Week 3 Topic Discussion : STEEP factors

[Wirichada Pan-ngum]

Reflect and report some factors related to healthcare resources during the pandemic, categorized by a STEEP letter in your setting.

STEEP – Social, Technologies, Environment, Economic and Political – what factors influence the healthcare resources in your setting based on these categories?
Lack of communication due to WFH and social distancing strategy – Social
Use of technology in healthcare services, reducing need for human resources – Technology
Large spending of government to support the country, lower budget for other projects – Economic/Political
Some examples…

[Zarni Lynn Kyaw]

In Myanmar, healthcare resources are already very limited, even before the COVID-19 pandemic because the government lack of accountability and indecision in implementing the National Health Plan (2017-2021). We dreamed of Thailand style 2002 health reform in Myanmar after the last democratic election and heavily advocated the need to prioritize health sector. On paper, we have some achievement as, it is the first time Myanmar have a plan toward universal health coverage (UHC) by the year 2030. After the on-paper plan, however, resources are not implemented properly and Myanmar is one of the worst hit country in COVID-19, especially after the coup and the COVID-19 third wave.

To analyze the situation using STEEP,
1) Social
– Lack of trust in the military government and it’s vaccination center after the coup
– Lack of coordination and cooperation between military government and ethnic groups after the coup
– Lack of communication from the military government during the third wave about the social distancing strategy

2) Technologies
– The military take over the COVID-19 response center and a warrant was issued to the previous head of COVID-19 Taskforce for being against the coup, result in COVID-19 daily report being untrustworthy.
– Even before the coup there is no unified system to collect real-time COVID-19 data and system fragmentation exist but there was a daily COVID-19 taskforce meeting where each states and region report the latest data at 7 PM everyday. That practice was totally lost after the coup and when the 3rd wave begin, there is no reliable source to estimate the correct data.
– Youtube and Facebook block government page after the coup because instead of disseminating COVID-19 information, the military government start to use those channel to disseminate propaganda

3) Environment
– Unsafe environment to charity organizations as the law for organization is amended by the military government
– Ongoing civil war disrupt the supply chain
– Due to the hostile environment, prices for basic necessities and medicine were increased at least two fold

4) Economic
– Hurtful central bank policies result in 300% inflation and 18% GDP reduction (according to the World Bank)
– Health budget was reduced 10 fold (according to the latest mini-budget)
– Impending economic collapse means a lot of rich people move their assets overseas and because of the massive potential for money laundering Financial Action Task Force (FATF) put Myanmar as a black-listed country

5) Political
– Majority of health volunteers/ health workers are jailed because of our participation in peaceful demonstrations against the coup. Human resource for health implication after the coup is massive.

– Political uncertainty beyond 2023 result in massive migration both internal and external

Although the question is to reflect and report some factors related to healthcare resources during the pandemic, in Myanmar, the coup is hurting health resources allocation from all angels. So, in my analysis, unfortunately, the coup have to be repeatedly mentioned.

Thanks,
Zarni

[Kansiri Apinantanakul]

Thank you for sharing.
Your story is very interesting.
As I observed from your factors, It seems that the political tensions affect the other factors as well.

[ABDILLAH FARKHAN]

I’ve identified each STEEP factor contributing to healthcare resources during the public health emergency. The lesson learned mostly related to Covid-19.

Social
– Good community practices at the grassroots level have successfully provided initiatives on how to coordinate safeguard, support, and observe their community member who is being self-quarantined, thus it helps the burden of healthcare staff.
– Plentiful hoax information (thousands in a year as estimated) changed public view, attitude, and behaviour. But as time goes by, people have learned how to ward off any misleading information.

Technologies
– The growth of telemedicine providers was the most outstanding innovation during Pandemic where it assisted people to take consultation to medical practitioners virtually
– Contact tracing was being adopted using mHealth. It could be used by community and public health center staff.

Environment
– Pandemic has modified operational standard of healthcare service. Hospitals and public health centers have identified and separated suspected Covid-19 at triage to minimize risks of infection at healthcare.
– Resources in the terms of infrastructure and logistics such as installing physical barriers, increasing hand hygiene stations and medical masks, and providing a separate waiting area for patients with and without Covid-19 symptoms

Economic
– Government has prioritized and refocused public expenditure on Covid-19 control. In healthcare, all Covid-19 patients were funded by the national social security system.
– Private insurance providers generated a new policy whereby Covid-19 disease could be covered with no elimination period.

Political
– The role of leadership respected all health personnel (doctors, nurses, public health specialists, pharmacists, laboratory staff, ambulance drivers, and funeral personnel), and protected and enhanced the welfare of those healthcare staff.
– The result of health diplomacy in bilateral and multilateral cooperations mostly focused on healthcare logistics such as drugs, vaccines, personal protective equipment, ventilator, and oxygen.

[Kawin Wongthamarin]

If I had been working in the government healthcare sector during the peak of the COVID-19 pandemic, I would have looked at STEEP factors as the following topics:

Social:
– Frontline workers are afraid of contracting COVID-19, resulting in fewer human resources.
– Lack of confidence in the public health system that will be able to cope with this problem.

Technologies:
– The use of telemedicine reduces the risk of infection for both healthcare workers and uninfected patients.
– Vaccine development technology helps stop the spread and severity of the disease.

Environment:
– There has been increased strictness in treating infectious waste to prevent the spread of infection.
– The terms and conditions for using the operating room have been improved to be safer during a pandemic.

Economic:
– Shortages of masks and hand sanitizers have led to higher prices and shortages in hospitals.
– Shortages of antiviral drugs and improper distribution have led to a shortage of medicines in many hospitals.

Political:
– Ambiguity in policies and directions for controlling COVID-19, causing inappropriate medical resource management planning.
– The government focuses on financial support to stimulate the economy rather than supporting public health.

[Tanatorn Tilkanont]

The STEEP analysis is used to identify the external factors that could significantly impact an organization. We can analyze the past and predict the future. The following STEEP listed the future factors which are uncertain and might affect health resources during the COVID-19 pandemic.

Social:
– Increasing awareness in the population to prevent infection -> fewer people get sick
– Increasing online education (as well as in healthcare) in the population -> increasing health knowledge
– Increasing demand for personalized care services -> Better healthcare service requires
– More healthcare workers interested in health technology -> Increasing future development of healthcare service (also Technology impact)

Technology:
– Increasing research and development of new medicines and health innovation
– Due to travel restrictions and social distancing, there is a rising development of eHealth technology -> New implementation of eHealth standards may require.
– Low internet accessibility in Thailand: there would be an increasing consideration for Internet access in rural areas to get the most benefit from health technology

Economic:
– Financial crisis due to more cost of healthcare resources required for pandemic infection management.
– Insufficient supply of quality vaccines and anti-viral medications for the population

Environmental:
– Strictly managing infectious waste and disposable medical devices
– Increasing waste of plastics, disposable gloves, masks, etc. affects an environment
– Traveling restriction during the pandemic helps to save the environment from pollution or carbon emission

Political:
– Creating an adoption of licensing rules to have electronic technology service
– Creating a policy for data confidentiality and privacy

[Tanyawat Saisongcroh]

Thanks for sharing. I agree with you to all factors that you mentioned. It seems like we suffer a lot during the pandemics, however, there are also many positive factors that could happen.

[SIPPAPAS WANGSRI]

Reflect and report some factors related to healthcare resources during the pandemic, categorized by a STEEP letter in your setting.

Imagining I’ve been working for the government healthcare sector, monitoring all healthcare resources in Thailand, A scenario planning strategic — STEEP (which stands for Social, Technologies, Environment, Economic and Political, respectively. ) is a tool to help us determine any potential factors which affect our results.

Social
– Social distancing policy has been enforced, so any physical contact is greatly reduced.
– People tend to believe fake news from communication platforms, including text messaging and gossips. Especially about an alternative remedy, pseudoscience without a solid evidence, or Anti-vaxxer.
– Some people may hoard, store and stock supplies, especially food, medical masks or medicines for their own purposes.

Technologies
– Technologies have become even more advanced during an epidemic, especially in telecommunication because of the lockdown and social distancing.
– Government sectors, healthcare facilities and researchers mainly focused on developing a solution for an epidemic.

Environment
– Use of healthcare devices and equipments increases, producing more waste to the environment. For example, a disposable glove, plastics, disinfectants. All of which may produce traces behind and not completely recyclable.

Economic
– There was once an imbalance of supply and demand in Thailand during an epidemic. People who have economical advantages can possess more resources.
– During an epidemic, global economic slows down to channel funding to research and healthcare problems (most countries, I believe). People don’t simply want to spend their money and save them for urgent matters.

Political
– Various policies by numerous parties were advertised in order to gain popularity and support even some of them were not pragmatic regarding the available resources.
– Some government might not even consider the epidemic an important matter, instead, they may focus and invest on things such as economy, military, gaining power rather than supporting healthcare and research until it was too late and the outbreak was out of control.

[Boonyarat Kanjanapongporn]

I will demonstrate some external factors during COVID -19 which have affected the settings in my pharmacy store. These factors will be categorized into STEEP models.

Social – A panicky feeling occurred among the general public since Covid-19 started. These affected the stock of medicines and products which were mostly recommended by different kinds of media. When the customer found out about the shortage of products that they wanted to buy, they started to feel more panic. This situation, where people felt unsafe and tried to stock up to protect themselves, also created pressure for healthcare workers.

Technology – Mobile applications have been useful and, could transfer some health data and management into people’s hands. MohPromt application offered vaccine certificates and Covid-19 certificates for the general public to use. Free ATK dispensing was done by PaoTang wallet which persuaded people to receive support from government. During the outbreak, these mobile applications provided convenience for users to reach data and health support. Moreover, it helped dispend the work to smaller healthcare units.

Political /Economic – Travel prohibition did affect many aspects of small pharmacy units. My pharmacy was in a Tourist area, therefore the total income massively decreased from travel restrictions along with the local people in the area needing to budget. These factors contributed to reallocation of available staff and their salaries which discouraged the workers.

Environment – Environmental restrictions to reduce disease transmission affected working lifestyles. Social distancing separated staff from spending the meal time together and in the pharmacy store there had to be plastic partitioning to divide staff and customers. Moreover, sanitizing of the environment had to be introduced into behavior, such as sanitizing the cashiering table and surfaces.

[Siriphak Pongthai]

I am not directly working in the government healthcare sector. However, the STEEP factors I noticed during COVID-19 pandemic are following:

Social:
– People have more awareness in social distancing to prevent spreading of the disease.
– Government raised important of vaccination campaign to enhance people to go vaccinate to reduce severity of the disease.

Technologies:
– By adapting into telework situation, most of people have experienced more in virtual meeting.
– Telemedicine implementation becomes more popular after COVID-19 outbreak.

Environment:
– Waste disposal management, particularly excessive used of PPE, gloves, disposable masks, and other infectious wastes.

Economic:
– High demand of masks, alcohol, and some categories of medicine caused product shortage. So the price of those goods were higher than before.
– COVID-19 caused less people traveling and spending, this significantly affected labor market/workers’ income and some jobs employment.

Political:
– In order to prevent the spread of the disease, Thai government decided to make urgent matter for COVID-19 pandemic. Emergency decree (curfew) was announced to be effective by Thai government thus this affected people living in Bangkok and vicinity. Consequently caused changing in operation hours for work, local and public transportation.
– Provided more budget in medical care and vaccine supply.

[Tanatorn Tilkanont]

Thanks for sharing. Your information shows obviously the factors that impact healthcare resources.
The emergency decree (curfew) announcement is not only a political issue but also impacts the economy as people are not able to work or transport during curfew.

[PREUT ASSAWAWORRARIT]

From my point of view, there are many challenges during a pandemic. Using basic knowledge and experience from the Covid-19 pandemic, I would like to forecast the future challenges by using STEEP letter.
Social factors:
– People are afraid of the pandemic, furthermore, there may be some fake news regarding the pandemic.
– In the future, there will be the larger proportion of elderly population which is vulnerable to the pandemic
Technological factors:
– There will be some newly invented hardware to detect outbreak or spreading in the area. This new technology may require personnel who have trained to use it.
– Advance research and development make sophisticated treatment available in the future.
Environment factors:
– Increasing concern regarding pollution results in detailed consideration of each production step whether there is waste by-product.
Economic factors:
– Because Thailand is a middle-income country, we have limited budget to provide laboratory investigation, medical equipment such as mechanical ventilators, vaccines, etc.
– Some advanced technology, for example a smart watch, will be easily afforded in general population.
– Wide range of inequality can result in that some groups of population cannot afford some medication or advanced treatment.
Political factors:
– Changes of the government or some ministry position cause policy alteration.
– There may be some additional legal concern in the future.

[Boonyarat Kanjanapongporn]

Thank you for sharing, interesting about the budget e-health gadget in the future. It could possibly elevate personnel health management, be reliable health data, reduce panic feeling and assist healthcare worker . Affordable technology along with educated users would have positive impacts to the disease management.

[Tanyawat Saisongcroh]

Considering some STEEP factors related to healthcare resources during on-going COVID-19 pandemic, an uncertainty and very challenging situation;

Social
– Increased in self-healthcare in general, whether awareness of the corona virus or other diseases due to less hospital access. On the other hand, non-covid patients with chronic disease might get worsening condition
– Increased healthcare staffs burnout both frontline workers for massive workload and non-frontline workers who are allocated to non-critical location and loss their routine activities.
Technological
– Increased in quantity and quality in healthcare IT system, e-health, m-health such as telemedicine adoption and there is more collaboration among different stakeholders in technology development .
– Increased in advance research and evidence-based information in IT healthcare field to improve the existing system and deploy new innovation
Environment
– Increased in infected waste product from healthcare system and dealing with its regulation
Economic
– Expansion of insurance reimbursement options for the treatment itself and vaccination sequelae
– Massive spending on support in healthcare field (infection control, investigation, treatment, medication and vaccine, all supply and equipments, healthcare IT implementation) instead of other dimensions
Political
– Changes in government regulation of healthcare such as increased documentation requirement, reimbursement policy
– Push and enhance local/primary healthcare system to increase higher performance

[Kansiri Apinantanakul]

Thank you for sharing.
I agree with you the COVID-19 pandemic drive the adoption of technology in every field including healthcare. Telemedicine growth rapidly in Thailand and worldwide.
However, the impact of this technology in long term should be assessed. For example
Is this lead to physician burnout?

[Kansiri Apinantanakul]

Since I’m just graduated during the COVID-19 pandemic and started my working in clinical research field. I have no experience working in the healthcare service field before, especially government section. However, I did have some sharing from my friend working there.
Social
People aware of the pandemic and keep the social distancing. The behaviors of people are changing rapidly. During the peak of pandemic, patient with mild symptoms did not visit OPD/ER at all. Thai people tend to rely on pharmacy and/or herbal medicine more than the past. Even it seems that the workload of the HCP has been reduced but it was balanced by the workload of managing COVID-19 patient.

Technologies
COVID-19 pandemic drives the rapid growth of technology in Thailand including the telemedicine service and the m-Health platform including various application by both government sector and private sector. This may lead to the change in the workload and way of working for the healthcare professional.

Environment
The unplanned large number of wastes generated during the peak of COVID-10 including the PPE, physical barriers, masks were managed improperly. This created the unsafe environment for healthcare professional. Each hospital may have their own policy on the waste management but there is no official policy at the national level.

Economic
From the past, it is obvious that the compensation for healthcare professional working on government sector is less than private sector. The high inflation rate and the delay in claiming the additional bonus created the tension in government sector.

Political
The government sector put the effort on the compensation for the healthcare professional who is the frontline worker. However, the process of claiming the additional bonus take long time and this issue affects almost all levels of hospital in Thailand.
Apart from that, there is the shortage of PPE, vaccine and/or other equipment to support frontline worker.
It was observed the large number of resignations in government section due to the improper management of mid-level up to the national policy level.

[Boonyarat Kanjanapongporn]

Thank you for sharing your STEEP idea toward COVID-19, I agree with your point of view. Improper management of COVID related waste could create environment issue which could harm general and healthcare professionals later. There weren’t unclear on waste management such as Used ATK kits or medical mask which could lead to environmental contamination. This could be further development policy on managing contamination waste among overall population.

[Hazem Abouelfetouh]

STEEP Factors

Social
– Increase in population awareness of infectious diseases, hygiene, and social distancing.
– Increase of elderly patients.
– Decrease social crowd gatherings.
– Change of working hours especially for hospital workers.
– Increase of population stress and fear levels.
Technological
– Increase of Telehealth usage by hospitals and governments including remote medical consultation for non-critical cases.
– Using social media platforms for awareness campaigns.
– Increase the need for interoperability for better COVID-19 management.
– Moving to virtual meetings.
Economic
– Shortages and increases in the prices of face masks and hand sanitizers.
– Change of insurance reimbursement policies.
– Increase in hospital admission rates.
– Increase of inflation rate in countries with a weak economy.
Environment
– Increase in biohazard wastes.
– Change in environmental regulations and travel restrictions.
– Increase in the unemployment rate.
Political
– Increase governmental Telehealth adoption for better control and monitoring of COVID-19 cases.
– New government policies and regulations.
– Travel restrictions and changes in immigration policy.

[ABDILLAH FARKHAN]

Thank you to mention logistic insecurity as an important economical factor. My country has also experienced a supply shortage and the skyrocketing prices of medical devices such as masks, thermometers, and oxygen.

[Author]

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