# Maintaining essential health services during COVID-19: cross-country lessons of health system resilience from Asia, Sub-Saharan Africa and Latin America

## TL;DR

This study explores how six low- and middle-income countries maintained essential health services during the pandemic and identifies strategies that improved health system resilience.

## Contribution

The paper presents cross-country insights into health system resilience strategies during the pandemic in diverse regions.

## Key findings

- Whole-of-government approaches and multisectoral collaboration were key to maintaining health services.
- Strong primary healthcare systems and public trust in government enabled better pandemic responses.
- Inequitable access to technology and lack of real-time data were major challenges in some countries.

## Abstract

The COVID-19 pandemic severely disrupted the delivery of essential health services (EHS)
worldwide, contributing to excess morbidity and mortality from preventable conditions.
Some countries employed innovative strategies that may have enabled their health systems
to be more resilient than others in responding to COVID-19. This cross-country analysis
aimed to identify beneficial practices and policies employed by six low- and middle-income
countries (LMICs) in Asia, Sub-Saharan Africa and Latin America to maintain access to EHS
while responding to COVID-19. Cross-country research partners (CCRPs) led a mixed methods
assessment to identify best practices and strategies for COVID-19 response and continued
provision of EHS between April 2021 and September 2022. A cross-country analysis was
conducted to extract and thematically code best practices that were reported as beneficial
by three or more study countries based on desk reviews, key informant interviews and
quantitative and qualitative analyses. Cross-cutting enablers, barriers and lessons learnt
were also documented. Cross-country themes include whole-of-government approaches;
multisectoral collaboration and decision-making; early outbreak control measures;
partnerships with the private sector; innovations in service delivery and health
financing; a robust health workforce; adaptation of existing disease response capacities;
and community engagement. Long-standing investments in health systems strengthening and
preparedness, integrated health systems, public trust in government, leadership and
political will, prior experience in responding to epidemics, strong primary healthcare
systems, existing health financing mechanisms and provision of social and economic
supports were identified as cross-cutting enablers. Lack of context-specific definitions
for EHS, inequitable access to technology and lack of access to real-time, high-quality
data were identified as challenges in study countries. This study provides valuable
insights into the practices that may be considered beneficial and worthy of pursuit by
other countries wishing to strengthen health system resilience and preparedness for future
health emergencies. Further research is needed to evaluate the effectiveness of these
practices in different settings.