The world is learning great lessons from the ongoing COVID-19 pandemic. A consistent theme coming out of various studies and reports is the criticality of leadership and governance systems at global, national, and sub-national levels. Even countries that scored high on global health security index, fared poorly in their response to the pandemic, due to ineffective leadership and governance systems.

Countries that were exposed to similar crises in the recent times such as SARS, MERS, Bird Flu, Swine Flu, Ebola etc., seem to have fared better than others. The ability to learn from a crisis, adopt innovations that worked during the crisis, and prevent and prepare for the next crisis comes from good leadership and governance. Pre-existing legislation on crisis response mandates that are time bound to prevent their misuse during normal times, enable the leadership to be armed with the needed legal sanction to act swiftly and definitely.   

Countries that have strong public health and primary healthcare systems with deep community engagement did far better. Nearly one million Accredited Social Health Activist, popularly known as ASHA workers that India has invested in as part of its National Health Mission did yeoman service in rural India during the ongoing pandemic. It is an important lesson for the leadership to invest more in public health systems and comprehensive primary healthcare.

The power of advanced digital and molecular technologies was evident during the pandemic. Like any disruptive technology, these will have certain negative aspects that can cause misuse, as the world comes back to new normal. Governments should not only provide support for the growth of these fields but also offer proper stewardship in the form of policy clarity and regulation to prevent future misuse.

COVID-19 made it clear that health systems cannot function in isolation as they are intricately connected with all other social systems. As we witness the increasing arrival of various zoonotic diseases, it is clear that the health of all living beings and the climate are important. Hence,  leadership and governments should embrace the concepts of ‘One Health’, ‘One Earth’, ‘Whole of Government’, and ‘Whole of Systems’ in their policies and legislations.

Disease surveillance is fundamental to pandemic prevention and response. Most countries have agreed to be bound by the International Health Regulations (IHR). However, most governments have not made the needed investment in surveillance systems on an ongoing basis. Digital and molecular technologies will transform the surveillance systems across the world. Standards-based, interoperable health information flow is essential to develop a robust, live surveillance system. Legislatures should quickly address the concerns surrounding data privacy and security for these methods to be adopted and accepted.

As global supply-chains got disrupted, countries faced huge challenges in responding to the pandemic. Health systems that were not prepared for the unexpected shocks with national and state-level reserves in critical resources (human, financial, drugs, disposables, vaccines and other health technologies) fared badly in pandemic response. The leadership should develop policies and strategies deriving from this important lesson to prepare their people for any future shocks.

One of the key responsibilities of leadership is to communicate transparently and clearly to all concerned (both external and internal). Leadership that respects scientific evidence in their policies, actions and communications are generally well trusted by people. People’s trust in their leadership and the governments has been identified as one of the critical variables that influenced their behavior and adherence to the directives.     

Countries that empowered public health institutions to mount rapid response and coordinate with various stakeholders did well. Countries with federal political structures with health falling under State governments need a dynamic coordination to orchestrate harmonious response across the nation. Leadership that ignored established public health bodies and scientific advice, despite well prepared systems fared badly as was evident in USA. The lesson for the leaderships is to establish institutional mechanisms along with detailed rapid response manuals in place to avoid incoherent and poorly coordinated response.

Health systems in most countries have evolved into mixed provider systems with equal or more provision by private sector. Governments tend not to engage non-governmental stakeholders in their policies and executive actions. Community engagement has been identified as one of the factors in better response. Hence, the leaderships have to provide stewardship over private sector and engage all key stakeholders in various policies and response plans.

In summary, the leaderships have a responsibility to take evidence-informed policies, engage all key stakeholders in their plans, plan and arrange for adequate financial, human and material resources not only for normal times but also for crises times, to inform and educate people through right communication strategy, to provide stewardship and regulatory oversight over private sector, to strengthen health information system to integrate fragmented and complex health systems, and to invest in resilient healthcare provider and public health systems to strengthen health and social systems and secure people’s lives and livelihoods during unforeseen shocks.

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

Photo Credits:  UNDRR  

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