Care Philippines Integrated Risk Management Director Celso Dulce shares his thoughts on how the Philippines could have handled the pandemic better.
The Philippines has been acknowledged globally as a leading practitioner on disaster risk reduction, applying community-centred approaches. We should have been drawing from this vast reservoir of experience and knowledge in dealing with the COVID-19 pandemic. The call of the frontline healthcare workers to “sit down and talk and replan with a sense of urgency,” as infections rise unabated despite four months of lockdown, should impel us, and especially our government leaders to rethink and recalibrate.
We are very good at managing natural disasters. The COVID-19 pandemic, however, is an unknown, unfamiliar threat. We must saturate therefore communities, in urban slums and gated villages, in coastal areas as well as remote mountain villages, with correct information on the risks related to COVID-19. The infection prevention and control (IPC) protocols, the need to wear face masks, to frequently wash hands, to not to touch eyes, nose and mouth, to keep physical distance require behavioural change. This change does not come overnight. There is therefore the need for constant reminders, about the risks, about the capacity of the healthcare system being swamped, and about what the people can and should do. The messaging that we are doing okay, that we have beaten the UP projection, that we are doing better compared to other countries does not help.
Threats of, and actual arrests are also not achieving their intended outcomes. Threats of arrests alone do not work. A comprehensive plan and approach, and effective implementation should prove superior to threats of arrest. It is also equally important that the leaders we look up to, from the national level to the community, are observed to be models in practicing IPC protocols. It is important that leaders lead by words and by actions.
Equally important, let us undertake risk communication applying our vaunted community-based approaches. Let us raise the awareness and educate every community official, every informal community leader, every community member, on the risks of the pandemic and on the appropriate measures to defeat the threat. Let us mobilize all of them as our risk communicators.
Monitoring, testing, tracing, isolating, and treating
Health surveillance should involve every individual in every household, community, economic enterprise big and small, and all government offices and facilities. Self-assessment tools are available. Some households and offices are already conducting self-assessment regularly for early detection of symptoms of infection among them. This practice should be expanded, with support in terms of setting up reporting mechanisms linked to official COVID-19 surveillance systems in the community and local government unit.
Much energy has been spent on the debate about mass testing. We need free, mass testing. By mass we mean bulk, or quantity, not 100% of the 110 million total population. Targeted mass testing should be done, informed by monitoring information on the geographic concentration of COVID-19 cases. With targeted mass testing, 100% coverage can be carried out in specific communities and sub-villages. Why free? Vulnerable households cannot afford the costs of testing. Free testing also removes the excuse for not undergoing the test.
Failure to identify infected persons, using available information coming out of the tests, will put to waste all pandemic response efforts, and result in unimaginable economic costs and human suffering, as we are now experiencing.
Aggressive contact tracing must be carried out. This is an efficient use of the mass testing results compared to random, hit and miss testing. It also narrows down substantially the number of individuals that will be actively monitored for possible infection.
Effectively isolate the confirmed, suspected and probables. Apply a mix of approaches appropriate to specific contexts. Home quarantine is possible for upper middleclass households but not for the urban poor. Conditions among the poor (highly congested living spaces) would just result in whole families being infected. Putting urban poor communities under hard lockdown, with threats of arrest but without putting in place other measures to isolate the confirmed, suspects and probables would be counter-productive. Continued access to critical services shall also be made available especially to vulnerable groups including older people, persons with disabilities, seriously ill persons, and indigent households in lockdown situations so that there is no reason to violate protocols.
More isolation facilities can be set up. Alternative temporary shelter models are available; they can be adapted to different requirements for isolation, in place of cramming people during lockdowns into congested spaces with little WASH facilities and other basic necessities.
Provide free treatment to those infected, giving priority to the poor. The cost of hospitalization and treatment is literally driving potential patients to the ground. By encouraging people to seek treatment, think about the benefits in terms of the number of individuals that will no longer be affected because patients are actively seeking health care.
Our healthcare system is near collapse. There is no reason not to believe the cry for a timeout and for decision-makers to reflect on the situation and to introduce essential changes. For a start, government should take better care of our frontline healthcare workers. Provide adequate PPEs, better working environment, shorter working hours, increased salaries and benefits, and transportation support. Without improving their working conditions, we cannot expect prospective healthcare workers to queue in recruitment offices.
All the surveillance efforts must be closely linked to risk communication objectives. A negative test is not a guarantee that an individual will no longer be infected later. A patient that has recovered already is not guaranteed that reinfection will not occur. Risk communication must be continuous, so that the change in behaviour we want is achieved and maintained.
Household livelihoods should be given equal importance. We must not be blind to the fact that many people are violating protocols because they feel they have no choice. This is supported by a Gender Analysis study. “Its either the virus will kill us, or hunger will” is also an oft-repeated declaration of the poor. Government should support financially and technically poor and economically-displaced households to shift to livelihood activities that are safe to undertake for them and for the community. Disasters can also create opportunities, including in livelihoods. Now more than ever, the strategies of diversification, protection and strengthening must be applied to make livelihood activities resilient.
For those employed in the private sector or government, each office or business enterprise must put in place strict IPC protocols. Daily symptoms monitoring must be carried out, work from home arrangement be put in place where appropriate, workplace safety measures must also be in place. Extreme lockdowns are bad for business. Serious infection in workplaces are similarly bad for business. A happy balance between keeping the business going and ensuring safety of employees and the public must be achieved. In this light, the responsibility of government to monitor private and public sector compliance with health protocols as well as employees rights must be ensured.
Transportation and travel
Transportation is the lifeblood of the economy. Transportation is also vital in delivering basic services, as well as urgent humanitarian assistance. Strangle transportation and we asphyxiate the economy, basic service and humanitarian assistance delivery. There is a need to rethink the transportation strategy in the time of the pandemic. Pre-COVID, developing mass transportation was seen as the ideal path to development. Mass transportation has become more important at the time of the pandemic, due to IPC concerns. Government must therefore seek out new strategies to make mass transportation available to the public. Look at the option of subsidizing the operations of bus companies. Seriously rethink the policy on jeepneys and motorcycles. If there are risks about observance of health protocols, what should be done to mitigate the risks? This of course should be combined with limiting movement to essential travel. Require big private companies and government offices to bring to the office and bring back home their workers. In the minimum government should provide transportation to hospital workers. They can barely don off and then put on again their PPEs. The least that government can do is reduce the hours they need to go home to their families, if we desire our healthcare system not to totally collapse.
In terms of compliance to let travel restrictions, enforcement should be made at point of source and destination instead of having highly visible checkpoints that create monstrous traffic jams along major thoroughfares. Let us empower communities and homeowners’ associations to become responsible travel restriction enforcers.
Participation and community engagement
The magnitude of the problem is so massive that government alone cannot manage the pandemic. To be successful, government has to rely on the people, on their participation in all aspects of COVID-19 response. As mentioned earlier, we have extensive experience in community-centred DRR. We should use such experience to our advantage.
Vulnerable groups have specific needs. We have seen an elderly couple, the husband pushing a wheelchair several kilometres going to the hospital for regular dialysis on wheelchair. We have seen young couples with dead babies in their arms because they could not be admitted in hospitals. We have seen senior citizens braving the rain and possible infection to get their ayuda (assistance). The list is long. Older people, persons with disabilities, persons with chronic illness, pregnant and lactating women, solo parents, indigent households and indigenous people, among other have specific needs during disasters and pandemics that must be identified and addressed.
Civil society organization, NGOs, international NGOs, UN agencies and institutional donors have been our partners in past emergencies. They should not be excluded from participating in all aspects of the response to COVID-19.
Upholding human rights
All people have rights, including the right to life with dignity. The rights cannot be set aside in the name of pandemic protection and control, or any disaster. Where people are vulnerable to natural hazards, climate and environmental risks, or pandemics, violations of human rights exist. Their vulnerability indicates the lack of access to basic services. These vulnerabilities are often heightened during times of humanitarian emergencies, when access to basic services and humanitarian assistance is denies. The right to receive assistance, the right to participate, the right to have a say in decisions affecting them, the right to life with dignity are often violated during emergencies.
It is the right of the people to benefit from quality design and delivery of programs and services. This right creates an obligation on duty bearers, foremost the government, to constantly work for excellence, regularly reflecting on implementation to with the aim of identifying areas where improvement can be undertaken. All duty-bearers have the responsibility to uphold these rights, especially during emergencies. And being onion-skinned in the face of public criticism has no place in public service.