Health system preparedness for emerging infectious diseases: A synthesis of the literature

Abstract

This review reflects on what the literature to date has taught us about how health systems of low-and middle-income countries (LMICs) respond to emerging infectious disease (EID) outbreaks. These findings are then applied to propose a conceptual framework characterising an EID prepared health system. A narrative synthesis approach was adopted to explore the key elements of LMIC health systems during an EID outbreak. Overarching themes ('core health system constructs') and sub-themes ('elements') relevant to EID preparedness were extracted from 49 peerreviewed articles. The resulting conceptual framework recognised six core constructs: four focused on material resources and structures (i.e. system 'hardware'), including (i) Surveillance, (ii) Infrastructure and medical supplies, (iii) Workforce, and (iv) Communication mechanisms; and two focused on human and institutional relationships, values and norms (i.e. system 'software'), including (i) Governance, and (ii) Trust. The article reinforces the interconnectedness of the traditional health system building blocks to EID detection, prevention and response, and highlights the critical role of system 'software' (i.e. governance and trust) in enabling LMIC health systems to achieve and maintain EID preparedness. The review provides recommendations for refining a set of indicators for an 'optimised' health system EID preparedness tool to aid health system strengthening efforts. ARTICLE HISTORY

Country-level factors associated with the early spread of COVID-19 cases at 5, 10 and 15 days since the onset

“…The number of cases in this study were, likewise, predicted by healthcare resources and expenditures, indicating that health systems with substantial amount of investment and health workers are essential in tackling the early spread of the disease. As there are currently no pharmaceutical interventions available, this may link to the availability of appropriate PPE amongst healthcare professions and the capacity to conduct testingboth of which are likely to be correlated with healthcare resources and expenditures (Chang et al, 2019;Goenka & Liu, 2019;Palagyi et al, 2019). Interestingly, we found that countries with a higher incidence of tuberculosis had a lower IRR for COVID-19 cases at 5, 10 and 15 days.…”

The COVID-19 Pandemic in Francophone West Africa: From the First Cases to Responses in Seven Countries

“…This lack of consistency between epidemiological curves and public health measures has thus sometimes led to scepticism about the very existence of COVID-19, as was sometimes the case with Ebola [31]. However, anticipation and preparation are precisely at the heart of epidemic management as the case of Ebola has clearly shown in the region [32] and trust and governance are essential elements of good pandemic preparedness [32].…”

A Systematic Narrative Review of Comprehensive Preparedness Strategies of Healthcare Resources for a Large Resurgence of COVID-19 Nationally, with Local or Regional Epidemics: Present Era and Beyond

“…Describing approaches falling under six predefined domains, 33 articles specifically focused on preparedness strategies of healthcare resources for the pandemic ( Table 1 ). 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 The final list of selected publications included 3 original articles, 9 commentaries, and 21 review articles. All but six articles were published between 2019 and 2020.…”

“…During the public health crisis, central-local cooperative governance should be created for developing an integrated and coordinated approach based on the regional centered healthcare system. 41 43 A decentralized healthcare system is favorable even in case of simultaneous local or regional epidemics. Subnational governments composed of regions and municipalities should be responsible for critical aspects of containment measures and health care, placing them at the frontline of crisis management.…”