Getting it right: multi-sectoral planning
In the step above, you considered the range of aspects a government must consider when planning a comprehensive response to an emerging epidemic. There are so many complex issues when it comes to responding to epidemics (or pandemics) and we are still getting to grips with what these are and how they play out in different country settings across the world.
What we do know is, that in this interconnected world, virus transmission can easily spread globally, making it a public health concern that requires attention from governments at all levels and from a range of sectors. We also know that this pandemic is much more than a health crisis. It requires a whole-of-government and whole-of-society response1. National public health emergency management mechanisms should be activated with the engagement of relevant ministries such as health, education, travel and tourism, public works, environment, social protection, and agriculture, to provide an effective coordination of COVID-19 preparedness and response.
While the primary response may be focused on the front-line health response, governments along with other key stakeholders such as private sector and multi-lateral agencies, also need to consider larger and broader planning issues. These may relate to financing and fiscal policy during transitional and recovery phases, resource mobilisation, corporate regulation, provision of state benefits, alternative scenarios for maintaining education and economic productivity, ensuring food security and supply chains, and effect on public services such as transport. These all need to be considered alongside ongoing scenario projection and risk assessment and are critically important when it comes to disaster risk reduction response planning, which we will learn more about in Week 4.
Some general principles should also guide preparedness planning for any acute threat to public health:
Pandemic preparedness, response and evaluation should be built on generic preparedness platforms, structures, mechanisms and plans for crisis and emergency management;
To the extent possible, pandemic preparedness should aim to strengthen existing systems rather than develop new ones;
New systems that will be implemented during a pandemic should be tested outside pandemics periods;
Adequate resources should ideally be allocated for all aspects of pandemic preparedness and response;
The planning process, which involves implementing what is planned then testing and revising the plan in order for key stakeholders to familiarise themselves with the issues at hand, may be even more important than the pandemic plan itself;
Planning should be based on pandemics of differing severity while the response should be based on the actual situation determined by country specific risk assessments, drawing on a range of country data, such as evolving case numbers and hospital care capacity;
Not all countries will be in a position to contribute to global risk assessment, but they must all have the capacity to access and interpret data for national risk assessment from in-country data sources.
(These are adapted from ECDC preparedness for seasonal influenza outbreaks2)
The example of Indonesia
Indonesia has produced a comprehensive multi-sectoral response plan to COVID-19 which highlights parallel emphases on a range of sectors, with a multitude of overall aims such as the protection of vulnerable groups, mitigating the socio-economic impact of the crisis, enabling risk communications and community engagement, boosting food security, limiting macro-economic effects, and exploring indirect effects on people and livelihoods3. The plan summarises well why we need to look beyond the health sector when planning our response:
“The COVID-19 pandemic is much more than a health crisis; it is a human crisis in every country in the world claiming many lives and threatening the health, social and economic spheres of society. Invariably, the pandemic will diminish social services, economic activities, financial resources and infrastructure and exacerbate people’s existing vulnerabilities including those of low income households with limited or no access to critical healthcare services and lack of safe and nutritious as well as affordable food, those of immunosuppressed people, women who have been at the frontline of the response, children, the elderly, people with disabilities, refugees without access to cash assistance and with limited livelihoods opportunities to support themselves, and migrant and informal sector workers. Those who will be hit hardest by the COVID-19 crisis are those already at risk of being left furthest behind: particularly the poorest and most marginalized communities where social inequalities may be further exacerbated and the risk of gender-based violence and sexual exploitation and abuse is escalated”3.
In Week 3, you will hear more about research being conducted now which explores the impacts of COVID-19 on the sexual and reproductive health of specific marginalised communities in Indonesia.
© Nossal Institute for Global Health 2020