STRENGTHENING THE HEALTH SYSTEM

ACTION POINTS

RESPONSE TO COVID-19 IN THE WHO

TRANSMISSION SCENARIOS
Action points for the WHO European Region
(1 April 2020)
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1. Expand capacity for Boost the

communication and communication
proactively manage team at Ministries of
media relations Health, Public Health
Agencies, and local
governments in charge
of coordinating the
response.

In addition to risk Hold daily media Hold twice-daily Hold twice-daily

communication, develop briefings media briefings media briefings
clear messages related
to symptom recognition, Launch dedicated Update dedicated Update dedicated
first contact, appropriate website website website
use of health services,
continuity of essential Deploy social media Keep up social media Keep up social media
services, financial access strategy strategy strategy
and social protection
measures related to Establish joint task Keep up joint task Keep up joint task
COVID-19 (in addition to force of influencers force of influencers force of influencers
risk communication) and journalists and journalists and journalists

2. Bolster capacity of Activate the emergency Enhance the emergency Scale up the emergency Scale up of emergency
essential public health response plans and response plans response plans response plans
services to enable the mechanisms
emergency response Enhance surge capacity Scale up surge capacity Scale up surge capacity
Review capacities and of public health services of public health services of public health services
prepare a phased plan
for scaling up capacity
of public health services

Establish capacity for Implement COVID-19 Expand COVID-19 Adapt existing

COVID-19 surveillance surveillance surveillance capacity COVID-19 surveillance
systems (e.g. sentinel
Establish capacity Enhance the capacity to Scale up the capacity to surveillance).
to provide evidence- monitor the effect of the monitor the effect of the
informed advice on policy implementation policy implementation Scale up the capacity
COVID-19 policy and provision of further and provision of further to monitor the effect
development evidence-based evidence-based of the policy
policy advice policy advice mplementation and
provision of further
evidence-based
policy advice

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3. Clarify first point Develop a first contact Clearly communicate Clearly communicate Step up significantly
of contact strategy strategy with call center, first contact strategy first contact strategy communication about
for suspected COVID online platform, and/or first contact strategy
cases: phone, online, physical approach
physical

Develop capacity Increase capacity Increase capacity Increase capacity

expansion plan for three
stages of the outbreak Activate online platform
with chatbots to ease
burden on triage
personnel in call centers
and physical locations

Develop national Train incoming triage Train incoming triage Train incoming triage
triage algorithms with personnel personnel personnel
pathways based on
WHO-recommended
case management and
distribute them

4. Protect other Put in place standard Activate standard Practice standard Practice standard
potential first contact operating procedures operating procedures operating procedures operating procedures
health system entry that include measures
points assuming not for assessing and
all people will follow isolating individuals,
advice infection prevention
and control, protecting
staff and initiating
notification systems
for all health facilities
potentially used for
first contact

Develop national Apply protocol Apply protocol Apply protocol

triage algorithms with
pathways based on
WHO recommended
case management,
distribute them, and
train personnel

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5. Designate hospitals Assess, estimate and Designate hospitals Activate designated Expand designated
to receive COVID-19 continuously review to receive COVID-19 hospitals hospitals by surge plan
patients and prepare to needed hospital patients based on the in both public and
mobilize surge acute capacity to treat surge plan and assess private sectors
and intensive care unit COVID-19 patients their capacity and
(ICU) capacity with severe or critical readiness Expand COVID-19 space
presentations also in designated hospitals
including options in by repurposing ORs
the private sector and recovery rooms

Use surge calculator to Expand beyond

predict needed hospital designated hospitals
and ICU capacity into alternative
including HRH and designated public and
oxygen therapy for private facilities if
coming 3 months needed e.g. fever
tents, hotels

6. Organize and Develop case Test case management Apply home care Apply surge scenario
expand services management protocol protocol for home-based protocol and test and scale-up home
close to home for for home care for mild care with home isolated surge scenarios care services expanding
COVID-19 response cases (with a surge cases phone and online
scenario using phone capabilities
and online capabilities)
and train primary
health care (PHC) and/
or community health
workers

7. Maintain continuity Identify essential Identify services, Begin to postpone non- Fully activate business
of essential services medicines, services, including elective urgent hospitalizations, continuity plans at all
while freeing up and equipment whose treatment, that can be reduce frequency levels of service
capacity for continuity must be postponed or delivered of visits for chronic delivery by dropping all
COVID-19 response maintained (e.g. through alternative patients, apply tele- non-essential services
antenatal care, births, mechanisms medicine solutions
management of chronic
diseases, renal dialysis,
urgent response, critical
care services, etc.)

Protect populations Activate standard Practice standard Implement active

seeking care with other operating procedures operating procedures discharge management
health conditions from for elderly and social
COVID-19 in health care patients in synergy
facilities through with community and
reinforcing standard home care providers
operating procedures
for facility based Reduce the number of
infection control, persons that have
including separation of access to hospitals,
pathways and dedicated namely patients,
hospital equipment students, medical
representatives,
patient visitors, etc 3
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8. Train, repurpose and Review or develop plans to increase surge capacity in
mobilize the health preparation for community transmission reinforced
workforce according to by designated mobile communication channels and
priority services measures to reprofile and upskill the workforce, with
appropriate training and supervisory support, and
aligned with scopes of practice, as necessary
• Free up health workers from regular patient load;
• mobilize reserve capacity;
• mobilize staff from other specialisations with
basic training in infection control and physical
care skills;
• rely on pharmacists purposefully on the provision
of front-line advice to the public and to resolve
supply chain difficulties;
• encourage retired staff to return to the work in a
low risk environment releasing serving staff with
lower risk status to support COVID-19 responses;
• move employed staff at risk of elevated mortality
to lower risk care settings; and
• consider final year students for employment and
call on volunteers

9. Protect the physical Estimate personal Ensure access to PPE Ensure access to PPE Ensure access to PPE
health of frontline protective quipment for all health workers for all health workers for all health workers
health workers (PPE) needs including dealing with COVID-19 dealing with COVID-19 dealing with COVID-19
for surge period and patients with a review patients with a review patients with a review
ensure availability of how to use it, under how to use it, under how to use it, under
PPE stock. what circumstances this what circumstances what circumstances
needs to be used, how it this needs to be used this needs to be used,
will be made available and how to report
shortages

10. Anticipate and Establish a call hotline Activate hotline and Activate hotline and Activate and scale
address mental health for health workers for refine its approach refine its approach capacity if needed
needs of the health psychological support
workforce Implement training Implement training Implement training
Develop training in (online) in psychological (online) in (online) for wider
psychological support support for designated psychological support range of involved
to health workers hospitals for wider range of communities, teachers,
including psychological health facilities taking members of the police
first aid to alleviate part in COVID-19 force, fire personnel,
emotional burnout and response including store keepers and
distress using online PHC facilities volunteers
platform to reach wide
range of audiences
with a planned rolled
out relative to role and
involvement

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11. Review supply Adopt good Engage in regular stock Engage in regular stock Engage in regular stock
chain and stocks pharmaceutical management and define management and define management and define
for essential procurement practices emergency stocks at all emergency stocks at all emergency stocks at all
medicines and health including restriction level (region and central) level (region and central) level (region and central)
technologies of purchase to the
essential medicines
list, determination of
order quantities based
on reliable needs
estimation, competitive
tendering from qualified
suppliers, separation
of key functions and
monitoring of suppliers.
Ensure emergency
mechanisms are in
place for procurement
and registration of
medicines and health
technologies. Consider
increasing buffer stock
for essential medicines
and health technologies

Ensure availability of Engage in regular stock Engage in regular stock Engage in regular stock
all essential medicines management and define management and define management and define
and health technologies emergency stocks at all emergency stocks at all emergency stocks at all
(including specific level (region and central) level (region and central) level (region and central)
products for the COVID
19 emergency situation)
with procurement
following quality
minimum standards
and WHO technical
specifications

Regulate and promote Ensure supply is Ensure supply is Ensure supply is

local pharmacy available and monitor available and monitor available and monitor
based production of Good Manufacturing Good Manufacturing Good Manufacturing
WHO-recommended Practices Practices Practices
hand sanitizers and
disinfectants

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12. Mobilize financial Introduce emergency

support and ease legislation
logistical operational
barriers Mobilize emergency
reserve funds to pay
for increased costs

Relax selected
procurement and hiring
rules related to the
emergency response.
Clarify any barriers
to redeployment or
short-term contracting
of health workers for
the purposes of surge
capacity

13.Assess and mitigate Review benefit packages Communicate Communicate Communicate

potential financial and copayment clearly about benefit clearly about benefit clearly about benefit
barriers to accessing policies to ensure entitlements and entitlements and entitlements and
care that COVID-19 related free access to ensure free access to ensure free access to ensure
health services are free timely care seeking timely care seeking timely care seeking
of charge including and notification to aid and notification to aid and notification to aid
PHC, emergency containment efforts and containment efforts containment efforts
response, transport, timely treatment and timely treatment and timely treatment
emergency admission
and intensive care).
Wave any potential
fees associated with
COVID-19

14.Assess and mitigate Assess access and Establish explicit Continue monitoring Continue monitoring
potential physical potential barriers monitoring efforts for efforts for access of efforts for access of
access barriers for (especially to first access of vulnerable vulnerable groups vulnerable groups and
vulnerable groups of contact and transport) groups activate intervention
people for vulnerable strategies in case
population groups. of need
Establish list of
vulnerable groups
to monitor

Develop intervention
strategy to strengthen
prevention and
support access among
vulnerable groups in
case of need

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15.Optimize social Optimize social Implement new benefits Implement new benefits Implement new benefits
protection to mitigate protection arrangements
the impact of public to mitigate the impact
health measures on of public health
household financial measures on household
security incomes including sick-
leave rules and benefits,
compensation in case of
taking care of children
due to school closures
(if cannot telework), and
of elderly due to closure
of nursing homes

16.Ensure clarity in Clarify roles and Continue to clarify roles Continue to clarify roles Continue to clarify roles
roles, relationships, relationships, and responsibilities as and responsibilities as and responsibilities as
and coordination and coordination required required required
mechanisms in health mechanisms
system governance and Promote transparency Promote transparency Promote transparency
across the government Communicate them in decision-making in decision-making in decision-making
clearly to all including process process process
the general population
to ensure transparency
of decision-making
in the emerging
response process

Operationalize Continue coordination Continue coordination Continue coordination

coordination mechanisms between mechanisms between mechanisms between
mechanisms between the governance structure the governance structure the governance structure
the governance of the emergency of the emergency of the emergency
structure of the management team and management team and management team and
emergency management the governance structure the governance structure the governance structure
team and the in health services in health services in health services
governance structure in delivery to ensure a delivery to ensure a delivery to ensure a
health services delivery continuous adaptation continuous adaptation continuous adaptation
bridging public-private of the emergency of the emergency of the emergency
providers and health response based on the response based on the response based on the
and social care developing scenario developing scenario developing scenario

Designate focal point

for essential services

Activate inter- Continue inter- Continue inter- Continue inter-

sectoral coordination sectoral coordination sectoral coordination sectoral coordination
mechanisms to mechanisms to mechanisms to mechanisms to
implement above implement above implement above implement above
measures and mitigate measures and continue measures and continue measures and continue
the impact of the to mitigate the impact to mitigate the impact to mitigate the impact
outbreak on households of the outbreak on of the outbreak on of the outbreak on
and the economy households and households and households and
the economy the economy the economy

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