Coronavirus disease (COVID-19) has exposed long-standing fragmentation in health systems strengthening efforts for health security and universal health coverage while these objectives are largely interdependent and complementary. In this prevailing background, we reviewed countries’ COVID-19 Preparedness and Response Plans (CPRPs) to assess the extent of integration of non-COVID-19 essential health service continuity considerations alongside emergency response activities. We searched for COVID-19 planning documents from governments and ministries of health, World Health Organization (WHO) country offices and United Nations (UN) country teams. We developed document review protocols using global guidance from the WHO and UN and the health systems resilience literature. After screening, we analysed 154 CPRPs from 106 countries. The majority of plans had a high degree of alignment with pillars of emergency response such as surveillance (99%), laboratory systems (96%) and COVID-19-specific case management (97%). Less than half considered maintaining essential health services (47%); 41% designated a mechanism for health system–wide participation in emergency planning; 34% considered subnational service delivery; 95% contained infection prevention and control (IPC) activities and 29% considered quality of care; and 24% were budgeted for and 7% contained monitoring and evaluation of essential health services. To improve, ongoing and future emergency planning should proactively include proportionate activities, resources and monitoring for essential health services to reduce excess mortality and morbidity. Specifically, this entails strengthening subnational health services with local stakeholder engagement in planning; ensuring a dedicated focus in emergency operations structures to maintain health systems resilience for non-emergency health services; considering all domains of quality in health services along with IPC; and building resilient monitoring capacity for timely and reliable tracking of health systems functionality including service utilization and health outcomes. An integrated approach to planning should be pursued as health systems recover from COVID-19 disruptions and take actions to build back better.

National public health institutes and WHO collaborating centres, and their global networks, are a key resource to support public health system strengthening with essential public health functions and generate evidence for health policy central to national health and socioeconomic development. The COVID-19 pandemic has laid bare global inequities in public health capacities, made urgent the need to examine sources of global knowledge and understand how to better invest in and use public health institutes and their capacities. This analysis paper incorporates experiences and perspectives from the WHO and International Association of Public Health Associations including the ongoing pandemic and work conducted in the UK-WHO ‘Tackling Deadly Diseases in Africa Programme’. We acknowledge geographical disparities in public health capacities both within and across countries and regions, provide examples of novel ways of working for global health actors, and define the challenging environment in which public health authorities operate. We identify four incentives for all countries to invest in public health and strengthen institutions: (1) transparency and trust; (2) socioeconomic dividends; (3) collective health protection and (4) knowledge sharing and equity. By pursuing shared priorities; enabling voices from low-resource settings to be more equitably heard; facilitating collaboration and learning within and across regions, we articulate actionable next steps to develop and better harness public health institutes and international networks.

The COVID-19 pandemic, climate change-related events, protracted conflicts, economic stressors and other health challenges, call for strong public health orientation and leadership in health system strengthening and policies. Applying the essential public health functions (EPHFs) represents a holistic operational approach to public health, which is considered to be an integrated, sustainable, and cost-effective means for supporting universal health coverage, health security and improved population health and wellbeing. As a core component of the Primary Health Care (PHC) Operational Framework, EPHFs also support the continuum of health services from health promotion and protection, disease prevention to treatment, rehabilitation, and palliative services. Comprehensive delivery of EPHFs through PHC-oriented health systems with multisectoral participation is therefore vital to meet population health needs, tackle public health threats and build resilience. In this perspective, we present a renewed EPHF list consisting of twelve functions as a reference to foster country-level operationalisation, based on available authoritative lists and global practices. EPHFs are presented as a conceptual bridge between prevailing siloed efforts in health systems and allied sectors. We also highlight key enablers to support effective implementation of EPHFs, including high-level political commitment, clear national structures for institutional stewardship on EPHFs, multisectoral accountability and systematic assessment. As countries seek to transform health systems in the context of recovery from COVID-19 and other public health emergencies, the renewed EPHF list and enablers can inform public health reform, PHC strengthening, and more integrated recovery efforts to build resilient health systems capable of managing complex health challenges for all people.

Health system strengthening towards universal health coverage and health security are key objectives promoted by health policy actors. However, bringing together these agendas has presented challenges. Health investments are often reactive and siloed e.g. emergency and humanitarian response programmes. There has been disinvestment in public health and primary health care (PHC), and limited linkages with allied sectors (e.g. environmental and animal health). There is a need to better understand policies that promote integration and enable effective response to threats such as COVID-19 in tandem with maintaining routine health system functions (e.g. PHC and essential individual and population health services). We conducted document analysis of national health sector, security and public health policies and plans and drew on perspectives of key stakeholders to investigate integration using a health systems resilience framework. We examined the extent and manner in which policies are integrated to enable national and subnational systems to prepare for, prevent and adapt to shocks while maintaining routine and essential functions. While we identified a recognition of the need for better integration to promote health security within health systems strengthening efforts and vice versa including strengthening governance, accountability and capacity for stewardship within national and local health and allied authorities, evidence of such an approach was limited. National laws to support IHR (2005) implementation were often outdated and insufficient to produce the policy environment for multi-sectoral working. In 2020, only 47% of national COVID-19 plans from 106 countries considered the maintenance of non-COVID-19 essential health services - a key component of health systems resilience. Policies which strengthen PHC services and preventative interventions can be cost-effective and efficient whilst bridging pandemic response and other essential functions of the health system. Key messages COVID-19 is an opportunity to promote and sustain greater integration and inter- and multisectoral engagement. Everyone can play a role to foster an integrated approach focussing on preventative, cost-effective health services to ensure health systems resilience.

Community Engagement (CE) plays a crucial role in successful public health actions, achieving universal health coverage, and the realization of the United Nations Sustainable Development Goals. It has emerged as an effective strategy across different settings through prevention, preparedness, readiness and response, and recovery towards attaining community resilience, Primary Health Care (PHC) strengthening and universal health coverage (UHC), health security, and sustainable development. We reviewed the existing literature and various data sources and found that several CE training packages are available from international partners, focusing on the principles, theories, general questions, and CE techniques. However, there are still challenges because they are often fragmented, with little or no systematic procedures to guide the CE processes in different settings. In this light, WHO initiated a discourse on the CE Package (CEP) development in consultation with some selected international partners. The CEP Project will focus on developing a database, learning, and workshop packages based on curation of CE experiences in different settings using defined criteria. The CEP would harmonize CE processes and facilitate the reinforcement of the CE integration into public health. Further, the CEP Project serves as a collection of selected best practices for pre-service and in-service training packages for health professionals. Also, there is an anticipated inclusion into curricula of health training institutions and WHO staff capacity development. Finally, the database for compiling best practices is designed such that it can be periodically updated and becomes a compendium of CE for learning, research, and informing practice.