By Baturu Mboge, New York, U. S. A.
Public health is about the health of the population. And part of an essential public health function or service is to inform, educate, and empower people about health issues, monitor health status, and enforce laws and regulations for the greater good of the community. Since the outbreak of COVID-19, all public health departments across the globe are working to prevent the spread of this virus, by promoting and encouraging healthy behaviors and expanding access to health services and protecting the healthcare workforce in line with the International Health Regulations (IHR). However, the pandemic is placing significant strains on health systems, public health services, families, and communities.
Therefore, these are extraordinary times and thus require extraordinary interventions from all of us. Since the emergence of COVID-19, we witnessed a proliferation of information from all angles, especially on the social media platforms. I am aware that people have a right to their opinions. And a right to free speech is a constitutionally guaranteed right. However, our right to free speech must not be exercised at the detriment of the health of the population. It is an undisputed fact that not all of us have the same degree of sophistication to filter the information we receive daily on COVID-19. We should ask ourselves a simple question. How could we transform data from the scientific community into insightful information to amplify their message for greater public consumption? Our best fight of COVID-19 is to stay informed. People must stay home in the face of this emerging risk to do their part and to do it well. We must discourage social norms, belief systems, and other cultural determinants that are not in line with the public health guidance on COVID-19. The government could ease the burden of the social distancing directives on poor households and communities which must comply with the strict guidelines to reduce the spread of the contagion to prevent the pandemic in our country. We do know that stopping the spread of COVID-19 could be even more challenging in resource-poor communities such as The Gambia with a high level of deprivation—poverty, low literacy, poor housing, unemployment, and weak social services and safety net. The government could and should help alleviate that pain.
In all fairness, it is incredible the work the Ministry of Health is doing in keeping the public informed on COVID-19 in The Gambia. However, that is not enough. The President should seize the moment to communicate with Gambians regularly on this matter. It will show the importance and complexity of the public health crisis we are facing right now. It could be done by establishing the Incident Command System (ICS) at the Statehouse and collaborate with the Vice President, who is tasked with the responsibility of coordinating the COVID-19 response. The President utilizing the ICS structures like most leaders in the world will show presidential leadership at a time when it is needed most. ICS was designed to help manage fire incidents in California. Later it was used in other domestic incidents, including natural disasters as well as terrorist attacks in the United States. According Hurricane Katrina and the 9/11 Commissions’ reports, one of the major challenges of the National Incident Management System (NIMS) was the failure of coordination among federal, state, and county governments compounded by technological differences among key players such as the police, firefighter, health workers, and other frontline practitioners. The Gambia can learn from the United States to avoid those costly mistakes.
The National Disaster Management Agency (NDMA) is designed to work as an equivalent of the Federal Emergency Management Agency (FEMA) in the United States. It may not have comparable operational capabilities and logistics. However, it should have basic management structures to help coordinate all domestic incidents by integrating a combination of facilities, equipment, personnel, procedures, and communications operating within a standard organizational structure. The National Incident Commander may not necessarily have to come from NDMA. The organizational structure at the national and regional levels should facilitate activities in major functional areas such as command, operations, planning, logistics, intelligence and investigations, finance, and administration. Therefore, Gambia’s COVID-19 response will require the full participation of other ministries and relevant actors, including Medical Research Council (MRC), The Gambia Red Cross, and other Civil Society Stakeholders as well as the Private Sector. The Ministry of Health COVID-19 Operations Center could continue to provide leadership on the International Health Regulations but work collaboratively with the NDMA-Incident Management System for the command and coordination of multiple stakeholders across systems.
We know from public health literature that the 1918 flu pandemic infected about 500 million people from which an estimated 40 million people died. In this era of globalization, we know very well the greatest threat to our planet would be an outbreak of an infectious disease like COVID-19. We all saw how COVID-19 ravaged societies with even robust health systems. However, nations that are prepared and demonstrated steady leadership are more likely to fight this virus better, protect their people and communities, and will come out stronger.
Social and behavioral change is the foundation of public health. Behavioral change is both an individual and collective responsibility. The Government can enforce laws, provide resources, but it will take full cooperation and collaboration from the citizenry to make it work. The frontline workers, support staff, community leaders, media practitioners, faith-based groups, trade unions, teachers and student unions, women groups, the broader civil society must comply with public health guidance, laws, and regulation. We are all in this together as we must support each other because we are all vulnerable to COVID-19. COVID-19 is not for a few days. It will be here for weeks and months, and we must be ready to fight it and cut the transmission of this virus. We don’t know the magnitude of COVID-19 because we are behind the curve in terms of testing, preparation, and supplies. If we fail to follow the advisory from the Ministry of Health, it could lead to severe consequences as the potential for a second wave is already predicted in other countries. Do not leave this fight to the central government. The local government could play a crucial role in addressing this pandemic.
What are we doing to protect the front-line workers and first responders? The Government of the Gambia should be aggressive in protecting the frontline workers, their families, and other health care providers. We will be in serious trouble if the doctors, nurses, police officers, soldiers, firefighters, other caregivers start testing positive to the COVID-19 virus. The truth is we are limited in terms of the healthcare workforce, testing capacity, intensive care support, and personal protective equipment. What are we doing to communicate density enforcement in our big towns and cities? What is the plan for the most vulnerable in our communities? Are we willing to compromise some individual rights and freedom in the interest of the greater good?
Finally, we cannot afford to have COVID-19 become political. After this is over, we would have to hold each other accountable and learn from this to ensure we are prepared for the next emergency. Yes, there will always be health emergencies; we must get ready for them! In the long term, The Gambia Government must improve the public health infrastructure. For example, it should establish national public health laboratories; review public health laws and regulation and enforcement of IHR; conduct simulation exercise on NIMS; set up a contingency fund for emergencies; and develop the communication infrastructure for public emergencies.
About the Author:
Baturu Mboge is Senior Director of Care Management at Advance Care Alliance (ACANY). He was an Independent consultant for the New York State Office for the People with Intellectual and Developmental Disabilities Services. Before this, he worked for Westchester Institute for Human Development(WIHD) as a program supervisor on a wide range of social services. WIHD is a University Center for excellence on Intellectual and Developmental Disabilities. In The Gambia, he had experience working with West African Rural Development Center, Child Fund International and African Center for Democracy and Human Rights Studies. While in The Gambia, Dr. Mboge participated in many social research projects and was a strong advocate for women & youth empowerment, good governance and people-centered development.
Dr. Mboge’s research interest include health system strengthening in sub-Saharan Africa, female genital mutilation/cutting, and community-based organizations that offer services to vulnerable and underserved populations. He received his Bachelor of Arts (Honors) in Development Studies and Sociology from the University of The Gambia, his Master of Public Administration in Emergency Management at John Jay College of Criminal Justice, City University of New York. He got his Master of Public Health and Doctor of Health Policy and Management at New York Medical College (NYMC). Dr. Mboge is also a recipient of a Graduate Certificate in Global Health from NYMC.