Transitioning the COVID-19 response in the WHO African region: a proposed framework for rethinking and rebuilding health systems

Abstract

The onset of the pandemic revealed the health system inequities and inadequate preparedness, especially in the African continent. Over the past months, African countries have ensured optimum pandemic response. However, there is still a need to build further resilient health systems that enhance response and transition from the acute phase of the pandemic to the recovery interpandemic/preparedness phase. Guided by the lessons learnt in the response and plausible pandemic scenarios, the WHO Regional Office for Africa has envisioned a transition framework that will optimise the response and enhance preparedness for future public health emergencies. The framework encompasses maintaining and consolidating the current response capacity but with a view to learning and reshaping them by harnessing the power of science, data and digital technologies, and research innovations. In addition, the framework reorients the health system towards primary healthcare and integrates response into routine care based on best practices/health system interventions. These elements are significant in building a resilient health system capable of addressing more effectively and more effectively future public health crises, all while maintaining an optimal level of essential public health functions. The key elements of the framework are possible with countries following three principles: equity (the protection of all vulnerable populations with no one left behind), inclusiveness (full engagement, equal participation, leadership, decision-making and ownership of all stakeholders using a multisectoral and transdisciplinary, One Health approach), and coherence (to reduce the fragmentation, competition and duplication and promote logical, consistent programmes aligned with international instruments).

Investing in health system resilience: A scoping review to identify strategies for enhancing preparedness and response capacity

“…A total of 43 publications that met the inclusion criteria were included in the final sample (Figure 1). Of these studies, ten focused on the African Region [6][7][8][9][10][11][12][13][14][15] , seven on South-East Asian Region 9,13,[16][17][18][19] , four on European Region 2,19-21 , six on Region of the Americas [22][23][24][25][26][27] , and nine studies did not have a specific geographical focus 1,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] . (Table 1)…”

“…healthcare, and attaining a sustainable performance of healthcare systems (SPHS) 1,2,7,9,[11][12][13][14][15]18,29,20,22,23,[26][27][28]30,31,[35][36][37]40,43 . Fragmentation can hinder effective responses and undermine the overall capacity of the health system.…”

Liberia health system's journey to long-term recovery and resilience post-Ebola: a case study of an exemplary multi-year collaboration

“…Liberia's successes in improving integration and multi-partner, multi-sectoral collaboration for resilience offer a broad range of steps for other countries to choose from. Within the country, there is a need to further institutionalize integrated health system resilience efforts, including linkages with funding streams and accountability mechanisms ( 28 ). The Ministry of Health and NPHIL need to work together to steer available and potential internal and external health investments to promote and operationalize an integrated approach to health system strengthening toward resilience, even when targeting specific health problems such as emergencies, specific diseases, or life-course issues.…”

“…Health system resilience efforts must be further decentralized ( 28 ) and owned by key actors within the system, especially at the sub-national levels with a focus on strengthening primary healthcare ( 22 , 28 , 31 ).…”

A step towards reinvigorating the COVID-19 response: an intra-action review of the WHO Regional Office for Africa Incident Management Support Team

“…Furthermore, it sought to make proposals for possible future strategic propositions and potential response scenarios for COVID-19 pandemic forecast. However, the latter areas have been published elsewhere and are not part of this paper 12–14…”