It is with great pleasure that I welcome the opportunity to contribute insights from a Canadian perspective. This COVID-19 Special Issue on “Strengthening Health Systems in ASEAN” is timely to reflect on the challenges posed during this unrelenting global pandemic.
As our partners are aware, Canada continues to be a strong and vocal advocate at home and around the world for gender equality, the empowerment of women and girls, and the realisation of their human rights. Despite global progress, gender inequalities persist in all sectors of social and political life, in all countries, including in Canada and here in the ASEAN region.
Apart from its devastating economic impact, the pandemic has widened the gender and economic inequality in the world. Women across the ASEAN region have been disproportionately affected due to their overrepresentation in sectors hardest hit by the pandemic— manufacturing, textiles and garments, care services, hospitality, and tourism. Globally, women make up to 70 per cent of the health and social care workforce. Economic necessity forces many to continue working, despite the risk of infection for them and their families. The economic fallout and the health risk for women will intensify the gap, and without gender-responsive policies in place, the crisis can have regressive impacts and derail hard-won gains in gender equality and other inclusionary efforts.
The surge in COVID-19 cases is straining even the most advanced and best-resourced health systems. With resources diverted to fighting the pandemic and the cancellation of other essential health services, many women were left without adequate maternal and sexual and reproductive health services and rights. Despite the pandemic’s strain on health systems, governments must ensure that essential health services continue with initiatives integrating gender mainstreaming to safeguard gender equality in its policies and programming to protect the sexual and reproductive health and rights of women and girls and their newborns.
Current health systems approaches do not adequately address the impact of COVID-19 on certain groups who are most severely impacted by the pandemic—in particular women. In Canada, while responding to COVID-19, the first focus was on descriptive statistics (number of cases), but there was no analysis on who was affected most. This kind of research should be done sooner to help design interventions. Initiatives to assess gender impacts and differential impacts on the poor and marginalised are also needed in other countries to share with decision-makers so that interventions are targeted and not too diluted.
Strengthening health information systems to improve sex-disaggregated data, and data disaggregated by other factors are extremely important to inform appropriate interventions. Closing the gender data and information gap requires: 1) collection of real-time COVID-19 data on incidence, hospitalisation, testing, and mortality; 2) greater support to national statistical systems, strengthening of gender data collection, and integration of a gender perspective in all statistical operations; and 3) investments in dissemination and use of gender data.
Improving access to gender-responsive health services for all women and all gender orientation requires initiatives that decentralise health systems by strengthening the role of primary health care services to reach vulnerable groups and provide gender-responsive services, including ensuring that concerns, needs, and priorities of the poor and the marginalised are included in the service provision.
But, there is also the question of preventing, detecting, and responding to health threats. Canada’s Weapons Threat Reduction Program (WTRP) deeply values its impactful collaboration with the ASEAN Health Sector through the Mitigation of Biological Threats (MBT) Program. This collaboration has meaningfully enhanced the capacity of ASEAN partners to prevent, detect, and respond to all manner of biological threats, whether natural, accidental, or deliberate in origin. Canada is particularly pleased that the capacity built has supported the ASEAN response to the COVID-19 pandemic, including the ASEAN Emergency Operations Center Network (led by Malaysia) and the ASEAN BioDiaspora Virtual Centre (led by the Philippines, with support from Singapore). We are committed to furthering these successful partnerships and working with ASEAN to engage other partner nations and organisations with a shared commitment to strengthening health security. We see an opportunity to better engage with other members of the G7-led Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), in close cooperation with the Philippines (the only ASEAN member of the GP). Similarly, the new ASEAN Centre for Public Health Emergencies, if properly structured, has the potential to serve as an important base for projects supported by Canada and other donors.
Access to health care underpins the ability to respond. Universal and publicly funded health care is a core Canadian value. By ensuring reasonable access to health care services, Universal Health Coverage (UHC) enables a healthy and productive labour force, and inclusive and sustainable economic growth. Ensuring all people have access to health care services can help reduce the impact of inequities, including those based on gender, race, and disability status. Canada’s health-care system is designed to ensure that all eligible residents have reasonable access to medically necessary hospital and physician services on a prepaid basis, without charges related to the provision of insured health services.
In terms of lessons learned from Canada’s health system, we can underline a couple of key points. The system offers a competitive advantage for Canada in a competitive world. It is a driver of a more inclusive and productive economy, as businesses are not burdened with financing health insurance premiums for their employees. It enables employees to change jobs and move between regions without fear of losing their health care coverage. Also, the system is flexible: while provinces and territories manage health care services tailored to the needs of the residents of each jurisdiction, the federal government ensures national standards for hospital and physician services are maintained through the Canada Health Act.
The COVID-19 pandemic has shown Canada’s UHC strengths and weaknesses. Cost is not a barrier to accessing medically necessary hospital and physician services. COVID-19 testing and virtual care services are available free of charge. Inequities have been reduced (e.g. testing is available for everybody, and there is a commitment that vaccines will be free for all). Provincial/territorial management of the health care system means that centralised management and reporting systems were already in place to deal with the pandemic, e.g. testing, tracking, and contact tracing of cases, supply and distribution of personal protective equipment, and supply of hospital intensive care resources.
However, COVID-19 exposed long-term care as a clear vulnerability in Canada—early data show two out of three deaths from COVID-19 in Canada occurred in long-term care facilities, and the rate of death from COVID-19 among longterm care residents is higher than in many countries. These tragedies may be due, in part, to long-term care not being fully embedded in UHC in Canada and not benefitting from the same attention as other areas of health care, such as hospital safety and governance.
One fact is clear: to respond effectively to a global pandemic there needs to be a collective effort. The COVID-19 pandemic has underscored the need to reinforce and deliver on joint commitments by the international community to strengthen health-security systems and reinforce prevention, preparedness, detection, and response capabilities worldwide. The UN Secretary-General has flagged that the pandemic may increase bioterrorism and other international security threats. Canada is committed to working with partner countries and organizations to deliver concrete and impactful programming to mitigate all manner of biological threats, including in the ASEAN region.
One key lesson from the pandemic is that international security partners (e.g., Canada’s WTRP) have the ability to move quickly and decisively to deliver assistance during a crisis, which underscores the importance of further strengthening collaboration at the health-security interface. In addition, it will be important to encourage traditional partners to apply creative and innovative solutions for a range of pressing challenges, including real-time disease surveillance (using big data analytics, machine learning, and artificial intelligence, such as that offered by the BioDiaspora Virtual Centre) and the development of new types of sustainable biological laboratories and equipment. The pandemic has revealed the fragility of supply chains and the vulnerability that comes with concentrating critical industries in a few countries (whether vaccine production or PPE manufacturing)—key issues that will need to be considered if the international community is to be better prepared to prevent, detect, and respond to the next pandemic.
