Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

Abstract

Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.

Building a multisystemic understanding of societal resilience to the COVID-19 pandemic

“…Experiences in several countries across the world have shown that rapid actions are largely successful in preventing community transmission. 10 When they were not, community transmission leads to a surge of patients in healthcare systems. Healthcare resilience to the COVID-19 pandemic relies primarily on how hospitals cope with a surge of patients and, when capacities are exceeded, adapt through reorganisation and an appropriate and timely allocation of resources.…”

Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department

“…The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed an ongoing burden on healthcare systems globally [1,2]. During the first COVID-19 wave in the Netherlands, which lasted from 27 February 2020 (first confirmed infection) to 30 June 2020, there were 50,262 confirmed cases of infection (of which 11,877 were hospitalised) and 6113 confirmed COVID- 19-deaths [3].…”

“…However, a lack of knowledge on clinical presentation impeded the identification and segregation of COVID-19 patients. Early in the pandemic, EDs were forced to work with case definitions that focused on acute respiratory illness and travel or contact history [2,12,13]. With increasing exposure to this new infectious disease, it became apparent that COVID-19 patients could be relatively asymptomatic in the early stages of illness or present with gastro-intestinal or atypical symptoms [14][15][16][17][18].…”

Survival of the wealthiest? Wait in line for COVID-19 vaccination

“…2 Distribution of COVID-19 vaccines is dependent on the existent infrastructure of health systems at state or territory level. 3 COVAX was established to ensure equitable distribution of vaccines, once available, regardless of the economic differences globally-a donor-based model of vaccine equity. 4 This initiative, however, failed to account for high-income countries (HICs) outcompeting through purchasing vaccines at a higher price.…”

“…Initiatives to promote equitable distribution were enforced through individual governments, and agencies focusing on local vaccine production capacities in lower/ middle-income countries (LMICs) and redistribution of vaccines from HICs to LMICs. 3 The WHO is promoting capacity building across health systems in LMICs to reduce inequity for vaccine distribution. 7 8 The question remains-is this solution to vaccine inequity enough?…”