Initial COVID-19 Responses in Bangladesh, Kenya, Pakistan, Sierra Leone and Uganda: Documentation and Learning from March to May 2020
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Initial COVID-19 responses in Bangladesh, Kenya, Pakistan, Sierra Leone and Uganda: Documentation and learning from March to May 2020 COVID-19 Series: Synthesis Report Debbie Hillier, Tom Newton-Lewis, Rithika Nair, and Christoph Larsen July 2020 Initial COVID-19 responses in Bangladesh, Kenya, Pakistan, Sierra Leone, and Uganda About Maintains This five-year (2018–2023) operational research programme is building a strong evidence base on how health, education, nutrition, and social protection systems can respond more quickly, reliably, and effectively to changing needs during and after shocks, whilst also maintaining existing services. Maintains is working in six focal countries—Bangladesh, Ethiopia, Kenya, Pakistan, Sierra Leone, and Uganda—undertaking research to build evidence and providing technical assistance to support practical implementation. Lessons from this work will be used to inform policy and practice at both national and global levels. Maintains is funded with UK aid from the UK government; however, the views expressed in this material do not necessarily reflect the UK government’s official policies. Acknowledgments The authors appreciate the immense contribution and input from Syed Zulfiqar Ali, Akaco Ekirapa, Kevin Grieco, Shah Monir Hossain, Rumana Huque, Niccolo Meriggi, and Yasmina Yusuf, who provided detailed country-based reports that have fed into this synthesis report. We also recognise their work, and that of many others, in reviewing and strengthening drafts. We would also like to gratefully acknowledge the financial and technical support from DFID. Contacts [email protected] www.maintainsprogramme.org @MaintainsProg www.linkedin.com/company/maintains/ Maintains is implemented through a consortium led by Oxford Policy Management Limited as the managing agent. Oxford Policy Management is registered in England: 3122495. Registered office: Clarendon House, Level 3, 52 Cornmarket Street, Oxford, OX1 3HJ, United Kingdom. www.opml.co.uk. Initial COVID-19 responses in Bangladesh, Kenya, Pakistan, Sierra Leone, and Uganda Table of contents List of tables, figures, and boxes ................................................................................... v List of abbreviations ..................................................................................................... vi Executive summary ....................................................................................................... 1 Introduction and approach ............................................................................... 1 Governance ..................................................................................................... 4 Mitigating secondary impacts .......................................................................... 6 Health system.................................................................................................. 8 Conclusions and implications for Maintains ..................................................... 9 1 Introduction ................................................................................................... 12 2 Methodology .................................................................................................. 14 2.1 Analytical framework for this report .................................................... 14 2.2 Data collection ................................................................................... 18 2.3 Scope and limitations ......................................................................... 18 3 Overview of COVID-19 in Maintains countries ............................................... 20 3.1 Progress of the pandemic .................................................................. 20 3.2 Country timelines ............................................................................... 22 4 Governance ................................................................................................... 30 4.1 Competent leadership and multi-disciplinary team ....................... 30 4.2 Adaptive plans and solid policy and legal framework .................... 34 4.3 Collaboration, coordination, and partnerships .............................. 39 4.4 Timely, flexible, and adequate access to crisis financing ............... 42 4.5 Trust, transparency, and accountability ........................................ 45 5 Mitigating secondary impacts ........................................................................ 49 5.1 Pro-poor implementation of movement restrictions ...................... 49 5.2 Ensuring gender equality and social inclusion ............................ 53 5.3 Providing social protection ........................................................... 60 5.4 Adequate nutrition and food security for all ................................... 68 5.5 Accessible, equitable, and inclusive education ............................ 74 6 Health system................................................................................................ 79 6.1 Service delivery: Quarantine, testing, isolation, treatment, and contact tracing ................................................................................................ 80 6.2 Maintaining delivery of essential services .................................... 85 © Maintains iii Initial COVID-19 responses in Bangladesh, Kenya, Pakistan, Sierra Leone, and Uganda 6.3 Dedicated health workforce with surge capacity .......................... 89 6.4 Efficient information systems and surveillance ............................. 92 6.5 High-quality supplies, logistics, and infrastructure ......................... 94 6.6 Genuine community engagement ................................................ 96 7 Conclusions ................................................................................................. 100 7.1 Governance ..................................................................................... 100 7.2 Mitigation of secondary impacts ....................................................... 100 7.3 Health system .................................................................................. 101 References ............................................................................................................... 103 Annex A Conceptual model of a shock-responsive health system ............................. 119 Annex B Terms of reference ...................................................................................... 121 Annex C Summary of COVID-19-related social protection programmes .................... 127 © Maintains iv Initial COVID-19 responses in Bangladesh, Kenya, Pakistan, Sierra Leone, and Uganda List of tables, figures, and boxes Table 1: Analytical framework for the report: response attributes and key factors .... 2 Table 1: Analytical framework: domains, response attributes, and key factors ....... 15 Table 2: Key figures on tests, case fatality rates, and doubling times ..................... 23 Table 3: Key figures from the Global Health Security Index ................................... 35 Table 4: National response budgets and major international funding ..................... 44 Table 5: Trust in the government, and in doctors and nurses ................................. 46 Table 6: Different approaches to movement restrictions ........................................ 50 Table 7: COVID-19 infection and mortality rates by sex and age ........................... 54 Table 8: Lack of a gendered COVID-19 response .................................................. 57 Table 9: Some key factors concerning vulnerability ............................................... 62 Table 10: Types of social protection measures introduced in response to COVID-19 64 Table 11: Key food security and malnutrition statistics ............................................. 70 Table 12: Summary of COVID-19-related social protection programmes ............... 127 Figure 1: Confirmed COVID-19 cases by population size ........................................ 21 Figure 2: Confirmed COVID-19 deaths by population size ...................................... 21 Figure 3: Timeline and cases in Bangladesh ........................................................... 25 Figure 4: Timeline and cases in Kenya ................................................................... 26 Figure 5: Timeline and cases in Pakistan ................................................................ 27 Figure 6: Timeline and cases in Sierra Leone ......................................................... 28 Figure 7: Timeline and cases in Uganda ................................................................. 29 Figure 8: Model of a shock-responsive health system ........................................... 119 Box 1: Important note on data and information .................................................... 20 Box 2: Compounding impacts of COVID-19 and other crises .............................. 37 © Maintains v Initial COVID-19 responses in Bangladesh, Kenya, Pakistan, Sierra Leone, and Uganda List of abbreviations ADB Asian Development Bank BISP Benazir Income Support Program CDC Centers for Disease Control CHWs Community health workers CSSE Center for Systems Science and Engineering DFID Department for International Development DRC Democratic Republic of Congo DRF Disaster risk financing EOC Emergency Operations Centre GBV Gender-based violence IDPs Internally displaced persons IEDCR Institute of Epidemiology, Disease Control and Research IMF International Monetary Fund IPC Infection prevention and control