Examining priority setting in the national COVID-19 pandemic plans: A case study from countries in the WHO- South-East Asia Region (WHO-SEARO).

Background: The World Health Organization- South-East Asia Region (WHO-SEARO) accounted for almost 17% of all the confirmed cases and deaths of COVID-19 worldwide. While the literature has documented a weak COVID-19 response in the WHO-SEARO, there has been no discussion of the degree to which this could have been influenced/ mitigated with the integration of priority setting (PS) in the region's COVID-19 response. The purpose of this paper is to describe the degree to which the COVID-19 plans from a sample of WHO-SEARO countries included priority setting. Methods: The study was based on an analysis of national COVID-19 pandemic response and preparedness planning documents from a sample of seven (of the eleven) countries in WHO-SEARO. We described the degree to which the documented priority setting processes adhered to twenty established quality indicators of effective PS and conducted a cross-country comparison. Results: All of the reviewed plans described the required resources during the COVID-19 pandemic. Most, but not all of the plans demonstrated political will, and described stakeholder involvement. However, none of the plans presented a clear description of the PS process including a formal PS framework, and PS criteria. Overall, most of the plans included only a limited number of quality indicators for effective PS. Discussion and conclusion: There was wide variation in the parameters of effective PS in the reviewed plans. However, there were no systematic variations between the parameters presented in the plans and the country's economic, health system and pandemic and PS context and experiences. The political nature of the pandemic, and its high resource demands could have influenced the inclusion of the parameters that were apparent in all the plans. The finding that the plans did not include most of the evidence-based parameters of effective PS highlights the need for further research on how countries operationalize priority setting in their respective contexts as well as deeper understanding of the parameters that are deemed relevant. Further research should explore and describe the experiences of implementing defined priorities and the impact of this decision-making on the pandemic outcomes in each country.

An analysis of how health systems integrated priority-setting in the pandemic planning in a sample of Latin America and the Caribbean countries.

BACKGROUND: Latin America and the Caribbean (LAC) are among those regions most affected by the COVID-19 pandemic worldwide. The COVID-19 pandemic has strained health systems in the region. In this context of severe healthcare resource constraints, there is a need for systematic priority-setting to support decision-making which ensures the best use of resources while considering the needs of the most vulnerable groups. The aim of this paper was to provide a critical description and analysis of how health systems considered priority-setting in the COVID-19 response and preparedness plans of a sample of 14 LAC countries; and to identify the associated research gaps. METHODS: A documentary analysis of COVID-19 preparedness and response plans was performed in a sample of 14 countries in the LAC region. We assessed the degree to which the documented priority-setting processes adhered to established quality indicators of effective priority-setting included in the Kapiriri and Martin framework. We conducted a descriptive analysis of the degree to which the reports addressed the quality parameters for each individual country, as well as a cross-country comparison to explore whether parameters varied according to independent variables. RESULTS: While all plans were led and supported by the national governments, most included only a limited number of quality indicators for effective priority-setting. There was no systematic pattern between the number of quality indicators and the country's health system and political contexts; however, the countries that had the least number of quality indicators tended to be economically disadvantaged. CONCLUSION: This study adds to the literature by providing the first descriptive analysis of the inclusion of priority-setting during a pandemic, using the case of COVID-19 response and preparedness plans in the LAC region. The analysis found that despite the strong evidence of political will and stakeholder participation, none of the plans presented a clear priority-setting process, or used a formal priority-setting framework, to define interventions, populations, geographical regions, healthcare setting or resources prioritized. There is need for case studies that analyse how priority-setting actually occurred during the COVID-19 pandemic and the degree to which the implementation reflected the plans and the parameters of effective priority-setting, as well as the impact of the prioritization processes on population health, with a focus on the most vulnerable groups.

Were forcibly displaced people prioritized in the COVID-19 national response plans?

BackgroundForcibly displaced people represent a huge humanitarian problem globally. At the end of 2020, the total number was 82,4 million;from those, 34,4 million were refugees, asylum seekers, and Venezuelan displaced abroad. Forcibly displaced people were identified as priority populations during the pandemic due to their risk of being the last served populations with healthcare. This paper aimed to identify if this population was prioritized in the COVID-19 national response plans of a sample of 86 countries.MethodsThis study is part of a document analysis of 86 COVID-19 national response plans, assessing the degree of comply to quality parameters of effective priority setting. One of the parameters included was the degree to which vulnerable populations such as forcibly displaced people were explicitly prioritized for receiving COVID-19 related interventions or for continuity of non-COVID healthcare services. The analysis involved assessing whether and how forcibly displaced people were prioritized in the COVID-19 national response plans. This was compared with the displaced populations identified in the host countries’ UNHCR Forced Displacement 2020 report.ResultsOnly five countries among 86 analyzed prioritized forcibly displaced people in their COVID-19 national response plans. Among the top ten forcibly displaced people hosting countries, Uganda was the only one with an explicit prioritization of this vulnerable group. Although Turkey, Colombia, and Germany account for nearly one-fifth (6,6 million) of refugees, asylum seekers and Venezuelans displaced abroad, none of the COVID-19 response plans of these countries prioritized these populations.DiscussionFew countries recognized forcibly displaced people as a vulnerable population in their COVID-19 response and preparedness plans. Governments may have incorporated actions and interventions for these vulnerable groups after publishing the COVID-19 response plans. It would be essential to evaluate the impact of this lack of prioritization on the health and wellbeing of these population groups.

Adaptations for rehabilitation services during the COVID-19 pandemic proposed by scientific organizations and rehabilitation professionals.

OBJECTIVE: To describe adaptations in the provision of rehabilitation services proposed by scientific and professional rehabilitation organizations to avoid interruptions to patients rehabilitation process and delays in starting rehabilitation in patients with COVID-19. METHODS: A narrative review approach was used to identify the recommendations of scientific and professional organizations in the area of rehabilitation. A systematic search was performed in the main data-bases in 78 international and regional web portals of rehabilitation organizations. A total of 21 publications from these organizations were identified and selected. RESULTS: The results are presented in 4 categories: adequacy of inpatient services, including acute care services and intensive care unit for patients with and without COVID-19; adequacy of outpatient services, including home-based rehabilitation and tele-rehabilitation; recommendations to prevent the spread of COVID-19; and regulatory standards and positions during the COVID-19 pandemic expressed by organizations for protecting the rights of health workers and patients. CONCLUSION: Health systems around the world are rapidly learning from actions aimed at the reorganization of rehabilitation services for patients who are in the process of recovery from acute or chronic conditions, and the rapid response to the rehabilitation of survivors of COVID-19, as well as from efforts in the prevention of contagion of those providing the services.

[Mental health interventions for college and university students during the COVID-19 pandemic: a critical synthesis of the literature]. / Intervenciones para la salud mental de estudiantes universitarios durante la pandemia por COVID-19: una síntesis crítica de la literatura.

BACKGROUND: College and university students are a population vulnerable to mental disorders, especially during the COVID-19 pandemic. Their mental health has been affected by confinement, difficulties in the development of academic activities, and the demands of new pedagogical modalities. We aimed to respond to the question: what are the actions around a) promotion and prevention, b) mental symptoms care, and c) pedagogical adaptations that can be developed in order to improve the mental health of college and university students? METHODS: We conducted a critical synthesis from a systematic review of the literature. A search was made for scientific articles with descriptive, analytical, empirical or evaluative designs, as well as web resources of organisations related to the topic. A synthesis was carried out based on the three aspects of the question by means of a constant comparative method, until the aggregation of actions by similarity in the actors. We anticipated low evidence quality; therefore, a standardised evaluation was not performed. RESULTS: We explored 68 articles and 99 web resources. After reviewing the full text, 12 scientific articles and 11 web resources were included. As general guidelines, we found that the most frequent suggestion is the design of a specific structured mental health programme within universities, one that should be multidisciplinary, inclusive, dynamic and culturally sensitive. All actions taken by the university should be reported and published periodically so that students and other members of the university community are clear about them. Ideally, it is suggested to keep them until the post-pandemic period and include alumni. Regarding a) promotion and prevention, digital psychoeducation was recommended, with information about healthy lifestyles, common emotional reactions to epidemics, coping strategies and warning signs. Peer participation is suggested as a support strategy, as well as spaces for social interaction that focus not only on academic aspects but also on leisure. Screening for mental symptoms is suggested through frequent submission of online forms or mobile applications. In addition to mental health, it is important to inquire about the degree of satisfaction of basic and technology-related needs. For b) the care of mental symptoms, one of the actions commonly identified was a consulting centre that can provide mental health care by telephone, by technology, and even in person --if required --, with permanent availability with rapid response teams for crisis situations, such as suicidal behaviour and domestic violence. For c) pedagogical adaptations, fluent communication is an indispensable requirement; having clear instructions on academic activities can reduce uncertainty and therefore anxiety. The teaching and pedagogical staff at the institution can offer direct advice (via video calls or online group meetings) to provide support in study habits, degree-specific material and mental health. CONCLUSIONS: Included resources suggest the creation of a programme that specifically addresses the mental health of students. This synthesis can provide guidelines that facilitate decision-making by the university, without losing sight of the fact that the institution and the student are immersed in a complex context, with circumstances and other actors at various levels that also intervene in mental health. Research is required on the evolution of the mental health situation and the effect of the actions that are being taken.