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Source: Dr. Elizabeth Gitau, CEO, Kenya Medical Association
News that a local health worker has contracted the coronavirus has just demonstrated the increased need for the provision of personal protective equipment for the individuals on the frontline combating the spread of the virus.
As essential health workers take care of patients with COVID-19, they require personal protective equipment (PPE) that include surgical masks, respirators (N95 masks), eye protection (goggles), latex gloves, boots, long-sleeve gowns and hazmat suits.
A study by the World Health Organization (WHO) indicates that the current global stockpile of PPE is insufficient, particularly for medical masks and respirators; and the supply of gowns and goggles is soon expected to be insufficient. Surging global demand − driven not only by the number of COVID-19 cases but also by misinformation, panic buying, and stockpiling − will result in further shortages of PPE globally. The capacity to expand PPE production is limited, and the current demand for respirators and masks cannot be met, especially if widespread, inappropriate use of PPE continues.
Health workers around the world have improvised PPEs as shortages hit, with nurses in New York using garbage bags as gowns, and doctors in Italy improvising snorkelling masks to be used as reusable respirator masks.
The situation in Kenya is no different. There has been increased demand for personal protective equipment especially surgical masks, N95 masks and disposable gloves. This accompanied by reduced supply from China, a major supplier of medical equipment, has resulted in hiked prices of the commodities by suppliers due to surge in demand.
Many private facilities are struggling to access the PPEs due to unavailability from suppliers and increased prices, which are up to 10 times the normal prices. Some private health facilities are even considering scaling down operations or closing their facilities to avoid exposing their healthcare workers to COVID-19 in the absence of PPEs.
Getting it right
The management of PPE should be coordinated through the essential national and international supply chain management mechanism to reduce the bottleneck in access. This would entail the Government of Kenya considering taking control of the PPE supply chain through direct importation, explore government to government deals with China, India, and other countries who are major exporters of medical supplies and centralising the ordering process of PPEs. The Government should also consider the reduction of importation taxes on essential medical supplies.
To encourage local manufacturing of PPEs, the government should subsidise production cost for local manufacturers and reduce the regulatory and licencing issues for local manufacturers that can produce PPEs for Kenya and the region to accelerate processes of manufacturing PPEs without compromising quality. Innovation aimed at designing PPEs from locally available materials should be encouraged by the government to reduce the bureaucracy associated with approval of new innovation.
The main pharmaceutical suppliers, KEMSA and MEDS, who are major distributors, should be allowed to supply PPEs to private facilities in addition to the public facilities and faith-based health institutions they currently supply.
Greater coordination by all stakeholders including the Ministry of Health, KEMSA, development agencies, KEPSA and KAM would ensure optimisation of the supply chain. This would enable price control of PPEs as opposed to allowing market forces to determine prices.
PPE use in hospitals should be based on the risk of exposure and health workers should be sensitised on the various PPE needed for the different setups as per WHO guidelines. Health administrators need to be aware of the concerns of health workers to allay their anxiety and reduce the insistence of use of full PPEs out of fear of their health.
Hospitals can minimise the use of PPEs by embracing telemedicine consultation, use of physical barriers such as glass windows for pharmacists dispensing medicine and restricting patient rooms to only health workers taking care of the patient.
The severity of the situation dictates that we need to protect our health workers, who day-in-day-out are doing all things possible to protect the rest of the country from a full-blown outbreak. If we leave the health workers to undertake this daunting task without the necessary equipment and they end up getting infected, where does that leave the country in the efforts to mitigate the surging spread of COVID-19?