Public health ethics and the COVID-19 pandemic

Health is a human right anchored in values as a basic necessity of life. It promotes the well-being of persons, communities, economic prosperity, and national development. The coronavirus disease-2019 (COVID-19) pandemic caught the world unaware and unprepared. It presented a huge challenge to the health and economic systems of every country. Across the spectrum of human endeavor and liberty, several ethical questions have been raised with regard to its management, particularly the public health control measures. Decisions for pandemic control measures are made under difficult circumstances driven by urgency and panic, with uncertainties and complexities for public goods over individual rights. Global solidarity in controlling the pandemic is being tested. National governments have the responsibility to protect public health on the grounds of common good. Political considerations should not be the basis for decision-making against the best available epidemiological data from pandemic disease dynamics. Hence, the need to adhere to the values of honesty, trust, human dignity, solidarity, reciprocity, accountability, transparency, and justice are major considerations. A literature search was conducted for the publications from academic databases and websites of health-relevant organizations. I discuss the ethical questions and challenges of the COVID-19 pandemic in the context of public health control measures using the standard ethical principles of respect for autonomy, beneficence, nonmaleficence, and social (distributive) justice. It is observed that, at the country level, the World Health Organization (WHO) guidelines are used to control the pandemic. As WHO through the COVAX strategy distributes the vaccines to less developed countries, a lot still needs to be done to address the complex bottlenecks of allocation and distribution. There is a need to ensure acceptable and transparent system that promotes cooperation, equitable access, and fair distribution of vaccines on a global scale.

Sources of Health Care Financing among Patients at the Ahmadu Bello University Teaching Hospital; Zaria; Nigeria

Introduction: Health care financing is the mobilization of funds for health care services. This study determined the various sources of health care financing among the patients on admission at the Ahmadu Bello University Teaching Hospital (ABUTH); Shika-Zaria in 2011 and the effects of the medical bills on the patients and their family members. Methodology: A multi-staged sampling technique was used to select 100 clients for the study. The clients were stratified into the four major wards of the ABUTH; the medical; surgical; obstetrical and gynecological and the pediatric wards. A total of 25 clients were equally allocated to each ward and these were then selected by balloting. Information was sought on their socio-demographic characteristics; sources of the health care financing and the adverse effects of the medical bills on the patients and their family members. Results: Majority of the clients were married; Hausa Muslim housewives who earned N5;000/month (less 1 $/day). Most were aged between 20 and 29 (34) with a mean age of 36.7 years. Patients' relatives paid for the medical bill in most of the cases (48); 37 paid through out of pocket; while 11 used the National Health Insurance Scheme (NHIS) respectively. The medical expenses affected family feeding (29.3); while 16 of the patients could not get full medical services due to lack of funds; 8.8 could not pay school fees of their children and 12.2 were indebted. There were no significant association between the age; sex; marital status; monthly income; occupational status and the clients' sources of health care financing. Majority of the clients (65) were not aware of the NHIS. Most (80) of the patients would want to use the health insurance scheme (NHIS) if they have access to the opportunity. Conclusions: The main source of health care financing in this tertiary center was through out of pocket expenditure by patients and their relatives. Recommendation: There is a need for the urgent implementation of the community health insurance scheme in Nigeria for the benefit of the less privileged