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Introduction The coronavirus disease 2019 (COVID-19) pandemic profoundly affected health systems as well as economies and societies more broadly. (1,2) As countries grappled with increasing numbers of COVID-19 cases, many [...], Objective To assess national pandemic preparedness and response plans from a health system perspective to determine the extent to which implementation strategies that support health system performance have been included. Methods We systematically mapped pandemic preparedness and response implementation strategies that improve resilience to pandemics onto the Health System Performance Assessment Framework for Universal Health Coverage. Using this framework, we conducted a document analysis of 14 publicly available national influenza pandemic preparedness plans, submitted to the European Centre for Disease Prevention and Control, to assess how well health system functions are accounted for in each plan. Findings Implementation strategies found in national influenza pandemic preparedness plans do not systematically consider all health system functions. Instead, they mostly focus on specific aspects of governance. In contrast, little to no mention is made of implementation strategies that aim to strengthen health financing. There was also a lack of implementation strategies to strengthen the health workforce, ensure availability of medical equipment and infrastructure, govern the generation of resources and ensure delivery of public health services. Conclusion While national influenza pandemic preparedness plans often include provisions to support health system governance, implementation strategies that support other health system functions, namely, resource generation, service delivery, and in particular, financing, are given less attention. These oversights in key planning documents may undermine health system resilience when public health emergencies occur. Objectif Evaluer les plans nationaux de preparation et de reaction aux pandemies du point de vue du systeme de sante afin de determiner le niveau d'inclusion des strategies de mise en oeuvre qui soutiennent la performance du systeme de sante. Methodes Nous avons systematiquement identifie les strategies de mise en oeuvre de la preparation et de la reaction aux pandemies qui ameliorent la resilience dans le cadre devaluation de la performance des systemes de sante pour la couverture sanitaire universelle. Ce cadre nous a servi de base pour proceder a une analyse documentaire de 14 plans nationaux de preparation a une pandemie de grippe accessibles au public. Ces plans ont ete soumis au Centre europeen de prevention et de controle des maladies, afin devaluer la prise en compte des fonctions des systemes de sante dans chaque plan. Resultats Les strategies de mise en oeuvre figurant dans les plans nationaux de preparation aux pandemies de grippe ne prennent pas systematiquement en compte toutes les fonctions des systemes de sante. Elles se concentrent plutot sur des aspects specifiques de la gouvernance. En revanche, les strategies de mise en oeuvre visant a renforcer le financement de la sante ne sont que peu, voire pas, mentionnees. Les strategies de mise en oeuvre visant a renforcer les effectifs du personnel de sante, a garantir la disponibilite des equipements medicaux et des infrastructures, a regir la generation de ressources et a assurer la prestation de services de sante publique font egalement defaut. Conclusion Si les plans nationaux de preparation aux pandemies de grippe comprennent souvent des dispositions visant a soutenir la gouvernance des systemes de sante, les strategies de mise en oeuvre qui soutiennent d'autres fonctions des systemes de sante, notamment la generation de ressources, la prestation de services et, en particulier, le financement, beneficient d'une attention moindre. Ces lacunes dans des documents de planification cles sont de nature a nuire a la resilience du systeme de sante en cas de situation d'urgence liee a la sante publique. Objetivo Evaluar los planes nacionales de preparacion y respuesta ante una pandemia desde la perspectiva del sistema sanitario para determinar en que medida se han incluido estrategias de implementacion que apoyen el rendimiento del sistema sanitario. Metodos Se trazo un mapa sistematico de las estrategias de preparacion y respuesta ante pandemias que mejoran su resiliencia en el Marco de Evaluacion del Rendimiento del Sistema Sanitario para la Cobertura Sanitaria Universal. A partir de este marco, se realizo un analisis documental de 14 planes nacionales de preparacion ante una pandemia de gripe y de acceso publico, presentados al Centro Europeo para la Prevencion y el Control de las Enfermedades, con el fin de evaluar en que medida se tienen en cuenta las funciones del sistema sanitario en cada plan. Resultados Las estrategias de implementacion que se encuentran en los planes nacionales de preparacion ante una pandemia de gripe no consideran sistematicamente todas las funciones del sistema sanitario. En su lugar, se centran sobre todo en aspectos especificos de la gobernanza. Por otro lado, apenas se mencionan las estrategias de aplicacion destinadas a reforzar la financiacion sanitaria. Tambien faltan estrategias de implementacion para reforzar el personal sanitario, garantizar la disponibilidad de equipos medicos e infraestructuras, gobernar la generacion de recursos y garantizar la prestacion de servicios sanitarios publicos. Conclusion Aunque los planes nacionales de preparacion ante una pandemia de gripe suelen incluir disposiciones para apoyar la gobernanza del sistema sanitario, se presta menos atencion a las estrategias de implementacion que apoyan otras funciones del sistema sanitario, en concreto, la generacion de recursos, la prestacion de servicios y, en particular, la financiacion. Estos descuidos en documentos de planificacion clave pueden debilitar la resiliencia del sistema sanitario cuando se producen emergencias de salud publica.

Author(s): Feifei Zhang [sup.1] , Humphrey Karamagi [sup.2] , Ngoy Nsenga [sup.2] , Miriam Nanyunja [sup.2] , Miriam Karinja [sup.3] , Seth Amanfo [sup.1] , Margo Chase-Topping [sup.4] [sup.5] , [...], Countries of the World Health Organization (WHO) African Region have experienced a wide range of coronavirus disease 2019 (COVID-19) epidemics. This study aimed to identify predictors of the timing of the first COVID-19 case and the per capita mortality in WHO African Region countries during the first and second pandemic waves and to test for associations with the preparedness of health systems and government pandemic responses. Using a region-wide, country-based observational study, we found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity but later in island nations. Predictors of a high first wave per capita mortality rate included a more urban population, higher pre-pandemic international connectivity and a higher prevalence of HIV. Countries rated as better prepared and having more resilient health systems were worst affected by the disease, the imposition of restrictions or both, making any benefit of more stringent countermeasures difficult to detect. Predictors for the second wave were similar to the first. Second wave per capita mortality could be predicted from that of the first wave. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning. A new study from the WHO African Region identifies features of countries that predict timing of the first case and the per capita mortality rate for the first and second waves of the COVID-19 epidemics.