Post COVID-19, Where to?

OPINION A disaster like COVID-19 poses numerous challenges and problems across all sectors of healthcare and for global economies.

Prof Morgan Chetty, visiting Prof: Health Sciences, DUT chairman, IPAF, CEO: KZNDHC

IN THE SHORT term we will see a concerted effort by all sectors. To mention a few: - Economic sector - Religious / faith-based - Healthcare sector - Governments.

These efforts championed by each group is to complement the strategies in place to contain this pandemic.

Daily updates on this pandemic are posted by McKinsey and Co. We have collated these messages to provide a 'helicopter' view.

WHAT SHOULD DISASTERS TEACH US? - We need to work together at multiple levels to reach an optimal level of disaster preparedness - We need to improve structures we have and not ’dismantle‘ them (Dr Nabil Shabeeb). - Learn from the mistakes and shortcomings of our system and structures.

We are not going back to the 'normal' we had before Coronavirus (Kevin Sneader – McKinsey & Co). One thing we are sure of is that nothing is going to be the same.

This will 'set' a new normal and is a different way of operating (Kevin Sneader).

Healthcare, commerce and the entire economy are in a conundrum – not just for the future but how do we get past the present challenges.

We cannot predict the future. The present is a state of unfamiliarity and uncertainty. So, Kevin Sneader asks, if we cannot go back to the way it was before, what is the next normal?

Provider behaviour (health professionals) and patients is changing.

“Will it go back to the way it was?” The general consensus is, no. We notice the increased focus on AI, IT and telemedicine, telehealth and online efficiencies. These efficiencies will become reinforced and entrenched as a new way to care for the sick and will not go back to where we were before. We witnessed in this pandemic, poor preparedness and lack of efficiency of our healthcare supply chain. We need to make this more resilient.

The question we need to ask is what will the strategies be towards the next ‘normal’. What have we learnt from being poorly prepared to re-engineer and reform our present healthcare offering? The present challenges have pointed us to: - Need for integrated health platforms versus solo platforms - Telemedicine and telehealth – will be the new normal - Coordinated care pathways will result in quality outcomes and increased efficiencies - Value-based reimbursement – will force us into delivering care that is reimbursed for measured outcomes and value - Increased emphasis of preventing illness versus treating people who are already ill.

We will move to a Wellness System versus the Sick Care system that we are currently in.

We will not just innovate technological advanced ways to treating illness but focus on prevention and public health efficiencies.

So, the net result is that we will need to re-engineer, restructure, remodel to make healthcare fit for purpose and to be resilient.

Healthcare workers will not only have to change the way they practice, but the whole healthcare system must be remodelled to manage the challenges ahead. The issues we face today will change the way we look at healthcare in the future. What is certain is that the future of health is not the normal we had before the Coronavirus global crisis.

HOW DO WE NAVIGATE THIS HEALTHCARE CRISIS? This Pandemic was not the first – there were others. The recent epidemics were more regional. Unlike the Ebola and Zika virus, Covid-19 is global.

Certainly, no country was prepared for the rapid spread, the high morbidity and certainly a disproportionate number of deaths. What is even more difficult to explain is that the high socio-economic countries were more inflicted.

Certainly, in South Africa, we were unprepared, and the rate of the spread globally resulted in too short a period to prepare.

McKinsy and Company describe five stages, leading from the crisis of today to the next normal that will emerge after the Coronavirus is over: Resolve; Resilience; Return; Reimagination and Reform.

1. RESOLVE Presently Healthcare is in crisis and our response is in full motion.

We are challenged with shortages of medical supplies, test kits and PPEs. There are numerous strategies in place to alleviate these shortages.

The challenge we are facing is that healthcare services must go on despite the shortages of essential items, no vaccines and definitive treatment guidelines.

2. RESILIENCE “The Pandemic has affected the economy to such an extent that healthcare is also in crisis and its ability to protect public health is jeopardised.” (Kevin Sneader – McKinsey & Co).

The duration of this crisis is unknown. The McKinsey Institute Analysis states, the shock and economic impact could be the biggest in a century. They go onto state that in the face of these challenges, resilience is a vital necessity, as much of the country will be experiencing uncertainty.

3. RETURN • Return to business after a severe shutdown is extremely challenging • Most businesses need to reactivate their entire supply chain • The Return will have its own challenges for the health sector – o State of health

Increased burden of disease Health system strengthening Rebuilding public health, etc.

4. REIMAGINATION The shock of this health crisis and economic crisis will see new shifts to the way we manage the post viral era. The challenges and vulnerabilities must be worked through but we need to also look at the opportunities that present to improve the performance of the healthcare business.

“We will see opportunities to push the envelope of technology for the future of health. IT and AI will pave the way to bring in efficiencies.” In the light of an escalation of NCDs, AI will set the platform to achieve efficiencies.

5. REFORM “Business leaders need to anticipate popularly supported changes to policies and regulations as society seeks to avoid, mitigate and pre-empt a future health crisis of the kind we are experiencing today.” (McKinsey & Co).

We will need to find ways to manage increased patient loads. “This may mean seamlessly across in-patient and virtual care” (Kevin Sneader).

We need to remodel and restructure the way our supply chain functions optimally – this will include increased medical devices, equipment, medication and facilities.

We will need to reflect on the past inefficiencies and shortcomings and put programmes and systems in place to fast track a new normal.

Healthcare will not be improved unless we restructure and improve alongside the global economic sector.

The success of the future will depend on how we reflect on the past and how we set about developing a new normal from the shortcomings and inefficiencies of the past.

The stock and aftermath will bring healthcare stakeholders together as we all will need to commit to a new way in which we deliver healthcare.