The Belgian health system is relatively complex due to the different layers of administration at federal and regional levels. Whilst the health system is managed by the Federal Public Service (FPS) for Health, the Flemish, Walloon, and German-speaking communities all have their own administrative healthcare divisions. The system is funded by a combination of health insurance and social security contributions, and citizens are in charge of paying the remainder of the unsubsidised care.
Despite the complex system, the occupancy rate of intensive care units never exceeded 60 percent, which resulted in a relatively high survival rate of patients in those facilities.
How has the national government responded to COVID-19?
Belgium has been in the ‘federal phase of crisis management’ since 12 March during which the Risk Assessment Group (RAG), the Risk Management Group (RMG), and the Scientific Committee for Coronavirus have provided advice to CELEVAL. CELEVAL is an ‘Evaluation Unit’ chaired by FPS Public Health and is made up of representatives of Sciensano – the committee set up for COVID-19 – the Superior Health Council, the administrations responsible for public health at the level of the Regions and Communities, and the FPS Home Affairs and Mobility. It advises the authorities on matters of public health, so they can take decisions to tackle the pandemic.
Belgium went through a strict lockdown period from March until May during which only essential travel was allowed, people were advised to stay at home and schools were closed. The Federal Government published its exit strategy on 24 April, outlining a roadmap to gradually scale back various lockdown measures.
Although lockdown measures were eased throughout the summer, phase 5 of the roadmap has been postponed until at least September and protective measures have been tightened. This is due to an increase in COVID-19 cases from the end of July onwards, first in the Antwerp region and then in Brussels.
On 18 March, Belgium banned all non-essential travel abroad. Since then, the Government has relaxed rules on cross-border travel within the EU, and to the United Kingdom, Norway, Iceland and Switzerland. The Foreign Affairs Ministry updates a list of allowed and not-allowed countries for travel for Belgian citizens and permanent residents.
At the moment, travel from Belgium to the United Kingdom is possible but requires a quarantine. Travel from the United Kingdom to Belgium is allowed but travellers are advised to be more vigilant in certain regions and Aberdeen has been added to the red list, so people returning to Belgium from the area will have to quarantine.
Should travelling be fully banned between Belgium and the United Kingdom, Brexit negotiations could be impacted. Face-to-face negotiations have already been sparse between the two sides as most of the discussions have taken place virtually but with a deadline for finalising the negotiations looming at the end of October, a full ban on travel between the two countries would not be helpful.
What is the impact on the health system of these measures?
From March onwards all hospitals have been asked to have an appropriate emergency service in place and to create a critical care capacity to tackle the pandemic for both ventilated and non-ventilated patients.
Although the Belgian health system has earned a good reputation, the COVID-19 pandemic has highlighted shortcomings in the system’s ability to deal with a severe public health crisis. The system suffers from a structural shortage of health workers and will need to ensure sufficient critical medical products, including personal protective equipment (PPE), are available for health workers.
There has also been limited access to testing in Belgium. Originally only health workers were able to get tested, but the policy has evolved from May. GPs are able to test or refer their patients to a testing centre if they suspect COVID-19. Anyone referred for a test will also need to make a list of who have been in contact with which will be used for tracing if the test is positive.