We adopt a holistic—micro, meso, macro—approach to health leadership ethics to examine how low- and middle-income countries have responded to the COVID-19 pandemic. Healthcare delivery happens within complex settings in low- and middle-income countries and high-income countries. These settings are riddled with systemic political and economic challenges which, in some instances, make it difficult for health leaders to be ethical. These challenges, however, are not unique to low- and middle-income countries. Globally, countries can learn from ethical health leadership missteps that occurred during low- and middle-income countries’ responses to COVID-19. We discuss the implications of problematic ethics in health leadership on managing pandemics in low- and middle-income countries, using Zimbabwe as an example. We offer suggestions on what can be done to improve ethical health leadership in response to future health crises in both high-income and low- and middle-income nations.
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References
1.
ChiribogaDGarayJPauloBMadrigalRSRispelLC. Health inequity during the COVID-19 pandemic: a cry for ethical global leadership. Lancet. 2020;395(10238):1690–1691.
2.
HopmanJAllegranziBMehtarS. Managing COVID-19 in low- and middle-income countries. JAMA. 2020;323(16):1549–1550.
3.
CohenDHuynhTSeboldAHarveyJNeudorfCBrownA. The population health approach: a qualitative study of conceptual and operational definitions for leaders in Canadian healthcare. SAGE Open Med. 2014;2:1–11. Available at: https://doi.org/10.1177/2050312114522618
4.
ScottES. Perspectives on healthcare leader and leadership development. J Healthc Leadersh. 2010;2:83–90. doi:10.2147/JHL.S8292
5.
HoAPinneyS. Redefining ethical leadership in a 21st-century health care system. Healthc Manage Forum. 2016;29(1):39–42.
6.
BeauchampTLChildressJF. Principles of Biomedical Ethics. 3rd ed. Oxford University Press; 1989.
7.
GillonR. Four principles plus attention to scope. BMJ. 1994;309(6948):184–188.
8.
BerlingerNWyniaMPowellT, et al.Ethical framework for healthcare institutions responding to novel coronavirus SARS-Cov-2 (COVID-19): guidelines for institutional ethics services responding to COVID-19. The Hastings Center. 2020;1–12.
9.
Population Reference Bureau. 9 Billion World Population by 2050. Population Reference Bureau; 2000.
10.
CoastE. Population trends in LMICs. [Online]. London. LSE Research Online. 2002. Updated September 16, 2020. Accessed September 22, 2020. Available at: http://eprints.lse.ac.uk/archive/00000268.
MackeyKTVianTKohlerJ. The sustainable development goals as a framework to combat health sector corruption. Bull World Health Organ. 2018;96:634–643.
16.
BurkiT. Corruption is an “ignored pandemic”. The Lancet. 2019;19(5):471.
17.
BrucknerT. The Ignored Pandemic: How Corruption in Healthcare Service Delivery Threatens Universal Healthcare Coverage. Transparency International. 2019;1–35.
The Lancet Global Health. 2020-30: the decade of anti-corruption?Lancet Glob Health. 2020;8(1):e1. doi:10.1016/s2214-109x(19)30500-5
20.
KraemerEMWunsch-VincentS. The Informal Economy in Low- and Middle-Incomenations: Hidden Engine of Innovation. Cambridge University Press; 2016.
21.
MeagherK. WIEGO Working Paper no. 27. Unlocking the Informal Economy: A Literature Review on Linkages Between Formal and Informal Economies in LMICs. Women in Informal Employment Globalizing and Organizing; 2013.
22.
LoayzaVNPenningsS.Macroeconomic policy in the time of COVID-19. World Bank E-library. Washington, DC: World Bank. 2020. Updated March, 2020. Accessed July 26, 2020. Available at: https://elibrary.worldbank.org/doi/pdf/10.1596/33540.
23.
LewnardJALoNC. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis. 2020;20(6):631–633.
African Research Bulletin. Zimbabwe: economy stumbles after Mugabe re-election. Economic, financial and technical series. Africa Res Bulletin. 2013;50(7):20043A–20045C.
DongEDuHGardnerL. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. February19, 2020. Updated February 19, 2020. Accessed July 17, 2020. Available at: https://doi.org/10.1016/S1473-3099(20)30120-1.
GoFundMe. Zimbabwe COVID-19 citizens healthcare support fund. GoFundMe. Updated September 11 2020. Accessed September 22, 2020. Available at: https://ca.gofundme.com/f/covid-zimbabwe.
31.
PersadGWertheimerAEmanuelEJ. Principles for allocation of scarce medical interventions. Lancet. 2009;373(9661):423–431.
32.
EmanuelJEPersadGUpshurR, et al.Fair allocation of scarce medical resources in the time of COVID-19. N Engl J Med. 2020:382(21):2049–2055.
United Nations. Transforming our world: the 2030 agenda for sustainable development. A/RES/70/1. 2015.
35.
DalglishS. COVID-19 gives the lie to global health expertise. Lancet. 2020;395(10231): 1189.
36.
FrichJCBrewsterALCherlinEJBradleyEH. Leadership development programs for physicians: a systemic review. J Gen Intern Med. 2015;30(5):656–674.
37.
HargettCWDotyJPHauckNJ, et al.Low- and middle-income model for effective leadership in healthcare: a concept mapping approach. J Healthc Leadersh. 2017;28(9):69–78.
38.
BryneMJ, Administrative ethics: good intentions, bad decisions. Healthc Manage Forum. 2018;31(6):265–268.
39.
ShanafeltTRippJTrockelM. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323(21):2133–2134.
KhemaniS.An opportunity to build legitimacy and trust in public institutions in the time of COVID-19. World Bank E-library. Washington, DC: World Bank2020. Updated May, 2020. Accessed July 26, 2020. Available at: https://elibrary.worldbank.org/doi/pdf/10.1596/33715.
43.
KavanaughMMEranduNATamariO, et al.Access to life saving medical resources for African countries: Covid-19 testing and response, ethics and politics. Lancet. 2020;395(10238):1735–1738.
