Assessing health systems’ capacity to cope with the COVID-19 pandemic: preliminary evidence from MENA countries

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Mohammad Abu-Zaineh and Sameera Awawda share their views and research findings on the economics of epidemics, testing, health.

With the spread of COVID-19 to the Middle-East and North African (MENA) region, many health experts share concerns about the capacity of these countries’ health systems to halt such a pandemic. While a variety of factors may affect the spread of any infectious disease, health systems remain ultimately responsible for early detection, prevention and treatment. We assess and compare the readiness and capacity of the health systems in a set of MENA countries to respond to the current pandemic, using two mashup indices previously proposed to measure countries’ detection capacity, risk of, and vulnerability to infectious diseases.

As of May 1st 2020, the MENA region countries had a total of 213 045 confirmed cases of COVID-19, while the total number of deaths stood at 4 907. Although most of the confirmed cases (69%) and deaths (84%) are concentrated in Turkey and Iran, COVID-19 fatality rates remain relatively low in these two countries (2.6% and 6.4%, respectively) as compared to other countries in the region (Algeria: 11.2% and Egypt 7.1%). Reported figures from developed countries suggest that the fatality of COVID-19 depends, inter alia, on the demographic structure of the population, with more than 80% of fatalities concentrated amongst the elderly. Although disaggregate data by age is not readily available in the MENA countries, the high fatality rates observed are in line with global trends: with the exception of Israel and Turkey, COVID-19 fatalities appear to be higher in countries with a higher share of elderly people (Figure 1). However, other factors pertaining to health systems’ capacity may explain the discrepancies observed between countries.


Figures 2 and 3 depict COVID-19 prevalence and fatalities reported in each country against, respectively, the capacity of the health systems and the countries’ vulnerability to infectious disease. As shown in Figure 2, countries with a high prevalence of COVID-19 appear to have higher health system capacity. Moreover, countries with high vulnerability to infectious diseases (low score) report higher fatalities (Figure 3).

Once the vulnerability to infectious disease index (IDVI) is broken down into its components (the risk factors), it emerges that the health domain score is closely associated with the number both of COVID-19 cases and of fatalities. Figure 4 depicts the association between the health domain score and COVID-19 health outcomes in the MENA countries. As shown, countries with low health scores tend to have high fatality rates (Algeria and Egypt) indicating high vulnerability to infectious diseases. By contrast, countries with high health scores (Israel and Qatar) tend to have higher numbers of laboratory-confirmed cases. This may reflect their health systems’ greater detecting and testing capacity.

Although preliminary, reported results suggest that the MENA countries are at moderate to high risk of the spread of COVID-19. Of the risk factors we study, the capacity of a country’s health system (as measured by size of health workforce, health expenditure, health infrastructure and health status) emerges as key to curbing the spread of the disease.

All health sector stakeholders are urged to expand health systems’ capacity to perform timely mass testing. This also entails implementing a set of targeted emergency responses that involve identifying, evaluating, and properly addressing all risk factors likely to be associated with the spread of COVID-19. In parallel, proper implementation of means-tested government benefits can help mitigate the adverse economic consequences of the pandemic on the most vulnerable groups, who may incur the double disease burden (health and economic losses). Should more detailed data be made available, further research will be required to thoroughly comprehend the dynamics of the current pandemic, its determinants, and consequences at both the micro and macro-levels.


→ This article was issued in AMSE Newletter, Spring 2020 - Special edition on Covid-19 Crisis