What does a pandemic proof health system look like?

Figures & data

Table 1. Summary of policy, structural and operational issues that might need attention

	Institutions	Resources	People
Governance level High- and low-income countries	Revised law of epidemics Cooperation between low- and high-income countries Laws, regulations and guidelines on preparedness Revisiting the role of private sector providers Establishment of national and internationally linked surveillance-response systems	Investment in resources, infrastructure and telemedicine Investment in surveillance systems including genetic sequencing	Laws to ensure health systems have HR development plans to assure the constant supply of health care workers Valued health care workers with more pay and better working conditions
Policies and Strategy level High- and low-income countries	New policies and strategies to take services to where the people are- homes Renewed approaches for health promotion and prevention in societies and populations	Policies that promote local production of resources e.g. PPE that is environmentally friendly Development of environmentally friendly products particularly disinfectants	Review policies of health cadres- cadre for epidemic preparedness and surveillance- response Provision of satellite testing and vaccination centres
Service delivery/operational level High- and low-income countries	Expansion of telemedicine from triage, diagnosis and follow up services covering all conditions (acute to chronic)? taking care where the people are- through home-based care services? Acknowledgement and reinforcement of health as wealth Health promotion and prevention services provided to people in their homes Expansion of services to include preventive and promotive mental health services? In what format? Online, face to face formats or home visits? Establishment of research units- Ongoing institutional studies to ascertain treatment guidelines and use of off-label products for unknown disease entities in observational clinical studies Science vs Social media -will institutions adapt and become centres of knowledge dissemination- telemedicine and all possibilities of e- and m-health and provide knowledge to people at home, on what symptoms to look out for, where to test, how to self-care etc? for other conditions too and not only COVID-19	Functional supply chain systems Testing kits Vaccines for all age-groups	Develop more Online training and reference resources for staff. Home based vaccination programmes Mental health support for staff to reduce stress, burn out, debriefing and counselling services
Infrastructure High- and low-income countries	Structural changes e.g. air filters, ventilation systems, patient flows. Adaptation of waiting rooms to have windows that can be opened Disinfection and aeration of rooms	Storage facilities to stores sufficient material and prepare for future pandemics	Mobile vans etc to take care into the homes, dialysis teams etc
Staff and training High- and low-income countries	Systems thinking and within systems understand essence and processes of surveillance-response	Systems thinking and within systems understand essence and processes of surveillance-response	New level cadre, training and within systems understand essence and processes of surveillance-response Systems thinking

Figure 1. A pandemic proof health care system