This is, in part, because of context and systems factors including a country’s previous experience with epidemics, its health system’s strength and structure, and the onset of SARS-CoV-2 in-country. These and other factors helped shape each country’s COVID-19 response, as well as its ability to continue delivering EHS in the first two years of the pandemic. However, these context and system factors cannot be easily changed during the onset of an infectious disease outbreak, and as a result this cross-country synthesis primarily focuses on the interventions countries implemented in response to COVID-19. A full list of cross-cutting interventions (called “promising practices”) that all or most countries implemented can be found in the table below. Click on the blue cells of the table to see examples of the promising practices in each country.

Cross-Country Promising Practices

Exemplars in Global Health.

This section describes seven key cross-cutting national, governmental, and population-level measures that all or most of the countries implemented in some form. The identification of similar beneficial approaches by separate research teams in multiple countries increases our confidence of their utility and potential generalizability in comparable settings.

During the COVID-19 pandemic, purposeful collaboration between health and non-health agencies and the early establishment of empowered national decision-making bodies facilitated swift and concerted action

Starting in March 2020 or even before, several countries acted quickly to implement a coordinated, multisectoral response to the COVID-19 emergency. Senior government officials established and empowered national decision-making bodies to act quickly to make policy decisions and to mobilize human and financial resources for emergency response. These bodies included senior representatives from across the government, including non-health sectors such as education and finance, to ensure that the policy response addressed the far-reaching societal impacts of the pandemic.

For example, Costa Rica established a National Situation Analysis Room, part of its new Emergency Operations Center, in early 2020. The National Situation Analysis Room included officials from across the government (including the Ministries of Health, Economy, and National Planning and Economic Policy) as well as representatives from organizations such as the Pan American Health Organization and from academic partners. This multidisciplinary team monitored and analyzed health, economic, and other key data and used them to inform policy recommendations.

In Thailand, a centralized, multisectoral Center for COVID-19 Situation Administration (CCSA), chaired by the country’s prime minister, steered the national COVID-19 response starting in March 2020. The CCSA’s members, top-level officials from health and non-health ministries across the government, adopted a holistic view of the crisis and championed a whole-of-society response that addressed its health, economic, political, and social impacts.1

Anutin Charnvirakul, Thailand's Deputy Prime Minister and Minister of Public Health distributes protective face masks to people at a hospital before a news conference about the new coronavirus situation in Bangkok, Thailand, February 3, 2020.
Anutin Charnvirakul, Thailand's Deputy Prime Minister and Minister of Public Health distributes protective face masks to people at a hospital before a news conference about the new coronavirus situation in Bangkok, Thailand, February 3, 2020.
Credit: Athit Peraongmetha; © Reuters

In Uganda, the Office of the Prime Minister quickly established a multisectoral and multidisciplinary National COVID-19 Task Force in March 2020.2 Task force members and subcommittees included officials from the Ministry of Health and other ministries—including Gender, Labour, and Social Development; Local Government; Education and Sports; Information and Communications Technology; Defense, Finance, Planning, and Economic Development; and Agriculture—as well as representatives from private sector and civil society organizations. Together, they were responsible for coordinating Uganda’s pandemic preparedness and response activities, including contact tracing, risk communication, EHS continuity, and social and educational safety nets; building support for public health and social measures; and addressing other challenges associated with the COVID-19 pandemic, such as an increase in gender-based violence. Uganda’s robust multisectoral coordination structure might have contributed to the relatively high levels of public satisfaction in the government’s response to the pandemic.

Suppressing transmission of the virus that causes COVID-19 also minimized disruption to EHS delivery.

Prior experience with epidemics and other public health emergencies encouraged the countries we examined to intervene in early 2020 to contain the spread of SARS-CoV-2. The public health and social measures they implemented included:

  • Testing for diagnosis and detection
  • Contact tracing
  • Personal protective measures
  • Risk communication
  • Surveillance
  • Vaccination

For example, Ghana’s COVID-19 response focused primarily on testing, tracing, and treating suspected cases and high-risk individuals (known as the “3T strategy”). However, officials also implemented many public health and social measures as part of the health system’s immediate response, such as border closures and suspending in-person classes across the education system. On March 30, 2020, officials established partial lockdowns in COVID-19 “hotspots,” mostly in Greater Accra and Greater Kumasi. They asked about 6 million people to stay home except to shop for essential goods (such as food, medicine, and water), visit public toilets, or go to the bank.3

In early 2020, Sri Lanka implemented a “zero-COVID” strategy with two prongs: 1) preventing the entry of the novel coronavirus via effective border security and 2) if any cases did slip through, acting aggressively to stop any local outbreaks by implementing strict contact tracing and isolation. The objective of this strategy was to prevent any local transmission of the virus so communities’ economic and social activity could resume behind protected borders. The figure below summarizes Sri Lanka’s zero-COVID strategy.

Sri Lanka’s strategy for eliminating COVID-19 at the population and patient levels

Sri Lanka State Intelligence Service

As shown in the chart below, each of the six countries in this analysis were often able to scale up testing capacity in response to surges in COVID-19 cases. Click on the country buttons below this visual to see how COVID-19 testing changed in response to surges in COVID-19 cases for each country.

Daily new confirmed COVID-19 cases and tests (2020–2021)


Even before Uganda confirmed its first case of COVID-19 in March 2020, officials imposed a variety of public health and social measures, such as school closures and mobility restrictions.4 After COVID-19 was detected in Uganda, the country’s National COVID-19 Task Force (NTF) activated district task forces to coordinate subnational and local pandemic response activities such as surveillance, contact tracing, and isolation. The NTF’s response plan emphasized risk communication and community engagement to promote public health and social measures.

Robust vaccination efforts

In addition, several countries focused on the early procurement and rollout of vaccines when they became available. These countries vaccinated health workers first to support the health system, and then focused on delivering the vaccine to the broader population. Review the figure below to understand overall COVID-19 vaccination levels and the course of vaccine rollout in each country (note that COVID-19 vaccination coverage was not part of the country selection process for this work).

Share of people who completed the initial COVID-19 vaccination protocol


For instance, Costa Rica was one of the first countries in Latin America to launch a mass COVID-19 vaccination campaign and to achieve broad coverage for those eligible to be vaccinated. By December 2021, over 65% of the country’s population had received all doses of the vaccine.5 Community health workers (asistente técnico de atención primaria, or ATAPs) delivered many of these vaccines, especially to people living in rural and isolated areas.6 Private sector partners helped establish vaccination centers in places such as shopping centers and stadiums and donated key infrastructure such as refrigerated trucks for vaccine transport and distribution.7

Despite initial delays in the launch of Thailand’s COVID-19 vaccination campaign, the country rapidly rolled out the COVID-19 vaccine throughout the second half of 2021 and 2022. In June 2021, just 2% of the country’s population were fully vaccinated (received two vaccine doses) and by August 2022, over 75% of the country was fully vaccinated8. Vaccine rollout was aided by the Ministry of Public Health’s Mor Prom (Doctor’s Ready) app, which enabled users to make appointments for vaccination, track vaccine availability, and report side effects9.

When the Dominican Republic began its COVID-19 vaccination campaign in February 2021, officials leveraged existing immunization structures such as the Expanded Program on Immunizations to deliver vaccines nationwide. They also launched a digital platform (VacúnateRD/Get Vaccinated DR) to provide public information related to the COVID-19 vaccine, such as the location of vaccination centers.10 The private sector also played a key role in providing vaccination facilities and transporting vaccine doses.

A health care worker administers a dose of the Oxford/AstraZeneca vaccine against the coronavirus disease (COVID-19), in Santiago, Dominican Republic February 17, 2021.
A health care worker administers a dose of the Oxford/AstraZeneca vaccine against the coronavirus disease (COVID-19), in Santiago, Dominican Republic February 17, 2021.
Credit: Ricardo Rojas; © Reuters

Academic–government collaborations enabled decision-making based on the latest research and evidence.

In most of the positive outlier countries, strong partnerships between academia and government helped with data-driven decision-making, documentation, and policy translation during the first two years of the COVID-19 pandemic. Collaborations between local research entities and health decision-makers enabled the regular analysis of COVID-19 surveillance data and informed local and national guidance on public health and social measures.

For example, in March and April 2020, researchers at the Dominican Republic’s Technological Institute of Santo Domingo developed a predictive model for COVID-19’s epidemiological behavior, enabling ongoing case management, data analysis, and health planning. The country’s director of epidemiology used this model to manage the country’s COVID-19 response and reduce the burden of hospitalizations.11

Uganda’s National Task Force established an interdisciplinary scientific advisory committee whose members—including researchers from Makerere University’s schools of public health, medicine, and statistics; the country’s Medical Research Council; and the Uganda Virus Research Institute—translated new and evolving data into evidence-based policies and strategies for pandemic response.12

Uganda Virus Research Institute (UVRI) in Entebbe, Uganda on January 21, 2022. Credit: Gates Ventures, LLC.
Uganda Virus Research Institute (UVRI) in Entebbe, Uganda on January 21, 2022.
© Gates Ventures, LLC

Partnerships with the private sector helped mobilize key resources to support COVID-19 response and EHS maintenance.

All six countries demonstrated the importance of strong public–private partnerships for effective COVID-19 response and EHS maintenance. Private sector partners helped obtain personal protective equipment (PPE) such as masks, disinfectants, and other key supplies for health workers and vulnerable communities, which helped keep health workers and others safe from infection and enabled EHS delivery inside and outside of health facilities. Private sector partners also helped scale up national and local capacity for testing and vaccine delivery.

The Costa Rican Social Security Fund established temporary partnerships to expand drug service delivery when mobility was particularly restricted, to improve access to treatment for patients who could not visit a health center. In addition, Costa Rica’s Local Supply Initiative for Personal Protective Equipment (ALEPP), a collaboration between the Costa Rican Chamber of Commerce, the Costa Rican Social Security Fund, and academic institutions, helped essential workers procure key protective equipment.

ALEPP coordinated local supply chains to boost production of PPE; for example, it enabled Grupo Vargas, a manufacturer of packaging materials, to produce more than 600,000 plastic face shields for health workers.13

In Thailand, private companies sponsored the development of negative-pressure isolation rooms and intensive care units in public hospitals.14 Similarly, in Sri Lanka and several other countries of study, private laboratories partnered with the public sector to expand the country’s PCR testing capacity.

Flexible financing mechanisms supported COVID-19 response.

Five of the countries used contingency funds or other preexisting financing mechanisms to support emergency preparedness and response. These mechanisms allowed countries to deploy capital quickly to build or improve necessary infrastructure (such as infectious disease treatment facilities and quarantine centers), compensate health workers, obtain key testing supplies and vaccines, and provide social and economic support to vulnerable populations.

For instance, in 2016, officials in Costa Rica created a US$200 million contingency fund to prepare for natural disasters or health emergencies In 2020, this fund enabled rapid adaptation to the pandemic15 as officials used that emergency funding to hire (and pay overtime to) health workers, boost the physical capacity of existing health facilities, and equip a new specialized facility for COVID-19 patients (Centro Especializado de Atención de Pacientes con COVID-19, or CEACO) with ventilators and beds in the intensive care units.16

Thailand allocated funding from its central budget for overtime and risk compensation for health workers, vaccines, and costs associated with quarantine. Emergency loans from internal and external sources paid for the procurement of key supplies, vaccine research and development, and other pandemic-related expenses such as social and financial support for vulnerable populations.17 Thailand’s National Health Security Office, which manages the country’s universal health coverage program, also directed funding toward the country’s pandemic response. Because officials established a discretionary fund for COVID-19 response separate from the rest of the country’s health budget, funding for essential health service delivery remained stable throughout the pandemic, which helped with continuity of services.

Expanded universal health coverage (UHC) and other health financing schemes boosted access to emergency health care and EHS during the COVID-19 pandemic.

Four of the countries expanded UHC or other preexisting funding schemes to improve access to COVID-19 care as well as EHS. The expansion of UHC schemes for low-income and vulnerable people (such as migrant workers) likewise boosted community health and well-being throughout the early phase of the pandemic.

For example, as a part of the country’s push to provide economic relief to those hit hardest by the pandemic financial downturn, the board of directors of Costa Rica’s Social Security Fund extended health insurance coverage to unemployed workers through the end of June 2021.

The Costa Rican Social Security Fund (La Caja Costarricense de Seguro Social) logo is seen in the oldest hospital of Costa Rica, the San Juan de Dios Hospital in San José, Costa Rica, March 28, 2019. Credit: Juan Carlos Ulate.
The Costa Rican Social Security Fund (La Caja Costarricense de Seguro Social) logo is seen in the oldest hospital of Costa Rica, the San Juan de Dios Hospital in San José, Costa Rica, March 28, 2019.
Credit: Juan Carlos Ulate; © Reuters

At the beginning of the COVID-19 pandemic, the Dominican Republic extended the national Family Health Insurance scheme, which protects unemployed people, informal workers, and workers who earn less than the minimum wage, to cover 2 million additional people (roughly 20% of the population). By December 2020, the Family Health Insurance scheme covered 96% of the population.18

Government initiatives and policies specifically aimed at maintaining EHS delivery supported all patients, even during pandemic surges.

As demonstrated in the figure below, research from the Institute for Health Metrics and Evaluation shows that all six countries experienced initial disruptions to routine immunization services during the COVID-19 pandemic, with recovery to previous levels by the end of 2020. The analysis uses DTP3 immunization rates as a proxy for the maintenance of essential health services. This indicator refers to the monthly number of doses of the diphtheria, tetanus, and pertussis vaccine given to children younger than one year of age. Click on the country buttons below this visual to see how DTP3 immunization rates changed in each country over the course of 2020.

Disruption in DTP3 vaccine doses in 2020


To maintain access to routine immunizations and other EHS, five of the countries established policies prioritizing the delivery of EHS in 2020 and 2021. New guidelines and policies for service delivery focused on reducing exposure to COVID-19 in health facilities and limiting patient contact with health facilities altogether.

For example, Ghana’s Ministry of Health and Ghana Health Services kept health facilities open to all patients throughout the COVID-19 pandemic. They minimized transmission of the virus that causes COVID-19 by requiring extensive symptom screening at facility entrances, adopting an appointment system to minimize patient crowding, and enabling health workers to deliver essential services such as antenatal care and routine immunizations in patients’ homes. Health officials also developed guidelines for the care of people living with HIV in the COVID-19 context (delivering services via telemedicine, for example).

The Sri Lankan Ministry of Health took proactive measures to ensure the maintenance of maternal and child health services from the beginning of the COVID-19 pandemic, and officials specifically instructed all medical officers of health to keep their clinics open to deliver these services. Officials also issued guidelines for hospitals to expand the availability of Mithuru Piyasa, “friendly havens” in health facilities for survivors of gender-based violence.19

A health official uses a thermometer to take the temperature of a healthcare worker during a simulation exercise for the coronavirus disease (COVID-19) vaccination in the Piliyandala suburb, south of Colombo, Sri Lanka January 23, 2021.
A health official uses a thermometer to take the temperature of a healthcare worker during a simulation exercise for the coronavirus disease (COVID-19) vaccination in the Piliyandala suburb, south of Colombo, Sri Lanka January 23, 2021.
Credit: Dinuka Liyanawatte; © Reuters

In April 2020, the Ugandan Ministry of Health established a committee focused on the continuity of EHS.20 Members included Ministry of Health officials, district government representatives, public health authorities, and international partners such as UNICEF and WHO. The committee oversaw all efforts to maintain access to—and adapt service delivery for—EHS.

  1. 1
    World Health Organization (WHO). Thailand: Decision Making for Social and Movement Measures in the Context of COVID-19: Snapshot as of November 2020 [interview with Viroj Tangcharoensathien, MD, PhD]. Geneva: WHO; 2020. Accessed January 2, 2023.
  2. 2
    Uganda Ministry of Health. COVID-19 Response Hub: Coordination structure. Accessed December 1, 2022.
  3. 3
    Ghana: authorities impose lockdown on two regions due to COVID-19 from March 30. Crisis24. Published March 28, 2020. Accessed February 6, 2023.
  4. 4
    Kyeyune H. Uganda declares curfew to curb spread of COVID-19. Anadolu Agency. March 31, 2020.
  5. 5
    Our World in Data. Daily new confirmed COVID-19 deaths per million people. Accessed January 12, 2023.
  6. 6
    Center for Strategic and International Studies. Building a resilient health system: Costa Rica's 80 year experiment. Published October 19, 2021. Accessed January 12, 2023.
  7. 7
    Zúñigo A. Private companies support Costa Rica vaccine push. Tico Times. September 30, 2021.
  8. 8
    Our World in Data. Coronavirus (COVID-19) vaccinations. Accessed January 2, 2023.
  9. 9
    Bangkok Hospital. Epi1: Mor Prom application and COVID-19 vaccines in Thailand. Accessed January 2, 2023.
  10. 10
    VacúnateRD. Accessed December 14, 2022.
  11. 11
    Instituto Tecnológico de Santo Domingo. INTEC delivers COVID-19 risk management and predictive model to public health. Published October 6, 2021. Accessed December 14, 2022.
  12. 12
    Uganda Ministry of Health (MOH) and Technical Inter-Sectoral Committee COVID-19. National Community Engagement Strategy for COVID-19 Response. Kampala: MOH; 2020. Accessed December 1, 2022.
  13. 13
    Pérez CC. Grupo Vargas era una imprenta que ahora brinda servicios a firmas externas y produce las 600.000 caretas sanitarias de la Caja. El Financiero. April 28, 2020.
  14. 14
    Thai Synchrotron National Lab. SLRI designed and built prototypes of negative pressure isolation room for use at field hospitals. Accessed January 2, 2023.
  15. 15
    CCSS has executed more than 64 billion colones in the control of the COVID-19 pandemic. Costa Rica News. August 25, 2020.
  16. 16
    Presidencia de la República de Costa Rica. CEACO aumenta nivel de complejidad en abordaje de pacientes COVID. September 4, 2020. Accessed January 12, 2023.
  17. 17
    Oxford Policy Management (OPM), United Nations Thailand. Social Impact Assessment of COVID-19 in Thailand. Oxford, UK: OPM; July 2020. Accessed January 2, 2023.
  18. 18
    Superintendencia de Salud y Riesgos Laborales (SISALRIL). Superintendencia de Salud y Riesgos Laborales. Estadísticas. Published 2022. Accessed December 14, 2022.
  19. 19
    Sri Lanka Ministry of Health and Indigenous Medical Services (MOH). National Supplementary Guideline for Mithuru Piyasa/Natpu Nilayam Staff to be Adopted During COVID-19 Pandemic. Colombo, Sri Lanka: MOH; 2020. Accessed January 28, 2023.
  20. 20
    Uganda Ministry of Health. COVID-19 Response Hub: Coordination structure. Accessed December 1, 2022.

Promising practices: measures for health system adaptation