Description
Introduction: In the face of the COVID-19 pandemic, low- and lower-middle-income countries (L-LMICs) were tested in unprecedented ways, revealing the critical importance of resilient and antifragile health systems. Resilience in health systems refers to the capacity to effectively predict, prepare for, absorb, and adapt to significant external shocks, thereby maintaining essential functions and swiftly returning to a stable state. Antifragility goes a step further, describing the ability of systems to not only withstand adversity but to use these challenges as catalysts for systemic advancement and improvement. This scoping review explores how L-LMICs utilized Integrated Health Service Delivery (IHSD) systems to maintain routine or non-COVID-19 healthcare services during the pandemic, emphasizing resilience and antifragility in health system responses.
Methodology: Adhering to Joanna Briggs Institute guidelines for scoping reviews and PRISMA-ScR protocols, we systematically searched seven electronic databases to identify relevant studies. This methodological rigor allowed a comprehensive synthesis of evidence on IHSD strategies employed in L-LMICs during the pandemic. The review focused on studies that illustrated the WHO's definition of IHSD and its various typologies—organizational, functional, service, and clinical integration—within L-LMIC health systems.
Results and Discussions: The search yielded 8,312 articles, with 30 meeting the inclusion criteria. These studies encompassed a range of health topics, including systems strengthening (n=8), non-communicable diseases (n=6), specialized care (n=6), HIV (n=3), mental health (n=3), and other services (n=3). The results demonstrated a dynamic blend of organizational, functional, service, and clinical integration, enabling health systems to adapt and innovate in response to the pandemic. Fifteen studies highlighted organizational integration, highlighting how joint planning, resource mobilization, and decentralized coordination across public and private sectors were vital to maintaining routine health services. Functional integration was observed in 17 studies that emphasized the significance of training healthcare workers, enhancing data systems, and utilizing digital platforms. Innovations in non-clinical support and back-office functions, as observed in Ghana and the Philippines, were crucial for maintaining service continuity. Service integration was most reported (n=27), informing on adapting routine services to pandemic conditions. This adaptation involved using telehealth, community outreach, and dedicated COVID-19 infrastructure to facilitate the uninterrupted delivery of healthcare, particularly for populations living with HIV, cancer, and non-communicable diseases. Lastly, 15 articles reported on the clinical integration of routine healthcare with COVID-19 response measures. This involved developing new screening and treatment protocols and modifying existing care pathways.
Conclusions: This review underscores the significant role of IHSD in bolstering the resilience and antifragility of L-LMIC health systems amid the COVID-19 pandemic. The adaptability and innovative capacity demonstrated by these systems offer critical lessons for global health resilience. By integrating these insights into health system planning, L-LMICs can enhance their capacity to manage future healthcare uncertainties, contributing to more equitable health outcomes. Emphasizing IHSD can help ensure that health systems are not only prepared for future crises but also equipped to use such challenges as opportunities for systemic improvement, driving progress toward global health equity.
| Contact Geneva Health Forum | I would like to receive information about the GHF 2024 conference and other GHF activities / Je souhaite recevoir des informations sur la conférence GHF 2024 et d'autres activités du GHF. |
|---|
