Shutdown needs to be lifted cautiously in phases: ADB Country Director

Country Director of the Asian Development Bank (ADB) in Bangladesh Manmohan Parkash has said a carefully-crafted exit strategy that draws a fine balance between normalising socioeconomic activities and containing the spread of virus is needed for Bangladesh.

"There's a growing debate among the policymakers, if easing of the restrictions is necessary now to help restart the economic activity. Given the potential severity of the pandemic and it's unclear and unknown impact, a carefully-crafted exit strategy that draws a fine balance between normalising socioeconomic activities and containing the spread of virus is needed," he said in an interview with UNB.

Manmohan Parkash said both health-related and non-health related actions together are needed to control the spread of the disease and open up the economy.

He mentioned that health-related actions would include ramping up healthcare procedures, systems and supplies while non-health actions would include easing up of supply chains and logistics, particularly for the movement of much-needed essential goods and services, restoration of livelihood, manufacturing activities and managing large number of migrant workers coming from rural areas to work in Dhaka.

Replying a question how should the Covid-19-induced current shutdown be lifted, the ADB country director said the shutdown needs to be lifted cautiously in a pragmatic manner to allow economic activities while maintaining the basic health instructions for managing Covid-19 outbreak and sustaining the progresses achieved so far.

He said the ongoing shutdown is seriously affecting economic activities, including employment and livelihood opportunities.

"The poor and the vulnerable are the hardest hit by the shutdown, which is essential to save people from infection and to control the spread of the disease. There's no certainty on the behaviour of the epidemiological curve and hence it is nearly impossible to predict the ideal time frame to ease the lockdown."

Easing of restrictions cannot be sudden and complete. An environment needs to be created where people will feel reassured to go back to work without fear of getting infected, Manmohan said.

"Strict enforcement of rules and regulations is a key. Good law and order will help ensure social distancing. Cooperation from people is key to lift the shutdown step by step, adopting a slow but steady process."

Factories & Safety Plan  

Manmohan said the factories that reopening must have a health and safety plan. They should educate the workers also about the best practices that they should follow at the workplace. Crowded factories may consider initiating multiple shifts to avoid accommodating too many workers in one room.

He mentioned that the factory authorities should distribute adequate simple protective gears such as masks among the workers and carry out awareness programmes for the employees.

"Public transportation system like buses may be allowed with proper spacing of passengers, for example with less than 30 percent occupancy."

Manmohan said the shutdown needs to be lifted cautiously in a pragmatic manner to allow economic activities while maintaining the basic health instructions for managing Covid-19 outbreak and sustaining the progresses achieved so far.

Bangladesh's Request & ADB's Response

The ADB country director also said they are working hard to quickly respond to the government's request for $500 million in budgetary support.

"We're also working hard to quickly respond to the government's request for $500 million in budgetary support to augment the government of Bangladesh's efforts to manage the impact of the Covid-19 pandemic on the economy, health, and livelihoods," he said.

ADB board in its meeting on May 7 will decide the fate of this request from Bangladesh side.

Manmohan said this budgetary support will help the government address the challenges posed by Covid-19, with a strong focus on alleviating fiscal strain, expanding social safety net for vulnerable groups, providing increased salary support to export-oriented manufacturing industry workers and low-interest loans to industrial sectors and farmers.

"I am confident Bangladesh will successfully manage the Covid-19 challenges with help from all stakeholders and partners," he said.

Manmohan also said the Manila-based lending organisation on April 30 approved $100 million in assistance to support the government's efforts to address the immediate public health requirements of combatting the novel coronavirus disease (Covid-19) pandemic.

"This support will help strengthen Bangladesh's response to the Covid-19 outbreak by providing urgently needed health equipment, medical supplies, diagnostic systems, and upgrading of the capacity of the health workforce," he said.
He mentioned that this project will support the immediate procurement of equipment and supplies for testing; upgrade of medical infrastructure; and the development of system and community capacities for surveillance, prevention, and response to the pandemic in Bangladesh.

Saying that over the last few weeks, Bangladesh has taken decisive actions to manage the Covid-19 outbreak in the country, the ADB country director said the next set of policy measures need to focus on maintaining the progress achieved so far while looking for strategies to resume economic activities and livelihood opportunities for people.

"Though good progress has been achieved in controlling the spread of the virus, through the closure of offices and businesses, it has come at a high-economic cost," he added.

Lives & Livelihoods

Manmohan said it has disrupted the lives and livelihoods of the people. Businesses and industries are closed, demand for goods diminished, supply chains have collapsed, daily wagers have lost livelihood, and many employers are finding it hard to retain employees.

Talking about details of health-related actions that are necessary or would help, Manmohan said fundamental change that is needed for the containment of Covid-19 contagion is the human behavioural change. This includes limiting people's mobility, maintaining physical distance, and personal hygiene.

Policy Change

He said the first policy change needed is to move from physical containment to medical containment, which is Test, Trace and Quarantine. There should be more emphasis on testing. Currently, around 6,000 tests are carried out every day.

"This needs to be increased to 10,000-15,000 a day or even more. More testing would mean catching infections early, isolating patients and treating them faster for quicker recovery and lesser mortality. Tracing the contacts early will help containing the epidemic and quarantining them will help avoid the spread."

In this connection, Manmohan said Korea is a good example of overcoming the Covid-19 pandemic by following these principles of Test, Trace and Track.

Another key policy action needed, he said, is to protect and minimise the loss of front-line fighters including healthcare professionals and law enforcement personnel.

"Keeping them safe will help us fight the battle effectively. Providing them with proper protective gear, training, and support such as food, accommodation and recognition would help."

The ADB country director said the government has made good progress on developing additional infrastructure for quarantine and treatment by nominating hospitals, including in private sector.

Getting More Hospitals Ready  

This should be continued, and if necessary, more hospitals could be prepared by refurbishment and make-shift arrangements of facilities. While increasing diagnostic testing will help avoid the community spread, faster procurement and distribution of medical supplies would greatly help to protect the health professionals and treating patients, added.

"Good progress has been made for procuring PPEs, including N95 masks. More are needed, and all efforts should be made, including at diplomatic levels, to procure these items."

Manmohan pointed another key policy action which is needed to be ensure is normal healthcare regime for non-Covid related illnesses. This can be done by designating hospitals solely for handling non-COVID- 19 related health matters.

There is general fear among the people to visit hospitals and this could be overcome with this as there will be specific hospitals where there will be no Covid-19 patients.

Lastly, he said, existing public health initiatives must continue. Further emphasis on cleanliness and sanitation will help. This is critically important as the dengue season is around the corner. Continuation of public awareness and capacity building of entities dealing with the pandemic will go a long way in behavior change, which is so essential to manage this crisis.

Talking about non-health related actions that can help, he said, restoring the normal supply chain and logistics for the seamless movement of essential goods and services is the first priority.

"This will help ensure adequate availability and accessibility of food and other essential items, particularly in this Ramadan period. Closer coordination among road and rail transporters, district administrations, traders, and market aggregators can help."

He mentioned that the current crunch in demand can be managed by increasing government expenditure, providing salary support to the workers, helping people to raise their incomes, creating employments, enhancing people's mobility and boosting livelihoods in general.

Turning crisis into opportunities

"This crisis can be turned into opportunities for the future by improving healthcare system, public health, and supply system as well as coordination among various government agencies to deliver public services quickly and efficiently. Educational activities must continue with the help of ICT and online arrangements."

He praised the Government for announcing 'a very good social protection program'.

"Now it is critical to deliver the benefits to the targeted people to help them recover from the livelihood shocks that they suffered due to the lockdown. Post-harvest handling of the current boro crop needs to be completed quickly to avoid any losses from the seasonal rains and storms."

He put emphasis on a nationwide behavior change communication program could be launched to help people learn about the best practices in health, hygiene and nutrition.

"While Bangladesh has enough food to feed its entire population, the supply system must be managed well so that food is available, and everyone, particularly the poor, vulnerable and destitute, get enough food to eat."

Investing More in Health Sector  

Responding to a query, Manmohan Parkash put emphasis on more investment in the health sector.

"A key lesson is that countries that invested more in their health sector as a percentage of GDP have been able to manage the crisis better, with better medical care for its citizens, and lesser mortality."

In this connection, Manmohan mentioned Germany, Canada, Australia, New Zealand, Korea, and Japan as examples.

"Allocation for health sector and health-related items could be increased in the upcoming national budget. Incentives may be allocated for the pharmaceuticals, hospitals and health related industries and businesses. More support for research and development of communicable diseases, vaccines and treatments could be a priority."

Manmohan said the existing hospitals across the country could be categorised into two groups for treating Covid-19 patients and non-Covid-19 patients separately.

"Hospitals need to be selected for these separate functions strategically so that people can avail treatment in their own region and do not have to travel a long distance to go to hospitals."

Adequate supply of medicines, medical staff, and oxygen supply needs to be increased to provide effective support to the patients with breathing problems to help avoid putting them on ventilator, as ventilators are scarce, he said adding that there could be closer coordination between the specialised treatment centres and general hospitals.