The achievement of Universal Health Coverage (UHC) has become more attainable globally with the passing of the years, with many countries becoming able to invest in stronger and more equitable health systems.
In 2020 however, within the span of a few months the coronavirus disease (COVID-19) pandemic spread across the world causing direct and indirect morbidity and mortality due to the virus itself, the difficulties in continuing essential health services and other socioeconomic impacts. In this context, the importance of Universal Health Coverage - including the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation, and palliative care - has never been so widely recognized.
On the occasion of this year’s Universal Health Coverage Day, we feature the role of Health Sector Coordination in Cox’s Bazar which has been pivotal to leaving no one behind by keeping the promise of health for all among some of the most vulnerable refugee populations of our times.
Home to nearly 860 000 Rohingya refugees, over the past few months Cox’s Bazar has witnessed the relentless commitment of health partners to ensure the delivery of health care amid the pandemic. WHO Bangladesh/Tatiana Almeida
Coordination and planning during the COVID-19 emergency response have been conducted by the Health Sector in Cox’s Bazar led by the World Health Organization (WHO), and consists of dozens of partner organizations to support the Government of Bangladesh in ensuring appropriate emergency response while maintaining essential health services for over one million Rohingya refugees and affected host population.
In the months prior to the first COVID-19 patient in Cox’s Bazar (March 2020) and in the Rohingya refugee camps (May 2020), WHO organized sensitization sessions to prepare humanitarian and government staff from all sectors to prevent transmission of the disease through infection prevention and control (IPC) measures to be undertaken at individual, organization and community levels. To date, over 3000 humanitarian workers from all sectors were trained.
Health Sector Coordination meetings stage important decisions based on inputs provided by each partner. In this meeting held at Ukhiya Upazila Health Complex, in September 2020, provision of essential health services was in discussion to minimize the impact of the pandemic. WHO Bangladesh/Tatiana Almeida
Under the leadership of the Civil Surgeon, the Ministry of Health and Family Welfare coordination cell (MoHFW CC) and the Refugee Relief and Repatriation Commissioner (RRRC), the Health Sector coordinates efforts from actors on the ground, camp management, government and across sectors to achieve the best possible health outcomes among the affected populations.
The Health Sector in Cox’s Bazar is comprised of 62 international partners, 59 NGOs and five UN agencies. In the Rohingya refugee camps, health partners run 97 health posts and 38 primary health care centers which are open 24/7. Additionally, numerous government-run health facilities in the host community are supported by partners, including 10 community clinics, six union sub-centres and six Health and Family Welfare Centres, two Upazila health complexes and the district-level Sadar Hospital.
At the Sadar Intensive Care Unit (ICU) and Hospital High Dependency Unit (HDU), rapidly established with the support of UNHCR and technical support from WHO and the only ICU/HDU at district level in Bangladesh, it is visible how the coronavirus has hit hardest those who can least afford getting sick: the elderly, people suffering from chronic diseases, poor and vulnerable populations. Here, each and every patient is granted health care and treatment free of charge.
Dr Sarah Tahera Mahmud, Public Health Specialist at Sadar Hospital HDU, assessing the condition of Shandijida Akter, a COVID-19 patient with co-morbidities. WHO Bangladesh/Tatiana Almeida
“Before getting sick I would wear a mask occasionally, I honestly did not think I would be infected with COVID-19. But when the first symptoms started for me and my daughter - cough, fever, chest pain - we immediately rushed to the hospital”, tells Shandijida Akter.
Aged 37, Shandijida Akter is a single mother with three co-morbidities: diabetes, cholesterol and hypothyroidism. Her health conditions led to the decision of admitting her at the High Dependency Unit but with no one to leave her daughter Anisha with, the 8-year-old became the youngest patient at the unit to date. Mother and daughter have successfully recovered from COVID-19.
“One of the things we have been noticing since the beginning of the pandemic is the impact of the stigma. Many of our patients have been dropped alone at the hospital, sometimes in the middle of the night, by their respective families. We have been trying to call the sons of an 80-year-old patient to no avail. Thankfully, we provide treatment and food to everyone including the most vulnerable”, recounts Dr Sarah Tahera Mahmud, Public Health Specialist at Sadar Hospital.
“Universal health coverage means that all people have access to the health services they need. This includes essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. If there is one lesson - and there are many - that we can take from COVID-19, it is the urgency to the quest for universal health coverage. So much was achieved over the past months thanks to the relentless support of humanitarian partners. To help Cox’s Bazar achieve UHC, WHO is helping enhance high quality health services and equipping skilled health workers to provide quality, people-centred care”, says WHO Head of Sub-Office Dr Kai von Harbou.
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A Rohingya patient explaining his symptoms to a Medical Officer at an IOM severe acute respiratory infection (SARI) isolation and treatment center. To prevent the risk of COVID-19 transmission, patients and health staff are separated by a window shield. WHO Bangladesh/Tatiana Almeida
An example of the meaningful coordination of the Health Sector in Cox’s Bazar is the scaling up of isolation facilities to meet the projected demand of COVID-19 positive cases in the camps and host communities. WHO Bangladesh/Tatiana Almeida
Under the leadership and technical expertise of WHO, health partners collaborated to establish 15 severe acute respiratory infection (SARI) isolation and treatment centers (ITCs) in an admirable example of collaboration by UNHCR, IOM, UNICEF / icddr,b, Save the Children, IRC, Hope Foundation, Relief International, FH-MTI, IFRC, and MSF (OCA, OCB, OCBA), creating approximately 1200 beds with capacity to provide care for severely ill patients, including provision of oxygen therapy, by November 2020.
Through promoting coordinated health action and best practices in Cox’s Bazar, the Health Sector has been instrumental to prevent morbidity and mortality as a result of coronavirus infections.
To date, 73 and 10 deaths occurred in the host community and Rohingya refugee camps, respectively, in the district.