Table 4 Exploring resilience in PHC system using WHO building blocks framework

Governance

 Adequate and effective leadership

1. Having a clear vision for an effective PHC strategy

2. Reliance on the best available evidence but adopting the precautionary principle where evidence is uncertain

3. Culture of learning; ability to act fast; effective and transparent communication (especially regarding uncertainty);

4. Community participation; participation in the international community (e.g. joint procurement, clinical networks, etc.)

 Coordination of activities across government departments and among key stakeholders

5. Presence of a clear and widely understood strategy

6. Coordination within government (horizontal and vertical) and key stakeholders including civil society

Financing

 Ensure sufficient monetary resources in the system and flexibility to reallocate and inject extra funds into the system

7. Ensuring sufficient monetary resources in the system and flexibility to reallocate and inject extra funds into the system

8. Ensuring the financing arrangement prioritizes the provision of essential PHC services

9. Any evidence of a disaster risk financing mechanism

 Purchasing flexibility and reallocation of funding within the system to meet changing needs

10. Ability to quickly adapt procurement and payment systems while maintaining transparency, timeliness, and quality, including measures to prevent corruption

Health workforce

 Appropriate level and distribution of human resources

11. Ensuring a sufficient supply of personal protective equipment for the workforce

12. Workforce available and well deployed across urban and rural areas to provide services

 Recruitment and capacity building of the health workforce

13. Ability to mobilize additional human resources via training of existing workforce or adapting their roles, alongside recruiting and training volunteers

 Motivated and well-supported workforce

14. Ensuring mental health (e.g. psychological counselling), family (e.g. childcare), physical (e.g. respite breaks), and financial support for healthcare workers

Service delivery

 Absorptive, adoptive and transformative capacity

15. Absorptive capacity: PHC continues to deliver the same level (quantity, quality and equity) of basic healthcare services and protection to populations

16. Adoptive capacity: determines the health system actors to adapt to the crisis to deliver the same level of healthcare services with fewer and/or different resources

17. Transformative capacity: the ability of health system actors to transform and reorient the functions and structure of the health system to respond to a changing environment

 An essential package of services

18. Having a package of services that is properly resourced, organized and distributed

19. Identifying vulnerable population groups (ensuring that appropriate data are collected) and ensuring adequate access to services

20. Evidence of continuing essential public health functions

 Evidence of services related to COVID-19 pandemic

21. Having strong (or strengthening) public health capacity (with a system to find, test, trace, isolate, and support

 Ability to deliver services safely

22. Having strong (or strengthening) primary health in maintaining non-COVID essential services to catchment populations

23. Mechanisms in place to ensure effective implementation of infection prevention and control in healthcare settings

Information system

 Surveillance enabling the timely detection of data during COVID-19 pandemic

24. Evidence of active and/or passive surveillance system

25. Evidence of timely data generation

 Effective communication systems and flows

26. Having (or establishing) well-functioning communication channels linked to lines of accountability, including hard and soft infrastructure

Supplies and equipment

 Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery

27. Stock of PPE

28. Adequate stock of essential equipment and supplies