Table 3 Examples of health service delivery 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
Construction of new treatment facilities China: large specialty field hospitals (for example, Leishenshan and Huoshenshan) were rapidly constructed to deliver respiratory care services. Niger: Médecins Sans Frontières constructed a 50-bed treatment center at the Amirou Boubacar Diallo National Hospital in Niamey, with the potential to accommodate up to 100 beds should case numbers increase. Argentina: in May 2020, the government built 12 modular hospitals in 20 d, mostly in the Buenos Aires suburbs; hospitals have 76 beds, of which 24 are for intensive care and are provided with respirators, and the rest of the beds have oxygen. They are also equipped with primary-care rooms, guardrooms, shock rooms, clinical analysis laboratories, consulting rooms and diagnostic imaging areas. United States: in New York, a faith-based organization built an emergency field hospital in Central Park with a respiratory unit and ICU capability. Nigeria: The United States Department of Defense Africa command donated four field hospital tents that have negative-pressure isolation facilities and can house up to 40 patients. The facilities were assembled by an all-Nigerian team. Russia: prefabricated modular infectious disease centers were built across the country, for example, the Ministry of Defence of the Russian Federation built 29 multifunctional medical centers using prefabricated modular structures in 23 constituent entities of the Russian Federation with a total capacity of more than 3,000 beds.
Converting public venues into treatment facilities Vietnam: anticipating high demand following the Danang outbreak in July 2020, Vietnam converted a sport stadium into a 1000-bed field hospital. China: converted large public venues into specialty hospitals (for example, Fangcang) to deliver respiratory care services. Brazil: worked with football clubs to transform stadiums into field hospitals. Peru: Villa Panamericana de Lima, the residential complex used for athletes of 2019 Pan American Games, was converted into a 3,000-bed hospital facility, with the Armed Forces responsible for the conversion and allocation of medical equipment. Pakistan: designated COVID-19 hospitals across the country with the necessary equipment, including PPE, and nominated a focal person to manage IPC at all times. Germany: the first specialized treatment centers for patients with COVID-19 and patients with respiratory symptoms were set up by the Regional Association of Statutory Health Insurance (SHI) Physicians in North-Rhine Westphalia. Some diagnostic centers have been converted into specialized centers and are designated for suspected and confirmed cases.
Reconfiguring existing medical facilities Thailand: reconfigured many tertiary hospitals to increase the number of negative-pressure rooms and equipment to deliver respiratory care services. Mozambique: private sector company Total LNG refurbished a 50-bed hospital to manage patients with COVID-19. United States: some tertiary hospitals augmented COVID-19-related services and built more negative-pressure rooms and integrated a separate heating, ventilation and air-conditioning channeling system. United Kingdom: hospital trusts were directed to optimize their infrastructure by redesigning existing space for clinical use and converting existing wards to make them suitable for patients with COVID-19. Critical-care capacity increased from around 4,000 to 7,000 beds. Liberia: the Incident Management System established a dedicated treatment unit and precautionary observation centers using renovated public buildings and the 14 military hospitals. South Korea: reconfigured designated tertiary hospitals into respiratory split hospitals that effectively segregate suspect and positive cases from non-respiratory disease so that these facilities can continue to provide essential tertiary-care services.
Postponement of elective medical procedures Mozambique: yes. Uganda: yes. United Kingdom: yes. Spain: yes. Uruguay: yes. New Zealand: yes.
Increased usage of digital health technologies for regular consultations Vietnam: Hanoi Medical University Hospital introduced the ‘digital hospital’ to provide services remotely, and the ‘remote health and examination. project was also approved to trial and promote similar digital initiatives. Thailand: promoted the use of teleconsultation services for nonurgent and stable chronic cases, with drug delivery services provided. United States: the government developed a new website for telehealth guidance during COVID-19 for patients and providers. The website was developed in collaboration with the Health Resources and Services Administration, an agency working on programs that provide healthcare to people who are geographically isolated and economically or medically vulnerable. Argentina: The Ministry of Health authorized doctors to make online prescriptions for certain medications to help people comply with the mandatory self-isolation period. Chronic and non-transmissible diseases may be prescribed through this system. WhatsApp, email and fax are some of the platforms that may be used. South Korea: initially, telemedicine was not approved in South Korea for clinical care. In 2020, the Korean government temporarily allowed telemedicine only for established patients. Singapore: actively expanded telemedicine services following an increased demand that came with implementing social distancing measures.
Primary-care providers as the first point of contact before triaging to onward care Vietnam: local commune centers provide primary-care services to the community. They help provide information on prevention and identify potential cases and cases for triaging to other care facilities. Uganda: CHWs are the first contact point for the community. They provide education, detect cases and perform referral to higher levels of care. United Kingdom: clinical commissioning groups work with general practitioners in primary-care networks to implement a total triage and remote consultation model during the pandemic to ensure that every patient is triaged before an appointment is made. Brazil: the COVID-19 Service Centers for Coping, available to all municipalities, act as a reference point for primary care within the service network of the Unified Health System (SUS). It is a strategy that seeks to expand diagnoses and care for people with influenza, while providing greater resolution of care to people with mild symptoms related to COVID-19. Singapore: PHPCs were set up with general practitioners trained in IPC, with necessary equipment and PPE provided. PHPCs are used to forward triage suspected cases to other levels of care. Japan: Public health centers began to systematically allocate patients to a wider network of hospitals, including privately owned facilities, matching patients to appropriate designated or non-designated hospitals by symptom severity and resource availability while urging mild and asymptomatic patients to stay at home or in converted hotels without a mandatory hospitalization.
  1. Countries were selected according to the recorded number of deaths attributed to COVID-19 per 100,000 inhabitants on 6 November 2020. IPC, infection prevention and control; PHPC, public health preparedness clinic.