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An adaptive governance and health system response for the COVID-19 emergency.

ABSTRACT: In the absence of an efficacious and affordable vaccine, the current crisis of COVID-19 is likely to be a long drawn one for many developing countries. In Bangladesh, where the entire population is susceptible and strict lockdown has been relaxed (as of May 31st 2020) due to concerns over saving livelihoods, the best available resources and capacities in the country have to be mobilized for an integrated and adaptive response strategy. In this paper we argue that a suitable response strategy for a country with highly constrained health system, must consider how response components will be delivered at scale, along with what can be delivered. In order to save maximum number of lives, an optimal strategy will be one that is able to iteratively select the most feasible set of health response and the network of organizations that can deliver most effectively at scale. This might require thinking outside of the conventional vertical network of public health system. Given its history of high-capacity non-government organizations in Bangladesh, it is likely that there are multiple alternative horizontal network options for delivering any set of response interventions. In fact many horizontal networks are already actively engaged in COVID-19 response work. The goal should be to identify and coordinate these networks, create new networks, and embed mechanisms for scaling up what works and scaling down what does not work. For a rapidly escalating and unpredictable crisis such as COVID-19, an adaptive response strategy is needed which allows for old and new networks of organizations to align and work collectively with minimum loss of lives.

SUBMITTER: Khan M

PROVIDER: S-EPMC7519722 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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An adaptive governance and health system response for the COVID-19 emergency.

Khan Mushtaq M Roy Pallavi P Matin Imran I Rabbani Mehnaz M Chowdhury Rajiv R

World development 20200926

In the absence of an efficacious and affordable vaccine, the current crisis of COVID-19 is likely to be a long drawn one for many developing countries. In Bangladesh, where the entire population is susceptible and strict lockdown has been relaxed (as of May 31st 2020) due to concerns over saving livelihoods, the best available resources and capacities in the country have to be mobilized for an integrated and adaptive response strategy. In this paper we argue that a suitable response strategy for ...[more]

PMID: 33012954

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Project description:BackgroundThe response to the COVID-19 pandemic in the United Kingdom included large scale changes to healthcare delivery, without fully understanding the potential for unexpected effects caused by these changes. The aim was "to ascertain the characteristics of patients, uncertainty over diagnosis, or features of the emergency response to the pandemic that could be modified to mitigate against future excess deaths".MethodsReview of the entire pathway of care of patients whose death was registered in Salford during the 8 week period of the first wave (primary care, secondary care, 111 and 999 calls) in order to create a single record of healthcare prior to death. An expert panel judged avoidability of death against the National Mortality Case Record Review Programme scale. The panel identified themes using a structured judgement review format.ResultsThere were 522 deaths including 197 in hospital, and 190 in care homes. 51% of patients were female, 81% Caucasian, age 79 ± 9 years. Dementia was present in 35%, COVID-19 was cause of death in 44%. Healthcare contact prior to death was most frequently with primary care (81% of patients). Forty-six patients (9%) had healthcare appointments cancelled (median 1 cancellation, range 1-9). Fewer than half of NHS 111 calls were answered during this period. 18% of deaths contained themes consistent with some degree of avoidability. In people aged ≥75 years who lived at home this was 53%, in care home residents 29% and in patients with learning disability 44% (n = 9). Common themes were; delays in patients presenting to care providers (10%), delays in testing (17%), avoidable exposure to COVID-19 (26%), delays in provider response (5%), and sub-optimal care (11%). For avoidability scores of 2 or 3 (indicating more than 50% chance of avoidability), 44% of cases had > 2 themes.ConclusionsThe initial emergency response had unforeseen consequences resulting in late presentation, sub-optimal assessments, and delays in receiving care. Death in more vulnerable groups was more likely to display avoidability themes.

Project description:It is of great reference significance for broadening the research perspective of pandemic governance, improving the efficiency of pandemic governance and the credibility of the government, to scientifically measure and analyze the public medical and health system costs. This article takes the typical case “pandemic prevention and control event of S city, China” as the research background. First, the concept of public medical and health system costs during pandemic governance is defined. Then, the public medical and health system costs are embedded into the pandemic governance system, and the generation process of the public medical and health system costs in the actual situation are investigated. Furthermore, through in-depth interview, multi-case grounded theory and fuzzy subordinate function analysis, the scientific construction of the public medical and health system cost index system are completed. Finally, based on G1 method/entropy method combined with weighting and fuzzy comprehensive evaluation method, the public medical and health system costs of the pandemic prevention and control events of S city is measured. The results show the following: (1) it is important that good single dimensions and reliable indicators are embodied in the public medical and health system costs scale. Among them, the behavioral public medical and health system costs of the masses is the largest proportion of all indicators; (2) after the pandemic prevention and control event is over, the public medical and health system cost are difficult to repair, and some lagging ideas and behaviors shown by local governments lead to a continuous expansion of the public medical and health system costs associated with pandemic governance; and (3) local governments should not conceal information asymmetry. Instead, local governments should give greater freedom to other actors to deal with pandemic governance, and governance entities should cooperate with each other. This will mitigate the effect of public medical and health system costs. Corresponding policy recommendations are proposed.

Dataset Information

An adaptive governance and health system response for the COVID-19 emergency.

Publications

An adaptive governance and health system response for the COVID-19 emergency.

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