Israel’s new health minister inherits a sick country in need of a lot of care, despite the low number of daily COVID-19 cases.

Horowitz inherits a ministry that has suffered from a nearly one-and-a-half-year battle against a global pandemic that has been intensely politicized by Prime Minister Benjamin Netanyahu.

He is also taking over in the context of a number of fraud schemes that center around his department.

Last week, it was reported that two senior advisers to former health minister MP Ya’acov Litzman were being questioned for plotting to influence government policy on health issues such as food in exchange for bribes.

Litzman himself is also under investigation for two offenses during his tenure: one which involved meeting with the Jerusalem district psychiatrist to urge him to publish a false assessment for the sex offender. accused Malka Leifer and the other for trying to influence inspectors to reopen a restaurant that failed a health visit.

Horowitz’s job will be to keep the number of daily COVID cases low while moving past the pandemic to address other issues plaguing Israel’s health care system, and to regain the Israeli public’s trust in the system.

“The things he will have to manage will require original thinking and major reforms,” ​​said Professor Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research. Jerusalem post. “I hope he has the sense of humility to know he should surround himself with some of the best people in the business.”

These should be the top five priorities of the next Minister of Health:

1 – Mental health

Mental illness – primarily but not just depression – is among the fastest growing health issues for the state of Israel.

A recent survey published by researchers at Tel Aviv University found that Israelis’ level of personal resilience reached a two-year low during the recent escalation in Gaza.

Researchers measured resilience on a scale of one (weakest) to five (strongest). In 2018, the Israelis’ level of resilience was 4.68. At the height of the pandemic in October 2020, it fell to 4.28. In January 2021, during the third wave, it fell to 3.48. And in the recent operation in Gaza, it dropped to 2.47.

The data is “very worrying” and even “dangerous,” said study principal investigator Dr Bruria Adini. To post.

Israel still lacks services and understanding of mental health issues, said Professor Hagai Levine, former president of the Association of Public Health Physicians.

“We have treated the COVID-19 pandemic well with the vaccines, but now we have severely traumatized people,” Levine told the To post.

He said there has been an increase in the number of people seeing their family doctors for other causes rooted in stress and depression.

“There is a link between mental health and physical health,” he said.

The coalition agreements indicated that the new government plans to add psychological services to the public – an important first step if implemented.

“Healthcare workers need to be mentally healthy to take care of people,” Levine said.

2 – COVID-19 surveillance

While Israel was among the first countries to emerge from the coronavirus crisis, vaccinating nearly 5.5 million Israelis and thus opening up its economy, health experts understand that the pandemic is not over yet.

With hundreds of thousands of new coronavirus cases worldwide daily, Israel is still vulnerable to vaccine-resistant COVID variants that could enter the country through Ben-Gurion Airport.

Overall, the Ministry of Health has maintained a strict and effective border closure since the third wave. Any unvaccinated Israeli or Israeli returning from high infection countries should be quarantined upon arrival for at least 10 days. And all passengers are required to pass a PCR-grade coronavirus test before boarding and upon arrival.

A minimal group of vaccinated tourists have entered Israel since last month. An announcement from the Ministries of Tourism and the Interior last week indicated that vaccinated tourists will be able to enter from July 1. It will be up to the new Minister of Health to test and confirm that these travelers are COVID-free while in Israel.

Earlier this month, a group of 16 olim (new immigrants) from India who claimed to have tested negative for COVID in their hometown were infected with the virus upon arrival. Surveillance caught the infected immigrants and they were placed in state-run COVID hotels until they recovered. Strict screening protocols must be maintained.

At the same time, health officials need to keep tabs on what’s going on inside the country. Israel must find a way to maintain a minimum number of daily tests to detect outbreaks before they start.

Ben-David suggested that serologic testing could be offered to patients undergoing routine blood tests, for example. Or PCR testing could be part of the annual review.

3 – Health workers

Israel’s healthcare system entered the COVID-19 crisis in a state of famine, forcing Israel into three lockdowns lest hospitals collapse under pressure from so many critically ill people.

It is because the country does not have enough doctors, nurses, technicians or even helpers.

Israel has one of the worst nurse-to-population ratios, with five nurses per 1,000 population – well below the Organization for Economic Co-operation and Development (OECD) average of 8.8 – and the number of graduates nursing schools is also low, which means there is little hope for growth.

When it comes to doctors, Israel has barely fewer doctors per capita than the OECD average. However, this is mainly due to the massive influx of new doctors in the 1990s from the former Soviet Union – and these doctors are getting older.

While doctors over 75 make up just 1% of the total workforce in OECD countries, in Israel they make up over 10%, Ben-David explained. And, like nursing students, Israel is at the bottom of the OECD in terms of the number of recent medical graduates.

During the coronavirus crisis, Health Minister Yuli Edelstein added around 2,000 new posts, but funding came through extra-budgetary payments intended for the virus and the posts were due to expire on June 30.

A decision was made to extend the posts until a new government is formed and the next budget is prepared, making it the responsibility of the new Minister of Health to fight for these roles.

In addition, residents of Israeli hospitals are working unsustainable 26-hour shifts – a situation that hospital heads say must change.

4 – Infrastructures

The infrastructure issue is vital, as the number of hospital beds per capita has been plummeting for decades, leaving Israel with the highest rate of hospital congestion in the developing world. This leads to a deficient level of care, despite the great professionalism of the staff.

“We have this dichotomy: very good doctors and nurses who qualitatively are the best in the world, working in a system that in some cases is not part of the developed world,” said Ben-David.

And people treated in hospital corridors lead to unnecessary infections.

Israel has entered this pandemic with by far the highest number of people dying from infectious diseases per capita in the developed world – 73% more than No.2 Greece.

A March 2020 state comptroller report highlighted Israel’s lack of a detailed program to address identified gaps in the health system, including intensive care beds and equipment.

Given that a new state budget is due to be approved for the first time since March 2018, it is essential that the Minister of Health works closely with the Minister of Finance to secure the necessary funds.

At the same time, Horowitz should strive to run his ministry more effectively by offering hospitals and health funds a greater sense of control and accountability, implementing new ways of measuring and evaluating health. success.

“The healthcare system often takes a band-aid approach or extinguishes fires all the time,” Levine said. “The system needs longer term planning and execution.”

5 – An aging population

While Israel is young compared to OECD countries, its population is aging rapidly – and the health ministry has not prepared for this new reality.

The number of older people in Israel is expected to reach 1.66 million by 2035, according to projections by the Central Bureau of Statistics – an increase of 77% between 2015 and 2035, which “will take a heavy toll on the health system.” said Ben-David.

Health officials must focus on finding better solutions for the care of the elderly, both in nursing homes and through home care. This could include telemedicine and digital surveillance programs that could save money and keep seniors safe.

“Health is one of the most important aspects that determines the quality of life,” said Ben-David. “The COVID-19 pandemic has shown the shortcomings of our country’s health system. No one can claim it isn’t broken – it is.

The question now is whether Horowitz will take the necessary steps to address it.