By Betsy Amsalu

As access to healthcare becomes more challenging due to the rising costs and in many cases, the lack of health care professionals, telemedicine has become an integral aspect of health care delivery in health systems globally. It is now possible for patients to connect with a physician, get a diagnosis, and order prescriptions all from the comfort of their home. The importance of telemedicine cannot be overstated, especially in the era of Covid-19. However, the conveniences of telemedicine do not apply or operate in most developing countries like Ethiopia. Despite overall gains in healthcare access and quality, the majority of Ethiopians are still unable to obtain medical care due to the high out-of-pocket costs for health services, inadequate access to transportation, and mistrust of modern medicine and healthcare providers caused by the inability to understand and analyze health information required to make informed health decisions. The incorporation of telemedicine is arguably the most viable solution to the dire health care problems in Ethiopia. There are several proven telemedicine models in different countries that can be replicated with minimal investment, which can yield improved health outcomes.
Ethiopia’s health system is unable to meet the demand for care, causing prolonged wait times to see primary care providers and specialists. Instead of waiting, patients choose to see private providers, despite the immense financial strain. Limited access to care, in addition to the lack of resources to manage the prevalence of disease, the Ethiopian life expectancy is a mere 66.95 years. Although the maternal mortality rate has shrunk significantly since 2000, the maternal mortality rate sits at 412 per 100,000 live births and child mortality rate at 67 per 1,000 in 2020 according to USAID. Additionally, a 2018 study by the World Bank found that there is only one physician per 10,000 people in Ethiopia. Few nations, most of which in Africa, have a lower physician-to-population density compared to Ethiopia. These poor health statistics can be reversed by implementing telemedicine as a vital component of the health system. Ethiopia has one of Africa’s most sophisticated telecommunications industry as well as one of the fastest-growing economy. Information and Communication Technology (ICT) has seen remarkable growth in the last few decades. Although, development of telemedicine on a grand scale requires serious financial and human resources, Ethiopia’s growth in the ICT sector is a promising development for telemedicine’s prospect.
There are proven models that have successfully managed to bridge the healthcare gap and can be replicated in Ethiopia. For example, MedicallHome, a telemedicine program in Mexico provides telephone access to licensed doctors 24/7, coupled with sizable discounts at a national network of more than 10,000 healthcare providers. The program mainly serves low- and middle-income households and costs $2 to $5 per month. The implementation of this model has led to the dramatic reduction in inefficient utilization of health services. The program successfully reduced the number of users that utilize emergency room services, which resulted in significant savings for patients and the overall health system. In addition to the potential for cost reduction, this model relieves some pressure in an overstrained healthcare system. With over 80 million mobile subscriptions in Ethiopia, the country has the capacity to adopt this model and expand health care access to millions of citizens. The primary goal of telemedicine in Ethiopia should be the expansion of healthcare access with the objective of improving the poor health statistics.
Although telemedicine is an important component of a healthcare system, there are immense application challenges and barriers. There are several factors that will affect the proper implementation and utilization of telemedicine in Ethiopia. These factors include, but not limited to, the government’s willingness to provide sufficient funding to coordinate and administer high quality telehealth services, active collaboration between academia and health care providers to train new healthcare professional entering the workforce on the proper use of telemedicine, and securing foreign investments and expertise to support costs. According to the Word Bank, Ethiopia spent a mere 3.3% of GDP on health care in 2018 compared to the 5.47% health care expenditure in 2010. Restructuring the existing healthcare delivery workflow to include telemedicine will require a robust collective effort from all stakeholders, including the unwavering financial backing of the federal government and the Ministry of Health.
Ethiopia has achieved significant health improvements in the last few decades, such as lowering infant and maternal mortality, but more work is required-particularly in rural areas. Telemedicine alone will not solve the crumbling health care system in Ethiopia. However, with the proper guidance from the government and much needed investment from the private sector, telemedicine can play a significant role in improving the health of the nation. The implementation of telemedicine on a grand scale will undoubtedly meet many challenges along the way. However, it can be achieved with a collective collaborative effort of various sectors. The Federal Ministry of Health along with organizations like the Bill & Melinda Gates Foundation, should develop a strategy to implement telemedicine in Ethiopia’s health infrastructure.

The writer can be reached via ba53584n@pace.edu

Globally, antibiotic use in hospitals has surged since the start of the COVID-19 pandemic, and over-the-counter sales, legal in many countries, have soared. This is further fueling the global crisis of antimicrobial resistance, as bacteria evolve and become immune to these drugs.

By LOICE ACHIENG OMBAJO

Fear of COVID-19 is driving increased over-the-counter (OTC) sales and in-hospital prescriptions of antibiotics – and fueling a silent pandemic in its wake.
Globally, antibiotic use in hospitals has surged since the start of the COVID-19 pandemic. Even though studies show that only 8% of patients admitted to hospital with COVID-19 also have an infection requiring antibiotics, more than 70% receive them. In addition, many people worried about possible or actual COVID-19 symptoms, and alarmed by global reports about the pandemic, have turned to buying antibiotics without seeing a health-care worker.
This is further fueling the global crisis of antibiotic resistance, as bacteria evolve and become immune to these drugs. We must move quickly – with international policy, national laws, and local action – to control what the World Health Organization has identified as one of the ten leading health threats to humanity.
Antibiotics treat infections caused by bacteria, and have no impact on a virus such as SARS-CoV-2, which causes COVID-19. Overusing them merely accelerates the emergence of antibiotic resistance, which will undercut our ability to treat common diseases. Simple infections such as pneumonia or urinary tract infections, which currently can be quickly cleared by common antibiotics, may prove impossible to treat and become deadly.
This is particularly true in many African, South American, and Asian countries, where access to health-care workers is limited and there are no restrictions on antibiotic sales. In India, antibiotic sales have risen astronomically in recent years, largely driven by unregulated OTC purchases, including of unapproved drugs. Likewise, in Kenya, all antibiotics can be purchased without a prescription.
Bacteria that develop resistance to multiple antibiotics are responsible for causing difficult-to-treat infections, which are up to three times more likely to kill people than infections caused by non-resistant bacteria. And data from several countries – including China and Egypt – indicate that up to 50% of bacteria-causing infections in critical-care units are resistant to several antibiotics. In the United States, it is estimated that close to three million people get an antibiotic-resistant infection each year, leading to more than 35,000 deaths annually.
Drug-resistant bacteria are also more likely to spread from person to person, and have been known to cause large disease outbreaks in hospitals. Many COVID-19 treatment wards around the world are currently grappling with this problem.
As an infectious-disease specialist working on the COVID-19 management front line and also leading the treatment of drug-resistant infections in Kenya, I have often struggled to treat patients with severe bacterial infections that had developed resistance to all available antibiotics. Many of the recently developed drugs that could potentially treat resistant bacteria are often extremely expensive and not available in many countries. A ten-day course of one such antibiotic in Kenya, for example, costs almost $10,000, putting it beyond the reach of most patients.
In fact, many patients entering the hospital for COVID-19 treatment say that they have already taken one or more antibiotics at home in an attempt to address some of their symptoms. Often, using these drugs had made them feel that they were being treated, so they delayed going to the hospital.
Some may argue that allowing unrestricted use of antibiotics can enable access to treatment for those unlikely to be able to see a doctor, and may be cheaper for the poor. But the resulting antibiotic resistance is expensive to treat and potentially costs lives.
What must we do to forestall this next pandemic? For starters, the WHO and other global agencies must speak out much more strongly and explicitly against the use of antibiotics in cases of COVID-19, unless these drugs are specifically indicated for another bacterial infection.
In addition, national governments must tighten restrictions on OTC antibiotic purchases. Evidence suggests that introducing and enforcing laws to limit such sales can be effective if these efforts are sustained over time. Requiring pharmacies to display a notice stating that it is illegal to sell antibiotics to customers without a doctor’s prescription also has been associated with reduced antibiotic sales.
Hospitals should adopt so-called antibiotic stewardship strategies to reduce unnecessary prescriptions. These measures can lead to reduced antibiotic use and cost, and decrease the risk of antibiotic-resistant infections in hospitals. Effective strategies could include developing guidelines for managing common infections, restricting antibiotic use in viral infections, strengthening laboratory capacity – especially in low- and middle-income countries – to help clinicians identify the correct bacteria to treat, and providing continuing education for all clinicians.
Finally, individuals – despite their understandable fears of COVID-19 – should not risk harming themselves by using antibiotics unnecessarily.
The message is clear: if we do not act now to curb antibiotic use, we will invite a new pandemic. And, unlike COVID-19, no vaccine will save us.

Loice Achieng Ombajo is an infectious-disease specialist at the University of Nairobi and a 2021 New Voices Fellow at the Aspen Institute.

At the dawn of the nuclear age, Albert Einstein wrote that “a new type of thinking is essential if mankind is to survive and move toward higher levels.” As the world confronts the escalating climate crisis, a new type of thinking is needed once again – and it starts with a new type of accounting.

By Andrew Sheng and Xiao Geng

Last week, the world marked the 51st Earth Day. This year’s theme – “Restore Our Earth” – was apt. As the COVID-19 pandemic has reminded us, the effects of human activity on the planet do not respect borders. The Earth is a single living, self-regulating system, and it demands a single, shared system of accounting that balances at the global level. We need a one-Earth balance sheet.
In a 1946 telegram, Albert Einstein pleaded for funding to finance the “life-and-death struggle to harness the atom for the benefit of mankind and not for humanity’s destruction,” arguing that a “a new type of thinking is essential if mankind is to survive and move toward higher levels.” The same can be said about the environmental crisis humanity has created. Surviving it, and achieving a better, more sustainable future, requires “a new type of thinking.”
The old type of thinking produced a policy framework based on the nation-state. Policymakers consider the material impact of their actions on the local population, as measured by quantitative economic indicators like GDP. The United Nations System of National Accounts – devised in 1953, updated in 1993, and reaffirmed in 2008 – emphasizes the measurement of flows, such as income, expenditure, imports, and exports.
But even if there were enough data – such as on land valuation and intellectual property rights – national accounting systems would suffer from stock-flow inconsistencies. Under-measurement of many assets and liabilities, and of profits and losses, means that imbalances are often lumped into Errors and Omissions, making their impact difficult to gauge.
At the one-Earth system level, all flows and stocks would have to balance. This would make it far easier to measure the impact of each country’s activity on the whole.
There is a traditionally economic dimension to this imperative. After the 1997 Asian financial crisis, for example, it became clear that efforts by Japanese firms and banks to restore their balance sheets led to depression or financial contagion elsewhere. In today’s ultra-integrated global economy, there is no pretending that national balance sheets exist in isolation. And if one country’s balance sheet becomes too fragile, others will also be put at risk.
But there is also a social dimension to this challenge. Consider the growing global debt overhang. Every debt incurred has a corresponding asset, which is sustainable if it yields a social rate of return larger than the cost of the funds. Yet these social returns (or costs) are rarely measured – a significant blind spot for those devising policies to avoid debt distress. A better approach would account for both the debt and the associated asset, including the relevant costs and benefits. That requires a global perspective, shaped by economic, social, and ecological considerations.
More broadly, a one-Earth balance sheet would go a long way toward mapping global imbalances. Some, such as income and wealth imbalances, are already obvious. But others, such as pollution and choke points in global supply chains, have not yet been mapped adequately.
Innovative initiatives by companies like Visual Capitalist suggest the benefits of such maps. For example, by charting high-cost carbon-emitting consumption patterns more clearly, the world would be better equipped to address them through targeted innovation and investment.
This points to another major benefit of the one-Earth balance sheet: it may reveal areas where global or regional cooperation would deliver important, if indirect, benefits. For example, a system-wide perspective would probably show that the world has a strong economic and ecological interest in acting collectively to help Africa manage challenges relating to population, food, energy, health, and security.
Perhaps most fundamentally, the one-Earth balance sheet would highlight that individual countries’ right to act in their interests comes with obligations. If a country, say, expands intensive land use or builds polluting factories, its national account would highlight the GDP benefits, which might be deemed to outweigh the ecological costs. But the one-Earth account would show how externalities like deforestation and pollution damage human health, jobs, and the environment elsewhere, thereby changing the calculation significantly.
Japan’s recent decision gradually to release treated wastewater from the Fukushima Daiichi nuclear plant into the Pacific provides a clear example of this tension. Japanese authorities say opposition is unscientific. But critics insist the release would damage the environment and violate human rights in surrounding countries.
Whatever the best solution is, the issue clearly does not affect only Japan. The country must, therefore, account for not only the internal costs of finding an alternate solution, but also the external obligations its chosen solution implies. Even if the wastewater itself proves safe, the decision could fuel mistrust that may end up producing large shared losses.
The pandemic has highlighted how collective challenges need whole-of-government and whole-of-society solutions. It has also showed how a lack of complete, transparently shared data can lead to flawed and piecemeal approaches, as well as harmful misunderstandings.
We have enough economic and ecological data to prepare a first draft of a one-Earth balance sheet, thanks partly to Big Data and social media. These data can and should be compiled collectively, much like Wikipedia. Indeed, given the one-Earth balance sheet’s multidimensional and multi-disciplinary nature, it would be inappropriate for any one individual or group to take on the task. A global commission, convened under multilateral auspices, should spearhead this effort.
Creating a one-Earth framework will not be easy and will undoubtedly run into nationalist resistance in many countries. But, like the harnessing of the atom, this is a life-and-death struggle. And a one-Earth balance sheet represents the “new type of thinking” we need to “survive and move toward higher levels.”

Andrew Sheng, Distinguished Fellow of the Asia Global Institute at the University of Hong Kong and a member of the UNEP Advisory Council on Sustainable Finance, is a former chairman of the Hong Kong Securities and Futures Commission. His latest book is From Asian to Global Financial Crisis.
Xiao Geng, Chairman of the Hong Kong Institution for International Finance, is a professor and Director of the Research Institute of Maritime Silk-Road at Peking University HSBC Business School.

By Yi Fan
With COVID vaccines rolled out in more countries, we have reason to expect to be more equipped in the fight against the pandemic. Exiting the pandemic and reviving the economy is a first-order priority for all countries.
Africa, like other parts of the world, has fought hard in containing the virus and reinvigorating the economy. Addressing the fallouts and looking forward to post-COVID recovery, governments of African countries have adopted comprehensive response plans. In Ethiopia, for example, relief asssitance has reached families and businesses, in addition to tax cuts and liquidity support.
For us all to navigate this trying time, cooperation and mutual help between China and Africa are critically important. Last week, China hosted the annual meeting of the Boao Forum for Asia, a China-based international forum with a mandate to explore better solutions for the common good of the whole world despite its name. Delegates from both online and offline discussed how the world can best recover from the pandemic. As countries in Africa are also striving for a stronger emergence from the pandemic, perhaps here are some of the priority areas where greater synergy can be built:
No. 1: China and Africa can grow faster together with the help of the Belt and Road Initiative.
The pandemic brought the world to a sudden halt. But for most of the time, the Belt and Road projects have remained resilient in keeping global supply chains running. The freight trips along the New International Land-Sea Trade Corridor were up by 104.9% in 2020. New routes were opened, such as the one from the southwestern Chinese city of Nanchong to Nigeria. A record number of goods, including the much-needed medical supplies, were shipped to cities in Africa,Asia and Europe. On this continent, the Ethiopia-Djibouti Railway, a flagship Belt and Road project, recorded an over 51 percent increase in revenue in the first half of 2020, when the pandemic was at its height. The railway was instrumental in ensuring the transportation of supplies in Ethiopia.
With China at the beginning of implementing its 14th Five-Year Plan, a guideline toward more efficient, equitable and sustainable growth, the Belt and Road Initiative is now aiming at higher-quality development. This, along with China’s own economic recovery, will foster greater connectivity, openness and inclusiveness, further energize the development of participating countries, and, as a result, inject greater confidence and impetus to global post-COVID growth.
No.2: China and Africa can embrace new prospects with a digital boost.
The pandemic has, to some extent, given a strong boost to the already-flourishing digital economy worldwide. New technologies and creative forms of business including 5G, online shopping and remote learning are gaining momentum, providing a new pathway for economic growth.
Both China and Africa will benefit from this digital boom. Africa, a continent with around 1.3 billion people,is now enjoying fast growth in telecommunications and e-commerce. As it seeks to improve its digital infrastructure, China is ready to share its experience in e-commerce, digital payment and logistics management.
Such mutually-beneficial cooperation is already paying off during the pandemic, as the two cooperated in selling African agricultural products, including coffee and chili sauce, on Chinese e-commerce platforms. Likewise, Kilimall, an online shopping mall set up by Chinese founders in Africa, has served as a window for African consumers to purchase Chinese products.
No.3: Multilateral economic cooperation can make us all better off.
The pandemic has reminded the world of the significance of cooperation. This is what both China and Africa have advocated as staunch supporters for multilateralism and free trade.
For Africa, the recently-commenced African Continental Free Trade Area (AfCFTA) has made the continent the world’s largest free trade area in terms of participating member states after the formation of the World Trade Organization. Signed by 54 African Union members, the AfCFTA will increase Africa’s capacity to respond to future crises, disease outbreaks and global economic shocks, and also assist in Africa’s economic recovery.
China too has made similar endeavors: setting up platforms for international economic cooperation, including the China International Import Expo and the China International Fair for Trade in Services; facilitating the signing of the Regional Comprehensive Economic Partneship (RCEP) agreement, one of the largest free trade agreements in recent history.
These efforts of China and Africa illustrate the critical importance of cooperation and multilateralism in unlocking economic potential. They may also present major opportunities for each other and the world at large, and pave the way for closer economic ties among countries and shared prosperity in the post-COVID world.
For a changing world eyeing for closer cooperation and a stronger, more resilient post-pandemic global economy, China and Africa, coming together, will surely set for the world a fine example of mutually beneficial cooperation, and contribute their share to the post-COVID global economy.

The author is a Beijing-based observer of international affairs