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

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.