Equality, Equity, and Good Practices

Field hospital in rural villiage.

Equality, Equity, and Good Practices
14 October 2022

In both developed and developing nations, it's important to address the accessibility and affordability of health services. Before COVID, there was already a disparity between one and another country regarding this issue. And now, on top of it, we have COVID-19. Taking Indonesia, Singapore, Thailand, China, and India as examples, these countries are in the same Asian region, but we see the death toll of COVID is very different from one to another. The concentration of population in these countries is at the highest level. How can we provide services and treatment to everyone in these countries? I'm sure that the government wouldn't take advantage, but around the government, many private sectors have an interest in taking advantage of this kind of situation. Even the pandemic started only last year, but now the so-called “money talking” has already happened at the primary care level in Indonesia. Fortunately, the government has regulated the services for COVID-19 patients in the whole country. This national regulation must be implemented by all health facilities, both public and private. Therefore, all patients could have the right to be treated as determined in the regulation.

It's a shame to see the inequality in the accessibility to and the affordability of vaccines between nations, owing to the current vaccine distribution throughout the world. Western countries in principle get more vaccines than Asian and African countries. Maybe it is the result of so-called negotiation power? Again, it is a political thing. Lots of the global stakeholders said that they were going to make the vaccines free or affordable. It turns out that, realistically, it's not going to happen now.

Health is a human right. Promoting health for all is the priority. However, sometimes the health provision needs to go around. For example, homosexuality in some countries is regarded as taboo. We might be able to take the HIV campaign as a health intervention for everyone in Chinese society, focusing on human rights that everyone should have the access to health services. Even though Western people said that there are no human rights in China, I don't think so. It's just different kinds of human rights are concerned. The concept of “health is a human right” can be implemented in China as well.

It's very important to examine the potential tensions between the government and the responses of the targeted population who received such interventions. People feel, people think, and people experience such services and respond. There are implications to delivering care to populations. And then, we also need global guidelines or international guidelines on disease prevention, treatment, and care (e.g., HIV). Countries can follow those technical guidelines for good practice. But it's very important to know that the local care providers understand the guidelines and how the local people may react. People can have very different views on medications. And people may protest or disagree with such treatment. So, these two issues always need to be considered.

When it comes to lockdowns as well, those have been imposed by different governments. There are differences in mindset and cultural differences as well. Having seen in Asia, Africa, and Singapore, we see how the government has a direct order from the top down to the people, and people just complied. But it's not the case for the Netherlands. For instance, the Dutch government can't directly tell people that we're going to have a lockdown. If so, people go crazy. As a non-scholar myself, it is interesting to see if this can be studied in a year or two years from now, on the thinking of the government stakeholders, as well as from the people, and what the social impact will be? In the case of COVID, it is very hard to come to a deal with the policies that we have to stay at home, keep a social distance, always wear masks, and wash hands.

Most of the stakeholders will be the government workers and those officials who are responding to COVID 19 at this moment. There is a debate about whether China needs to stick to a zero-tolerance policy toward COVID. Compared to other Western countries, the epidemic of COVID in China has been controlled. And in most parts of China, life has already been back to normal. Well, there are some consequences for those (isolated) communities, those local community workers and officials, and people who are working at hospitals. Local government workers are very much concerned about whether local cases could arise. Therefore, they adopted the COVID measures in a very strict way, a lockdown approach to their local communities. Well, this may have some negative consequences for the people who are living in those communities. For those stakeholders whose mind is to control the dynamic and to decrease the number of cases to zero. But for the people, there come some negative consequences, such as education and work. They have to stay at home for at least two weeks and are not able to work, especially people who cannot work online. There are some tensions between the government officials and the people. Whether they want to protect their population, or whether they just want to show that they have a good performance in this epidemic.

Here in the Philippines, despite the negative things that are happening, there are a lot of active private sectors trying to help. One example is a group that organised a community pantry, a community-driven food and commodity distribution. The source of food and commodities are concerned citizens who extend donations in their capacity. Donations include canned goods, noodles, vegetables, spices, rice and other crops that could sustain the daily subsistence of a household. The positive effect is that from one city, more cities were inspired, and their constituents imitated the practice across the country. More and more donors came in, including those people who are living hand-to-mouth and have nothing much to give. They tried their best to contribute and shared what they have. These sectors include farmers who donated the yield of their farmlands and fishermen who freely shared their catch of the day. The humanitarian spirit of the people has surfaced right now.

I think of the private sector when we talk about stakeholders. Many of you mentioned the importance of the government taking control and playing an important role in the COVID pandemic. What I've seen as well in other developing countries is that lot of the private sectors also play along in the human engineering area and help COVID, but also on vaccine distribution. Actually, the government has had a lot of help from the private companies’ campaigns, whereas you don't see such a thing happening in more developed countries like in Europe. The actions are mostly centralized by the government. So, there's also another interesting dynamic.



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