What does it take to coordinate multi-sectoral, multi-level pandemic responses?

Insights from the virtual collaborative launch webinar

Authors: Dr. Uchenna Gwacham-Anisiobi (Associate, HSDF), Dr. Christine Ezenwafor (Team Lead, Public Health Advisory, HSDF), and Agnes Gatome-Munyua, Senior Program Officer, R4D

COVID-19 has undoubtedly posed an enormous strain on health systems globally with over 230 countries, areas, and territories reporting cases[i]. Pandemic responses require multiple sectors, agencies, and stakeholders to play critical roles in the country’s response. However, siloed implementation by these actors limits the overall effectiveness of the response.

The Health Systems Strengthening Accelerator (Accelerator) in partnership with the Joint Learning Network for Universal Health Coverage (JLN), hosted a webinar on September 30, 2020 to introduce the topic of National Coordination of Multi-Sectoral and Multi-Level Pandemic Responses. Seasoned panelists from Mali (Professor Samba Sow), South Korea (Professor Jongsu Ryu), Ghana (Mr. Joseph Addo-Yobo) and Portugal (Professor Raquel Duarte) shared practical insights from their countries. The webinar was attended by more than 100 practitioners from Ministries of Health and Education, researchers, and development partners. A quick poll during the webinar showed that 54% responded their countries had weak coordination across levels of government, while 34% responded their countries had weak multi-sectoral coordination of the pandemic response – indicating that the topic was relevant to the audience. I drew out the following key insights about the critical roles of national coordination teams from the panelists’ discussions:

A multi-sectoral, multi-level response with well aligned objectives across sectors is vital for an effective response. When the national COVID-19 response coordinating unit engages effectively with all sectors involved in the pandemic response, this ignites a shared vision engendering a collective push towards better health system outcomes. In Ghana, the COVID-19 response is coordinated by the President’s Coordinating Unit. The Unit has the sole responsibility of coordinating a multi-sectoral response to COVID-19 through six advisory cells that each guide activities of multi-sectoral actors. In Portugal’s North Region, the COVID-19 coordination unit identified influential stakeholders in sectors such as public transportation, supermarkets, agriculture among others, and established channels for communication, negotiation and feedback on the enablers and barriers for the implementation of pandemic control policies. They co-created tools to help each sector asses their performance and the emerging insights guided policy decisions.

Open, honest, and proactive communication between the national coordinating teams (especially in decentralized governments) and stakeholders (regional coordination teams and the public) is best. In countries with decentralized government, channels for frequent debriefs between national and subnational coordination units are critical for effective coordination. In Portugal and South Korea, the intentionality to create transparency and build trust within and across regions was exemplified through national daily press briefings.

A multi-medium, high frequency, proactive communication with communities helps check misinformation and creates a sense of partnership in combating the pandemic. Experiences from Mali show that proactive risk communication strategies were vital in engaging communities, civil societies and vulnerable groups during the 2014 Ebola outbreak and the current COVID-19 pandemic. Poor communication especially among low literacy groups fueled by rumors caused setbacks in the early days of the Ebola containment. Deploying proactive, truthful and timely communication strategies using influential stakeholders was a useful catalyst for grassroot engagement in Mali. Managing the “infodemic” – mismatch of information either too much, too little, or misinformation – during the COVID-19 pandemic presents a unique challenge. All panelists agreed that frequent, truthful, and clear messaging is essential for curbing misinformation within the communities.

Good and timely data is invaluable for effective pandemic coordination. The Republic of Korea’s response to the 2015 Middle East Respiratory Syndrome (MERS) outbreak was marked by fragmented data and lessons learned led to the creation of an integrated information support system for infectious disease management. The strong political will and the desire to protect lives soon after the MERS outbreak drove the successful data integration across multiple agencies. These data systems were leveraged for the COVID-19 outbreak to integrate data from healthcare (through the health insurance data) as well as other ministries to create early warning systems and aid disease surveillance. This real-time integrated data management framework was vital for isolation, case categorization, care facility allocation, and contact tracing for COVID-19 cases. National pandemic coordination teams play a critical role in bringing together and analyzing multiple sources of data – and sharing the data with decision-makers, implementers, and the public in a transparent and timely manner.

Finally, the webinar launched a call for expression of interest for multi-sectoral country teams to participate in a 6-month virtual collaborative that will explore further best practices, lessons and challenges on national coordination of pandemic responses. The expression of interest can be accessed using this link. The deadline for submission is November 13, 2020.

[i] World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Available at https://covid19.who.int/