the current outbreak, go to waste,” said Professor Leung, framing one of the key takeaways of this webinar as an overarching need to routinize some practices and lessons learned for the future, post-COVID-19 world. For example, most countries could benefit from organizing annual health crisis practice drills put into place in Singapore after the SARS pandemic. Every year, surprise practice drills take place at the tertiary hospitals to test staff’s knowledge and capacity and reinforce procedures for the next public health emergency. Singapore also had a national stockpile of PPE that supported the demand during the early months of the crisis, which averted supply chain interruptions in acquiring additional supplies. Imagine if all countries around the world had had the same. The investment in preparedness measures cannot be overemphasized.

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The AAAH Webinar Series will continue with events on August 21 and 28; September 11 and 18; and October 9. Learn more about the upcoming webinars here. To register for upcoming webinars in the series, visit the AAAH home page and click on the registration link.