Building a health care system better prepared for health emergencies: The Bahamas COVID-19 experience

The Bahamas is a small archipelago of 700 islands and 2400 cays situated 50 miles off the coast of Florida, United States of America. The Bahamian health system aims to provide equitable access to quality health care for approximately 389 000 people; however, fragmentation of service delivery within the public and with the private health sector presents a challenge. Recent natural disasters and the COVID-19 pandemic have stretched the health system to capacity, exposing long-standing structural and systemic deficiencies. To strengthen the resilience of the Bahamian health system, the Pan American Health Organization/World Health Organization (PAHO/WHO) provided technical cooperation for capacity building to the Government of The Bahamas to rapidly detect and respond to future health emergencies.  

How did The Bahamas do it, and how did the WHO Secretariat support The Bahamas?

• By strengthening policy – PAHO/WHO provided technical advice and operational support to develop policies for public health and COVID-19 outbreak prevention and control. This included policy and guidelines for clinical management, infection prevention and control, disease surveillance, case and contact management, mental health and psychosocial support, travel, employers, schools, and social support for vulnerable groups.

• By mobilizing funds – PAHO/WHO supported the Ministry of Health and Wellness to mobilize financial and technical support for the COVID-19 response from other United Nations agencies, foreign missions, the public sector, and civil society. High-level discussions were held with the Prime Minister, Cabinet, and opposition on the COVID-19 situation, its links with public health and economy, and the various options for strengthening the public health response. The main focus areas included coordination, planning, monitoring, surveillance, operational support, logistics, supply chain, the continuation of essential health services, and risk communication.

• By strengthening disease surveillance – PAHO/WHO temporarily assigned epidemiologists to support the Ministry of Health and Wellness in surveillance and data management for COVID-19. In addition, PAHO/WHO guidelines on epidemiological surveillance, contact tracing, case isolation, and quarantine of contacts were adapted to The Bahamas context. PAHO/WHO conducted training and provided software to build capacity in data analysis and reporting, including the use of a contact tracing tool. The Ministry of Health and Wellness conducted a review of medical records to assist with the classification of COVID-19 deaths. PAHO/WHO provided financial support for an online contact tracing course in collaboration with the University of The Bahamas. A task force supported COVID-19 outbreak investigations and vaccine distribution with the participation of PAHO/WHO staff. PAHO/WHO provided technical support to develop a relational database integrating data collected from different stakeholders to improve data gathering, analysis, and information generation. PAHO/WHO continued support to strengthen the Ministry of Health and Wellness Emergency Operating Centre to monitor emergencies by providing equipment and developing reporting dashboards.

• By increasing surge capacity – Tools and guidelines prepared by PAHO/WHO facilitated planning for clinical and hospital surge capacities (hospital beds, human resources, and supplies). Assistance was provided for the expansion of acute care services. PAHO/WHO provided modular units to expand isolation and triage capacity, and medical equipment and devices to strengthen clinical care for COVID-19 cases in the main hospitals and primary health clinics. To minimize COVID-19 infections, improvements were made to patient and staff workflows. Guidance was provided to enable clinical guideline development and updated for patient management according to severity classification. PAHO/WHO also supported the operations, logistics, and supply chain by providing medical equipment and devices, laboratory equipment and supplies, personal protective equipment, nasopharyngeal swabs, and hand sanitizers, with an investment of over half a million dollars.

By enabling risk communication 

Risk communication and public education products on topics including mental health, cyber safety for children, prevention of gender-based violence and substance abuse, parenting during COVID-19, and tips for isolation during quarantine were developed with support from PAHO/WHO. The communication materials were disseminated through PAHO/WHO social media platforms and via local mass media and partner agencies, including press conferences, town hall meetings, radio/TV interviews, and social media. Logistical support was provided to the Ministry of Health and Wellness to prepare and print communication products, including the preparation of Haitian Creole-language communication products for use with the Haitian migrant community through collaboration with other United Nations agencies.

By overcoming multiple challenges, including human resources shortages, requisite multitasking, and scarce financial resources, The Bahamas significantly improved its capacities in key aspects of the health system, such as disease surveillance, clinical care services capacities, and risk communications, to rapidly detect and respond to future health emergencies sustainably. The government’s strengthened ability to respond, for example, to COVID-19 surges is likely to have already prevented thousands of COVID-19 infections and deaths. Strengthening is still required in some key areas, including reinforcing the Ministry of Health and Wellness surveillance unit with additional trained human resources and further data management and analysis support to sustain the progress gained over the past two years. By building a more resilient health care system, The Bahamas is now much better equipped to detect and respond to natural disasters and disease outbreaks in the future, which is expected to save thousands of lives.

[1] https://thenassauguardian.com/govt-working-on-a-national-covid-19-vaccination-plan/

Photo Credit: © The Bahamas Ministry of Health and Wellness

Photo Caption: PAHO/WHO Representative for the Bahamas and Turks and Caicos Islands, Dr Eldonna Boisson, the former Prime Minister, Honorable Dr Hubert Minnis, the former Minister of Health, Honorable Renward Wells, and other Ministry of Health officials receiving COVID-19 vaccines via the COVAX facility mechanism