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Don’t forget the ‘public’ in public health

As COVID-19 continues to wreak havoc across economies around the world, I guess there is really no other topic worth discussing. The usual caveats apply here. I am not a public health expert or an epidemiologist so as usual I will recommend you listen to the experts as you try to figure out what to do. That being said, the global pandemic has brought the issue of public health to the forefront of discussions, especially in the context of financing health care.

We know the typical Nigerian mantra. I provide my own electricity, provide my own water, hire my own security guards, send my children to private school. Basically, due to a variety of reasons including poor state capacity, we constantly try to do everything ourselves. The same is true when it comes to healthcare. I have no statistics to back this up, but many look forward to earning enough to afford their own health care or at least purchase their own private health insurance which will allow then go to privately run hospitals. The idea of public health care receives almost the same attention as public schools. It is often seen as only for the poor and those unfortunate enough to not afford better.

Unfortunately, as this COVID-19 pandemic has demonstrated, when it comes to healthcare you cannot really forget the “public” part. If a contagious virus hits your community and the community has no way to deal with the outbreak then everybody suffers, regardless of if you have access to private hospitals or not. This is not something unique to pandemics by the way. If you live in an area that is infested with malaria carrying mosquitoes, then you are more likely to get malaria frequently. Same for other “public” health issues. The health of your community is just as important as any measures you are taking for yourself.

So, can we really continue on this our path where the rich and well to do are left to their private health devices and everyone else has to manage with an increasingly broken health care system? Or do we have to figure out a way to put public health at the front and centre. Not forgetting public education of course, which is also as important. To be clear there are no easy options, as we frequently see from public health debates around the world. And the days of government funding everything with free revenue from crude oil are well and truly over. This is a discussion that needs to be had because the consequences of public health failures can be very deadly.

With regards to this COVID-19 outbreak, our whole strategy seems to be the flatten the curve as other are doing. Flattening the curve meaning limiting the spread of infections so that those who catch the virus and need hospitalization do not overwhelm the health care system. All that assumes there is a health care system to be overwhelmed in the first place. How flat does the curve have to be to overwhelm our healthcare system? It seems we are scrambling at the last minute, with the help of the private sector, to purchase emergency equipment and build emergency facilities. I hope we have not forgotten that health care really starts and ends with personnel and we may soon find out that all those our healthcare workers who migrated to saner climes have not exactly been replaced. I hear we are already asking for retired workers to volunteer their services. The same retired workers who are the most susceptible to complications from the virus?

Anyway, I fear I have overstepped by boundaries and strayed into an area where I have no real expertise. As always, please follow the advice of the experts. Stay home. Minimize contact. Wash your hands often. We hope for the best.

 

NONSO OBIKILI

Dr. Obikili is chief economist at BusinessDay

 

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