COVID-19: A "testing ground" for health system resilience

COVID-19: A "testing ground" for health system resilience

{The USAID MTaPS Program is supporting the Philippines in responding to the COVID-19 pandemic and ensuring the availability of quality health commodities in communities. Photo credit: MTaPS staff}The USAID MTaPS Program is supporting the Philippines in responding to the COVID-19 pandemic and ensuring the availability of quality health commodities in communities. Photo credit: MTaPS staff

Andre Zagorski of the MSH-led, USAID-funded MTaPS Program talks about the program's urgent work to help contain the virus in more than a dozen countries.

{Andre Zagorski} Andre ZagorskiHow did you and MTaPS rally to support USAID’s call for a rapid response to COVID-19 in a dozen countries? What were the challenges? 

MTaPS is the USAID Global Health Security Agenda (GHSA) go-to program for infection prevention and control (IPC), and we have been implementing activities to strengthen health systems for stronger IPC programs in 10 countries since the MTaPS award in 2018. We have offices and small but strong professional teams in these countries and have established productive working relations with national stakeholders and partners.

Thus, it was not a surprise for MTaPS when USAID provided additional funding for rapid COVID-19 response, specifically focusing on crucial technical areas such as all aspects of IPC for COVID-19 and management of the PPE [personal protective equipment] supply at the national and facility levels. We are providing support to 12 countries, and we expect that number will grow.

The MTaPS management and technical structure proved to be flexible and well suited for an emergency response of this urgency and volume. To assist countries in rapidly initiating response activities, we quickly established an agile MTaPS COVID-19 response group of technical experts with clearly defined responsibilities; developed an online work planning and reporting tool; and are testing distance training and mentoring options, as many country teams are already operating under lockdown.

Challenges include the need for very quick turnaround on all requests and activities and addressing the dire COVID-19 threat in most of our countries. However, we have solid and responsive support from the USAID GHSA team, our COR team, the USAID Missions, and our own MTaPS and MSH management, all of which help our country leaders and MTaPS staff perform at their highest capacity.

What are some of the strengths the program and its country partners are bringing to this fight? Has the program’s systems strengthening work contributed to a basis of action?  

These times will test health system strength and resilience. We see that even highly developed countries are failing in their COVID-19 response. Meanwhile, we are working in low- and middle-income countries, which are by definition those with scarce resources and vulnerable health systems. They clearly lack funding to address key gaps in the availability of commodities such as PPE and in the large number of trained health care workers needed for the COVID-19 response. 

There are many anecdotal reports—we are trying to collect data—on the negative impact that COVID-19 has had on the management of other diseases and related pharmaceutical services, such as access to essential medicines. Services are not available, programs are stressed, and attention and funding are being diverted to the coronavirus response.  

However, we also clearly see how government efforts to strengthen health systems in these countries, supported by donors like USAID and CDC, have developed a foundation on which to build our response. Countries have IPC technical working groups that are prioritizing the COVID-19 response, and many have good IPC guidelines, including those in Kenya, Tanzania, and Ethiopia created with earlier MTaPS assistance. Many also have good health management information systems at the national level, and partners are well coordinated, including through USAID mechanisms such as MTaPS.

Most vulnerability is at the facility and community levels, and this is the focus of our current response. MTaPS is developing guidelines and procedures on specific areas of IPC and emergency supply management and providing just-in-time training. To illustrate the scope of this work, in just in one country, Kenya, MTaPS trained 1,157 health care workers in key IPC aspects for COVID-19 response  in just two weeks after USAID approved the work plan. 

Government leaders must be apprehensive, and working exhaustively. MTaPS’ staff, too. 

Governments are apprehensive, which is understandable; but they are not panicking. It should be noted that in some countries, like Philippines and Burkina Faso, health ministers were among the first to be diagnosed with COVID-19 and quarantined. But because MTaPS country teams had already established themselves with national stakeholders in the IPC and supply management areas, they are very efficient in their communication with these authorities. All parties are indeed working exhaustively on the COVID-19 response and appreciate one another’s contributions. 

What will the COVID-19 response mean for MTaPS’ work going forward? Will the program be able to build on some of the emergency reinforcements laid now? 

COVID-19 is a global disaster, but it's also a testing ground for innovations, approaches, and people. COVID-19 will eventually subside, and there will be a recovery phase for countries and their health systems. Programs and organizations that previously had systems strengthening as a backbone for their work in countries, and that had it in mind even during the emergency response, will have accumulated a valuable and distilled experience, including in the understanding and techniques for strengthening health systems in a much faster and more efficient way.

MTaPS has been flexible and able to rapidly adjust to challenging epidemiologic and working situations. We have great staff—responsive, responsible, efficient, professional —and no whiners! It will be tremendously important to proactively promote our new wisdom and well tested approaches during a “time of peace” after the pandemic.

Andre Zagorski is a senior principal technical advisor for MTaPS, and is in charge of coordinating the program’s COVID-19 response.

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