DeLisle Worrell: Strengthening Health Systems to Tame Pandemics

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On July 13, McKinsey & Company, one of the agencies of the famous global consultancy, issued a report entitled “Not the last pandemic: Investing now to reimagine public health systems”. The lesson of the Covid-19 pandemic is that there are basic flaws in the health systems of many of the world’s richest countries, countries that boast the most sophisticated medical facilities. Their clinics, hospitals and equipment are the best and most advanced, and they are staffed by the world’s leading experts, but the system which delivers health services has serious weaknesses. As a result, the Covid-19 pandemic has had devastating consequences for some of the world’s richest countries. The McKinsey study identifies five areas that were crucial for those health systems that were most effective in saving lives in the face of the pandemic.

The first feature of the successful response systems is that they are always alert for the emergence of contagious diseases, and ready to spring into action at a moment’s notice. The contrast is with systems that have to be mobilized afresh for each new event. Health systems in Uganda that had coped with the Ebola virus, or in Hong Kong that had been effective for SARS, were more successful in suppressing surges of Covid-19 infections.

A second useful health system characteristic identified is a strengthening of mechanisms to detect infectious diseases, at the global, national and local levels. Health workers in clinics and hospitals around the world should be equipped and trained to identify infections from their early symptoms, and there should be swift and reliable systems of reporting, to national and regional centres for disease control, and to the World Health Organisation. The countries where the incidence of Covid-related deaths are lowest are the ones where the detection, reporting and coordination mechanisms were in place and working, as soon as the virus was identified.

Thirdly, the McKinsey study notes the value of administering existing vaccines more widely, taking special protection measures in areas where there is risk of animal-to-human transmission, and other preventive measures. The report states “Recent outbreaks of measles, for example, show that places with lower vaccination rates are more susceptible to diseases that vaccines can prevent. Achieving full global coverage of all the vaccines in our arsenal would save millions of lives in the coming decades.”

The fourth insight is that the most effective health care systems are those that are designed so that personnel, equipment and facilities can be rapidly provided for a surge in infections, without compromising essential health services. These systems have invested in training, equipment and facilities for epidemic preparedness, to enable the creation of temporary care facilities, field hospitals and the like.

Fifthly, there needs to be a large boost to research and development on infectious diseases. Medical research is conducted through global networks of collaboration, as has been demonstrated in the trials being conducted in the search for a Covid-19 vaccine. There are opportunities for all health systems, including our own, to take part in this research.

In addition to these health system features, the strength and cohesion of local community and neighbourhood organisations is important in supporting effective emergency measures to suppress surges in infections. Media reports have shown the important work of community volunteers in delivering food and necessities to persons at risk and people in self-quarantine, in cities as widely dispersed as Sao Paulo, Brazil, Denver, Colorado and Wuhan, China. In Cuba, the effectiveness of their community-oriented health system is demonstrated by the health care teams seen touring neighbourhoods on foot, to check the status of everyone in their homes. This aspect of Cuban health care is unique, in a world where health care in the home is mostly unavailable.

As our countries beef up health systems to help us to overcome the Covid pandemic, our Governments should invest with a view to incorporating all five of the desirable features identified by McKinsey & Company: emergency responses that are always at the ready, early detection systems, measures to reduce the risk of pandemics, standby staff, equipment and facilities, and participation in global trials and research. At the same time, we should all recognise the value of getting to know our neighbours, and of participating in and strengthening community networks. They can prove invaluable in an emergency.


43 thoughts on “DeLisle Worrell: Strengthening Health Systems to Tame Pandemics

  1. Whereas the McKinsey study has some application to small countries we are unsure whether it coould, in its entirety, be applicable in South countries.

    Where ever we’ve seem the Mckinsey brand show up with their capitalist religion the socalled free market doctrine follows. This time disaster capitalism being the preferred weapon.

    In healthcare this dogma will soon to privatising the QEH under the belief that private sector run health systems are more efficient in dealing with the expected pandemics of this century.

    This is disaster capitalism being preached by a man from whom better is expected.

    Maybe McKinsey should explain why the most private sector led hospital system in the world, the USA, has done far worse than public unsophisticated systems? Why a poor country like Barbados has done far better than the “great” USA, by any measure.

    Again, this former governor is no more than an agent for American economic hegemony.

  2. Mr Worrell is a disappointment. After tolerating constant humiliation from Sinckler, I was hoping that his new freedom would have led to a serious debate about the state of the Barbados economy.
    Instead of explaining what went wrong with the ten-years of DLP economic policy, he came out with nonsense about the dollarising of the Barbados currency.
    It is a silly idea, but more so now that gold has reached US$2000 an ounce as a direct result of the threat to the Greenback as the global reserve currency. I would have thought this was more urgent in the post-CoVid era than speculating about future health policies.

  3. Sixthly… Health & Fitness is best plan and solution in current situation.
    Firing up your cardiovascular breathing system, strengthening your heart and lymphatics to clean toxins, increasing your bodies immunity and resistance and making your body feel young is master key to longer life. This can be achieved with easy daily regular exercise, with kindness to your body, relaxing not pushing it.

  4. @ Pachamama August 5, 2020 8:50 AM

    For once, I completely agree with you!

    The USA is not a role model for us at all. In terms of cost-benefit ratio, they have the world’s worst healthcare system. The days of white supremacy with English as the native tongue are over.

    Wenn it comes to civilization, we should take the best small states as a model, i.e. Singapore and Switzerland, not white hell holes where people deliberately disregard hygiene measures and deliberately infect each other.

  5. Time for me to read again “Small Is Beautiful: Economics As If People Mattered”

    I remember once approaching Donville when he was our Health Minister to ask him a question [no I did not want money,or a pick or anything so] i just wanted to bring to his attention something in our health system that i perceived as a grave injustice, somehow the very brief conversation got around to a comparison of Barbados and American systems, and he told me “well I like the American system better” I was dumbfounded, because I knew that the American system even though supremely well funded did not deliver the best of even basic care to poor people, and i knew then that if your poor people are sick it won’t be too long before the rich people are sick also.

  6. My late nursing sister [one of many, many nursing sisters, nieces and sisters in law] said to me right here in my house post-SARS when we spent weeks having long, long conversations about matters big and small “one of these days we will have an epidemic and it will hit the United States really, really badly, because they do things so badly there, actually I am surprised that SARS did not ravage the United States.”

    17 years later, here we are.

    if we are going to fix health systems, the fix has to be led my nurses, doctors, epidemiologists etc and NOT by economists and/or politicians, for the same reason that when you have a burst pipe you do not call your lawyer. When it comes to public health economists, lawyers, politicians are as ignorant as the average 3 year old…the trouble is that they fail to recognize their ignorance about public health matters.

    So here we are.

    The politicians, lawyers, economists etc. are busy saying ‘we did not anticipate this” a girl who went to Alexandra school anticipated this more than a decade and a half ago. But alas politicians, lawyers, economists typically do not have deep, deep conversations with Alexandra school girls.

    This is only the first pandemic of the 21st century. There will come one as contagious as Covid19 but with a significantly higher mortality rate.

  7. @DElisle “At the same time, we should all recognise the value of getting to know our neighbours”

    True this.

    But as soon as we belive that we have arrived don’t we delight in being blasted “poor great poppets” who take great pride in NOT KNOWING our nieghbours?

  8. One of the things that both McKinsey and Delisle forgot to mention is TRUST. Trust in ourselves, oor neighbours, our young people, our institutions. Hal was asking if UWi had published the modelling, but whether or not they have there is a high degree of trust because in our small communities we can IF WE WISH get to know and trust people.

    3 of the front line medica people live less than 10 minutes walk form me. At least one I have know as we say in Barbados “before he born” that is I know his parents, grandparents, and some of his great grand parents. Do I trust him, “yes”even with my life.

    That sort of trust must be nurtured, cannot be bought from the shop

  9. Economists, politicians, lawyers know NOTHING about nurturing trust, principally because those professions are largely competitive, largely adversarial.

  10. I would of liked if Mr Worrell would focus his attention instead on The Barbadian Economy Post Covid.

    Would love to hear how he thinks we can close the $500M deficit we may face by December for instance. Maybe he could tell us how we can restructure the economy to replace the revenue loss from tourism.

    Forget the small fish and try and land the Marilyn instead.

    • Worrell was Governor where he presided during a period of unprecedented economic decline before he was fired by the worst minister of finance we have ever had.

  11. @ John A August 5, 2020 4:47 PM

    And what about the Covid19 council? Will Big Sinck now take over the part that our Most Honourable Prime Minister (MHPM) had assigned to OSA? Or was the project secretly and quietly buried because the results were despicable?

    And who will now be the new mine dog and leader of the suicide squad (see Guyana, see LIAT). Does our MHPM assign the role of election observer in Trixidad to Big Sinck?

    Why don’t we get African advisors to teach the local, pampered population to survive on a GDP of 5000 dollars per capita? All that diversification bulls***’s not gonna work anyway.

  12. @ Tron August 5, 2020 5:09 PM
    “And what about the Covid19 council? Will Big Sinck now take over the part that our Most Honourable Prime Minister (MHPM) had assigned to OSA? Or was the project secretly and quietly buried because the results were despicable?”

    Worrell is the ideal man to replace OSA.

    If the “Big Sinck” can be resurrected in order to run for President of the DLP why not De liar.

    At least he would be given one last chance to redeem himself.

    But he must first confess that the foreign reserves books were cooked in early 2013 by an inflated factor of $300 million in order to impress and promote his then political masters who, in true Sophocles style, eventually shot the messenger boy, the bearer of bad economic news.

  13. Sinckler as president of the DLP – a very good proposal. Preferably with Eastwitch, Lashley and Lowe as deputies and with the Don from New York as chairman of the party court for ethical misconduct.

    MAM could thus save herself the expenses of the next election campaign, because then people would vote for the BLP out of anger anyway.

  14. @Tron

    Yes not a word from anyone with regard to the restructuring of our economy post covid. The MOF quiet, the council on recovery quiet, even Chris Zerox Sinkler quiet. You feel they all waiting on divine intervention or a miracle? In the meantime the deficit on target to hit $500M this income year ending March 2021.

    What has the committee of big brain maguffees come up with? What is the timeframe and plan for restructuring the economy and reducing the demand on tourism, in the medium to long term? Tell us, what is the plan for reducing the demand on Fx in terms of energy imports over the next 3 years say?

    What dat wunna say nobody aint got the answers? Maybe wunna should do a blue paper and yellow paper first, maybe by then the economy will pick up on it own! Stupes.

    From where I sit there is no visible evidence that anything has been done so far to tackle these issues, that one could say yes actual progress is being made.

    Somebody say something neh!

  15. @ David August 5, 2020 5:56 PM

    If not Worrell then what about Boyce whom OSA dubbed the Quisling?

    At least the man has played for both political sides in the economic and fiscal management game and knows the strengths and weaknesses of the Bajan political economy.

    @ Tron: If the Downlow(e) can make a return to be one of the vile snakes of the DLP Medusa why not the Big Sinck?

    After all, both he and your red Majesty share more than just a birthday.

  16. @Miller August 5, 2020 6:30 PM

    Mia has towards Big Sinck simply maternal feelings, wants to protect the weak and challenged with their decimals.

    Therefore, I could well imagine the fallen Minister of Finance joining the ranks of the BLP. One could put him in charge of the asylum in Black Rock. Big Sinck is a specialist here and would certainly have an excellent relationship with the inmates.

    Or Mia sends him on a suicide mission to a failed state enterprise plus election observers in the Caribbean. As I predicted, she took down OSA with it. With Big Sinck, that would certainly work too. The conditions in Guyana, Haiti and Surinam are particularly suitable. There, people are just disappearing 😉

  17. Let me declare at the outset that Dr. Alan Palmer the author of the article below is a Doctor of Chiropractic, not an MD. Readers can come to their own conclusion as to the value of his advice about the importance of reinforcing the immune system with good nutrition through diet and with the use of nutritional supplements like Vitamin C, D3 etc. when necessary. He suggests our prime goal should be to reinforce the immune system’s natural, inherent ability to fight off disease to lessen the need for having an automatic reliance mainly on pharmaceutical drugs and vaccines to protect human health.

    The Shunning of Nutritional Science and Self-Care in the Public COVID-19 Narrative
    Editorial by Dr. Alan Palmer, Contributing Writer (Childrens’ Health Defense web site)

    [CHD Note: This is Part Three of a four-part series. In Parts One and Two I outline the case for the terrain being the most important consideration when it comes to outcomes from infectious diseases. The terrain represents the health of the individual, their nutritional status, their environmental exposures and surroundings, their access to clean water, personal and public hygiene, etc.]

    ( FYI, hyperlinks to Part One, “Why Has Everyone Seemingly Forgotten How the Immune System Works?” and Part Two COVID-19—Lessons from History and The Power of “The Terrain” are available by clicking the link below for Part Three. Part four has yet to be published. /GM)

    The incredible partnership between the miraculous human immune system and nature

    The biochemistry of how the intelligence of the body operates is truly remarkable. And the immune system is a symphony of players that when all working properly and in concert, make beautiful music together. Beautiful unless you are a pathogen. When working in harmony, the different players in the immune system are truly a formidable force to be reckoned with. They seek, identify and destroy the intruder. Rather than using a drug that often has risks of side effects to “kill” the infection, this approach fortifies and builds the body’s own defenses and mechanisms to fight the offending microbe and then clean up the mess and debris afterwards. This includes upregulating white blood cells and immune regulatory players like macrophages, natural killer cells (NK cells), neutrophils and monocytes. As an example, vitamin C greatly increases numbers, activity and effectiveness of macrophages, NK cells, neutrophils and monocytes. Human beings can’t make our own, so we have to get it from diet and supplementation. Vitamin C demands increase substantially during times of stress, injury and infection. Therefore, it is essential to meet those demands with increased consumption when you want your immune system to work at it’s best.


  18. @ John A August 5, 2020 6:15 PM

    The truth is: There is no economic salvation. We have to prepare for a declining living standard with high crime rate until all the tourists have returned. All publicly ventilated solutions (such as more agriculture or IT business) are the usual babble that our politicians have picked up on BU. Barbados is no breadbasket of the Caribbean and is no Silicon Valley or Shenzen.

    Even when the tourists are back, our politicians do not dare to do the things that would promote tourism, because the population is as mentally backward as the Taliban. I am thinking here of adult entertainment, casinos, soft drugs, marriage of same-sex couples and suchlike. In other words, everything that our Taliban consider to be devil’s handiwork. Our tourism product is at the fun factor level of the early 1950s: sun, sand and the beach.

  19. @ Cuhdear Bajan

    True this.

    “But as soon as we belive that we have arrived don’t we delight in being blasted “poor great poppets” who take great pride in NOT KNOWING our nieghbours?“(Quote)

    What is even more alarming is that we believe we have arrived intellectually and then don’t even take pride in knowing or understanding our region.
    Most of all our problems can be solved by a radical progressive regional approach but we jokers talking : Hong Kong, Switzerland and coming with all kinds of “internationalist/ global views that bear no relevance to our needs. It’s a vicious cycle of an inferior intellectual complex. A direct result of slavery. We are not mentally or intellectually free.
    We need thinkers and we need to think.

  20. @ William

    We must get to know and take pride in our region, but we cannot blank out the rest of the world. If we are good enough we can compete with anyone. If we cannot compete we want to Barbadianise every job on the basis that we are Barbadians. We can compete against the brightest and the best globally. Bring them on.

  21. @ Hal
    Entering any race or event without mental preparation is a recipe for failure. If we were to take the same energy we waste on referencing already failed systems and place them on our own ideas, we would become mentally prepared.
    The first step is food production. We talk fancy about foreign reserves and V this and W that. Yet our children are on the worst diets since independence. We need proper water management. People in rural areas are barely surviving without water. You tell me where we ,and I don’t mean Barbados , I mean the region , are going with all this fanciful intellectual mumbo jumbo. Most of it has its genesis in 17th century Europe. Yet we persist in parading it at every given opportunity.

  22. @ William
    I am not sure what you mean by intellectual mumbo jumbo. Incompetence is the big problem for Barbados. You do not have to be an intellectual to know that home cooking is better than eating greasy, chlorinated chicken from some diseased farm in Brazil or Holland; you do not have to be an intellectual to know that to water an 18-hole golf course takes as much water as it would for a small town of 1200 people. When last did the people in Cattlewash complain about a water shortage? What about hotel swimming pools?
    Thinking is not European; it is what we should do before we start shouting or attempting to read people’s minds. What is European is trying to blame others for our shortcomings.
    Thinking is a product of education and Bajans cherish education. Don’t confuse education with qualification; and do not confuse qualifications with being intellectual.
    One of the greatest British social policy professors was Richard Titmus, who did not have even a degree. CLR James did not go to university. Isaiah Berlin never wrote a book. In Barbados we worship Phds and DPhils and other crap titles.
    Look at the Mottley government. Did you hear Rudy Grant in the Senate yesterday? This is the folly that passes as being clever in Barbados.

  23. @ Hal
    Not attempting mind reading. Just saying that we inevitably find ourselves going around in circles because we are constantly trying to relate to systems that have already failed us. It’s a question of looking within . The question remains: Do we really think we are capable of solving our own problems?
    The biggest economic myth of recent times was both Sinckler and Mottley fooling people they are/were following “ home made “ economic programs. When closely examined they were the same failed prescriptions offered by the IMF.
    How often have you heard anybody on this blog quoting any Caribbean thinker. All we do is pour scorn on regional efforts.

  24. @ William

    You are right in that the nonsense of Cave Hill economics will not save a pigeon. Our failure is the outcome of a mindset created by the first Barrow government and subscribed to by subsequent BLP and DLP governments.
    Barbados is a failed state because the people who we elected as the guardians of the state failed. As fibbers usually say, to be fair, the white business community has also failed. The latest of this mob is Cave Shepherd, but the Trinidadians came in and bought them out, then they rushed off to Canada.
    As to Dr Worrell, he is more a disappointment than anything else. Now free of the oppressive hands of Sinckler, I thought we would get new ideas from him. He has failed.
    The other mob at Cave Hill has also failed. Where are the new ideas coming out of UWI? Not a single one of them has anything new or meaningful to say. What about our trade unions? They all seem more interested in being senators and MPs than in representing the interests of their members.
    @William, we need bottom up leadership. Commisiong is more interested in apologising for the coffee-coloured Cubans than in representing working class Barbadians. Denny promised to march for the widow of the man killed by a serving police officer while off duty, years later he is still on bail. Is he being paid? Has Denny forgot?
    This is the last chance saloon and all our president can talk about is ‘holistic education’. The woman is a joker. No doubt BU thinks she is wonderful.

  25. @ Hal
    Agreed totally.
    The Pan Africanist all went and supported Mottley in the last election. Comrade Commissiong saw no hope for his own political party, the People’s Empowerment Party.
    I thought they could have supported Comrade Prescod without using the movement. It was their political choice.
    I respect Comrade Prescod for speaking out. However there is always danger in running with the hare and hunting with the hound.

  26. Speaking of central bank(er)s and nonsense. This current Guv had this to say:

    “Preliminary data now suggests that economic output fell by 27 per cent in the second quarter, resulting in an overall decline of almost 15 per cent over the first six months of 2020,” he reported.

    I’m just a Dullard but my primary school maths tells me this something about this statement is fishy.

  27. What is fishy about the statement Dullard?

    GDP fell 3% in Q1 and by 27% in Q2. How can the total contraction over the two quarters be only 15%?

  28. @Theo

    I see what you have done but i dont think it is applicable in this instance.The Guv is talking about the total decline over the period. The ave monthly fall in GDP is not really a useful metric here.

  29. @ TheOGazzerts

    I ain’t no bright boy, but if you dealing with averages, if the total decline in Q1 = 27% and Q2 = 3% = 30% for the 2 quarters. Then the average decline for the 2 quarters should be 30% ÷ 2Q = 15%.

  30. The back-of-the envelope simple average arithmetic calculation regarding the fall in GDP( 15%) over the two quarters is okay. However, when you are dealing with concept like % change in growth, a geometric average is more appropriate. The geometric average use a compounding factor. Even then, the two figures wouldn’t diverge that much in my opinion.

  31. Using the geometric mean calculation, the GDP would have declined (14.01% per quarter) over the two quarters. Not much difference from the 15%.

  32. Until there is a vaccine, economies the world over will continue to struggle. This pandemic has put some countries in the region forty years back in terms of unemployment rate, business failures and collapse in government revenue. Our tourism dependent countries will be looking more like Haiti, in terms standard of living and poverty rates, if this thing continue into next year.

  33. But then again, the pandemic only lift the veil of pretention about our high standard of living and per capita GDP, when in reality our true worth is about US $3000 per capita per year in my opinion. Tron is BU resident jester and mischief, but he is dead right on this one.

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