Welcome to week 2

Welcome to week two of the COVID-19 Global Health Perspective Course. This week, we will be looking at what is involved in the health system response to a pandemic such as COVID-19. What balances need to be struck, what tough decisions need to be made, and how and why do these vary across context. What we have learned from other pandemics such as the West African Ebola pandemic, how varied have the responses been to COVID-19 so far and why. Throughout the week, we will draw on a range of country examples to illustrate up-to-date realities of various health system responses to COVID-19 as it continues to spread.

But first, as we start now at this point in the course to talk about health systems, it’s useful to consider what we actually mean by a health system.

This is the commonly used World Health Organization framework that describes health systems in terms of six core components or system building blocks, which are on the left of the screen. Service delivery, health workforce, health information systems, access to essential medicines and financing and leadership in governance. Through boosting the access and coverage of high quality and safe services, there is an expectation of improved health outcomes through higher coverage and equity of services, responsiveness of the health system, to actual population needs, improved social and financial risk protection, as well as improved efficiency in health service delivery.

This model is relatively simple enough to understand, though some have suggested that it also presents a rather narrow view of what a health system actually is. Is it suitable for analyzing, for example, dynamic complex and interlinked systems and impacts, which are necessary to consider when conceptualizing a global health crisis like COVID-19. A broad review is offered by the One Health approach, which was introduced in week one of this course As you have learned already, One Health is a collaborative multi-sectoral and transdisciplinary approach which works at the local, regional, national and global levels Its goal is to achieve optimal health outcomes, recognizing the interconnection between people, animal, plants and their shared environment.

The WHO building blocks are a useful framework for considering and discussing health systems because they do highlight the resources and inputs which are needed to mount a response. Through this week, we will also draw on a broader days of health systems by invoking the One Health approach, as we recognize that health systems do not operate independently from other political, social, economic and environmental systems. But before we dive into health systems, it’s helpful to understand the various phases of an epidemic or a pandemic. This is an example of traditionally what we have seen as the phases of a pandemic response, This continuum is from the WHO and was used as a basis for planning flu pandemic responses.

What we can see, is that there is a period first of animal infections with some human infections rising before we move to a phase of sustained human to human transmission. This could lead to a re-categorization of the epidemic as a pandemic if it starts to spread over multiple countries or continents. At the peak, there is widespread human infection with a possibility of further recurrent waves in the post-peak period, which can lead to multiple peaks. In the post-pandemic phase, disease activity could be at seasonal, levels or it could be eliminated These phases could all be overlapping and happen at any time frame. This is useful for understanding the phases that COVID-19 will go through.

But what about the different health effects of a different stage of a pandemic?

This final image of this presentation looks at the health footprint of COVID-19, or what we expect the health footprint of COVID-19 to be. In the first wave we see the immediate mortality and morbidity from the COVID-19 and in the tail of the first wave we see the recovery of severe cases which may have been hospitalized including in intensive care In the second wave, we see the impact of resource restrictions on urgent, non COVID-19 conditions. So conditions which needed acute or emergency care.

In the third wave, we see the impact of interrupted care of chronic conditions when people have not been able to access the routine or continuous care that they have needed due to lockdown restrictions or again reallocation of health system resources. Included here, could also be the need to address worsened health outcomes as a result of interruptions to preventative health services such as vaccination or prenatal care. Week three delves into these impacts on specific high-risk groups. Finally, in the fourth wave we will start to see the impact on psychic trauma, mental illness, burnout and conditions or mental health states, which have come about because of the various impacts of the pandemic.

This is all helpful context and useful for us, so we can effectively, as health policy makers and planners, effectively plan ahead But we are very aware that for many countries, we are not in the latest waves, yet. We’re very much in the early waves of pandemic. As such, throughout this week, as well as in weeks three and four which are to come, we will look at some examples of responses so far. But we’ll also consider what may be ahead.