The Tribune

* Nation fought crisis with paper-based system

* Millions needed for clinics fallen into ‘disrepair’

* IDB’s $400m generates 29% of deficit funding

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Government is set to borrow $60m to boost the public health sector in its fight with COVID-19 and eliminate the paper-based system it employed to manage the crisis up until August 2020.

An Inter-American Development Bank (IDB) paper, detailing how the first $20m of these advances will be spent, revealed that the Government and Ministry of Health’s analysis and decision-making during the pandemic’s first few months were “impeded” by the reliance on manual systems.

It acknowledged, though, that the situation had improved since August 2020 with support from the Pan American Health Organisation (PAHO) to move to a technology-based solution for testing, contact tracing and case investigation, with The Bahamas’ COVID-19 testing rate now matching those of major European countries such as France and Germany.

The IDD documents, which have been reviewed by Tribune Business, also disclose that a significant portion of the first $20m will be spent on retrofitting the ventilation and air conditioning (AC) systems of 56 public health facilities so they can receive COVID-19 infected patients.

They reveal, though, that many of the AC systems in the 18 public health clinics targeted as priorities for these upgrades are in poor condition, while several - especially the Fresh Creek Clinic and Nicholl’s Town Community Clinic in Andros - require multi-million dollar upgrades beyond this work.

And some $1.26m is being allocated to develop and install “prefabricated self-contained isolation units” at 42 Bahamian ports of entry, costing $30,000 apiece, so that travellers displaying COVID-19 symptoms or suspected of having the virus can be isolated from the rest of the population.

The IDB report revealed that the multi-lateral lender, via this $20m loan, a further $40m health sector “investment” and other advances, will be financing some 29 percent of the $1.39bn fiscal deficit that the Government is projected to incur in its 2020-2021 budget year.

“The Government of The Bahamas is planning on increasing its external debt by $1.39bn this fiscal year, of which IDB is projected to provide 29 percent of these funds,” it said. “This includes the $200m policy-based loan on competitiveness and sustainability approved in 2020, a $20m health prototype programme, a $40m investment loan in the health sector, and a second $140m policy-based loan in the areas of competitiveness and sustainability. The last three operations are due to be approved in December 2020 and throughout 2021.”

Detailing COVID-19’s threat to overwhelm the public health system, which has diminished slightly for the time being at least, the IDB report said The Bahamas was now better positioned to manage the crisis than it had been when the pandemic first erupted in March 2020.

“At the onset of the pandemic, the information and data management were manual and paper-based. This affected the speed and collation of data collection, flow and analysis, making it difficult to track the progress of the situation, and impeding decision-making,” the IDB said of the Bahamian public health sector.

“To address these weaknesses, in August 2020, the Ministry of Health, with the support of the Pan-American Health Organisation (PAHO), began to digitise data collection instruments to improve efficiencies in collection, collating and analysis of cases, contact tracing and laboratory test data.

“Currently, a SharePoint platform is used for multiple-user real time data entry for contact tracing, case investigation and laboratory results, while Go.Data, an open source application developed by the World Health Organisation (WHO), is used for analysis of epidemiological information.”

With PAHO also providing support for data entry and collection, and laboratory tests, the IDB added: “At the same time, other technology solutions are being considered to improve efficiencies of electronic data collection at the point of entry, and speed up flows of case investigation data and laboratory test results.

“The transition to digital applications highlights the need to update not only the processes and flow of information but also the technological infrastructure of the Ministry of Health, and of the points of entry, train health personnel and manage the process change that this entails.”

However, the IDB said the COVID-19 testing ramp-up had brought The Bahamas into line with major European nations. “The Ministry of Health conducts widespread testing; on average, 224 tests per 100,000 people between 20-27 October, 2020, with a 10 percent positivity rate,” it added.

“The number of tests per 100,000 that The Bahamas is performing is comparable to what France (283 per 100,000) is testing, and is above Germany (190) and Italy (164).” Still, the threat to the Bahamian public health system’s sustainability is never far away.

“To overcome the shortage of human resources, the Ministry of Health hired 29 senior house officers and 71 nurses. Nevertheless, the Ministry of Health still has shortages of healthcare workers, while those in the frontline are at risk of infection and burnout,” the IDB added.

“As of October 27, 2020, about 243 frontline healthcare workers out of approximately 2,800 have been infected with COVID-19, most of whom were working at the Princess Margaret Hospital (PMH). A similar number are also in quarantine. As a result, additional efforts are now needed to expand and protect frontline healthcare workers.”

And the burden imposed by caring for COVID-19 patients has also resulted in service cut-backs elsewhere. “Women at reproductive ages are facing diminished access to prenatal and obstetric services, as too are patients with chronic conditions and victims of gender-based violence.

“The pandemic exacerbated the shortages of health personnel,n and exposed limitations in infrastructure and lack of medical equipment, which is negatively affecting the provision of essential care services - care for diabetes, hypertension.”

To address the physical challenges, the IDB funding will invest a total $3.48m to retrofit the AC systems of up to 56 public health facilities so that they produce negative pressure and stop COVID-19’s airborne spread between different departments.

This, though, will be a challenge. Repairs to the Fresh Creek and Nicholl’s Town clinics apart from AC works have been pegged at $1.2m and $2.4m, respectively, with both locations said to be in a state of disrepair. The Bimini clinic’s roof is leaking, while the AC system at Exuma’s mini-hospital that was built between 2012 and 2016 is already said to be “in urgent need of replacement”.

Meanwhile, the Government has secured COVID-19 vaccines for 20 percent of its population via the Commitment Agreement (Committed Purchase Arrangement) with the Global Alliance for Vaccines and Immunisation (GAVI).

“The committed purchase agreement comprises the down payment for $251,520, equivalent to 15 percent of the cost of the doses, and the forward payment for $1.392m, equivalent to 85 percent of the total costs to access the vaccine doses for 20 percent of the population,” the IDB said.