Additional Author: Marc Estevadeordal

As part of Bechtel’s commitment to contribute 100 ideas to support the United Nations 2030 Sustainable Development Goals (SDGs), we highlight some of the underlying challenges brought by COVID-19 in the developing world and the critical role infrastructure plays.

SDG 3: Ensure healthy lives and promote wellbeing for all at all ages.

SDG 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

SDG 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.

SDG 9: Build resilient infrastructure, promote sustainable industrialization and foster innovation.

SDG Target 9.4. By 2030, upgrade infrastructure and retrofit industries to make them sustainable, with increased resource-use efficiency and greater adoption of clean and environmentally sound technologies and industrial processes, with all countries taking action in accordance with their respective capabilities.

As the world continues to grapple with the new COVID-19 reality, the ongoing pandemic has exposed the crisis of weakening socio-economic conditions. While the COVID-19 pandemic will eventually pass, the nature of this crisis is paradoxical in the sense that it can be tempting to correlate the conditions as a result of COVID-19 and concealing the deeper structural issues that were present prior to the pandemic. The pandemic should not be a scapegoat for many of the underlying issues vulnerable individuals and communities face.

Challenges in responding to COVID-19

While much of the news has been fixated on COVID-19 treatment options as well as the race for a vaccine, much of the world lacks access to what many of us take for granted. One of the best defenses against the coronavirus is frequent handwashing with soap and water. However, when 40% of the world’s population lacks access to soap and water at home, water for handwashing is in critically short supply, especially for densely populated cities or informal settlements in developing countries.

In addition to a lack of water, sanitation, and hygiene services, there are several other challenges many developing countries face in implementing interventions. In many of these countries, hospitals were already overwhelmed prior to the pandemic. In a phone survey conducted in Senegal, thousands have left the capital Dakar and moved to rural areas – further overwhelming rural health systems as well as spreading the disease.

In Sub-Saharan Africa, it is estimated that only 28% of health facilities have access to reliable electricity, hampering the effectiveness for clinics, medical equipment, and medicines necessary for doctors and first responders to combat the pandemic. When treatments and a vaccine become available, access to electricity is also crucial to establish a ‘cold chain’ - a system of storing and transporting vaccines at recommended temperatures. A lack of a cold chain and refrigeration would mean rural, vulnerable populations cannot access vaccines.

Additionally, isolation and quarantine are very difficult without good public health infrastructure such as efficient test-and-trace protocols. In highly urbanized areas, isolation is particularly difficult especially with densely occupied households. In India, the last census shows about 73% of households reported living in two rooms or less. For instances where isolation or quarantine is possible, we would then need to address logistical challenges in delivering food and water to difficult-to-reach areas, which was the case in Liberia during the Ebola outbreak.

Re-evaluating investment and development priorities

The COVID-19 pandemic has spurred many governments and international development agencies to pledge billions in investments and interventions. As a result, many development organizations have begun shifting priorities to address health infrastructure needs.

For example, the Asian Infrastructure Investment Bank (AIIB), which previously focused on energy or transportation infrastructure investments, has indicated that the “crisis accelerated the thinking… toward more social infrastructure projects.” Megatrends in Asia such as rapid urbanization and aging populations have renewed focus on critical investments in health care, water, and sanitation. The AIIB will support the emergency phase by building hospitals and financing supplies but suggested a shifting focus in 2021 on long-term infrastructure to prevent and mitigate future epidemics.

Unfortunately, despite the importance of water, sanitation, and hygiene in combatting the virus as stated previously – it is mostly absent in donor commitments, which focus more on vaccines instead. And until a vaccine is available, the only defense people have against COVID-19 right now is prevention.

Prior to the COVID-19 pandemic, the need for improved infrastructure for public health was evident. However, this pandemic exacerbates underlying conditions, including unplanned settlements, traffic congestion, isolation of last-mile communities, and poor access to clean water, reliable electricity, and internet connectivity.

Direct primary care and other innovative models focusing on expanding access to quality healthcare in the developing world is critical to addressing not only the immediate health risks from COVID-19, but also post-pandemic health management.

According to Ngu Morcho, Ashoka Fellow and Founder/Managing Director of Yako Medical Africa, “the pandemic has shown us the importance of health resilience – not only in the U.S., but in Africa and other developing countries. The transformation of healthcare systems need to be affordable, reliable, smart, and integrated. Global engineering and construction companies are the best at designing projects with integrated systems, standardizing the quality of physical assets, and building a supply chain of critical equipment and supplies.”

Engineering, construction, and project management companies like Bechtel are an integral part of rethinking pandemic risk reduction and the structural inequalities that have existed for decades putting vulnerable communities at greater risk. Like Ngu, we believe a healthy society and economy are two sides of the same coin. Our goal, like many others, is to help governments, health organizations, local communities, and businesses recover stronger and faster from COVID-19 and support a safe reopening of local economies.