Health governance to control COVID-19

Published in El Pais, 21 July 2020.

I am conducting collaborative research with several researchers from different countries on the control of COVID-19. In Bolivia, some of the results show a weakness in health governance and this negatively affects the control of the pandemic. What is governance? It is a form of government based on the balanced relationship of the State, civil society and the market to achieve stable economic and social development. In the case of COVID-19, this cooperation should help control the pandemic while respecting legitimacy and prioritizing efficiency to act in a timely manner in an environment of democracy and citizenship.

Bolivia has been in the past 14 years in a centralized model and has not given sufficient legitimacy to any independent institution. It is now clear that the government has wanted to centralize the testing of COVID-19, the dissemination of information, the COVID-19 health centers all controlled by the government. The government has wanted to monopolize the control strategy by failing to send a clear message on how to attack the pandemic among all with co-responsibility and giving legitimacy to institutions such as scientific ones. It has tried to do it only, both the scientific, strategic, health care and has collapsed without managing to regulate or give good quality to any of the aspects. Having 14 universities on average, none had a role to advise the government in planning with a dynamic model, or to define the treatment to adapt to the different stages of COVID-19, or the protocols to hospitalize or keep patients at home. As the government has left these large gaps, in addition to not supporting the strengthening of the health system, each health center has “done what it has been able to”, each one in a different way, widening the gap between the private sector, the public sector and the insurance sector. Bolivia has a high mortality rate among health personnel due to this error. The population that suffers from the lack of governance and leadership of the Ministry of Health, has also taken its own actions and self-diagnoses, self-medicates, self-internally, seeing that the entire health system is chaotic and has collapsed.

Epidemiological models for Bolivia show that, on average, the statistics presented by the government show less than 6 to 8 times the number of cases and less 6 times the number of deaths from COVID-19 because they are simply not testing everyone. Many countries are accepting the error in their statistics and this has served to make people co-responsible and act accordingly. Bolivia could do the same, give a common message and start a collaboration with other actors in society in order to control the pandemic more quickly and taking advantage of the strengths of each institution for better management.