Health system resilience and COVID-19 - reflections from South Asia

The health systems in South Asian countries are pluralistic with a mixed health workforce, which has been shown to contribute to better health outcomes under resource constraints. However, when the COVID-19 pandemic confronted the weak, fragmented, and poorly resourced health systems, they suffered a significant setback in maintaining essential services. The unprecedented, complex, and lengthy experience with COVID-19 in South Asian countries cannot be labeled as a simple success or failure; it was both and alternating over time. Depending upon the capacity to absorb shocks and adapt to the prevailing circumstances, responses varied from fragmented ad hoc efforts to a well-coordinated response. Countries with large populations struggled more than the smaller countries. One major limiting factor for a quick COVID-19 response was the ability to mobilize relevant frontline workers (doctors, nurses, technicians, lab people, etc.) to tackle the surge in COVID-19 patients in hospitals, given that most of these countries had shortages of such workforces. Besides being resilient, a comprehensive and inclusive approach integrating pandemic prevention, preparedness, and response (PPR) into the system and making effective and efficient investments in primary healthcare, including CHWs, is the only way to tackle the threat comprehensively.