2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
Physical resources to admit COVID-19 patients were non-existent at the outset. However, following the WHO official declaration of a pandemic, Public Health Emergency of International Concern plans were made and clinics/buildings were dedicated to COVID-19 management. Health authorities in RS developed plans based on WHO transmission scenarios (cases, clusters, community transmission) to increase the availability and RS distribution of COVID-19 physical resources. Designated hospital capacities were repurposed in Banja Luka (35 designated COVID-19 ICU beds in Banja Luka; 15 designated COVID-19 ICU beds in other 10 hospitals across RS), followed by increasing the number of available hospital beds in all RS hospitals in the case of a community transmission scenario. All 50 designated COVID-19 ICU beds require the necessary ICU equipment (ventilators). Health authorities in FBIH (which is devolved to 10 cantons with their own effectively independent health systems and corresponding physical resources) have provided information on the total availability of hospital beds and ventilators in FBIH (19 hospitals with 800 beds and 141 ventilators). They also initially designated 6 hospital facilities for clinical management of COVID-19 (Sarajevo, Bihac, Tuzla, Zenica, and two in Mostar), with total capacity of 264 beds. As of the 26 March the Director of the Clinical University Centre in Sarajevo has also announced that the Centre has secured 47 ICU beds for the most severe COVID-19 cases, equipped with more ventilators, a new CT scan and the potential to increase capacity up to 100 beds.
With a surge in number of COVID-19 patients requiring treatment and medical attention in July, almost all COVID-19 designated hospital facilities in BIH are urging to expand capacities in available beds. The situation appeared most critical in Sarajevo, where the stretched available capacities of 100 beds at ‘Pothrastovi’ hospital might be exhausted in a matter of days (20 July). The Government of Sarajevo Canton decided to urgently renovate one of the former military hospital units (within the General hospital Sarajevo complex) into an additional COVID-19 hospital facility for Sarajevo, with a capacity of 60-80 beds (16 July). However, as the renovation and equipping of that facility would require at minimum two months, the authorities proposed alternative temporary solutions, ie. repurposing of big Sarajevo halls (Zetra, Skenderija) which could be set up in 24 hours if needed (4 August). On 7 August, the Crisis Management HQ of Sarajevo canton announced that a new facility with 100 beds for COVID-19 patients with mild to moderate disease would be operational as of 10 August in the student centre ‘Bjelave’, in the proximity of the main ‘Pothrastovi’ facility.
In RS, the Prime Minister of RS confirmed that substantial financial resources would be allocated for the adaptation and reconstruction of additional capacities designated for COVID-19 treatment. In Banja Luka, the former surgery clinic building would be refurbished, while COVID-19 clinics would be also established in Bijeljina, Doboj, Foca and Nevesinje (15 July). In FBIH, the Prime Minister called for an emergency meeting on 10 August with all the cantonal Prime Ministers, representatives of FBIH Parliament, FBIH Ministry of Health, Crisis Headquarters and Civil Protection Administration to discuss the deterioration of the epidemiological situation. The meeting concluded with the announcement that all available hospitals In FBIH would be asked to activate COVID-19 isolation areas, while work would be initiated to develop a single COVID-19 database covering all the cantons. Cantonal authorities were also reminded that they could introduce additional specific measures reflecting the changing epidemiological situation, while FBIH Inspection Affairs announced stricter presence and fining.
There is a documented shortage of personal protective equipment (PPE), medical supplies, reagents and laboratory supplies, hospital capacity, ICU equipment and capacity and ventilators. Requests for urgent purchase of ICU equipment/beds for COVID-19 designated facilities, lab tests/kits and reagents, PPE, and hygiene/hospital disinfection have been prepared by both RS, FBIH and the Brcko District BIH (BD BIH), consolidated through the Ministry of Security of BIH on 24 March, and communicated to the international community in BIH. A UNDP Procurement Team, with technical assistance from the WHO Country Office for BIH, has been tasked with both local and international procurement of clinical management essential equipment – prioritized based on WHO specification https://www.who.int/publications-detail/disease-commodity-package---novel-coronavirus-(ncov) – lab tests/kits and reagents, case management, PPE, and hygiene/hospital disinfection material.
In both RS and FBIH, there is no formally written plan either for repurposing existing ICU hospital physical resources, or for moving existing ICU hospital resources or equipment to COVID-19 designated facilities/beds, which are all located in infectious diseases/TB hospital wards/facilities in separate buildings. Dedicated staff have been directed to work only with COVID-19 patients, without mixing with other health professionals or patients. Efforts to increase testing have been ongoing and contact tracing has been supported by medical students. The UNDP Procurement Team, guided by the WHO Country Office for BIH, is helping to fast-track local and international procurement. Both local and international procurement are proving difficult: for example, the local stock of ventilators available is well below projected needs but global and international supply chains have also been disrupted, meaning reduced availability. Both the availability and utilisation of confirmation tests has been increasing.