The COVID-19 pandemic continues to rattle the world even after two years. With the colossal loss of lives and livelihoods, the world has been responding in ways that were never imagined before. Adaptive innovations are becoming the new normal. It is time now for the world to reflect and learn, so that it can address systemic issues in a planned manner and to become stronger and more resilient in a bid to secure people’s lives and livelihoods.

Prepare to prevent and to respond

The world has been witnessing consecutive crises at an accelerated pace. These are from epidemics & pandemics, war & strife, climate change, mass migrations, and cyber-attacks among others. Few countries have robust monitoring systems to assess future threats and make plans to mitigate these. While some of these systems are global, others are national and sub-national. Countries can learn from each other and multi-lateral bodies on frameworks to assess vulnerability of their systems from future threats. They can share their experiences around prevention plans. The learning process has to be collaborative and transparent with a shared purpose of securing health of people across the world.

Each country responded uniquely to the COVID-19 pandemic. Existing pandemic preparedness and health systems resilience indices failed to predict the response of each country and the outcomes in terms of people infected, hospitalized, and deceased. This disconnect implies that we need to look at other variables that influenced the actual response of each country and the outcomes. There is a need to relook at the existing assessment frameworks, discuss why they did not predict the outcomes, arrive at a collective view point on the new indices that must be incorporated into these frameworks.

The pandemic demonstrated the power of human collaboration in responding to a crisis. The realization of an effective vaccine within a year of the declaration of the pandemic symbolizes human collaboration and ingenuity. COVID-19 demonstrated the power of connecting the entire world through digital technologies. The entrepreneurial spirit was never as evident as during the pandemic. The world can map these innovations, discuss which of these can be put to use during normal times and which of these are to be reserved for crisis times. There is also a need to understand the flip side of these innovations as we slowly recover from the pandemic.

The world has taken notice of the indomitable spirit of the health workforce and their sacrifice. While technology resources could be ramped up at a shorter notice, we cannot ramp up human resources in a similar way. We need to plan for the future, not only to address current deficits but also to plan for crises. There is a lot to discuss and learn on achieving a fine balance between systems resilience that depends on redundancy & stockpiling and efficiency that talks of real time supply chains. We can learn from what militaries across the world do to remain alert to future wars, especially in terms of soldiers.

Recurring theme of the role of leadership and governance 

There is growing consensus on the outsized role that leadership and governance played in the response to, in actual outcomes and in the recovery of each country and region. We do not have robust frameworks to assess this aspect of health systems. As health and other social systems evolve to become more dynamic and complex, the world has not focused on the needed competencies of those who lead and those who govern these. This is a critical area that needs to be a part of the global learning frameworks.   

We are an interconnected and interdependent world

It is increasingly being realized that no one is safe if everyone is not safe. It is also being realized that no living being is separate from other living beings as outlined in the emerging concept of ‘One Health’. Countries that pollute our fragile atmosphere put others at equal or greater risk. ‘One Earth’ is the symbol of an interconnected and interdependent world. Health security is closely linked to economic and social security as is clearly evident from the ongoing pandemic. ‘Whole of Systems’ approach encompasses the open and interconnected nature of health systems with other social systems. Hence, the learning process has to be extended to include the whole of earth, the whole of systems, and all living beings.  

The learning processes

In a complex system, the learning process has to be across the system, involving all actors at all levels who matter to the system. It can be at individual, family, community, state, country, region and the global levels. It can be between health tech producers and users, health payers and healthcare providers, researchers and policy makers, public and private health players, regulators and the regulated. It can be between states, countries, and regions. It can be through objective research, sharing of subjective experiences, dialogues, discussions and debates.

The learning process shall ultimately lead to actions to strengthen systems and make them more resilient. Leadership of health systems and their sub-systems, in both the public or private domain, are best positioned to apply their learning into policies and strategies, to transform the systems they lead. 

What can be done

There is a need for a learning collaborative that provides a platform to compile knowledge through primary and secondary research, expert interviews, and focus group discussions on select themes related to health systems resilience in general and pandemic prevention and preparedness in particular. The platform shall enable various stakeholders to access learning briefs through a knowledge portal and engage in peer-to-peer learning workshops between representatives of various countries. Various states or provinces can contribute to the learning process as the contexts may vary even between states.

Dr Krishna Reddy Nallamalla
President, InOrder
Regional Director, South Asia
ACCESS Health International

Photo Credits: Indian Express

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