In 2020 and 2021, the six countries studied—Costa Rica, the Dominican Republic, Ghana, Sri Lanka, Thailand, and Uganda—implemented different combinations of interventions aimed at controlling the spread of the virus that causes COVID-19 while maintaining the delivery of essential health services. However, although they showed many promising practices in their response to COVID-19 and maintenance of EHS, the pandemic still challenged their health systems in fundamental ways.

Around the world, countries experienced barriers to the delivery of EHS in 2020 and 2021, such as:

  • Provider and patient fear of infection in health facilities
  • No clear, context-specific definition of EHS and which health services should continue operating during the pandemic
  • Proliferation of false and misleading information about COVID-19
  • Lack of real-time, high-quality health data to inform decision-making
  • Limited access to telehealth services caused by inequitable access to technology

Despite the challenges these countries faced, they also offer important lessons that can be applied to future health emergencies. Key takeaways from this research include:

  • Multisectoral collaboration and strong leadership: Multisectoral collaboration and partnerships helped bolster countries’ responses to the pandemic by facilitating evidence-informed decision-making and swift policy action. Strong leadership and public trust in the government and health system also helped to increase adherence to public health and social measures and to maintain social cohesion. In addition, partnerships with the private sector strengthened increased access to financing, improved testing capacity, and strengthened other aspects of countries’ responses to the pandemic.
  • Health system adaptation and workforce deployment: All countries in this study adapted the delivery of health services and workforce distribution strategies to improve health systems’ capacity to provide COVID-19 care while maintaining EHS. Increased financial and social support to frontline health workers also helped health systems recruit and retain critical staff.
  • Early and agile response: Many countries benefited from an early and agile response to the pandemic. They quickly leveraged existing governance structures, deployed financial and human resources, and implemented public health and social measures aimed at limiting transmission of the virus that causes COVID-19.
  • Learning from past experience and leveraging existing infrastructure: The countries studied applied lessons learned from past experiences with infectious disease outbreaks to respond to the COVID-19 pandemic. They quickly activated or adapted existing infrastructure (such as laboratories and surveillance networks), personnel, and emergency response plans and strategies.
  • Investments in health systems and UHC: Many countries benefited from pre-pandemic investment in their health systems. For instance, they had strong primary health care systems, expanded their universal health coverage, strengthened the health workforce, created access to financing for systemwide health emergencies, or some combination of these. In addition, the pre-pandemic integration of health systems allowed for greater operational flexibility and integrated care delivery.
  • Robust community engagement: Risk communication via press briefings, social media, and other channels likely helped communities stay informed, better adhere to public health and social measures, and reduce fear of COVID-19 exposure. Community health workers also played a key role in relaying information, conducting surveillance, and providing EHS in their communities.

As we enter a new era of pandemic preparedness, the global health community has a unique opportunity to act on the lessons identified during the COVID-19 pandemic to promote health system resilience and preparedness for future health emergencies.