Health System Preparedness: Lessons for COVID-19 response in Zimbabwe and South Africa (ZimSoNet)

Background and problem statement: The novel coronavirus disease 2019 (COVID-19) epidemic was first seen and reported in China in 2019 and the WHO declared the COVID19 a Public Health Emergency of International Concern on 31 January 2020. Since then the virus has stress-tested global health systems, pandemic response mechanisms, health innovation systems and national health delivery systems. Unfortunately, global health systems have been found to be inadequately prepared resulting in unimaginable losses of lives and, livelihoods. The management and control of COVID-19 heavily depends on a country's health system preparedness and its initial and sustained response to the outbreak. Although COVID-19 is a novel disease, it is believed that the history and science of responding to pandemics of greater proportions including the 1918 flu virus, the 2009 Avian flu virus, SARS, MERS and HIV stand as prerequisites for managing COVID19 outbreak as similar preventative behaviours and approaches can be deployed. Main Objective: The objective of the study is to assess the effectiveness of the health system response to COVID 19 using an adapted WHO model of health system in selected COVID-19 hotspots in Zimbabwe and South Africa. The specific objectives are 1) to conduct a desk review to understand what lessons were learnt from similar infectious diseases outbreak preparedness in Southern Africa; 2) to assess what and how lessons learnt from responding to previous pandemics in Southern Africa influenced and shaped the response to COVID-19 outbreak; 3) to assess innovative approaches in COVID-19 outbreak response in human resources requirements, service delivery coping mechanisms, information system optimization, medical products, financing and leadership/governance requirements; 4) to identify specific socio-cultural barriers and facilitators for the containment of the spread of coronavirus in communities; 5) to assess the impact of COVID-19's response on access to and utilization of sexual and reproductive health services. Methods: A mixed methods study will be conducted. A desk review will be conducted to understand what lessons were i) learnt and ii) applied from similar infectious diseases outbreak preparedness in Southern Africa. This will be followed by a review of national policies and regulations on public health preparedness and response in previous pandemics in Zimbabwe and South Africa. Using the WHO's six health system building block plus community assessment, 112 health system leaders, managers and implementers per country will be interviewed to identify innovative COVID-19 outbreak responses in human resources, service delivery, information system, medical products, financing, leadership/governance and community. Interviews with 1000 community members per country will be conducted to assess the COVID-19's response on sociocultural barriers and facilitators for the spread of coronavirus and access to sexual and reproductive health. Analysis of data: A review will be conducted on literature on outbreaks in Southern Africa. A review of national policies and regulations on health system preparedness will be conducted. Thematic analysis on qualitative data collected from health system leaders and managers will be conducted. Multiple regression analysis will be conducted on community members' data to identify factors associated with COVID-19 drivers and preventative success in each country. Expected Outputs The proposed research has five key outputs which include 1. Two scientific publications in open source international peer reviewed journals, 2. At least two policy/action non-academic papers ( 1 policy review, 1 policy brief, 1 preparedness review, 1 community prevention report on COVID-19 barriers, facilitators and impact on sexual and reproductive health response 3. Two conference abstracts/presentations at local, regional and international conferences 4. Two stakeholder engagement workshops for knowledge sharing.