How can we strengthen partnership and coordination for health system emergency preparedness and response? Findings from a synthesis of experience across countries facing shocks

Abstract

Background Discussions of health system resilience and emergency management often highlight the importance of coordination and partnership across government and with other stakeholders. However, both coordination and partnership have been identified as areas requiring further research. This paper identifies characteristics and enablers of effective coordination for emergency preparedness and response, drawing on experience from different countries with a range of shocks, including floods, drought, and COVID-19. Methods The paper synthesises evidence from a set of reports related to research, evaluation and technical assistance projects, bringing together evidence from 11 countries in sub-Saharan Africa and South Asia. Methods for the original reports included primary data collection through interviews, focus groups and workshop discussions, analysis of secondary data, and document review. Reports were synthesised using a coding framework, and quality of evidence was considered for reliability of the findings. Results The reports highlighted the role played by coordination and partnership in preparedness and response, and identified four key areas that characterise and enable effective coordination. First, coordination needs to be inclusive, bringing together different government sectors and levels, and stakeholders such as development agencies, universities, the private sector, local leaders and civil society, with equitable gender representation. Second, structural aspects of coordination bodies are important, including availability of coordination structures and regular meeting fora; clear roles, mandates and sufficient authority; the value of building on existing coordination mechanisms; and ongoing functioning of coordination bodies, before and after crises. Third, organisations responsible for coordination require sufficient capacity, including staff, funding, communication infrastructure and other resources, and learning from previous emergencies. Fourth, effective coordination is supported by high-level political leadership and incentives for collaboration. Country experience also highlighted interactions between these components, and with the wider health system and governance architecture, pointing to the need to consider coordination as part of a complex adaptive system. Conclusion COVID-19 and other shocks have highlighted the importance of effective coordination and partnership across government and with other stakeholders. Using country experience, the paper identifies a set of recommendations to strengthen coordination for health system resilience and emergency management.

Roles of health system leadership under emergency in drought-affected districts in northeast Uganda: a mixed-method study

“…Community engagement,28 29 partners coordination and intersectoral collaboration1 6 30 are the most important leadership activities in emergency response. These findings are consistent with the current study results in which community engagement implemented by trained VHTs, response activities coordination at each level of health system and intersectoral collaborations played an essential role in emergency response and maintenance of health services.…”

Understanding Health System Resilience in responding to a pandemic: experience and lessons from an evolving context of federalization in Nepal

“…Due to lack of clarity in roles and decisions, further delays in action and poor implementation were the resulting consequences. Therefore, crucial to health system resilience is to ensure that the coordination and communication channels and approaches should be appropriate and reach targeted audiences on time with clear messages 21 . Gender and equity was another area that received less attention in the policy documents, nevertheless, reactive management during implementation led to adaptations when issues started to be reported.…”

Conditions for health system resilience in the response to the COVID-19 pandemic in Mauritania

“…These conditions include the empowerment of frontline health workers, and the development of social networks and collaborations within the local health system and beyond, which would lead to more legitimate, sustainable and socially acceptable policy decisions 26 40 41. In addition, it requires a favourable environment: an atmosphere of learning, mentoring, accountability and a certain level of autonomy to test and adapt strategies at operational level 42 43…”