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
There is currently no reported immediate shortage of PPEs for use both in the testing hubs and also within medical facilities. Primary care physicians who work solely in the private sector are also provided with a limited supply of PPEs against a one-time administrative fee. In the Maltese health system, around two-thirds of primary care consultations occur in the private sector, paid for through out of pocket payment and provided in small clinics by solo general practitioners (GPs). At the start of the COVID-19 outbreak many of these solo GPs curtailed their services, deeming that the walk-in system in a small clinic with no isolation facility posed too high a risk for themselves and their patients. A number have opted to substitute their service using telephone or virtual consultations through digital health and this practice has been endorsed by the Medical Council, the competent authority that regulates medical practice in Malta. This has resulted in a spill over of a number of patients to the public primary health care system and to hospital emergency facilities.
The number of isolation beds in hospitals have been increased, with arrangements made to have an additional 600 isolation beds available within a few weeks to enable the isolation of positive cases. These were created in non-clinical areas of Malta’s only major acute hospital, within private medical facilities and within other state-owned health facilities which have been vacated for this purpose. The number of Intensive Therapy Unit (ITU) beds has been increased five-fold (from 20 to over 100). There has also been a proportionate increase of ITU and isolation beds in Gozo. The setting up of a prefabricated hospital within 8 weeks in order to further increase ITU bed capacity within the hospital grounds is also under consideration. Separate COVID and non-COVID accident and emergency (A&E) – otherwise known as emergency room - areas have been created within the acute hospital to attempt to segregate COVID cases from non-COVID cases. Elective surgeries and elective outpatient appointments have been postponed in order to be able to focus resources where they are most needed.
Direct acquisition of PPEs is being undertaken at national level. Malta has also joined the EU joint procurement process for PPEs, laboratory reagents and tests and ventilators. Malta, like other countries, has been negatively affected by the export bans imposed by some countries, which is impeding the further acquisition of protective and medical equipment in a rapid manner. Malta is using all its channels and means to secure the necessary supplies, the demand for which is expected to increase with rising local transmission; however, as a small country with finite resources it intrinsically faces a procurement disadvantage in political, diplomatic and economic terms. All measures are being taken to ‘flatten the curve’ and avert strain on the health system from having to deal with a potential overwhelming sudden increase in the numbers of cases requiring intensive care.
With respect to medicines and active ingredients, Malta is actively monitoring the situation in order to identify and anticipate any possible shortages and take immediate remedial action, especially in the case of border closures by third countries [such as India] which usually supply the medicines or active ingredients. So far, no shortages of immediate consequence have been identified.