Debbie Hillier, Tom Newton-Lewis, Rithika Nair, and Christoph Larsen
Introduction and approach COVID-19 has been an unprecedented challenge globally. This is an executive summary of the full report that documents the experiences and challenges of scaling up the response to COVID-19 in the first three months of the outbreak – March to May 2020 – in five countries: Bangladesh, Kenya, Pakistan, Sierra Leone, and Uganda.
This work was undertaken under the DFID-funded Maintains programme, to inform Maintains’ research, technical assistance, and learning agendas. The primary objective was to see what Maintains can learn around the national ability to scale up in response to a shock. This will consider the governance of the outbreak and its impacts across social sectors, with a focus on the health sector.
Rapid analyses were undertaken by country teams who reviewed documentation issued by government and other stakeholders, and interviewed a range of government and partner organisations (to the extent feasible under lockdown conditions), following a pre-designed standardised research framework. This was further strengthened by secondary data collection and the findings synthesised into this report to support comparability and identify key themes and learning. This work was undertaken in a rapid fashion, in a fast-moving context, and attempts to summarise a broad array of impacts into a concise analysis; it therefore cannot tell the full story in all its complexity but rather seeks to provide pointers and early lessons.
The pandemic has played out differently in the five countries. Pakistan and Bangladesh were hit first (26 February and 8 March respectively) and hard (with the highest number of both confirmed cases – 72,000 and 47,000 by 31 May respectively – and cases per capita).
Lockdowns were imposed, but then significantly eased due to economic pressure after about two months, during May, even whilst daily cases were continuing to rise.
The first cases were confirmed slightly later in Kenya, Uganda, and Sierra Leone (13, 21, and 31 March respectively) and all three of these countries have far fewer confirmed cases –all below 2,000 by the end of May. They all took swifter response measures – with handwashing at Freetown airport from January and Uganda going into lockdown even before the first case – and lockdowns in Uganda and Kenya have been slower to ease. Sierra Leone’s response has been severely limited by resources, and it has the highest fatalities per capita. In all countries, cases per capita have measured highest in the capital city.
An analytical framework has been developed for this report that will be further tested and developed during the life of the Maintains programme. The framework analyses the response through three broad domains, as follows, which are further broken down into response attributes and key factors and summarised in the table below:
The overarching governance of the response, across all sectors, which includes leadership, plans, legal frameworks, partnerships, financing, trust, and accountability.
Mitigation of secondary impacts. We have focused on how the social systems that are core to Maintains – social protection, nutrition, and education – can respond to the secondary impacts of the pandemic, and take a particular look at impacts on gender equality and social inclusion (GESI). This section also considers the impact and implementation of movement restrictions, which affect every other part of the response.
How the health system and been able to maintain existing essential health services, as well as scale up to respond to the epidemic with stringent infection prevention and control. Other key aspects of the health response include the health workforce, information systems and surveillance, supplies and logistics – all of which require strong surge components – as well as genuine community engagement.