Table 5 Examples of key findings at the country level (refer Additional file 4)
[SR number] | Countries | Governance | Financing | Workforce | Service delivery | Information system | Supplies and equipment | |
|---|---|---|---|---|---|---|---|---|
1 | Albania | NIL | NIL | Motivated and well-supported workforce Monthly salary raises for the entire duration of the crisis from the central government [SR-4] | Evidence of service related to COVID-19 PHC providers supported public health surveillance teams in contact tracing [SR-4] | NIL | NIL | |
2 | Bangladesh | Adequate and effective leadership National guidelines on MNCH&FP Services had been developed in the context of COVID-19 [SR-13] Coordination of activities across government departments and among key stakeholders Multisectoral coordination committee formed at the facility level [SR-25] | NIL | Recruitment of health workforce Recruitment of additional doctors, nurses and midwives [SR 12] to ensure the continuity of essential services; 2000 medical doctors and 5000 nurses were newly recruited and posted to primary-level health facilities [SR-25] Capacity building of the health workforce Trained Rohingya refugees (worked as CHVs) ensured that routine healthcare support, including immunizations, management of non-communicable diseases, and maternal and child health continued in the community [SR-07] Virtual orientation on maternal, newborn, and child health guidelines was provided to healthcare workers. In addition, virtual platform for training was offered to staff on revised integrated management of childhood illnesses (IMCI) protocols [SR-12] Motivated and well-supported workforce Provision of accommodation close to the facility and transport to the facility [SR-25] | Adoptive/ transformative capacity 24/7 Telecounselling services were offered via government call centres [SR-12] Digital platforms (WhatsApp, Viber), hotlines and telemedicine and support services on maternal, child, reproductive, and adolescent health provided (some 24/7) [SR-12] Evidence of continuing essential public health function Community and volunteer groups were engaged to help distribute healthcare information to families [SR-12] Evidence of service related to COVID-19 A dedicated cadre of health workers introduced for COVID-19 treatment [SR-13] | Surveillance and timely generation of data during the COVID-19 pandemic Early and continuous monitoring of data at the PHC level was fundamental to informing the response strategies to restore the availability and use of essential health services [SR-11] Effective communication systems and flow of information Frequent online meetings with PHC facilities to support the maintenance of essential health services [SR-25] Scaled-up regular monitoring of essential health service activities at primary level, that is, community clinics [SR-25] | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and infection prevention & control (IPC) in all health facilities ensured [SR-12] | |
3 | Bhutan | Adequate and effective leadership Operational guidelines for the continuity of SRMNCAH were created at the health systems level, and guidelines/standard operating procedures (SOPs) were prepared to facilitate the implementation of contingency plans and policies at the facility level [SR-13] The efficient functioning of health systems was boosted by the implementation of stewardship and good governance [SR-13] | Ensuring sufficient monetary resources in the system and flexibility to reallocate and inject extra funds into the system Financial support from the private sector to ensure government mobilization of PPEs was mobilized to supplement existing stock [SR-12] | Capacity building of health workers Continued medical education and online capacity development of healthcare providers [SR-13] Appropriate level and distribution of human resources Allocation of human resources for health [SR-13] | Absorptive capacity Contingency plans were developed to ensure the provision of essential healthcare services and micro-plans for health facilities were activated [SR-13] Ability to deliver services safely Prevention of infections among health workers was addressed through the operational guidelines of MCH services [SR-13] | Effective communication systems and flow of information Social mobilization and community empowerment activities were undertaken by the government, including awareness-generation campaigns on essential healthcare services and emergency services during the lockdown [SR-13] | NIL | |
4 | Bolivia | NIL | NIL | Capacity building of the health workforce Use of digital technology for the orientation and training of health personnel [SR 12] | Transformative capacity Strengthened referral systems to higher-level of public and private centres for the management of complications related to maternal and newborn health and offered abortion services [SR-12] Provided virtual care through telemedicine and WhatsApp [SR-12] Use of digital technology for educating the public [SR-12] Government-supported youth initiative programs that utilized WhatsApp and call centres to provide health information and service referrals [SR-12] Absorptive capacity National Network of People Living with HIV and AIDS and National Sexually Transmitted Infection/HIV/AIDS Programme provided RT for people living with HIV/AIDS [SR12] Ability to deliver services safely Scheduling of prenatal and postnatal visits to reduce the number of women in close contact at health facilities [SR-12] Evidence of service related to COVID-19 Screening, triage, and isolation for COVID-19 patients [SR-12] | Surveillance enabling the timely detection of shocks and their impact RedBol12 (National Network of People Living with HIV and AIDS) and National Sexually Transmitted Infection/HIV/AIDS Programme coordinated to support surveillance, information, and referral centres Monitoring of population health problems, and health education for the general population [SR-12] | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and IPC in all health facilities [SR-12] | |
5 | Bosnia and Herzegovina | Adequate and effective leadership Developing formal channels for transferring science into policy by newly establishing expert advisory groups [SR-4] | NIL | Motivated and well-supported workforce Financial compensation to support the health workforce in the form of one-time bonus payments [SR-04] | NIL | NIL | NIL | |
6 | Botswana | NIL | NIL | NIL | Absorptive capacity Extension of review periods for stable patients with a history of NCD and medication refills at pharmacies without prior doctor consultation [SR-24] Community health workers (CHWs) provided home visits for follow-up of patients with HIV, tuberculosis (TB), mental disorders, postnatal care, and palliative care needs [SR-24] Ability to deliver services safely Delivered medications, non-pharmaceutical equipment, and supplies to people at home living with chronic conditions, thus protecting them from potential exposure at primary care facilities and in public transport [SR-24] An essential package of services Public health education campaigns were carried out through community organizations and social media [SR-24] | NIL | NIL | |
7 | Brazil | NIL | NIL | Appropriate level and distribution of health workforce Relocation of specialists to primary health centres to expand access to care for pregnant women [SR-12] Recruitment of health workers Emergency recruitment of extra health workers [SR-12] | Absorptive capacity Vaccination teams dispatched to speciality centres and basic health units in urban and rural areas for immunization Mobile units were organized for vaccination campaigns (immunization) [SR-12] Scheduling of antenatal care (ANC) appointments farther apart, except for the final stage of pregnancy [SR-12] Prioritization of high-risk prenatal care at obstetric clinics, with low-risk prenatal care assigned to basic health units [SR-12] Adoptive/transformative capacity Contracting arrangements were made with universities to provide obstetric services, such as ultrasounds and echocardiograms, for pregnant women Paediatric services were established within emergency care unit with semi-intensive care beds for patients with symptomatic COVID-19 [SR-12] Implementation of telemedicine consultations to increase user access and reduce in-person contact at health facilities [SR-12] An essential package of services Implementation of Elderly Health Home Record Book to record personal, social and family data; health conditions; health behaviours and vulnerabilities; and guidance on self-care [SR-12] | NIL | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and IPC in all health facilities [SR-12] | |
8 | Bulgaria | NIL | NIL | Motivated and well-supported workforce Developed helplines or apps and online support for the mental health of health workers [SR-4] | NIL | NIL | NIL | |
9 | Cameroon | NIL | NIL | NIL | Absorptive capacity Special and catch-up campaigns in certain areas for cholera, polio, and measles vaccines immunization [SR-12] Adoptive/transformative capacity Modification of frequency of vaccination clinics and outreach schedules from weekly to monthly immunization and increased intervals between clinic visits (MNCAH) [SR-12] Expansion of role of CHW to include family planning (FP) and vaccination counselling and to assist with adherence to public health programs [SR-12] Telehealth appointments for ANC and PNC [SR-12] Evidence of service related to COVID-19 Screening, triage and isolation for patients with COVID-19 [SR-12] Ability to deliver services safely Community-based ANC for pregnant patients with positive for asymptomatic/mild COVID-19 [SR-12] | Effective communication and flow of information Broadcast, print and social media campaigns to raise awareness of the reopening of health facilities for routine services [SR-12] | Arrangements for the continuity of medicines, supplies and equipment National carrier arrangement to ensure uninterrupted medicine supply chain [SR-12] | |
10 | Congo | NIL | NIL | Appropriate level and distribution of health workforce Redeployment and accelerated retraining of nursing staff as midwives for uncomplicated births [SR-12] Capacity building of health workers Online training modules for obstetrics, neonatal emergency care and other RMNCAH services [SR-12] | Adoptive/transformative capacity Teleconsultation services provided for pregnant women who were unable to travel to health facilities. Services included ANC and prescriptions [SR-20] Mobile and on-site community vaccination campaigns were organized [SR-12] | Effective communication and flow of information Media channels used in the community and in hospitals to raise awareness of breastfeeding [SR-12] | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and IPC in all health facilities [SR-12] | |
11 | Ethiopia | Coordination of activities across government and key stakeholders Ethiopian Public Health Institute (EPHI) launched the COVID-19 Plan Revitalization Movement, which focussed on enhancing the COVID-19 response by increasing community awareness through risk communication and community engagement, detection capacity, and improving the quality of care at national and subnational levels [SR-14] Adequate and effective leadership Strengthening of public health at sub-national levels: engagement of communities in communications and testing campaigns [SR-16] | NIL | Capacity building of health workers Mobile learning platform (LEAP), interactive text messages, and interactive voice response for training Health Education Workers (HEWs) on RMNCAH services during COVID-19 (Ethiopia) [SR-12] | Adoptive/transformative capacity Reduced frequency of follow-ups for children with malnutrition and increased ready-to-use food rations Reduced the frequency of prevention of mother-to-child transmission of HIV (PMTCT) appointments to every 3 months (a model known as 3MMD) [SR-12] Ability to deliver services safely Implementation of prevention measures and respiratory hygiene measures, such as face coverings, physical contact [SR-14] Evidence of service related to COVID-19 An establishment of new public health laboratories and linkages with private (including research) laboratories [SR-16] | Surveillance enabling the timely detection of shocks and their impact Ethiopia upgraded the surveillance system from manual to DHIS 2, which is a sophisticated, open-source, and customizable software platform that supports data collection, analysis and visualization [SR-16] Effective communication and flow of information Public health broadcasts on protecting mental health during lockdown [SR-12] | Arrangements for the continuity of medicines, supplies and equipment Reinforced support for monitoring and procurement of RMNCAH commodities [SR-12] | |
12 | Ghana | NIL | NIL | NIL | Adoptive/transformative capacity Telephone consultations, telemedicine and web-based platforms were used to keep patients from attending health facilities [SR-24] Ability to deliver services safely Delivered medications, non-pharmaceutical equipment and supplies to people at home living with chronic conditions, thus protecting them from potential exposure at primary care facilities and in public transport [SR-24] Evidence of service related to COVID-19 Home visits and contact tracing at the district, sub-district and community levels [SR-22] An essential package of services Public health education campaigns were carried out through community organizations and social media [SR-24] | Effective communication and flow of information Risk communication activities for maternal healthcare were established (these cover community engagement and the development of broadcast materials) [SR-22] Surveillance enabling the timely detection of shocks and their impact Surveillance system in placed [SR-22] | NIL | |
13 | Haiti | NIL | NIL | NIL | Adoptive/transformative capacity Adoption of national guidelines for safe maternal healthcare [SR-23] Absorptive capacity Preservation of CHW/village health worker (VHW) activities related to maternal health [SR-23] | NIL | NIL | |
14 | India | Adequate and effective leadership Two guidelines were developed: (1) Enabling delivery of essential health services during the COVID-19 outbreak (14 April 2020) and (2) Guidelines on the provision of RMNCAH + N services during and post-COVID-19 pandemic (24 May 2020) [SR-13] | Ensuring sufficient monetary resources in the system and flexibility to reallocate Insurance cover for healthcare workers was offered and payments to families were also announced in the unfortunate event of the death of a healthcare worker in the line of duty [SR-13] | Appropriate level and distribution of health workforce Additional nursing staff redeployed from other facilities [SR 12] Capacity building of health workers CHWs were trained in COVID-19 prevention activities including preventing the spread of rumours and misinformation in the community [SR-7] Department of Personnel and Training launched a learning platform (https://www.pradhanmantriyojana.co.in/igot-onlinetraining-portal-covid/) for all frontline workers for training and to provide updates on coping with the pandemic [SR-12] Telemedicine training and webinar series on providing safe RMNCAH care during COVID-19 [SR-12] Recruitment of health workforce Recruitment of contractual staff and re-recruitment of retired health staff [SR-8] | Adoptive/transformative capacity Mapped all health facilities at block, district and state levels and reorganized healthcare service delivery for COVID-19 and non-COVID-19 care [SR-10] Telemedicine digital platform (E-Sanjeevani) was offered for caregivers, medical professionals and those seeking health services (India) [SR-12] WONDER app: dedicated mobile-based application developed in Darbhanga, Bihar for tracking high-risk pregnancies and providing referrals and ambulance service [SR-12] An essential package of services The promotion of the ‘new normal’ behaviours have been integrated into national CHW guidelines; CHWs have played a critical role in promoting these ‘new normal’ behaviours by engaging with their communities to understand people’s perceptions and by framing the behaviours in the relevant context [SR-7] Evidence of service related to COVID-19 Standard operation procedures for screening, triage, and isolation for suspected maternal and newborn COVID-19 cases were developed [SR-12] Ability to deliver services safely Private doctors involved in emergency ANC services, ANC services strengthened by home visits; continuity of services was maintained using door-to-door distribution of medicines for NCD, TB, and ANC [SR-8] | Surveillance enabling the timely detection of shocks and their impact Effective pandemic management was carried out through an integrated disease surveillance system [SR-10] | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and IPC in all health facilities [SR-12] | |
15 | Indonesia | NIL | NIL | NIL | Adoptive/transformative capacity IMCI and COVID-19 protocols were combined with triage protocols (Indonesia) [13] Pregnancy and childbirth services were modified, in addition to family planning services and methods [13] Introduce digital technology to fight against COVID-19 infodemics [SR-13] Evidence of service related to COVID-19 CHWs have been providing COVID-19-related information to the community [SR-7] Ability to deliver services safely Services were scheduled on the basis of appointments and implemented with IPC norms [SR-13] | NIL | NIL | |
16 | Kenya | Adequate and effective leadership The government issued national-level policy guidance related to RMNCH service continuity [SR-20] Coordination of activities across government and key stakeholders The government of Kenya established the National Emergency Response Committee (NERC) on coronavirus to ensure cohesive and effective coordination of the country’s preparedness efforts, mandate included coordinating disease surveillance, building the capacity of healthcare workers, coordinating the supply of tests and other medical supplies, and developing mitigation strategies [SR-14] | NIL | Appropriate level and distribution of health workforce Staff were redeployed within and between facilities [SR-1] Motivated and well-supported workforce Staff received counselling and psychosocial support on how to cope with the pandemic [SR-1] | Absorptive capacity Special guidelines were put in placed to ensure that pregnant and breastfeeding women continued to receive the requisite care without any disruption, guidelines also ensured that no pregnant woman was refused MNCH services due to barriers such as cost [SR-1] Adoptive/transformative capacity Reorganization of space for service provision: screening and triage area. Sitting positions and waiting areas were established for clients coming to the facility were marked [SR-1] Phone-based guidance for providing birthing and PNC counselling services [SR-20] Ability to deliver services safely Guidelines on the provision of MNCH services during the COVID-19 pandemic, which emphasized necessary preventive measures to be put in place when offering services in the context of the COVID-19 pandemic [SR-1] An essential package of services Utilization of community services during COVID-19: health education and sensitization of the community [SR-1] Evidence of service related to COVID-19 Increased diagnostic capacity for COVID-19 [SR-14] | Effective communication and flow of information Communication of COVID-19-specific policy/mitigation measures and messaging instituted [SR-01] | Ensured a sufficient supply of PPE for the workforce Provided PPE to all county health facilities [SR-14] | |
17 | Kyrgyzstan | NIL | Ensuring sufficient monetary resources in the system and flexibility to reallocate Complemented government funds with humanitarian aid [SR-04] | Motivated and well-supported workforce Financial compensation to support the health workforce in the form of one-time bonus payments [SR-04] | NIL | NIL | NIL | |
18 | Lesotho | NIL | NIL | NIL | Adoptive/transformative capacity Adoption of national guidelines for safe maternal care {SR-23] Absorptive capacity Preservation of activities of CHWs/VHWs related to maternal health [SR-23] | NIL | NIL | |
19 | Liberia | NIL | NIL | NIL | Adoptive/ transformative capacity Adoption of national guidelines for safe maternal care [SR-23] Absorptive capacity Preservation of activities of CHWs/VHWs related to maternal health [SR-23] An essential package of services (including health education and awareness) Implementation of communication campaigns [SR-23] | NIL | Adequate stock of essential equipment and supplies Supply chain strengthening [SR-23] | |
20 | Malawi | NIL | NIL | Recruitment of health workers Recruitment of new health professionals [SR-23] Appropriate level and distribution of human resources Increased the workload of community health workers, known in the Malawi health system as health surveillance assistants, responsible for surveillance activity [SR-3] CHWs tasked with additional responsibilities, including sharing information about COVID-19 and prevention measures, making home visits to people who tested positive for COVID-19, and disinfecting their homes as they recovered [SR-3] | Adoptive/transformative capacity Adoption of national guidelines for safe maternal care [SR-23] Reorganization of space for service provision to reduce congestion, only pregnant women were admitted, and no companions were allowed to stay [SR-3] Absorptive capacity Preservation of activities of CHWs/VHWs related to maternal health [SR-23] An essential package of services Implementation of communication campaigns [SR-23] Ability to deliver services safely Service providers were required to always have facemasks on and to observe social distancing [SR-3] | Surveillance enabling the timely detection of shocks and their impact CHWs assisted in surveillance activities [SR-3] Effective communication and flow of information Communication of COVID-19-specific policy/mitigation measures and messaging instituted [SR-03] | NIL | |
21 | Maldives | NIL | NIL | Capacity building of health workers Online refresher training was offered to health professionals in relevant SRMNCAH areas [13] | Adoptive/transformative capacity Outreach programs were conducted for ensuring timely ultrasound scans and ANC consultations for clients [SR-13] Evidence of service related to COVID-19 CHWs provided COVID-19-related information to the community [SR-7] An essential package of services Campaigns promoting care-seeking behaviour were also implemented [SR-13] | Surveillance enabling the timely detection of shocks and their impact Digitization of MCH records to further harmonize real-time data generation [SR-13] Effective communication and flow of information Community-level actions undertaken. This included awareness generation through leaders and peers to reduce fear and combat misinformation about the pandemic [SR-13] | Adequate stock of essential equipment and supplies Monitored the stock of PPE and essential drugs through the Central Medical Supply of the Ministry of Health [SR-13] | |
22 | Mexico | NIL | NIL | NIL | Adoptive/transformative capacity Adoption of national guidelines for safe maternal healthcare [SR-23] Absorptive capacity Preservation of activities of CHWs/VHWs related to maternal health [SR-23] | NIL | NIL | |
23 | Morocco | Adequate and effective leadership Since the announcement of the epidemic in China, the Moroccan government has deployed an institutional and risk-based communication strategy without having had any COVID-19 cases notified in the country [SR-15] Coordination of activities across government and key stakeholders Political commitment endorsed at the highest level, model of organization and coordination of the response integrated all key sectors and considered all levels of intervention (central, regional and local) [SR-15] Ethical aspects were integrated into the policy and practices in terms of preparedness and response to the pandemic [SR-15] | NIL | Motivated and well-supported workforce Remote platforms were established to provide psychological support and counselling services to health professionals [SR-15] | Adoptive/transformative capacity Remote platforms were established to provide psychological support and counselling services to health professionals and citizens who developed certain disorders in the form of distress, depression or acute panic disorders resulting from fear or confinement [SR-15] Evidence of services related to COVID-19 Management protocols were developed in collaboration with the Scientific, Technical, and Advisory Committee of the Ministry of Health for the management of COVID-19 and were regularly updated on the basis of new knowledge about the disease [SR-15] Ability to deliver services safely Treatment services were integrated into all care structures and offered at home when the indication was justified [SR-15] | Effective communication and flow of information Multiple awareness-raising spots on preventive measures were produced and material distributed continuously to raise awareness to avoid the risk of contamination [SR-15] | Adequate stock of essential equipment and supplies Medicines and other pharmaceutical products were mobilized very early [SR-15] | |
24 | Mozambique | Adequate and effective leadership The government issued national-level policy guidance related to RMNCH service continuity [SR-20] | NIL | Transformative/adoptive capacity Reorganization of space for service provision: reduced number of patients per day, reduced follow-up visits, reorganized maternity wards to maintain an appropriate distance between women in labour and to have a dedicated room for pregnant women with COVID-19 symptoms Vaccination was offered in more open spaces, and only small groups were allowed in the health facility at any one time [SR-2] Evidence of service related to COVID-19 Establishment of new public health laboratories and linkages with private (including research) laboratories [SR-16] | Effective communication and flow of information A WhatsApp account enabled individuals to send a message saying Olá (‘hello’ in Portuguese) to a particular number and get updated information about local COVID-19 case rates [SR-16] | NIL | ||
25 | Myanmar | NIL | NIL | Capacity building of health workers An online training session was conducted for volunteers through video conferencing on volunteers’ psychosocial support for pregnant mothers, newborns, children, older people, and survivors of gender-based violence (GBV) [SR-12] Appropriate level and distribution of human resources Task shifting of staff [13] | Adoptive/ transformative capacity Pre-scheduled appointments were held for outpatient services, hospital based, and for immunization [SR-12] Free teleconsultations and information on FP and sexual health provided by non-governmental organization (NGO) partner [SR-12] Teleconsultations and hotlines carried out for older people’s health, alongside the provision of psychological support [SR-12] Evidence of service related to COVID-19 ANC services, PMTCT testing, weighing, immunization, and iron supplements provided for pregnant women in quarantine centres [SR-12] Ability to deliver services safely IPC standards implemented in health facilities [SR-12] An essential package of services Ministry of Health and Sports website provided messages on menstrual hygiene, self-care, and nutrition, and hosted frequently asked questions for pregnant and lactating mothers and newborns/infants (Myanmar) [SR-12] | NIL | Adequate stock of essential equipment and supplies Additional supplies of self-injecting contraceptive (DMPA-SC) to prevent stock-outs introduced [SR-12] | |
26 | Nepal | Adequate and effective leadership Interim guidance for SRMNCH services during the COVID-19 pandemic developed by the Ministry of Health and Population was approved and rolled out [SR-13] | NIL | Motivated and well-supported workforce Online portal for providing mental health and psychological support to healthcare providers [SR-12] Appropriate level and distribution of human resources Additional workforce for health acquired and health workforce reorganized to bring services to a normal level [SR-13] | Adoptive/transformative capacity Regional guidelines on the continuity of SRMNCAH services have also been used. These guidelines covered services for women, newborns, children and adolescents, including GBV [SR-13] Helplines were operationalized for reporting GBV and/or domestic violence [SR-12] Adolescents were provided with psychosocial counselling and online counselling regarding adolescent sexual and reproductive health [SR-12] Ability to deliver services safely IPC standards implemented in health facilities [SR-12] Essential packages of services RMNCAH information in the local catchment area was provided via public media and mobile text messages for sexual and reproductive health (SRH) awareness [SR-12] | Surveillance enabling the timely detection of shocks and their impact Continuous monitoring and assessment were used for evidence‐based planning and response [SR-13] | Adequate stock of essential equipment and supplies FP forecast was adjusted to anticipate a surge in migrant returnees [SR-12] Procurement of FP commodities [SR-12] Increased supply of FP commodities at the PHC level in partnership with private entities and NGOs [SR-12] | |
27 | Nigeria | Adequate and effective leadership President signed the law for COVID-19 Health Protection Regulations 2021 [SR-14] Coordination of activities across government and key stakeholders The National Primary Health Care Development Agency (NPHCDA), multisectoral partners and stakeholders, and donors collaborated closely to develop a plan for continuing and optimizing PHC services during the COVID-19 pandemic [SR-9] | Ensuring sufficient monetary resources in the system and flexibility to reallocate and inject extra funds into the system Nigeria scaled up the delivery of social assistance to mitigate the financial impact of the pandemic on poor and vulnerable households This involved increasing coverage of the National Social Safety Nets Project (NASSP) routine cash transfer program [SR-9] Purchasing flexibility and reallocation of funding to meet changing needs Loans and importation of duty waivers granted to pharmaceutical firms for immunization [SR-9] | Recruitment of health workers Additional front-line health workers recruited and trained to provide RMNCAHN services [SR-12] Motivated and well-supported workforce The government provided incentive pay for health workers [SR-12] | Adoptive/transformative capacity The service delivery structure was reorganized to be responsive to the demands of the lockdown period. In some facilities, MNCH care, which was previously delivered to service users using a batched system on specific days, was adapted to occur on a rolling basis [SR-17] The government also procured trucks for TB case finding, targeting homes in TB hotspots and remote locations [SR-9] Proactive and mobile approaches to immunization, a mobile and outreach scheme for PHC, was introduced (e.g. I-MOP) [SR-9] Nigeria’s CDC integrated an interactive chat box into existing technology being used for communication [SR-16] Text messaging to provide psychosocial support and mental wellness for families [SR-12] Essential packages of services Innovations such as the mobile itinerant diagnostic facility (WoW truck), which provided diagnostic and treatment services for patients with TB, were introduced [SR-09] Ability to deliver services safely Delivered medications, non-pharmaceutical equipment, and supplies to people at home living with chronic conditions, thus protecting them from potential exposure at primary care facilities and in public transport [SR-24] Evidence of service related to COVID-19 Screening, triage, and isolation for patients with COVID-19 [SR-12] | Surveillance enabling the timely detection of shocks and their impact Surveillance modernization: the Nigeria CDC deployed the Surveillance Outbreak Response Management and Analysis System, which supports case-based digital surveillance from health facilities [SR-16] Effective communication and flow of information Broadcast messages and awareness raising by NGOs)/community groups on accessing essential RMNCAH + N services and immunization [SR-12] | Adequate stock of essential equipment and supplies A dashboard for FP was developed to monitor and distribute adequate supplies of contraceptive commodities [SR-12] The Nigeria CDC established a centralized warehouse from which it distributed supplies to laboratories, treatment centres and the health ministry [SR-16] | |
28 | North Macedonia | Coordination of activities across government and key stakeholders Coordinated effectively within (horizontally) and across (vertically) levels of government for developing new entities, such as special government emergency committees [SR-4] | Ensuring sufficient monetary resources in the system and flexibility to reallocate Complemented government funds with humanitarian aid [SR-04] | NIL | NIL | NIL | NIL | |
29 | Pakistan | NIL | NIL | Appropriate level and distribution of human resources Redeployment of personnel from departments with low patient load to RMNCAAH departments [SR-12] Mobilized previously non-active female doctors for digital delivery of RMNCAH services through private partnerships [SR-12] Capacity building of health workers Training for health providers using distance learning/e-courses (Pakistan) [SR-12] | Adoptive/transformative capacity Routine and non-serious cases declined and referred to digital platforms [SR-12] Expanded Program on Immunization (EPI) services delivered by motorbikes and vans and door-to-door visits and counselling for child vaccination (routine immunization) [SR-19 & SR-12] Mobile phone apps, WhatsApp for accessing RMNCAH services, that is, telehealth consultations for maternal and newborn care in cities [SR-12] Ability to deliver services safely Delivery of contraceptives to homes, door-to-door medical abortion counselling, and FP commodities [SR-12] | Effective communication and flow of information Public broadcast channels, social media (Instagram), and health partners relayed public messages on COVID-19 protection and SRH, safe motherhood, self-care for pregnant women, nutrition, and GBV (Pakistan) [SR-12] | Stock of PPE Availability of PPE helped ensure the provision and utilization of maternal services, particularly delivery services [SR-19] | |
30 | Rwanda | Coordination of activities across government and key stakeholders National COVID-19 Joint Task Force and COVID-19 prevention task force were setup [SR-14] Adequate and effective leadership Control guidelines were issued [SR-14] | NIL | NIL | Adoptive/transformative capacity Adopted new technologies to address difficult issues. For example, in Rwanda, drones were flown above houses in Kigali and remote areas to increase awareness of the COVID-19 pandemic and communicate prevention messages in the communities [SR-14] Evidence of service related to COVID-19 People with COVID-19 and contacts in home isolation received text message check-ins via SMS for 2 weeks, enabling self-reporting of new symptoms or issues [SR-16] | NIL | NIL | |
31 | Russian Federation | NIL | NIL | Motivated and well-supported workforce Financial compensation to support the health workforce in the form of one-time bonus payments [SR-04] | NIL | NIL | NIL | |
32 | Senegal | Coordination of activities across government and key stakeholders Coordinated multi-sectoral response: Senegalese response, where public health and economic strategies were seen as inseparable (Senegal) [SR-14] | Ensuring sufficient monetary resources in the system and flexibility to reallocate and inject extra funds into the system Budget was made available for the resilience package and allocated to the health system to improve testing, treatment, tracing and prevention, and to enable the recruitment of additional health workers [SR-14] | Recruitment of health workforce Recruitment of 1500 additional health workers, especially in rural districts [SR-14] | NIL | NIL | NIL | |
33 | Serbia | Coordination of activities across government and key stakeholders Coordinated effectively within (horizontally) and across (vertically) levels of government by establishing Operational Intersectoral Headquarters [SR-4] | Ensuring sufficient monetary resources in the system and flexibility to reallocate Complemented government funds with humanitarian aid [SR-04] | NIL | NIL | NIL | NIL | |
34 | Sierra Leone | NIL | NIL | NIL | Adoptive/transformative capacity Adoption of national guidelines for safe maternal care [SR-23] Absorptive capacity Preservation of activities of CHWs/VHWs related to maternal health [SR-23] An essential package of services Implementation of communication campaigns [SR-23] | NIL | NIL | |
35 | South Africa | NIL | NIL | Appropriate level and distribution of human resources Suspension of redeployment/rotation of staff in obstetric or newborn/neonatal facilities, wards, or clinics to other wards/clinics [SR-12] Motivated and well-supported health workers Psychosocial support and information for staff through Health-Connect app/Health Worker Alert [SR-12] | Absorptive capacity CHWs provided home visits for follow-up of patients with HIV, TB, mental disorders, postnatal care, and palliative care needs [SR-24] Adoptive/transformative capacity Virtual communications technology was used by the National Department of Health (NDOH) to support and provide technical guidance to provinces, partners, and front-line workers [SR-12] Mom-Connect (NDOH mobile health program for ANC and maternal health) platform linked to other services for early ANC booking, reminder messaging, facility status information, and referrals [SR-12] Ability to deliver services safely Delivered medications, non-pharmaceutical equipment and supplies to people at home living with chronic conditions, thus protecting them from potential exposure at primary care facilities and in public transport [SR-24] Evidence of service related to COVID-19 Establishment of new public health laboratories and linkages with private (including research) laboratories [SR-16] An essential package of services Public health education campaigns that were carried out through community organizations and social media [SR-24] | Surveillance enabling the timely detection of shocks and their impact South Africa’s National Institute for Communicable Diseases worked with the National Department of Health to develop COVID-Connect and the COVID Alert South Africa app notification systems to provide results and notify people if they were in close contact with a patient diagnosed as positive [SR-16] Effective communication and flow of information Broadcast and social media campaign for health messaging on breastfeeding and service continuity for immunization, child health and nutrition, SRH, and ANC [SR-12] | Adequate stock of essential equipment and supplies Enhanced monitoring of vaccination supplies [SR-12] | |
36 | Sri Lanka | Adequate and effective leadership Developed many guidelines, such as the Preparedness and Response Plan, rational use of PPE, hospital preparedness, and Stakeholder Engagement Plan (SEP) [SR-13] | NIL | Appropriate level and distribution of human resources Measures such as relocation of staff for specialized MNCH care in designated hospitals and safeguards to strengthen health workforce protection were put in placed [SR-13] Capacity building of health workers Staff were also trained on the use of PPE [SR-13] | Adoptive/transformative capacity Provided care in the ‘new normal’ phase (including high-risk approach in antenatal care, growth monitoring and immunization services, PPE and protective measures as well as implementation of national technical guidelines and reorganization of clinic services) [SR-13] Emergency referral transport for women, newborns, children, and adolescents was provided through a government-funded ambulance service [SR-13] Ability to deliver services safely Care of children under 5 years of age with illnesses such as diarrhoea, pneumonia, and severe acute malnutrition at the primary care level was continued with IPC measures and a reduction in the number of visits [SR-13] | Effective communication and flow of information The country used mass communication (including a social media campaign) and roped in the mass media to create awareness about MNCH [SR-13] | PPE and other essential supplies and equipment for PHC service delivery Equipment and supplies for EmONC care and supplies to protect personal hygiene were mobilized [SR-13] | |
37 | Sudan | NIL | NIL | Appropriate level and distribution of human resources Redeployment of health workers [SR-12] Recruitment of health workforce Temporary recruitment of health workers [SR-12] Motivated and well-supported workforce Provision of incentives and staff retention in selected areas [SR-12] | Adoptive/transformative capacity Telemedicine, e-health, and m-health hotlines were established, i.e., hotline/call centre for FP and virtual consultations and the use of WhatsApp to send results and prescriptions [SR-12] Evidence of service related to COVID-19 Screening, triage and isolation for patients with COVID-19 [SR-12] | NIL | Adequate stock of essential equipment and supplies Reinforcement and adaptation of supply chains, procurement, and logistics arrangements [SR-12] | |
38 | Tajikistan | NIL | NIL | Motivated and well-supported workforce Provision of psychosocial support in the community for CMWs [SR 12] Capacity building of the health workforce Training on IPC protocols and measures for health workers and CHVs [SR 12] | Adopted/transformative capacity Night shifts introduced in PHC facilities [SR-12] ANC visits to health facilities were reduced to a maximum of four during pregnancy, with health workers conducting home visits [SR-12] Evidence of service related to COVID-19 Ministry of Health and Social Protection ensured regular home visits for early detection of COVID-19, registration of pregnancies, and provision of ANC and other services [SR-12] Ability to deliver services safely IPC standards implemented in health facilities [SR-12] | NIL | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and IPC in all health facilities [SR-12] | |
39 | Thailand | Adequate and effective leadership Developed guidelines to protect essential SRMNCAH services during emergencies [SR-13] | NIL | Capacity building of health workers Offered continuous training for health service providers on SRMNCAH [SR-13] | Adoptive/transformative capacity Expanded the role of VHVs for surveillance and generated community capacity for resilience response [SR-7] MCH including FP and birth control services at the community level through VHVs conducting visits to families, providing information and referrals, and monitoring the risk of COVID-19. They also facilitated and sent public health information from the community to public health officers [SR-13] | NIL | NIL | |
40 | Timor-Leste | Adequate and effective leadership MoH developed specific clinical protocols and guidelines for ANC and intrapartum and immediate postpartum care [SR-13] Coordination of activities across government and key stakeholders Country preparations and responses to the pandemic (included strengthening of the health system, isolation rooms, laboratory facilities, and PPE distribution as well as encouraging preventive measures, and reactivation of RMNCH working group) [SR-13] | NIL | NIL | Absorptive capacity Maternal and newborn health catch-up service provision through comprehensive outreach activities and pre-scheduled appointments [SR-12] Adoptive/transformative capacity All SRMNCAH services were provided at all levels. Family planning services and methods, routine immunization for children under 5 years of age, and nutrition counselling and growth monitoring of children under 5 years of age were continued at the community level through community workers and mobile clinics [SR-13] Modified Integrated Medical Outreach Programme that enabled immunization and contraceptive access and general health care services for mothers and young children in rural and remote areas [SR-12] Evidence of service related to COVID-19 Establishment of a separate maternity isolation ward at the maternity clinic [SR-13] | NIL | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and IPC in all health facilities [SR-12] | |
41 | Uganda | Adequate and effective leadership The government issued national-level policy guidance related to RMNCH service continuity [SR-20] | NIL | Motivated and well-supported workforce Transport for health workers organized where needed; improvisation of overnight lodging facilities for health workers in some districts [SR-12] Daily risk allowance for health workers was offered [SR-12] Capacity building of the health workforce Training of trainers in essential health services [SR-12] | Absorptive/transformative capacity FP services were integrated into other health services, including postpartum, young child, and antiretroviral therapy (ART) clinics, PNC also integrated into EPI outreach [SR-12] CHWs provided home visits for follow-up of patients with HIV, TB, mental disorders, postnatal care and palliative care needs [SR-24] Special child clinics for MCH and HIV services to reduce congestion [SR-12] Psychosocial and ART adherence counselling via phone and WhatsApp for adolescents and mothers, and text message appointment reminders [SR-12] An essential package of services Community outreach activities for adolescents regarding SRH, HIV counselling and testing, ANC, contraception, condom distribution, and human papillomavirus immunization [SR-12] Ability to deliver services safely Delivered medications, non-pharmaceutical equipment, and supplies to people at home living with chronic conditions, thus protecting them from potential exposure at primary care facilities and on public transport [SR-24] Evidence of service related to COVID-19 People with COVID-19 and contacts in home isolation received text message check-ins via SMS for 2 weeks, enabling self-reporting of new symptoms or issues [SR-16] | Surveillance enabling the timely detection of shocks and their impact Surveillance modernization: Uganda shifted to the use of the Go-Data tool; managed by the WHO Global Outbreak and Response Network and included secure data exchange and functionality for case investigation, contact follow-up, and visualization of chains of transmission [SR-16] Effective communication systems and flow of information Many telecommunications companies incorporated public health messages into their routine services. In Uganda, MTN and Airtel disseminated messages about how to keep safe from COVID-19; [SR-16] | Personal protective equipment (PPE) and other essential supplies and equipment for PHC service delivery PPE for health workers, and IPC in all health facilities [SR-12] | |
42 | Ukraine | Coordination of activities across government and key stakeholders Coordinated effectively within (horizontally) and across (vertically) levels of government for instance created new entities, such as special government emergency committees [SR-4] | Ensuring sufficient monetary resources in the system and flexibility to Secured additional funding through loans and grants. (by financial assistance and through additional funding through debt service relief from international lending institutions such as the International Monetary Fund (IMF)) [SR-4] | Motivated and well-supported workforce Financial compensation to support the health workforce in the form of one-time bonus payments [SR-04] | NIL | NIL | NIL | |
43 | Yemen | NIL | NIL | Capacity building of health workers Training on IPC protocols and measures for health workers and community health volunteers. [SR 12] Provision of psychosocial support in the community for CMWs [SR-12] Motivated and well-supported workforce Health workers are retained with incentives to prevent health system collapse due to a reduction in donor support [SR-12] | Adoptive/transformative capacity Hotline services for FP, ANC, and support for women and girls at risk of/experiencing violence (e.g. WhatsApp for medical consultations including obstetrics/gynaecology) [SR-12] Hotline service for older people on general health, COVID-19 prevention, and chronic diseases [SR-12] Mid-upper arm circumference (MUAC) measurement was established as the sole criterion in assessing nutritional status and the basis of entry criteria to outpatient therapeutic/supplementary feeding programs [SR-12] Modification of entry and follow-up criteria to outpatient therapeutic/supplementary feeding programs for pregnant and lactating mothers with moderate acute malnutrition [SR-12] An essential package of services Awareness-raising activities on FP, maternal, newborn, and child services, GBV and nutrition services specifically targeting migrants and displaced persons (Yemen) [SR-12] Ability to deliver services safely Mobile units conducted examinations for physical and mental health among children in wake of school closures [SR-12] | Effective communication and flow of information Communication related to FP service availability through national broadcasting channels and community volunteer efforts [SR-12] | Adequate stock of essential equipment and supplies Construction and rental of additional warehouses for storing additional supplies [SR-12] Availability of additional supplies of medical commodities (FP, reproductive health kits, clean birth kits, medicines for treating rape and post-abortion care [SR-12] | |
44 | Zimbabwe | Adequate and effective leadership The government issued national-level policy guidance related to RMNCH service continuity [SR-20] | NIL | NIL | Adoptive/transformative capacity A mobile outreach model was launched that integrated community-based outreach with facility-based outreach [SR-21} Absorptive capacity CHWs provided home visits for follow-up of patients with HIV, TB, mental disorders, postnatal care, and palliative care needs [SR-24] Mop-up campaigns for immunization services to reach out to children who missed their appointments due to COVID-19 [SR-20] Ability to deliver services safely Delivered medications, non-pharmaceutical equipment and supplies to people at home living with chronic conditions, thus protecting them from potential exposure at primary care facilities and in public transport [SR-24] An essential package of services Public health education campaigns that were carried out through community organizations and social media [SR-24] | NIL | NIL | |