Covid-19 in MENA: A Stress Test on Resilience in a Data Deprived Environment

These feedback-response mechanisms were challenged by many factors. The novelty of the threat created great uncertainty that challenged all countries at the onset of the pandemic. But some countries fared far better in case detection (as reflected by share of positive tests, or test positivity rate). The problems in worst-performing countries included poor testing capacities or delay, hesitation, denial, or even willful suppression of testing. Reliable case detection was the critical feedback mechanism for an adaptive response, yet the global surveillance infrastructure did not keep pace with Covid-19 transmission. Without reliable data, the public health response could not be well-designed, and decisionmakers could not be held to account. As with diagnostic testing, similar stories could be told about viral genomic sequencing, availability of personal protective equipment for health and essential workers, utilization of hospitals, or vaccinations, among others.

Covid-19 in MENA: A Stress Test on Resilience in a Data Deprived Environment

At the end of August 2021, the MENA region had accumulated more than 12 million confirmed Covid cases and more than 200,000 confirmed deaths from Covid-19 (World Bank Data 2021). Official numbers indicate that Covid-19 became the fifth leading cause of death in the region (assuming 2020 causes of death were otherwise comparable to 2019). However, such factors as test positivity rates, seroprevalence (the actual infection rate), and known widespread health service disruptions suggest that the impact of Covid-19 is grossly underestimated.

Covid-19 placed intense demands on MENA health systems, which had limited ability to deal with shocks and were already struggling to cope with the truncated economic, demographic, and epidemiological transitions. On the eve of the pandemic, the capacity of public health systems in MENA to deploy public health service resources and deliver both individual health services and critical public health functions were stressed.

Resourcing a resilient health response. The existing weaknesses in financial, human, and physical resources before the pandemic challenged MENA health systems’ abilities to absorb the Covid-19 stress while maintaining core functions. Indeed, this was probably true around the world; and it is probably too early to draw firm conclusions about performance of MENA health systems during the ongoing crisis, particularly because of the imperfect information and public communication that are deployed in MENA. For example, 2020 health financing data on Covid-19 outlays, changes in total health spending, and the effect on OOPS and/or impoverishing spending, are not systematically or widely available.

Even if the stress test occasioned by the pandemic has not yet produced firm conclusions on the resilience of health financing, it seems clear that the limited resilience of the health-care workforce and the supply of medical products and technologies, caused critical bottlenecks. The WHO Pulse Survey found that 53 percent of the WHO Eastern Mediterranean Regional Office (EMRO) countries20 reported disruptions in the delivery of health care service because not enough staff were available (see Figure 6.1). Health care staffing was strained by the need to reassign workers to care for Covid-19 patients, the large number of infections among health care workers, and the absenteeism by workers who feared getting infected (fears that were undoubtedly exacerbated by a lack of personal protective equipment). Anecdotal evidence suggests that as many as 20 percent of health care workers contracted Covid-19 (WHO EMRO 2020), but there are no formally-collected or available data on worker infections (WHO Covid-19 Surveillance Dashboard 2021). Cancellations of elective care accounted for 47 percent of service disruptions.

20 The WHO EMRO countries comprise all MENA countries (except Algeria) plus Afghanistan, Pakistan, Somalia and Sudan.