Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges

Abstract

This paper conducts a comparative review of the (curative) health systems’ response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the ‘Health System Response Monitor’ platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy “flexible” intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.

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“…This implies that waiting with the implementation of public health measures until popular support for those measures is attained may cause an ineffective, slow response. Arguably, this is one of the successes in many countries’ policy responses to the pandemic; the first containment measures were usually introduced within days or weeks after the first case was detected 41 .…”

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“…4 Despite the poor state of public health infrastructure of the United States for a pandemic, hundreds of thousands of deaths could have potentially been avoided if public-private partnerships were developed for make up for the dearth in diagnostic testing and health workforce capacity. 27 The identi cation of new SARS-CoV-2 variants in a timely manner is critical to public health. While it is hard to prognosticate the future, it is possible to establish a method to prioritize research when new mutations are discovered on genetic coding segments of key proteins, like the SARS-CoV-2 spike protein.…”

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“…Moreover, although public-private collaborations were very useful in many countries as a way to increase capacity at early stages of the pandemic, the urgency of the measures adopted may have resulted in some cases both in a lack of transparency and inefficiencies. 3…”