COVID-19, caused by the novel SARS-CoV-2 is the worst catastrophe in this century that affected more than 228 million people and caused more than 4.6 million deaths globally. The proportion of cases was maximum in the Americas (39%), followed by Europe (30%), South-East Asia (19%), Eastern Mediterranean (7%), Western Pacific (3%), and Africa (3%) among WHO regions. Similar trend was observed regarding distribution of deaths, with Americas leading with 46% of the burden followed by Europe (28%), South-East Asia (14%), Eastern Mediterranean (6%), Western Pacific (2%), and Africa (3%). The health systems have been struggling to play a vital role to minimise the case load and morbidity by instituting preventive measures and avert mortality by providing appropriate case management.
Health system is defined as comprising all the resources, organizations, and institutions, which produce interdependent actions aimed principally at improving, maintaining, or restoring health. Health system responsiveness displays the strength and preparedness of nations to prevent, protect against, respond to, recover from health emergencies, help them cope, and not be overwhelmed by the sudden and disproportionate increase in the demand of health facilities. The performance of health systems is gauged by assessing the select parameters of its building blocks(encompassing service delivery, health workforce, medical products, health financing, health information system, leadership, and governance), within the overarching goals of better health, responsiveness to the expectations of the population, and equity of financial contribution with protection against financial risk. In order to combat any public health crises, a set of activities are required to minimize the danger and impact of acute public health events that endanger the collective health of populations living across geographical regions and international boundaries, collectively embedded under Global public health security measures. The parameters of health security covers prevention of emergence or release of pathogens, early detection and reporting for epidemics of potential international concern, rapid response to and mitigation of the spread of an epidemic, sufficient and robust health system to treat the sick and protect health workers, commitment to improving national capacity, financing and adherence to norms and overall risk environment and country vulnerability to biological threats. These parameters, too fall under the ambit of health systems, that are aimed to improve epidemic detection, preparedness, response, and case management.
A preliminary analysis was done to assess the strength of health systems of select countries and their capacities to respond to pandemic threats using WHO and Global Health Security frameworks, which had exposed the weaknesses of global health systems preparedness, the inability to respond timely in most countries, and the ineffectiveness of policy responses in many instances.
Reports have stated that a country’s health system is the first line of defense in the face of any crisis, and if the system is not resilient, it will be overwhelmed and collapse, exacerbating the health impact and adding to inequality. Countries such as Germany, New Zealand, South Korea, Taiwan Province of China, and Vietnam have demonstrated resilience in their health systems and therefore could tackle COVID-19better.
We therefore undertook a more comprehensive analysis on health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19across all countries. The objective of the analysis is to identify the health systems and GHS factors that are most predictive of mortality due to COVID-19 in all countries across WHO regions.