Table 2 Preparedness, impacts and lessons learned in responding to public health emergencies

Preparedness

Preparation and surveillance systems

Decentralised health system governance [25], intercity coordination [26], surveillance and daily summary reporting [27], preparedness, planning, surveillance, and proactive response with PHC services [28,29,30].

Shortage of staff and supplies, poor preparation for emergencies, missing standard operating procedure [31,32,33,34,35,36], poor transportation and communication [33,34,35,36], inadequate preparedness [37], knowledge gaps on contextual governance [13], poor understanding of PHC by non-health sector [16, 38], lack of planning [39].

Cameroon, Congo, Mali, Nigeria, Iraq, Ecuador, Indonesia, India, China, Japan, Central African Republic (CAR), Isreal

Impacts

Increased health needs

Lack of shock absorption and adaption capacity to respond to shocks [31, 32], lack of health services [33, 40], increased epidemic [41], collateral effects [42], increased displaced.

Host populations [43], weak capacity distribution of supplies, unavailability of quality services [42, 44], and postponed routine care in PHC [33, 45].

Cameroon, Congo, Mali, Nigeria, Iraq, Eastern Medicterrain Region (EMR), Libya, Yemen

Constraints in service delivery

Lack of trained workforces [46], failure of coordinated support overburdened hospitals [47], lack of primary care [45], high priority of hospitals services [48], health workforce workload [49, 50], an increase of infections [15], the hotspot of epidemics but blind spot of PHC services [28, 37], the spread of Ebola [43], increase of pre-existing diseases [34], reduced availability of services [45, 51].

Italy, Australia, Brasil, Malawi, SSA, CAR, Ecuador

Multiple impacts on building blocks of health systems

Inadequacies of service provision [47, 51, 52], isolation, lockdown, restriction [53, 54], collateral damage, interruption of service [53, 55,56,57,58], post-disaster disease outbreaks [33, 34], shortage of workforce and heavy workload [33, 34, 47, 50, 51, 55,56,57,58], reliance on short term staff [46], poor data quality [56], poor resource coordination and readiness [29, 52, 59], unavailability of digital tools [16, 27], poor digital interoperability remote areas [60, 61], poor partnerships, inadequate investment [56], market-oriented health systems [62], failure of global health response [63, 64], corruption in procurement, chronic under-investment [44, 60], and poor investment from private sector [43].

Malawi, sub-Saharah Africa (SSA), South

Africa, Germany, Ecuador, Australia, Japan, LMICs, Yemen

Increased health inequities

Exacerbated the existing disparities [39, 62, 64], increased geographic inequities [31], and poor global response to reduce inequities [12, 62].

Cameroon, Congo, Mali, Nigeria.

Responses

Integrated public health and primary care

Investment and reorganisation of PHC systems [28, 48, 51], coordinated public health and primary care [38, 65, 66], strengthened health systems [45, 67], and ability to adapt to the situation [58]. Cumulative service capacity [37, 68]. Implementation of PHC for equity [13], mobilisation of frontline workers [38, 59], technological innovations [55], caring for vulnerable populations, and use of information technology [55, 69]. Empowering PHC institutions for primary care [29], developing facility-specific preparedness plans standard operating procedures [36].

CAR, Brazil, Malawi, Germany, Cameroon, SSA, Liberia, India

Multisectoral actions

Linkages between policymakers, community based organisations, NGOs, and private sector [13], community resilience, satisfaction, and confidence [16, 30], Engaging stakeholders in planning [52, 64], multisectoral actions for prevention of pandemic [54], community collaborations [30, 70], multi-sectoral and comprehensive provincial pandemic and economy [56], “One Health” approach [29, 63], multisectoral actions for non-health sector response [71], multisectoral coordination, integration of fragmented approaches [72].

Israel, Thailand, South Africa, Cuba

Communication and partnership

Strategic partnerships of international organisations [43, 49, 73, 74], rebuilding coordination and communication networks, [27, 47, 67], humanitarian response, maintaining and outreach or mobile clinics [31, 42, 68], hospitality towards displaced populations [40], regional forums, institutions [26, 72], global initiatives and cross-country lessons [71, 75].

Sierra Leone, China, Italy, Japan, Yemen, Cameroon, Congo, Mali, Nigeria, EMR

Use of digital tools

systems shift to using new technologies and digital tools [26, 45, 49, 50, 76], digital consultation communication in remote consultations [53, 55, 68, 76], learning tools [60], use in data collection and supervision [44], reached vulnerable groups, optimisation of workers, and telecare [50, 77,78,79], set alarm systems, generate real-time, monitoring and evaluation [50, 77, 78], sharing information and communication [39, 80], technology informed multidisciplinary care [67], DigiTech in data processing, research [43, 71].

China, Australia, LMICs, Dubai, SSA

Multidisciplinary health providers

service delivery by CHWs [44, 55], family health teams in flu assessment [67], VHVs’ role in identification and monitoring of returnees [81], CHVs’ role in child health services, control of Ebola and malnutrition [42], integrating health-care system to enhance the public workforce practitioners [26], redefining training plans for safe working environments [51, 56, 82], intrinsic motivation and self-initiative [58].

Yemen, SSA, Thailand, China, Malawi, South Africa, Germany

Planning for resilient health systems

organization and pre-emptive planning [52, 57, 58], context-specific priorities, resilient health infrastructures [83], institutionalizing health programs [69]. Provision care with resilience in difficult conditions [42, 52, 57, 58], decentralized Brazilian health system [65], integrated health-care system [26], national intersectoral government plan [54], adaption and restricting or transformative activities [32], national consensus on contingency plan [82], monitoring to avoid unnecessary contact [66, 84], reorient health interventions [28], incorporating preparedness exercises [43].

Germany, Yemen, Brazil, China, Iraq, European Union (EU), CAR