Lessons
from the pandemic response across Europe and beyond will help policy-makers prepare for future shocks
A compilation of lessons learned from the COVID-19 response is now available in a Special Issue of the journal Health Policy. An international group of experts and institutions compared the performance of 50 countries, mainly in the WHO European Region,
and considered why some have managed the pandemic more successfully than others.
The Special Issue stems from the work of the COVID-19 Health System Response Monitor (HSRM), a collaboration set up in March 2020 between the European Observatory on Health Systems and Policies, WHO/Europe and the European Commission.
As the early days of the pandemic left policy-makers and health professionals scrambling for information on how to manage the impact of the pandemic, HSRM filled thein the knowledge gap by collecting up-to-date information on how health systems were responding
to the crisis.
“From increasing intensive care unit (ICU) bed capacity or expanding the health workforce, to managing vaccination rollouts, the measures put in place by health systems can help to explain why some countries have been able to keep death rates comparatively
low even in the presence of severe COVID-19 outbreaks,” reads the foreword of the Special Issue.
As Reinhard Busse, Natasha Azzopardi Muscat, Isabel de la Mata and Josep Figueras from the three organizations explain, well-functioning health systems have often been able to limit disruptions to service delivery, preventing increases in waiting times,
but others have been forced to convert into almost exclusively COVID-care: “For many countries, the inability of the health system to cope with the pressures of COVID-19 was a significant factor behind repeated lockdowns”.
Comparing how countries responded between March 2020 and late 2021
All articles are based on the content featuring in the HSRM, focusing on a specific topic or comparing responses from groups of countries.
The papers identify lessons from the COVID-19 response across five main health system dimensions:
- In the article on preventing transmission, authors emphasize the importance of governance in introducing measures to reduce COVID-19 infection.
- To ensure sufficient infrastructure and workforce capacity, authors consider a range of options that are relevant for countries tackling backlogs of care in their systems, such as redeploying staff, using private providers and using inter-regional and cross-border patient transfers.
- Common strategies for adapting service delivery included postponing elective care, reconfiguring hospital wards and transforming primary care models, for example to use multidisciplinary teams.
- Authors also show that more can be done to better prepare financing systems for unexpected drops in public revenues, smoothing provider income losses due to reduced demand, and covering extra costs related to providing new types of services.
- Governance is another important theme. Although public health measures were relatively easier to implement earlier in the pandemic, this shifted over time as populations pushed back against restrictions, particularly in countries with lower trust in government.
The second set of articles of the Special Issue highlight the breadth of the Health Systems and Policy Network, covering experiences from 33 countries mostly from the WHO European Region, including all European Union members, plus Canada and the
United States.
For example, the authors show how in Nordic countries with strong welfare systems and high levels of trust in government, COVID-19 experienced less devastating impact, and how inconsistent messaging and alignment between health experts and political leadership
in English-speaking countries was a key factor in weak compliance with public health measures.
A source for policy-makers responding to future challenges
Despite the difficulty in maintaining measures over a long period of time, making it virtually impossible for any country to manage the pandemic consistently well, there are many examples of good practices and innovations that could help countries prepare
for similar shocks, such as coping with the rapid influx of refugees in 2022.
Editors of the Special Issue Ewout van Ginneken, Erin Webb, Anna Maresso, Jonathan Cylus and the HSRM network suggest that countries use experiences from the HSRM archive to test their health systems and identify weaknesses in the context of different
shocks:
“One of the key advantages of this resource is that countries do not need to rely solely on their own policy experiences but also can explore concrete examples that have been applied elsewhere, being mindful of course of specific country contexts”.
Moving forward, making health systems more resilient requires, among other measures, supporting the workforce, tackling backlogs of care, implementing new models of care, strengthening mental health services, and using digital health services appropriately.