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While in Mexico on December 12 the Virgin of Guadalupe has been celebrated annually with great devotion and huge concentrations of the population for more than four centuries, in the rest of the world the day of Universal Health Coverage ( CUS). On December 12, 2012, the United Nations General Assembly (UNGA) approved a resolution that urges countries to accelerate progress towards UHC. The idea that everyone, everywhere, should have access to quality and affordable healthcare as an essential priority for international development. Five years later, the UNGA officially designates December 12 as International Day of Universal Health Coverage and since then annual events have been held to discuss the CUS agenda for 2030. Due to the pandemic, in 2020 the celebration was carried out in a virtual, but in 2021 the modality of a face-to-face event is again adopted in Dubai. With the assistance mainly of officials from international agencies and some officials from some invited countries. The debate is around “Leave no one’s health behind: invest in health systems for all”.
To provide more context for the UAE meeting, three events should be highlighted.
a) On October 19 of this year, the WHO publishes its position on “The generation of resilience in health systems for Universal Health Coverage and Health Security during and after the Covid-19 pandemic.” This document highlights seven policy recommendations on building resilient health systems based on primary health care. To this end, the Director General of the WHO makes it clear that the pandemic has slowed progress towards UHC worldwide, forcing us to rethink the strategy to achieve the goals by 2030. “… We cannot build a safer world from top to bottom. below; we must start at the bottom. Preparedness, prevention, detection and rapid response to epidemics begins with strong primary health care and public health systems, trained health workers, and communities empowered and trained to take charge of their own health. That should be the center of our attention and our investment… “.
b) The year 2021 has been designated as the International Year of Healthcare Workers to recognize and thank the unwavering dedication of these workers to the fight against the Covid-19 pandemic. Health workers are all those in charge of providing health care. Not only doctors and nurses, but other professionals such as dentists, psychologists, nutritionists, as well as support staff: orderlies, quartermaster, laundry, etc. WHO highlights the urgent need to invest in health workers to obtain shared dividends in health, employment, economic opportunity and equity and adds “… this year, as we continue to thank health and care workers for their dedication and sacrifice, it’s time to go beyond the applause. Today we ask you to add your voice to that of those who ask for additional investments in health workers … ”
c) On October 21, the WHO issues a statement calling for actions to better protect health and healthcare workers against Covid-19. Through this document, member countries are invited to strengthen the monitoring and notification of infections, illnesses and deaths from Covid-19 among health and care workers. The statement also urges political leaders and policymakers to do everything in their power to make investment and regulatory decisions that ensure the protection of healthcare workers and their healthcare. Finally, the WHO calls to guarantee equitable access to vaccines for all health workers in the world.
Just as the world is in debt to public health, many countries remain in debt to those who are the backbone of health systems and therefore one of the factors of change to achieve UHC. Beyond issuing political statements on whether there is room in hospitals to combat the onslaught of the Omicron variant, the WHO call to protect health workers and act in all three senses must be carefully reviewed. Undoubtedly, the system for registering infections in health personnel must be improved. In Mexico, on October 25, 2021, the health authority published that there have been 283,122 cases of Covid-19 in health personnel and 4,517 deaths from this cause. These figures are surely underestimating the total, since it is not clear whether they include private sector health workers. As can be seen in the graph, the cases of Covid-19 in public sector health personnel in Mexico have followed the distribution of the 3 waves of the pandemic, not being the case of deaths. Thanks to the protection provided by timely vaccination, the third wave is much less intense than the previous two. This is an argument in favor of accelerating the placement of the third dose for health personnel, since it is known that they received their first two doses more than six months ago.
The better protection of health personnel proposed by the WHO requires paying more attention to their working conditions. For reasons of space, I highlight three aspects to consider. a) the use of appropriate protective equipment to avoid being infected by SARS-COV-2 and its variants; b) scheduling work days and breaks to combat and avoid stress and exhaustion (burnout). In some countries, reducing the length of the working day has worked to reduce exposure, as well as increasing the frequency of vacation periods. After two years of the pandemic, the vitality of health workers must be improved. c) Carefully analyze what has been called the moral damage suffered by health workers due to the intense suffering caused by the pandemic. It is identified in all personnel who face moral anguish for not being able to act as they wanted or as they were trained. In times of crisis, “you do what you can, with what you have” which leads to ethical dilemmas, to blame oneself for acts that are not guilty. It is a perverse combination of working overtime, not seeing family members, feeling vulnerable, and experiencing the pain of others that is sometimes unnecessary. Moral damage in health workers is a subject of research, and it must also be present in daily actions to improve the mental health of health workers.
Achieving universal coverage after having experienced serious disruptions in the health system in Mexico (public and private) is a complex matter. It must be shown that it is possible to improve the conditions of access and quality to the population’s health services by including better conditions for the working population in the health system. Nelson Mandela already said it, “do not judge me by my successes, judge me by how many times I fell and got up again” that is the challenge for the health authorities, to generate resilience in favor of universal coverage and health security.
* The author is a professor at the University of Washington’s Department of Health Measurement Sciences and the Institute for Health Metrics and Evaluation
https://www.healthdata.org/about/rafael-lozano
Twitter: @DrRafaelLozano
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