Health system resilience in managing the COVID-19 pandemic: lessons from Singapore

Singapore, one of the first countries affected by COVID-19, adopted a national strategy for the pandemic which emphasised preparedness through a whole-of-nation approach. The pandemic was well contained initially until early April 2020, when there was a surge in cases, attributed to Singapore residents returning from hotspots overseas, and more significantly, rapid transmission locally within migrant worker dormitories. In this paper, we present the response of Singapore to the COVID-19 pandemic based on core dimensions of health system resilience during outbreaks. We also discussed on the surge in cases in April 2020, highlighting efforts to mitigate it. There was: (1) clear leadership and governance which adopted flexible plans appropriate to the situation; (2) timely, accurate and transparent communication from the government; (3) public health measures to reduce imported cases, and detect as well as isolate cases early; (4) maintenance of health service delivery; (5) access to crisis financing; and (6) legal foundation to complement policy measures. Areas for improvement include understanding reasons for poor uptake of government initiatives, such as the mobile application for contact tracing and adopting a more inclusive response that protects all individuals, including at-risk populations. The experience in Singapore and lessons learnt will contribute to pandemic preparedness and mitigation in the future.

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Health system resilience in the face of crisis: analysing the challenges, strategies and capacities for UNRWA in Syria

Health Policy and Planning ◽

10.1093/heapol/czz129 ◽

2019 ◽

Author(s):

Zeina Jamal ◽

Mohamad Alameddine ◽

Karin Diaconu ◽

Graham Lough ◽

Sophie Witter ◽

...

Keyword(s):

Service Delivery ◽

Health System ◽

Model Building ◽

Health Service Delivery ◽

Crisis Response ◽

Annual Reports ◽

Group Model ◽

Organizational Flexibility ◽

The Face ◽

System Resilience

Abstract Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective qualitative case study utilizing diverse methods. We conducted 35 semi-structured interviews with UNRWA clinical and administrative professionals engaged in health service delivery over the period of the Syria conflict. Through a group model building session with a sub-group of eight of these participants, we then elicited a causal loop diagram of health system functioning over the course of the war, identifying pathways of threat and mitigating resilience strategies. We triangulated analysis with data from UNRWA annual reports and routine health management information. The UNRWA health system generally sustained service provision despite individual, community and system challenges that arose during the conflict. We distinguish absorptive, adaptive and transformative capacities of the system facilitating this resilience. Absorptive capacities enabled immediate crisis response, drawing on available human and organizational resources. Adaptive capacities sustained service delivery through revised logistical arrangements, enhanced collaborative mechanisms and organizational flexibility. Transformative capacity was evidenced by the creation of new services in response to changing community needs. Analysis suggests factors such as staff commitment, organizational flexibility and availability of collaboration mechanisms were important assets in maintaining service continuity and quality. This evidence regarding alternative strategies adopted to sustain service delivery in Syria is of clear relevance to other actors seeking organizational resilience in crisis contexts.

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Mathematical modeling of COVID-19 transmission dynamics in Uganda: Implications of complacency and early easing of lockdown

PLoS ONE ◽

10.1371/journal.pone.0247456 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247456

Author(s):

Joseph Y. T. Mugisha ◽

Joseph Ssebuliba ◽

Juliet N. Nakakawa ◽

Cliff R. Kikawa ◽

Amos Ssematimba

Keyword(s):

Contact Tracing ◽

Infectious Period ◽

Optimal Timing ◽

Intervention Measures ◽

First Case ◽

Latently Infected ◽

Imported Cases ◽

The Government ◽

Set Up ◽

The Impact

Background Uganda has a unique set up comprised of resource-constrained economy, social-economic challenges, politically diverse regional neighborhood and home to long-standing refuge crisis that comes from long and protracted conflicts of the great lakes. The devastation of the on-going global pandemic outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is likely to be escalated by these circumstances with expectations of the impact of the disease being severe. Materials and methods In this study, we formulate a mathematical model that incorporates the currently known disease characteristics and tracks various intervention measures that the government of Uganda has implemented since the reporting of the first case in March 2020. We then evaluate these measures to understand levels of responsiveness and adherence to standard operating procedures and quantify their impact on the disease burden. Novel in this model was the unique aspect of modeling the trace-and-isolate protocol in which some of the latently infected individuals tested positive while in strict isolation centers thereby reducing their infectious period. Results The study findings show that even with elimination of all imported cases at any given time it would take up to nine months to rid Uganda of the disease. The findings also show that the optimal timing of easing of lockdowns while mitigating the possibility of re-emergence of a second epidemic wave requires avoiding the scenario of releasing too-many-too-soon. It is even more worrying that enhancing contact tracing would only affect the magnitude and timing of the second wave but cannot prevent it altogether. Conclusion We conclude that, given the prevailing circumstances, a phased-out lifting of lockdown measures, minimization of COVID-19 transmissibility within hospital settings, elimination of recruitment of infected individuals as well as enhanced contact tracing would be key to preventing overwhelming of the healthcare system that would come with dire consequences.

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Enhancing Health System Resilience: Practical and Cost-effective Approaches to Face the COVID-19 Pandemic by Base Hospital UdugamaSri Lanka

International Journal of Community Resilience ◽

10.51595/injcr/11111117 ◽

2021 ◽

Author(s):

KJMD Taranga ◽

GHS Fernando

Keyword(s):

Health System ◽

Community Sample ◽

Unknown Origin ◽

Cost Effective ◽

Healthcare Services ◽

World Health ◽

Sample Collection ◽

Base Hospital ◽

System Resilience ◽

The Government

COVID-19 is a pandemic from pneumonia of unknown origin, first reported in Wuhan city China as information extracted from the World Health Organization. It was first reported in Sri Lanka on 27 January 2020 by a Chinese tourist. Handing the COVID-19 situation with scarce recourses within a limited time was challenging for the government hospitals. This paper aims to describe the practical and cost-effective actions implemented at the Base Hospital Udugama to enhance the health system resilience to prepare, respond to, and recover from the COVID-19 pandemic. We did a retrospective evaluation of the COVID-19 control project at the Base Hospital Udugama. The daily interventions carried out at the Base Hospital Udugama to prepare, respond and recover from the COVID-19 pandemic were documented in a journal. Also, we preserved evidence through photographs while collecting data from the routine hospital records. The temporally established COVID-19 coordinating committee managed all the activities. The committee increased awareness among staff and the public, maintained stock of Personal Protective Equipment, established preventive measures, established an isolation unit, arranged community sample collection, continued essential routine healthcare services and distribution of the clinic drugs to the doorsteps of the patients while protecting the Hospital staff against COVID-19. Even though the management of the COVID-19 pandemic was a challenge to the Base Hospital Udugama, with strong leadership and effective coordination with different units and departments within and beyond the hospital, it was possible to manage the response efficiently and effectively. We recommend enhancing the health system's resilience through timely investments in peripheral hospitals coupled with capacity building targeting multiple hazards, including pandemics. Keywords: COVID 19, Pandemic, Prevention, Resilience, Preparedness, Response.

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Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

2020 ◽

Vol 41 (1) ◽

Author(s):

Adweeti Nepal ◽

Santa Kumar Dangol ◽

Anke van der Kwaak

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Maternal Health Services ◽

Policy Formulation ◽

Social Accountability ◽

The Social ◽

The Government ◽

The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

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Health system gaps in cardiovascular disease prevention and management in Nepal

BMC Health Services Research ◽

10.1186/s12913-021-06681-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Archana Shrestha ◽

Rashmi Maharjan ◽

Biraj Man Karmacharya ◽

Swornim Bajracharya ◽

Niharika Jha ◽

...

Keyword(s):

Human Resources ◽

Health System ◽

Health Systems ◽

National Health ◽

Task Force ◽

Health Spending ◽

Building Blocks ◽

Critical System ◽

Government Organizations ◽

The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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Subcritical Transmission in the Early Stage of COVID-19 in Korea

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031265 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1265

Author(s):

Yong Sul Won ◽

Jong-Hoon Kim ◽

Chi Young Ahn ◽

Hyojung Lee

Keyword(s):

Incubation Period ◽

Early Stage ◽

Probability Distributions ◽

Likelihood Estimation ◽

Contact Tracing ◽

Statistical Characterization ◽

Serial Interval ◽

Imported Cases ◽

The Mean ◽

Reporting Delays

While the coronavirus disease 2019 (COVID-19) outbreak has been ongoing in Korea since January 2020, there were limited transmissions during the early stages of the outbreak. In the present study, we aimed to provide a statistical characterization of COVID-19 transmissions that led to this small outbreak. We collated the individual data of the first 28 confirmed cases reported from 20 January to 10 February 2020. We estimated key epidemiological parameters such as reporting delay (i.e., time from symptom onset to confirmation), incubation period, and serial interval by fitting probability distributions to the data based on the maximum likelihood estimation. We also estimated the basic reproduction number (R0) using the renewal equation, which allows for the transmissibility to differ between imported and locally transmitted cases. There were 16 imported and 12 locally transmitted cases, and secondary transmissions per case were higher for the imported cases than the locally transmitted cases (nine vs. three cases). The mean reporting delays were estimated to be 6.76 days (95% CI: 4.53, 9.28) and 2.57 days (95% CI: 1.57, 4.23) for imported and locally transmitted cases, respectively. The mean incubation period was estimated to be 5.53 days (95% CI: 3.98, 8.09) and was shorter than the mean serial interval of 6.45 days (95% CI: 4.32, 9.65). The R0 was estimated to be 0.40 (95% CI: 0.16, 0.99), accounting for the local and imported cases. The fewer secondary cases and shorter reporting delays for the locally transmitted cases suggest that contact tracing of imported cases was effective at reducing further transmissions, which helped to keep R0 below one and the overall transmissions small.

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Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level

Journal of Egyptian Public Health Association ◽

10.1186/s42506-020-00062-x ◽

2021 ◽

Vol 96 (1) ◽

Author(s):

Hoda Ibrahim Rizk ◽

Monira Mahmoud Elkholy ◽

Abeer Abdou Barakat ◽

Raghda Mostafa Mostafa Elsayed ◽

Shaimaa A. M. Abd El Fatah

Keyword(s):

Health System ◽

Access To Medicines ◽

Generic Medicine ◽

Essential Medicines ◽

Cross Sectional ◽

Urban Group ◽

Rural And Urban ◽

External Stakeholders ◽

Assessment Approach ◽

The Government

Abstract Background Equitable access to essential medicines of maintained efficacy, safety, quality, and cost-effectiveness must be ensured by a well-functioning health system. This study aims to identify the determinants of patients’ access to medicines at the primary health care (PHC) level from the perspectives of various (internal and external) stakeholders of the pharmaceutical system. Methods The study employed both quantitative and qualitative components. Quantitative component applied a descriptive a cross-sectional design and qualitative component applied an in-depth interview design. It was a health system research conducted at two (PHC) facilities (one urban and the other rural) in Egypt. It inquired upon political, economic, and managerial aspects of the pharmaceutical system utilizing the “Health System Assessment Approach: a How-To Manual” and the “WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations.” Results Analysis of the quantitative data extracted from the cross-sectional component with external stakeholders (patients) revealed that about one-third of patients in both facilities were unable to pay for the medicine. Patients in both settings took less than an hour to reach the PHC facility. The Percent of patients who believe that the private pharmacies’ medicine is better than the PHC one was significantly higher in rural than urban group (24% and 10% respectively) and the percent of medicines dispensed was 50% and 66.7% in rural and urban groups respectively. Analysis of the qualitative data extracted from in-depth interviews with internal stakeholders (key informants from regulatory agencies, pharmaceutical industry, academia, pharmacists, and physicians) were summarized utilizing Strengths-Weaknesses-Opportunities-Challenges (SWOC) analysis approach. Various viewpoints toward the determinants of patients’ access to medicines were disclosed. Conclusions The Percent of medicines dispensed was insufficient in both rural and urban facilities. There is a need to invest in building trust in generic medicine quality in the government health facilities focusing on improving medicine availability and ensuring enough amounts of high-quality drugs. Although there are drug committees in the two studied PHC facilities for demonstrating the prescribing and dispensing policies, yet the system required to enforce these policies is still deficient.

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Moving Faster than the COVID-19 Pandemic: The Rapid, Digital Transformation of a Public Health System

Applied Clinical Informatics ◽

10.1055/s-0041-1725186 ◽

2021 ◽

Vol 12 (02) ◽

pp. 229-236

Author(s):

Clair Sullivan ◽

Ides Wong ◽

Emily Adams ◽

Magid Fahim ◽

Jon Fraser ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Public Health System ◽

Digital Transformation ◽

Contact Tracing ◽

Programming Approach ◽

Data Governance ◽

Application Development ◽

Containment Strategy

Abstract Background Queensland, Australia has been successful in containing the COVID-19 pandemic. Underpinning that response has been a highly effective virus containment strategy which relies on identification, isolation, and contact tracing of cases. The dramatic emergence of the COVID-19 pandemic rendered traditional paper-based systems for managing contact tracing no longer fit for purpose. A rapid digital transformation of the public health contact tracing system occurred to support this effort. Objectives The objectives of the digital transformation were to shift legacy systems (paper or standalone electronic systems) to a digitally enabled public health system, where data are centered around the consumer rather than isolated databases. The objective of this paper is to outline this case study and detail the lessons learnt to inform and give confidence to others contemplating digitization of public health systems in response to the COVID-19 pandemic. Methods This case study is set in Queensland, Australia. Universal health care is available. A multidisciplinary team was established consisting of clinical informaticians, developers, data strategists, and health information managers. An agile “pair-programming” approach was undertaken to application development and extensive change efforts were made to maximize adoption of the new digital workflows. Data governance and flows were changed to support rapid management of the pandemic. Results The digital coronavirus application (DCOVA) is a web-based application that securely captures information about people required to quarantine and creates a multiagency secure database to support a successful containment strategy. Conclusion Most of the literature surrounding digital transformation allows time for significant consultation, which was simply not possible under crisis conditions. Our observation is that staff was willing to adopt new digital systems because the reason for change (the COVID-19 pandemic) was clearly pressing. This case study highlights just how critical a unified purpose, is to successful, rapid digital transformation.

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The fight of Armenia against COVID-19 in the context of international cooperation

Social'naja politika i social'noe partnerstvo (Social Policy and Social Partnership) ◽

10.33920/pol-01-2102-05 ◽

2021 ◽

pp. 127-133

Author(s):

M. A. Tamamyan

Keyword(s):

Mass Media ◽

Health System ◽

International Cooperation ◽

International Organizations ◽

Full Range ◽

Coronavirus Infection ◽

The Mass Media ◽

The Republic ◽

The Government ◽

External Actors

The article is devoted to the study of methods of combating coronavirus infection in the Republic of Armenia in the context of international cooperation. Attention is focused on the interaction of country with international organizations to overcome the pandemic in the country. This paper presents the author's table based on the analysis of the mass media in order to summarize the full range of cooperation between the Government of Armenia and external actors during the COVID-19. The article emphasizes the importance of creating an anti-crisis committee to combat coronavirus, as well as the need to increase funding for the health system.

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Economical effect on doubling of COVID-19 cases: examples of rich versus poor countries

Review of Economics and Political Science ◽

10.1108/reps-10-2020-0158 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Osama Ali Maher ◽

Dmitry Mun ◽

Fatma Giha ◽

Mayouson Ali ◽

Saverio Bellizzi

Keyword(s):

Health System ◽

Work Force ◽

Epidemiological Data ◽

Content Type ◽

Poor Countries ◽

Complex Emergencies ◽

Internal Conflicts ◽

Comprehensive Comparison ◽

The Government

Purpose The paper aims to examine some economical, political and health system indicators on the transmission of the COVID-19 transmission within the national system. The main objective is to investigate what are the most effective indicators which have led to the declared numbers by countries. Design/methodology/approach This study combined multiple sets of data to describe best the economical status of the health system including the government spending on the health system to draw some conclusion regarding the behavior of the pandemic. Findings Complex emergencies and internal conflicts negatively affected the quality of the reported cases and the size of the pandemic. The health work force was the most determinant factor of the health system. It can sometimes be impossible to understand the epidemic only with epidemiological data or health system one; economical aspects of health system and political situation have to be added to the equation. Originality/value The research according to the authors’ knowledge is the most comprehensive comparison so far that investigate the non-covid aspects from a political side in particular in complex emergencies and war situation added health system indicators.

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