Khan Mushtaq, Roy Pallavi, Matin Imran, Rabbani Mehnaz, Chowdhury Rajiv
Economics and Head of Anti-Corruption Evidence Research Partnership Consortium (ACE), SOAS University of London, United Kingdom.
ACE, SOAS University of London ACE, SOAS University of London, United Kingdom.
World Dev. 2021 Jan;137:105213. doi: 10.1016/j.worlddev.2020.105213. Epub 2020 Sep 26.
In the absence of an efficacious and affordable vaccine, the current crisis of COVID-19 is likely to be a long drawn one for many developing countries. In Bangladesh, where the entire population is susceptible and strict lockdown has been relaxed (as of May 31st 2020) due to concerns over saving livelihoods, the best available resources and capacities in the country have to be mobilized for an integrated and adaptive response strategy. In this paper we argue that a suitable response strategy for a country with highly constrained health system, must consider how response components will be delivered at scale, along with what can be delivered. In order to save maximum number of lives, an optimal strategy will be one that is able to iteratively select the most feasible set of health response and the network of organizations that can deliver most effectively at scale. This might require thinking outside of the conventional vertical network of public health system. Given its history of high-capacity non-government organizations in Bangladesh, it is likely that there are multiple alternative horizontal network options for delivering any set of response interventions. In fact many horizontal networks are already actively engaged in COVID-19 response work. The goal should be to identify and coordinate these networks, create new networks, and embed mechanisms for scaling up what works and scaling down what does not work. For a rapidly escalating and unpredictable crisis such as COVID-19, an adaptive response strategy is needed which allows for old and new networks of organizations to align and work collectively with minimum loss of lives.
在缺乏有效且可负担疫苗的情况下，当前的新冠疫情危机对许多发展中国家来说可能会持续很长时间。在孟加拉国，全体民众都易受感染，由于对生计问题的担忧，严格的封锁措施已经放松（截至2020年5月31日），该国必须调动现有的最佳资源和能力，制定综合且适应性强的应对策略。在本文中，我们认为，对于一个卫生系统高度受限的国家而言，合适的应对策略必须考虑如何大规模提供应对措施，以及能够提供哪些措施。为了挽救尽可能多的生命，最优策略应是能够反复挑选出最可行的卫生应对措施组合，以及能够大规模高效提供这些措施的组织网络。这可能需要突破传统公共卫生系统的垂直网络思维。鉴于孟加拉国拥有高能力非政府组织的历史，对于提供任何一套应对干预措施而言，很可能存在多种可供选择的横向网络。事实上，许多横向网络已经积极参与到新冠疫情应对工作中。目标应该是识别并协调这些网络，创建新的网络，并建立机制，扩大有效措施的规模，缩减无效措施的规模。对于像新冠疫情这样迅速升级且不可预测的危机，需要一种适应性应对策略，使新旧组织网络能够协同合作，将生命损失降至最低。
