The COVID-19 pandemic has exposed and exacerbated many of the vulnerabilities and weaknesses that have existed in healthcare systems for decades. As of June 2021, the world is approaching an astonishing four million deaths, and the effects of COVID-19 have been felt in virtually every country — without discrimination by geography, economic status, or system of government. Many emerging market healthcare systems are nearing collapse, while global infections are continuing to climb. As the world continues to grapple with the pandemic’s consequences, Aceso Global is working with numerous agents of innovation who are demonstrating that there are opportunities for health systems to grow, adapt, and become more resilient. Understanding and treating the sources of health system weaknesses — coupled with identifying areas associated with positive outcomes — can provide a basis for countries to rethink pandemic prevention, surveillance, and management for today and for future crises.

The Joint Learning Network for Universal Health Coverage (JLN) offers a unique platform for countries to interact, jointly consider both acute and structural problems, share partner country successes and failures, and build a body of lessons. As a network of 34 countries, JLN includes health leaders throughout government, non-profit, and private sectors, who co-develop knowledge products and implement systems-based improvement projects in consultation with one another. Through a process of shared learning, countries can find solutions faster than they would individually and provide feedback to learn from each other’s mistakes and avoid unnecessary pitfalls. In facilitating the JLN’s Learning Exchange on “Patient Pathways and Pandemics: Covid-19 and Beyond,”, Aceso Global convened 22 countries in order to identify key approaches during the COVID-19 pandemic to restructuring resources within fragmented healthcare systems to improve the efficiency and effectiveness of service delivery. Within the JLN network, Aceso Global has worked directly with over a dozen countries to identify specific gaps and develop corresponding solutions. Over the past year of remote gatherings and workshops, several innovative country-based initiatives have surfaced, and participating countries have identified, developed and shared numerous cost-effective methods to deploy and strengthen the utility of healthcare resources in low- to middle- income countries.

Emerging from the Learning Exchange, this work continues through two Communities of Practice (COPs)focused on the implementation of lessons learned in accelerating the transition to telemedicine in spite of longstanding resistance across the global healthcare community. Specifically, one COP is supporting the Malaysian Ministry of Health’s Primary Healthcare Team expand E-consultation services for both Covid and non-Covid patients. The second COP will work with three Sub-Saharan African nations to re-establish essential care by pivoting the use of digital tools for Covid-19 patients. Several providers have been identified to showcase the steps they have taken throughout the COVID-19 pandemic, as each participant showcases diverse contexts, lessons, demographics and socioeconomic conditions. We outline here a selection of highlights from our work with the JLN.

Cambridge Health Alliance (CHA) is an Accountable Care Organization located in the Boston metropolitan area that provides comprehensive services to 140,000 patients who are predominantly low income, non-U.S. residents, and non-English speakers. Even prior to COVID-19, CHA used a population approach and focused on primary care and behavioral health. With the onset of COVID-19, CHA was forced to shift its delivery model almost entirely to telemedicine within two weeks. In lieu of in-person visits, CHA utilized a number of pre-existing, under-utilized digital platforms including teleconsultation between providers, electronic specialist referrals, electronic pharmaceutical prescriptions and texting with patients. CHA’s existing partnerships with digital platforms allowed them to quickly scale-up services while pivoting to online teleconsults. The rapid development and deployment of clinical telehealth guidelines and standards ensured not just continuity of care for patients, but also improved the responsiveness of the local health system as the pandemic progressed. Leveraging their expertise through the JLN platform, and with support from COP country participants, CHA has been assisting the Malaysian Ministry of Health in the development of telemedicine guidelines for both patients and providers as Malaysia traverses its own transition and scale-up of online and remote care.

Praava Health is a healthcare provider operating out of Dhaka, Bangladesh, with more than 5 million patients. Though the majority of their patients are in urban centers, Praava Health has been expanding their services to patients with limited access to healthcare in rural areas. Through the JLN, Praava Health is showcasing their rapid scale-up and roll-out of a technology-enabled platform for tracking, monitoring, and managing COVID-19 cases, in order to assist the Malaysian Ministry of Health in the development of their own digital application. Their webtool, Praanno, provides both patients and doctors with the latest clinical guidance for effective clinical pathways, and also uses a personalized AI-enabled bot that is integrated into Facebook Messenger for Praava Health patients. Praanno’s algorithms can categorize patients’ risk level and match them with appropriate physicians according to risk. As Praava Health continues to expand their roll-out, they stay centered on their main objectives: to reduce the burden of COVID-19 cases on Bangladeshi hospitals, while providing clear medical advice to patients and family members. Along with the COP country participants, Praava is working with Malaysian counterparts to incorporate video-based personalized clinical advice into Malaysia’s e-health platform, MySejathera, and to expand the platform to support a broader set of diseases.

A team from Aceso Global is supporting the Malaysian Ministry of Health and National Institute of Health to monitor and evaluation the E-consultation extension. The teams are co-producing an analytical framework, indicators, data collection instruments and a plan to monitor the E-consultation scale-up and set up a sell-defined evaluation to measure impact. The vision is that the monitoring and evaluation (M&E) system will provide decision makers with timely information on the effectiveness of E-consultations to allow for inflight adjustments. Specific areas of interest include patient uptake and satisfaction, acceptance by providers and the quality of E-consultations.

PharmAccess is an international non-profit working across sub-Saharan Africa to connect more patients to quality healthcare using IT solutions. At the onset of the COVID-19 pandemic, PharmAccess partnered with Luscii Technologies and the federal governments of Nigeria, Kenya and Ghana to create the COVID Connect Centre (CCC) and a corresponding mobile application, operating out of central public hospitals in each country. The CCC call center disseminates health information and monitors COVID-19 cases. The CCC mobile application allows users to screen themselves for being at risk of contracting COVID-19, lowering the burden on healthcare providers while also empowering them to conduct targeted testing, ultimately driving efficiency. Moreover, through the application, data collected from CCC efforts can be shared with the government to inform better decision-making. Throughout our Learning Exchange, PharmAccess shared their successes and barriers throughout the process of developing and managing the CCC, providing other countries with valuable resources, expertise, and guidance regarding the scale-up of telemedicine initiatives. Nigeria, Kenya and Ghana seek to adapt the CCC App to address NCDs.

An over-reliance on hospitals, inaccessibility of primary care, a hesitancy towards telemedicine, and a focus on the short-term has handicapped both health and political systems in a time of deep crisis. Over the past year, Aceso Global has convened dozens of virtual engagements through our Learning Exchange and subsequent Community of Practice to workshop, learn, and co-produce potential solutions to many of the shared challenges experienced as a result of COVID-19. The examples listed above highlight several key lessons:

• In order to prevent future pandemics and to mitigate the impact of COVID-19 variants, the shortcomings of our current systems need to be acknowledged and specific gaps must be identified and proactively addressed. Reacting to pandemics, rather than forecasting and preventing them, has led to an unnecessary loss of life. Resilience and responsiveness need to be built into the systems of the future and be largely focused on preventative measures (Simultaneously addressing climate change will be crucial, too, as increasingly extreme weather patterns, loss of biodiversity, and warmer weather will amplify future pandemic risks).
• The tools used for service delivery should be diversified and prioritized to improve efficiency. Healthcare systems need to continue to invest in multiple platforms for the provision of services, including telemedicine, community health clinics and community testing sites. Reverting to systems that are overly reliant on in-person services will lower the utility of health resources, and increase the likelihood of shocks and delays when faced with a public health challenge. The pandemic has shown that telemedicine can be highly effective in a clinical setting, and IT can drive and promote resilience in healthcare systems, as it has done for Cambridge Health Alliance in Boston and PharmAccess in Nigeria.
• Engaging data collection and service delivery at the community level will create a more proactive and responsive healthcare system. A highly transmissible disease such as COVID-19 quickly affects clusters within populations, spreading across entire communities in a matter of days. The rapid spread of COVID-19 underscores the importance of community-based surveillance, data generation, and community-based health. Such community measures include encouraging and expanding access to quality primary health clinics, utilizing telemedicine for specialties, providing health screenings in schools and community spaces, and engaging with people where they are, rather than promoting patient pathways that create bottlenecks, overburden hospitals, and strain other tertiary health services. Community-based data generation improves case tracking and forecasting, empowering governments to develop more orchestrated efforts to address disease spread across regions. PharmAccess’s COVID Connect Centre and Praava Health’s Praano serve as examples for the future scale-up and integration of telemedicine and IT solutions in conjunction with primary care services. Aceso Global’s M&E system for E-consultations will provide timely data to decision makers to monitor effectiveness of implementation and make the necessary adjustments.
• The next pandemic is a matter of when, not if. The millions of deaths under COVID-19 is a wakeup call on preparedness and management of pandemics. Lessons from the JLN community of practice offer countries and health systems useful models for tracking, adapting and managing outbreaks.

For more information, please see our e-library of curated resources related to restructuring patient pathways throughout the COVID-19 pandemic.