Event summary: Lessons in COVID and health systems resilience from Thailand, Costa Rica, and Uganda
In a #PMAC2022 side event, a discussion on health systems resilience reveals lessons in fighting COVID-19 now and beating future pandemics, later
Ahead of the Prince Mahidol Awards Conference, several research organizations shared lessons from three countries – Thailand, Costa Rica, and Uganda – whose management of COVID-19 and ability to maintain essential health services during the pandemic may offer lessons for other low- and middle-income countries.
The case studies presented during the virtual side event to the annual conference entitled "Exemplars in Global Health – Collating Lessons Learned from COVID-19 and Health Systems Resilience" shed light on the importance of health systems resilience in improving national efforts to respond to both epidemics and pandemics. The findings were presented by research partners of the Exemplars in Global Health program, including the Johns Hopkins Center for Health Security, the Thai National Health Foundation, the Rockefeller Foundation, and Makerere University School of Public Health.
Dr. Piya Hanvoravongchai, Secretary General of the Thai National Health Foundation, said the country's robust initial response to COVID-19 enabled it to keep its overall caseload low even as cases spiked in neighboring countries. The United Nations has praised Thailand's swift COVID response as “an example of resilience.”
Thailand – which was notably the first country outside China to identify a COVID-19 case – moved quickly during the first phase of the pandemic to impose partial lockdowns, restrict people's movements, and suspended elective surgeries, which enabled its health system to adapt and continue to deliver essential health services. When COVID cases eventually increased and outpatient services became strained, the country created an ambitious plan to deliver home care, respond to outbreaks and provide essential services by, among other things, mobilizing a fleet of health service volunteers.
Dr. Andrea Prado, an associate professor at the INCAE business school, shared how Costa Rica maintained essential services during the pandemic through a universal health care program praised by the OECD for its integrated delivery of care. The government, she said, acted quickly when the pandemic struck – it carefully allocated specific resources for both COVID and non-COVID patients and de-prioritized care for certain conditions such as orthopedics to conserve scarce resources for more urgent areas like oncology. Additionally, the fact that Costa Rica has a national system of medical health records allowed patients to be transferred from hospitals to COVID centers more easily. The Latin American country also used telemedicine and the home delivery of medicines to help ease the strain on its health system.
Dr. Rhoda Wanyenze, Dean of the Makerere University School of Public Health, said Uganda was able to leverage systems established during its Ebola outbreaks to deliver COVID-19 care at the national, regional, and local levels, and decrease disruptions to its health system. For instance, she said, the country created a committee to develop national care guidelines and coordinate community-based delivery. The government carefully tracked data to monitor health system disruptions and forecast demand for services at the district and local levels. A flexible system of shift work for health workers also enabled the delivery of care where it was most needed, at any given time.
The participants also noted that, unlike some countries around the world, their people all generally accepted so-called non-pharmaceutical interventions such as lockdowns, social distancing, washing hands, and wearing masks. Dr. Hanvoravongchai said the Thai people's trust of the health system was at the heart of their acceptance and adherence to such measures. Dr. Prado said that some groups in Costa Rica, especially those in the tourism industry, initially resisted measures such as lockdowns, but that people were generally "willing to follow the protocols” if it meant the restrictions could be eased. In Uganda, Dr. Wanyenze said that despite misinformation affecting some people's willingness to adhere to such measures, most people socially distanced and wore masks to prevent further lockdowns.
In a panel that followed the presentation, several high-profile participants, including World Bank Health Specialist Dr. Sulzhan Bali, Harvard T.H. Chan School of Public Health Professor of Health Systems, Margaret Kruk, and Director-General of Department of Medical Services at Thailand's Ministry of Health, Somsak Akksilp, all agreed that the lessons from positive outliers like Thailand, Costa Rica, and Uganda could help other LMICs improve their current response to COVID-19 and prepare their systems for future pandemics and maintain essential health services.