Oh, mother, mother, I am sick,
Call the doctor very quick!
Doctor, doctor, shall I die?
Tell my mama do not cry
— Yoyoy Villame’s
a kindergarten song
Our people are getting sick and dying because of COVID-19. Our health system is on the verge of collapse. We are experiencing a new surge of transmission, which could make our urban areas suffer the catastrophe that Italy and New York City went through.
Whom do we call? Whom do we believe? The politician? The general? The businessman? Everyone has an opinion, but the doctor’s word ultimately carries the most weight.
Last weekend, on Aug. 1, doctors banded together in a press conference to present an appeal to President Rodrigo Duterte for a “return to Enhanced Community Quarantine (ECQ) in Mega Manila” for a period of two weeks. So far, 98 medical associations nationwide, and counting, have signed the letter of appeal.
Media organizations tend to highlight the call for a return to ECQ. But the main substance of the medical community’s message is how “to recalibrate strategies against COVID-19.”
The ECQ is necessary not only for the overwhelmed and exhausted health system to recover but also for the whole of government and the whole of society to regroup and build a consensus on the strategies to contain COVID-19.
In other words, the ECQ by itself is insufficient. The ECQ’s role is to wake up the nation, agitate the nation to act as one in pursuing the ideas and practices that work and abandon those that do further harm.
The doctors have outlined the areas that need “recalibration.” To wit: 1) hospital workforce deficiency, 2) failure of case finding and isolation, 3) failure of contact tracing and quarantine, 4) transportation safety, 5) workplace safety, 6) public compliance with self-protection, and 7) social amelioration.
Government is in fact aware of these issues. The problem lies in the weakness, if not failure, of execution. This brings to fore the role of governance and leadership. The statement of the doctors does not dwell on this, but the proposed “recalibration” of strategies around the seven areas enumerated above suggests a rethinking of leadership and governance.
Here, I present some ideas on leadership — in fact, ideas articulated many times over. It is an attempt to tackle the bull by the horns. I may miss other equally important elements, but my intention here is to push the limits of the appeal of the doctors.
First, the communications strategy is a strategy in itself. The war against COVID-19 cannot be won without a lucid and credible communications strategy. Transparency is also embedded in an effective communications strategy.
The recent example of failed communications was the knee-jerk response of Presidential Spokesperson Harry Roque to the appeal of the doctors. The doctors were still having their press conference when Mr. Roque issued a statement that thumbed down the call of the doctors to restore ECQ. Hours later, he took back his earlier pronouncement and said that the Palace would take up the recommendations of the doctors.
Another example of confused messaging, as observed by The Asia Foundation’s Jaime Faustino, is the government’s fixation on acronyms that are indistinguishable to the public. ECQ, GCQ, MECQ and the like make an alphabet soup that is not at all tasty.
Worse, the government becomes the purveyor of fake news. The President’s statement that gasoline can disinfect facemasks is no joke.
On matters relating to public health, let the Department of Health (DoH) do the talking. But even here, the DoH has shortcomings. The noise over the “mass recovery adjustment,” wherein tens of thousands COVID-19 patients were instantly categorized as recovered, could have been avoided. The DoH at the outset could have explained to the public the change in the criteria, consistent with international practices.
Arguably, to boost credibility, the DoH must have a Pinoy Anthony Fauci as the government advisor on the pandemic but who has the independence to call out leaders when they are wrong.
Second, the government suffers from the lack of an integrated over-all command, resulting in the breakdown of policy execution as well as policy inconsistency.
Take the case of contact tracing. The DoH had approved a strategy for contact tracing months ago. It also laid out the plans for an intensified house-to-house campaign in communities with clusters of infection to screen, test, trace, and quarantine. The implementation of this, however, rests on the Department of Interior and Local Government (DILG) and local government units (LGUs). Weeks have passed, but the DILG and LGUs have not moved this strategy.
The best illustration of policy inconsistency is about the issue of rapid antibody tests (RATs). The DoH and expert advice, both locally and nationally, have warned about the inappropriate use of RATs. RATs cannot be used to screen and diagnose people for COVID-19. This test yields a high number of false positives and false negatives. Their use is limited to determining serological prevalence (but even at the height of the pandemic, estimating serological prevalence is difficult to do technically). Yet, till now, some agencies and LGUs continue to use RATs for testing. The inappropriate use of the unreliable RATs has contributed to the virus spread.
The bottlenecks in policy implementation and the policy inconsistencies can be avoided by having an integrated command and an integrated strategy. But having “tsars” outside the DoH ambit, like the contact-tracing tsar and the testing tsar, and allowing LGUs to make their own rules that contradict DoH guidelines have exacerbated this problem.
The flow of decision-making in the Inter-Agency Task Force (IATF) itself is not clear either. Seeing the IATF’s organizational chart is like admiring Imelda Marcos’s doodle. The bottom-line is that the decisions and accountability rest on the different departments.
In truth, despite all the shortcomings of the DoH, it has demonstrated that it can execute good plans and strategies. It has shown this in the recent highly successful campaign to defeat the polio outbreak.
In this light, it is high time Secretary Francisco Duque moved from being the IATF’s chairman of the board to being a general in command of a field army that is the DoH.
Together with the support of the medical associations, the DoH can get a renewed boost. All of us must take in earnestness a whole-of-government, whole-of-society approach to fight COVID-19. Let’s heed the appeal of the doctors, and transform the crisis into an opportunity to put in place the institutional and policy reforms to beat COVID-19.
Filomeno S. Sta. Ana III coordinates the Action for Economic Reforms.