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 Table of Contents  
Year : 2020  |  Volume : 64  |  Issue : 6  |  Page : 211-216  

Assessing health systems' responsiveness in tackling COVID-19 pandemic

1 Professor, International Institute of Health Management Research, New Delhi, India
2 Associate Professor, International Institute of Health Management Research, New Delhi, India

Date of Submission25-Apr-2020
Date of Decision06-May-2020
Date of Acceptance11-May-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Sutapa Bandyopadhyay Neogi
International Institute of Health Management Research, Plot No. 3, Sector - 18 A Dwarka, New Delhi - 110 075
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.IJPH_471_20

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Health systems' responsiveness is the key to addressing infectious disease threats such as pandemics. The article outlines an assessment of health systems based on World Health Organization's building blocks for select countries. It also compares these with the findings from a more comprehensive analysis of Global Health Security (GHS) Index, which assesses the preparedness of the health system for such pandemics. The GHS report (2019) spelt out very objectively that none of the countries of the world was prepared to effectively handle such emergencies, should they arise. Observations emerging from different countries highlight these findings although some of them seem to be discordant. Overall, it appears that Asian countries could fight the battle better than most developed nations in the Europe and America during the current pandemic, despite having poor GHS scores. Experiences of these countries in facing similar crisis in the past probably sensitized their strained health systems for a greater good. There are several lessons to be learned from such countries.

Keywords: Health systems, pandemic, public health, responsiveness

How to cite this article:
Neogi SB, Preetha G S. Assessing health systems' responsiveness in tackling COVID-19 pandemic. Indian J Public Health 2020;64, Suppl S2:211-6

How to cite this URL:
Neogi SB, Preetha G S. Assessing health systems' responsiveness in tackling COVID-19 pandemic. Indian J Public Health [serial online] 2020 [cited 2023 Jan 27];64, Suppl S2:211-6. Available from:

   Introduction Top

Coronavirus disease 2019 (COVID-19) emerged in the Wuhan province of China in late 2019, was declared a Public Health Emergency of International Concern on January 31, 2020, and a pandemic on March 11, 2020.[1] As it started to spread across the world, the responsiveness of the health systems served as the litmus test to contain the epidemic. Not only the existence of strategies, but also their implementation proved to be the key determinant of an effective response.

Health systems can be defined as comprising all the resources, organizations, and institutions, which produce interdependent actions aimed principally at improving, maintaining, or restoring health. Health system responsiveness displays the strength and preparedness of nations to prevent, protect against, respond to, recover from health emergencies, help them cope, and not be overwhelmed by the sudden and disproportionate increase in the demand of health facilities. The performance of health systems is gauged by assessing the select parameters of its building blocks (encompassing service delivery, health workforce, medical products, health financing, health information system, leadership, and governance), within the overarching goals of better health, responsiveness to the expectations of the population, and equity of financial contribution with protection against financial risk.

Our article seeks to assess the strength of health systems of selected countries and their capacities to respond to pandemic threats using World Health Organization (WHO) health systems as well as Global Health Security (GHS) frameworks and relate the strength of their health systems to the response with reference to the ongoing COVID-19.

   Materials and Methods Top

The study is an analysis of secondary data available in the public domain. For a comparative analysis of health systems and their responsiveness, we have purposively included countries from every region of WHO: Europe (Italy and Spain), Western Pacific (Australia, China, and Singapore), South East Asia (South Korea and India), Eastern Mediterranean (Saudi Arabia and Egypt), Americas (the USA and Brazil), and Africa (Nigeria and South Africa). To maintain the comparability of assessment, we have selected only countries which are of either middle income (high and low) or high income.

The WHO health systems framework is the basis for assessing the responsiveness of public health systems. The performance of each building block is assessed with respect to the standardized indicators proposed by the WHO.[2] A list of indicators with respect to GHS has been drawn from the existing literature[3] and placed in [Box 1]. The selected countries have been compared along the lines of those indicators.

   Results Top

The findings are elaborated along the lines of the framework that provided useful insights while objectively comparing health systems. The current analysis showed that health systems of high-income countries are stronger than their counterparts from low- and middle-income countries, for example, Italy, Spain, the USA, Australia versus Brazil, Nigeria, and India [Table 1].
Table 1: An analysis of health systems of select countries according to WHO's health systems building blocks

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The GHS indicators, on the other hand, have several components related to health systems preparedness for a pandemic. The analysis, as per GHS index 2019, indicated that no country was fully prepared for global emergencies such as pandemics. The developed nations (sixty in number), according to the report, had an average score of 51.9 out of a possible maximum of 100. Apart from political, socioeconomic, and environmental vulnerabilities, several gaps existed in the health systems, in particular, for dealing with public health emergencies.[3] This is in contrast to the assessment of countries based on health systems building blocks where countries such as Italy and Spain scored high for most of the parameters.

The average score for health systems indicators of the GHS index was 26.4, the lowest scoring category. For the countries selected in our study, except for the USA (ranked first in the world with a score of 83.5), Australia (ranked 4 with a score of 75.5), and South Korea (ranked 9 with a score of 70.2), others including developed nations such as Italy and Spain scored low. The more specific health systems-related indicators also did not augur well for countries other than the USA, Australia, and South Korea [Table 2].
Table 2: Comparison of Global Health Security indicators of select countries

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Strong health system parameters per se did not seem to be sufficient to translate into adequate responsiveness of the health systems during the current pandemic. The efficiency of the health system is reflected from the timeliness of implementation of measures such as social distancing along with testing, tracing, and isolation as also their rigor and coverage. The onus lies on individuals too, yet public accountability is determined by the leadership and governance of a country.

The responsiveness of the countries is not totally consistent with the results emerging from assessment as per the health systems framework. The GHS findings, to a certain extent, were commensurate with the better response to the pandemic by South Korea and Australia; poorly responsive health systems in Italy and Spain validated their lack of ability to contain the current pandemic. On the other hand, the USA could not demonstrate effective responsiveness despite scoring high in the GHS. Moreover, countries such as Singapore could not score well in the health systems component of GHS, yet they could demonstrate efficiency compared to many countries in managing the pandemic.

There is, therefore, a need to revisit the indicators and identify those that are most predictive of the outcome of health systems responsiveness in a crisis of this nature.

   Discussion Top

An analysis of the health systems shows that public health systems is much stronger in higher economies but that does not necessarily translate into health systems responsiveness when dealing with global health emergencies. This is quite aligned with the experiences of different countries in the current pandemic.

The assessment of health systems based on the established indicators is indicative of the fact that those have to be robust and sensitive enough to predict the real-time preparedness of any crisis. While higher economy countries have the best of the health systems, yet they could not contain the epidemic. On the other hand, several low- and middle-income countries could demonstrate that strict and timely implementation of activities was enough to reduce the impact.

Strict containment measures taken by Singapore through an extremely efficient health system, stringent contact tracing, and isolation could keep the numbers of infected cases at bay.[4] South Korea geared up authentic testing facilities in the community for early detection and isolation.[5] It learned a hard lesson in the Middle East respiratory syndrome epidemic in 2015 when lack of tests forced people to move from one facility to another.[6] India reported cases of COVID-19 around the same time the disease started making its appearance in Italy and started instituting measures of surveillance, social distancing, and isolation. The Government of India has so far led from the front, with timely actions to deal with the evolving pandemic situation. India has been able to showcase the three steps needed to fight the threat: bold public health leadership, rapid innovations, and courageous political will.[7]

Pandemic preparedness relies on the ability of health systems to surge during crisis: equipment, physical space, human resources, and system. Conservative estimates suggest that even in the most developed health systems, large-scale epidemics would entail more than 170% utilization of intensive care unit-level resources.[8],[9] An attention to triage and surge planning supported by a strong ethical and legal framework are keys to efficient functioning in crisis situations.[9] It is mandatory that there is perfect coordination within the federal system of countries, between multiple sectors and with the civil society so that we rise as one against what the WHO describes as “enemy against humanity.”[10]

To conclude, the pandemic has exposed the weaknesses of global health systems preparedness, the inability to respond timely in most countries, and the ineffectiveness of policy responses in many instances. Whatever the outcome of this ordeal may be, it makes us realize that pandemics in future may be inevitable. As Dwight D Eisenhower mentions, “In preparing for battle, I have always found that plans are useless, but planning is indispensable.” The corona pandemic is and will be not only a constant reminder to the world that responsiveness of the health systems is way beyond the building blocks but also an eye-opener for instituting more adept indicators for its assessment.


The authors acknowledge the contribution of Prof. Shankar Das, Director, IIHMR Delhi, for his suggestions in improving the manuscript.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Hua J, Shaw R. Corona virus (COVID-19) “Infodemic” and emerging issues through a data lens: The case of China. Int J Environ Res Public Health 2020;17:2309.  Back to cited text no. 1
WHO. The Global Health Observatory: Explore the World of Health Data. Geneva: World Health Organization; 2020. Available from: [Last accessed on 2020 Mar 30].  Back to cited text no. 2
Global Health Security Index USA: NTI; Johns Hopkins Bloomberg School of Public Health; 2019. [Last accessed on 2020 Mar 29].  Back to cited text no. 3
Heijmns P, Bloomberg. Singapore's Coronavirus Response has Contained the Outbreak—but its Strategy is hard to Replicate; 2020. Available from: virus-contained-response/. [Last accessed on 2020 Mar 31].  Back to cited text no. 4
Guardian T. Mass Testing, Alerts and Big Fines: The Strategies used in Asia to slow Coronavirus. The Guardian; 2020. Available from: ar/11/mass-testing-alerts-and-big-fines-the-strategies-us ed-in-asia-to-slow-coronavirus. [Last accessed on 2020 Mar 31].  Back to cited text no. 5
Normile D. Coronavirus Cases have Dropped Sharply in South Korea. What's the Secret to its Success? South Korea; 2020. Available from: -have-dropped-sharply-south-korea-whats-se cret-its-success#. [Last accessed on 2020 Apr 01].  Back to cited text no. 6
Guest JL, Del Rio C, Sanchez T. The 3 steps needed to end the COVID-19 pandemic: Bold public health leadership, rapid innovations, and courageous political will. JMIR Public Health Surveill 2020;6:e19043. doi: 10.2196/19043.  Back to cited text no. 7
Kain T, Fowler R. Preparing intensive care for the next pandemic influenza. Crit Care 2019;23:337.  Back to cited text no. 8
Hamele M, Neumayer K, Sweney J, Poss WB. Always ready, always prepared-preparing for the next pandemic. Transl Pediatr 2018;7:344-55.  Back to cited text no. 9
Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak? Ann Transl Med 2020;8:48.  Back to cited text no. 10


  [Table 1], [Table 2]

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