Table 1 Examples of governance and financing approaches

From: Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

Subdomain Snapshot of health systems resilience measures in reviewed countries
Countries with the least deaths per 100,0000, with a population of over 20 million Countries with the most deaths per 100,0000, with a population of over 20 million Countries in the middle category in terms of deaths per 100,000 population
Governance approach China: established top-down governance structures to reach across all levels within the government and created a whole-of-government approach. The State Council established a Joint Prevention and Control Mechanism. It is a platform for communication, collaboration and mobilization of resources between 32 different ministries and departments. It consists of workgroups responsible for COVID-19 control, medical treatment, research, education, logistics and frontline workers. At local levels, emergency response leading groups, headed by local government leaders, were established in provinces, cities and counties across the country. The local emergency response leading groups are responsible for implementing the central government’s policies and control strategies, thus forming a top-down system. Mozambique: opted for a multi-sectoral, whole-of-government approach. The Ministry of Health established an Emergency Commission to ensure effective coordination of COVID-19 prevention and response through the efforts of nine Technical Working Groups co-led by Ministry of Health staff and development partners. The Government’s disaster agency (INGC) and the Ministry of Economy and Finance are currently working with line ministries to identify the needs and priority measures to be implemented. Aligned with this, the Humanitarian Country Team, led by the resident coordinator and composed of UN agencies, NGOs, Red Cross and donor representatives, is developing a response plan to COVID-19, focusing on sector-specific impacts of COVID-19. Peru: despite political instability, there was an emphasis on multi-sectoral action in the pandemic response. In the early stages (end of March 2020), the president convened a teleconference between regional health governors together with the Minister of the Interior, the Minister of Health and the Minister of Agriculture, who each presented the plans of their sectors and the measures that were adopted to guarantee security and food supply. Mexico: the Ministry of Health initiated a national meeting of state governors and health authorities to coordinate efforts to respond to COVID-19. During the meeting, state authorities agreed to participate in working groups to learn firsthand the national situation, updates and the decisions made to address each step of the pandemic. It was also agreed that local and municipal governments will be involved and will collaborate on communicating cases, incidents and necessary actions. Germany: a whole-of-government approach was adopted. At the national level, the central government convenes weekly as the ‘Small Corona Cabinet’. It consists of the Chancellor and various ministries. Additionally, the government convenes on a weekly basis in the ‘Large Corona Cabinet’. Besides the members of the small cabinet, ministers from specific ministries, depending on issues discussed, are invited to join. Japan: set up the coronavirus task force, consisting of diverse medical experts (virology, infectious disease, molecular genetics, genomic medicine and computational science) and includes 36 high-ranking bureaucrats from several ministries. The headquarters acts as the site of the prime minister’s decision-making process on the country’s virus countermeasures.
Coordination with scientific advice Uruguay: in June, an Honorary Scientific Advisory Group (GACH) was formed, which included a broader and more diverse group of expertise, including socioeconomic, than the previous committee formed in March. As of June 2020, this group comprised 55 members and holds weekly meetings with subgroups, makes biweekly reports to the Transition group, holds special meetings with the president and has daily contact with the government; all the announced measures have the support of scientists on the GACH. Uganda: CDC Uganda provides technical input to the Uganda Ministry of Health. For example, with CDC Uganda input, the Emergency Operations Center set up a national task force to prepare for the COVID-19 pandemic before the first cases were detected. CDC support for influenza surveillance at the Uganda Virus Research Institute is proving critical in the COVID-19 response. The Ugandan government drafted researchers into a COVID-19 scientific committee to inform the country’s prevention and treatment strategy for the pandemic after cases were reported in East Africa. This committee has been at the center of Uganda’s COVID-19 response, drafting local measures and guidelines for the prevention and treatment. Argentina: the government created a special government unit to respond to the COVID-19 pandemic. The unit’s main task is to advise the Presidency and the Ministry of Health on matters regarding available human resources and infrastructure. In addition, The Ministry of Health of Argentina has jointly coordinated the pandemic response together with provincial ministries of health within the Federal Health Council (COFESA) and the following groups of experts: National Immunization Commission, National Advisory Committee on Research Ethics and National Commission on Vaccine Safety, among others. Spain: the government has appointed highly recognized clinical experts and epidemiological scientists as members of the COVID-19 Scientific and Technical Committee to provide advice to the government and inform policymaking. The Ministry of Health, through the Centre for the Coordination of Health Alerts and Emergencies (CCAES, in Spanish), activated the COVID-19 protocol and coordinates the response with the departments of health in Spain’s 17 autonomous communities. To design the exit strategy plan and the vaccination strategy, a group of multidisciplinary experts were appointed to produce the reports. New Zealand: epidemiologists, immunologists and public health experts advised on the risk the virus posed to the country and helped communicate the threat to the public and the government officials in charge of the response. The Ministry of Health brought some of these experts into a Technical Advisory Group, established as part of the Ministry of Health’s response to COVID-19, which is chaired by the chief science advisor, Ministry of Health and comprises various health professionals (epidemiologist, pathologist, virologist, infectious disease physician, microbiologist, medical officer of health, coordinator and public health officer). The group met twice weekly to provide updated advice to the Director-General of Health. South Korea: the Korea Disease Control and Prevention Agency has the leading role in the country’s response to COVID-19. The COVID-19 Response Strategy Consultation Committee convenes on a regular basis to discuss government response strategies and areas for improvement. The Korean government supports Korean researchers by providing data that were used for forecasting the spread of COVID-19 and the effectiveness of response measures, which aided in decision-making for infection control. The Korea Institute of Science and Technology (KIST) used a supercomputer and Individual Simulation for Transfer Phenomena, KIST’s own modeling method, to analyze the effectiveness of disease control measures taken by the Korean government.
Cost of COVID-19 treatment services Thailand: the government covers the cost of seeking COVID-19-related treatment services at all levels of care. China: the government covers all COVID-19 costs for all patients, including domestic migrants, a payment structure that is part of its ‘wartime’ governance. United Kingdom: residents of the United Kingdom need not pay for COVID-19-related treatment services. The free services are also extended to certain exemption categories of people such as those covered by the immigration health surcharge. Peru: cost of COVID-19 treatment was reduced to make it more accessible for the general public after the government had struck an agreement with private healthcare providers to charge a lower fee for COVID-19-related services. Singapore: the government covers the costs of hospitalization bills incurred by patients with COVID-19 in public hospitals, which applies to Singapore citizens, permanent residents and long-term pass holders. Russia: the entire amount of medical care, including testing and treatment, is covered by the state insurance system. All assistance is provided to the population free of charge.
Cost of diagnostic testing Sri Lanka: testing is provided free of charge at designated public hospitals. Uganda: cross-border cargo truck drivers, Ugandans returning from abroad, visitors arriving in the country and individuals and employers who want their staff tested are required to pay a fee for testing. United States: the federal government enacted The Families First Coronavirus Response Act, which provides funding for free coronavirus testing, 14-d paid leave for American workers affected by the pandemic and increased funding for food stamps. Peru: after reports of private clinics charging for COVID-19 tests, the National Institute of Health of the Ministry of Health reaffirmed that this service is totally free, public and indispensable in the context of the pandemic. South Korea: free testing for all; initially, however, asymptomatic persons wishing to receive a COVID-19 diagnostic test on their own had to pay about 160,000 KRW/133 USD if their test results came back negative. New Zealand: COVID-19 tests are free of charge. This applies whether you have symptoms of COVID-19 or not, and regardless of your citizenship, immigration status, nationality or level of medical insurance coverage.
Financial relief packages to individuals/ households/ businesses Niger: an updated crisis response plan has been presented to donors with an estimated cost of 18.4% of GDP, divided into an immediate health response and broader economic and social mitigation. Key elements include food distribution, free utilities to vulnerable households and temporary tax relief for hard-hit sectors. The Finance Ministry also announced credit support to the private sector in the form of loan guarantees. The revised cost includes large-scale support for agricultural production, revenue shortfalls and the building of liquidity buffers. An additional supplementary budget with 1.3% of GDP was also approved. Vietnam: the government introduced a fiscal support package valued at VND 291.7 trillion/USD 12.5 billion or 3.6% of GDP to support the economy. Measures include deferring payment of rent and taxes. The government also approved a cash transfer package for affected workers and households with monthly cash transfers provided for no more than 3 months, among others. United Kingdom: financial support includes: (1) additional funding for the NHS, public services and charities (GBP 48.5 billion/USD 66.6 billion); (2) measures to support businesses (GBP 29 billion GBP/USD 39.8 billion), including property tax holidays, direct grants for small firms and firms in the most-affected sectors and compensation for sick pay leave; and (3) strengthening the social safety net to support vulnerable people (by GBP 8 billion/USD 10.9 billion) by increasing payments under the Universal Credit scheme, as well as expanding other benefits. The government has launched three separate loans schemes to facilitate business access to credit. Self-employed and furloughed employees also received financial support to cover loss of wages, among others. Brazil: a series of fiscal measures adding up to 12% of GDP, of which the direct impact in the 2020 primary deficit is estimated at 8.4% of GDP. Congress declared a state of ‘public calamity’ on 20 March 2020, lifting the government’s obligation to comply with the primary balance target in 2020. The fiscal measures included the expansion of health spending and temporary income support to vulnerable households, among others. Germany: the clause for exceptional circumstances in the debt break was triggered on 25 March 2020. This allows debt financing of a supplementary budget of EUR 156 billion/USD 185 billion or 4.5% of GDP to cover response measures. On 3 June 2020, an additional recovery package was agreed on of roughly EUR 130 billion/USD 154 billion or 3.8% of GDP for 2020 and 2021. Economic support for businesses and individuals during the second lockdown was also provided. Emergency loans were made available for self-employed workers and businesses, among others. Pakistan: the federal government announced a relief package worth PKR 1.2 trillion/USD 7.5 billion in March 2020. Key measures include cash transfers to 6.2 million daily-wage workers (PKR 75 billion/USD 4.9 million); cash transfers to more than 12 million low-income families (PKR 150 billion/USD 981 million); support to SMEs and the agriculture sector (PKR 100 billion/USD 654 million) in the form of power bill deferment, bank lending, as well as subsidies and tax incentives, among others.
  1. Countries were selected according to the recorded number of deaths attributed to COVID-19 per 100,000 inhabitants on 6 November 2020. CDC, Centers for Disease Control and Prevention; GDP, gross domestic product; NGO, nongovernmental organization; NHS, National Health Service; SME, small and medium-sized enterprise; UN, United Nations.