Health system preparedness for emerging infectious diseases: A synthesis of the literature

ABSTRACT

This review reflects on what the literature to date has taught us about how health systems of low- and middle-income countries (LMICs) respond to emerging infectious disease (EID) outbreaks. These findings are then applied to propose a conceptual framework characterising an EID prepared health system. A narrative synthesis approach was adopted to explore the key elements of LMIC health systems during an EID outbreak. Overarching themes (‘core health system constructs’) and sub-themes (‘elements’) relevant to EID preparedness were extracted from 49 peer-reviewed articles. The resulting conceptual framework recognised six core constructs: four focused on material resources and structures (i.e. system ‘hardware’), including (i) Surveillance, (ii) Infrastructure and medical supplies, (iii) Workforce, and (iv) Communication mechanisms; and two focused on human and institutional relationships, values and norms (i.e. system ‘software’), including (i) Governance, and (ii) Trust. The article reinforces the interconnectedness of the traditional health system building blocks to EID detection, prevention and response, and highlights the critical role of system ‘software’ (i.e. governance and trust) in enabling LMIC health systems to achieve and maintain EID preparedness. The review provides recommendations for refining a set of indicators for an ‘optimised’ health system EID preparedness tool to aid health system strengthening efforts.

KEYWORDS:

• Emerging infectious diseases
• health systems
• low- and middle-income country
• health system strengthening

Acknowledgements

The views expressed in this publication are the authors’ alone and are not necessarily the views of the Australian Government.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Anna Palagyi http://orcid.org/0000-0002-8127-9351

Ben J. Marais http://orcid.org/0000-0003-3404-2690

Seye Abimbola http://orcid.org/0000-0003-1294-3850

Stephanie M. Topp http://orcid.org/0000-0002-3448-7983

Emma S. McBryde http://orcid.org/0000-0002-9570-9172

Joel Negin http://orcid.org/0000-0002-2016-311X

Additional information

Funding

A.P. is supported by grant funding from the Department of Foreign Affairs and Trade, Australian Government [grant number APP1132153]: Tropical partnerships to strengthen health systems responses to infectious diseases threats (PI: E.S.M.). B.J.M. is funded by a National Health and Medical Council (NHMRC) Practitioner Fellowship [grant number APP1139182]. S.A. is funded by an NHMRC Early Career Fellowship [grant number APP1139631].