E-learning and Emergency conditions: Issues, opportunities and Challenges for Botswana Higher Education Institutions (preprint)

Purpose- E-learning and teaching became more common as a method of imparting knowledge to a wide range of learners following the outbreak of the global pandemic SARS-CoV-2. However, e-learning and teaching have received considerable attention in recent years. While the extant scholarship literature has focused on the efficacy of e-learning and teaching in countries in the Global North, there is still no comprehensive knowledge or assessment to gain insights into the preparedness of a HEIs to handle emergencies and adapt to future conditions effectively. As a result, this study assesses HEIs' preparedness to handle emergencies like COVID-19, opportunities and challenges of adopting e-learning and teaching in HEIs from the perspective of the heads of departments and lecturers of selected institutions in Botswana. Design/methodology/approach- A qualitative research approach and in-depth interviews were used to gain insights from 5 HODs and 5 lecturers. The qualitative data collected were analysed via thematic analysis to determine the research findings (outcomes) of the study. Findings- HoDs and lecturers appreciate the merits of using e-learning facilities and perceive the method to be more effective and economical for lesson delivery and student learning. In contrast, common challenges encountered by both HEIs and students include a lack of technological resources, poor internet coverage, inadequate staff training and a lack of management support. Originality/value- This article provides novel insights into the efficacy and preparedness of HIEs in the use of e-learning and teaching during future serious pandemics. This article has both theoretical, research and policy implications for the adoption of e-learning agendas in HEIs.

Youth-developed Recommendations on Public Health Planning for Future Pandemics or Public Health Emergencies: A National Delphi Study (preprint)

Background. In Canada, multiple studies reported an increase in youth-reported anxiety, depression, and substance use over the course of the COVID-19 pandemic. As the country has decreased restrictions, it is important to consider public health planning for future pandemics and emergencies, in light of the associated youth mental health and substance use burden. To prevent youth from falling further behind, we need to focus on public health planning recommendations to optimize Canada’s future response. The objective of the study was to generate concrete, youth-derived recommendations for government, policymakers, and service planners to support public health planning for the next pandemic or public health emergency. Methods. Using a virtual, modified Delphi, Youth Delphi Expert Panel Members rated recommendation items over three rounds, with the option to create their own recommendations items. “Consensus” was defined a priori if ≥ 70% of the entire group, or subgroups of youth (e.g., age, race/ethnicity, gender and sexual identities), rated items at a 6 or 7 (on a 7-point Likert scale). Items that did not achieve consensus were dropped in subsequent rounds. Content analysis was used for qualitative responses in Rounds 1 and 2. Youth were engaged as members of an expert advisory committee throughout the design, implementation, and interpretation of findings. Results. A total of n=40 youth participated in Round 1 with good retention (>95%) in subsequent rounds. Youth endorsed eleven recommendations to support public health planning for the next pandemic or public health emergency. Youth prioritized easily accessible, clear, and understandable information about pandemics; and equitably and efficiently distributed vaccines. They also prioritized increased awareness of timely and accessible mental health and substance use services in schools, workplaces and communities; greater investment in free or inexpensive MHSU services; and health professionals and scientists leading pandemic-related policy decisions. Conclusions. For Canada to move forward in a relevant, efficient, and ethically sound manner, decisions must be guided by the population that these decisions affect. These recommendations can be used to guide Canada’s strategies and policies to prepare for future public health emergencies and pandemics, prioritizing the needs of youth, families/caregivers, and communities.

Cancer is not a risk factor for severe COVID-19 in children, except in patients with recent allogeneic hematopoietic stem cell transplantion recipients or comorbidities. (preprint)

The EPICO-SEHOP platform gathers data from children with SARS-CoV-2 in Spain, allowing comparison between children with cancer or allogeneic hematopoietic stem cell transplantation (alloHSCT) and those without. The infection is milder in the cancer/alloHSCT group than in children without comorbidities (7.1% vs. 15%), except in children with recent alloHSCT (less than 300 days), of which 35.7% experienced severe COVID-19. These data have been shared with the SEHOP members to support treatment and isolation policies akin to those for children without cancer, except for those with recent alloHSCT or additional comorbidities. This highlights the collaborative registries potential in managing pandemic emergencies.

Uncertainty and decision-making in Critical Care: lessons from managing COVID-19 ARDS for the next pandemic (preprint)

Purpose COVID-19 ARDS was an emergent syndrome that led to high volumes of critically ill ventilated patients. We explored influences on decision-making regarding management of COVID-19 ARDS mechanical ventilation to identify modifiable factors to improve preparedness for future pandemics. Methods A systematic review of existing literature and small group interviews informed the development of an international questionnaire (UK, Italy, Germany and Netherlands) on factors influencing COVID-19 ARDS ventilation decision-making in critical care professionals. Participants were asked to rank four high-level themes in order of importance: disease (uncertainties around COVID-19 ARDS), contextual (cognitive strain), environmental (structural logistics) and team factors. Participants also ranked the subthemes within each theme. Thematic analysis was used to derive findings from qualitative data. Kruskal-Wallis, Mann-Whitney U and Kendall’s Tau were used for quantitative data analysis. Results Patient factors (co-morbidities, clinical and biochemical parameters) were the most heavily studied influences in the literature on decision-making regarding organ support, whereas uncertainty was one of the least explored subthemes. In total, 371 critical care professionals from 4 professional groups in 4 countries responded to the questionnaire. Disease uncertainty (lack of applicable guidelines and unfamiliarity with pathophysiology) was ranked as the most important influence on ventilation decision-making for COVID-19 ARDS across regions, professions and experience levels. This was followed by team, then contextual, then environmental factors (p<0.001). Participants were underconfident in their decision-making (median score: 9 out of 20), and this was unaffected by experience (p=0.79) or profession (p=0.58). Higher disease certainty, however, led to increased confidence (p<0.001). Major influences on disease uncertainty were the pathophysiology and natural history of COVID-19 ARDS, information sharing and experience over time. Modifiable influences on disease uncertainty were positive team factors and resource limitations. Conclusion Future pandemic preparedness programmes should target modifiable influences such as information sharing, teamworking and resource limitations to mitigate against the negative influence of uncertainty and thereby improve decision-making overall.

Pandemic Management Strategies and Outcomes- A study of the Indian Perspective regarding COVID-19 (preprint)

Purpose The unprecedented outbreak of Covid-19 left every country's management befuddled. The scarcity of literature on the virus and the control of emergencies encourages the present study to propose strategies for effectively managing emergencies. The study has addressed the administration strategies, policies, challenges, and outcomes. Design The present research describes the impact of Covid-19 on a national level by analyzing the media reports, WHO situation reports, the response programs by the authorities, and survey reports. The study conducted a comprehensive literature analysis of the measures adopted by Indian authorities, their impact on society and the economy, their outcomes, and suggestions for future management. Findings This study comprises the impact of Covid-19 measures adopted by the Indian government. Suggestions with evidence from outside countries are also explored in this research. This research has encouraged the use of technology and proper communication and coordination among public and private organizations to fight emergencies. Originality There is a shortage of literature on the origin of Covid-19 in the Indian context. This research provides an overview of the Indian situation and critically examines India's pandemic-related measures and outcomes. The study also discusses the effective measures adopted by outside countries to learn lessons. Research Implications This research's scientific contribution is to aid in making public health policies to battle emergencies and negative impacts on society and the economy. The study will play a significant role in uplifting the citizens' lives based on hard evidence by emphasizing the challenges and impact on their lives.

The future of SARS-CoV-2 in animals: what will be the role of animals in COVID-19 epidemiology? (preprint)

Animals are common hosts for many coronaviruses where bats and rodents are commonly regarded as primary reservoirs. The unquestionable emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a yet unknown animal host - in addition with reports of further anthropogenic spread and sustained transmission in mustelids, captive felids, and domestic dogs and cats owned by people previously tested as SARS-CoV-2-positive, rise some concerns about possible continuous maintenance of the virus in nature and domestic species. In this review, we discussed the current data about coronaviruses in domestic and farming animals, recombination events, animal species susceptibility, virus-cell receptor interactions, and clinical signs of most relevant Coronaviridae members of each genera. Also, we present what is known about SARS-CoV-2 in animals and what will be the potential role of those species in COVID-19 epidemiology. Apparently, the virus can infect pets on some occasions, where cats look to be more susceptible than dogs. Thus, pet infection by sick owners is not only likely but expected given the numerous opportunities for spill-over during a massive outbreak. Regarded to farm animals, attention should be focused on breeding species of the Mustelidae family since they are those that have been shown to be more susceptible in experimental infections and have also effectively exhibited animal-to-human transmission. Other intensively bred species such as poultry, swine, horses and ruminants seem to present little or no epidemiological risk so far. The continuous monitoring of SARS-CoV-2 in animals in close contact with people with COVID-19 may be a key in the understanding of this emergent disease and the animal’s role in epidemiology in the future. It is possible that some species will serve as important reservoirs and source of infection of COVID-19 for humans making it re-emergent in the future, as is theoretically proposed for the origin of SARS-CoV-2.

Serum banks for serological survey of SARS-CoV-2 and emerging infectious diseases (preprint)

In June 2021, Udom et al. published their article in  Transboundary and Emerging Diseases performing a serological survey revealed evidence of anti-N-IgG antibodies suggesting SARS-CoV-2 exposure in both dogs and cats during the first and second coronavirus disease 2019 (COVID-19) outbreaks in Thailand. Seroprevalence studies have proven an important tool to monitor the progression of the COVID-19 pandemic. The duration of immunity of SARS-CoV-2 is crucial for the course of the pandemic and for this reason the monitoring of antibodies against SARS-CoV-2 is important. The serum samples from different periods and regions were valuable in terms of scientific significance for serological survey of SARS-CoV-2 and emerging infectious diseases. In order to preserve the remaining serum samples and ensure the stability of anti-virus antibodies in storage serum samples, we strongly suggest that standard serum banks should be established worldwide.

Diabetes related emergency department visits among adults during the COVID-19 pandemic - an analysis of data from the New York City syndromic surveillance system (preprint)

ObjectiveNew York City was an early epicenter of the COVID-19 pandemic. We aim to describe population level epidemiological trends in diabetes related emergency department (ED) visits among adults in New York City, for the period prior to and encompassing the first four waves of the pandemic. Research Design and MethodsWe used data from the New York City ED syndromic surveillance system during December 30, 2018 through May 21, 2022. This system captures all visits from EDs in the city in near-real time. We matched these visits to laboratory confirmed COVID-19 positivity data beginning with February 15, 2020. ResultsCompared to pre-pandemic baseline levels, diabetes related ED visits noticeably increased during the first wave in spring 2020, though this did not necessarily translate to net increases overall during that period. Visits for diabetic ketoacidosis, particularly among adults with type 2 diabetes, sharply increased before returning to pre-pandemic levels, most notably during wave 1 and wave 4 in winter 2021-2022. Trajectories of diabetes-related ED visits differed by diabetes type, age, and sex. Some ED visit trends did not return to pre-pandemic baseline levels. ConclusionsThe COVID-19 pandemic, especially the first wave in the spring of 2020, coincided with a dramatic shift in diabetes related ED utilization in New York City. Our findings highlight the importance of on-going surveillance of health care utilization for chronic diseases during population-level emergencies like pandemics. A robust syndromic surveillance system that includes infectious and non-infectious syndromes is useful to better prepare, mitigate, and respond to population-level events. Article HighlightsO_LIDiabetes related emergency department (ED) visits in New York City increased dramatically with the emergence of the COVID-19 pandemic in spring 2020. C_LIO_LIThe trajectory of diabetes-related ED visits differed by diabetes type, age, sex, and pandemic wave. C_LIO_LIThe diabetes complication of diabetic ketoacidosis among adults with type 2 diabetes showed sharp increases in the first and fourth waves of the pandemic, respectively its initial emergence in spring 2020 and the Omicron variant in winter 2021-2022. C_LIO_LIOur findings highlight the importance of on-going surveillance of health care utilization for chronic diseases during population-level emergencies like pandemics. C_LI SummaryData from NYCs syndromic surveillance system showed major increases in #type2diabetes complications (e.g. diabetic ketoacidosis) during #COVID-19 waves 1 and 4 (Omicron) - this tool may be useful for population-level monitoring of chronic disease complications during emergencies

Multi-Agent Evolutionary Game Analysis of Group Panic Buying in China during the COVID-19 Pandemic (preprint)

With the global outbreak of COVID-19, the panic buying incidents triggered by the variants of the Omicron strain have severely affected the normal social order. This paper considers the complex interest game and interactive relationship among multiple subjects in the mass panic buying event caused by rumors and constructs a three-party evolution game model of local government, rumor-monger, and public. Based on the theory of evolution game, the evolutionary process of the strategy selection of game subjects is studied, and the strategy selection of the three-game subjects under different scenarios is compared and analyzed. Taking the example of the montmorillonite powder panic buying caused by the XBB virus strain rumor in China, the evolutionary game model constructed in this study is simulated and analyzed. The study shows that: the evolution process of the mass panic buying event is characterized by six stages: the initial stage E1(0,0,0); the outbreak stage E3(0,1,0);the spread stage E7(0,1,1);the climax stage E8(1,1,1);the relief stage E5(1,1,0);and the recovery stage E4(1,0,0); there are four stable points in the evolutionary game of the three game subjects, namely (no intervention, no rumor, no panic buying), (no intervention, rumor, no panic buying), (intervention, no rumor, no panic buying), and (intervention, rumor, no panic buying), and the strategy of government intervention will be adjusted according to the strategy selection of the public and the rumor-monger; under the mechanism of reward and punishment of the higher-level government, increasing the punishment and reward intensity of the higher-level government will promote the local government to intervene in the rumor-mongering event faster, but increasing the reward intensity has a more significant impact on the intervention behavior of the local government than punishment, and increasing punishment intensity has a more significant impact on the non-rumor-mongering behavior of the rumor-monger than reward; the parameters of social risk-bearing cost, risk transmission coefficient, rumor-mongering income and cost, and public drug purchase cost have different degrees of influence on the evolutionary behavior of game subjects. This study provides new ideas for effectively responding to mass panic buying events in the context of public emergencies.

Allocation strategy of medical supplies during a public health emergency: a tripartite evolutionary game perspective.

Ensuring the rational and orderly circulation of medical supplies during a public health emergency is crucial to quickly containing the further spread of the epidemic and restoring the order of rescue and treatment. However, due to the shortage of medical supplies, there are challenges to rationalizing the allocation of critical medical supplies among multiple parties with conflicting interests. In this paper, a tripartite evolutionary game model is constructed to study the allocation of medical supplies in the rescue environment of public health emergencies under conditions of incomplete information. The game's players include Government-owned Nonprofit Organizations (GNPOs), hospitals, and the government. By analyzing the equilibrium of the tripartite evolutionary game, this paper makes an in-depth study on the optimal allocation strategy of medical supplies. The findings indicate that: (1) the hospital should reasonably increase its willingness to accept the allocation plan of medical supplies, which can help medical supplies allocate more scientifically. (2) The government should design a reasonable reward and punishment mechanism to ensure the rational and orderly circulation of medical supplies, which can reduce the interference of GNPOs and hospitals in the allocation process of medical supplies. (3) Higher authorities should strengthen the supervision of the government and the accountability for loose supervision. The findings of this research can guide the government in promoting better circulation of medical supplies during public health emergencies by formulating more reasonable allocation schemes of emergency medical supplies, as well as incentives and penalties. At the same time, for GNPOs with limited emergency medical supplies, the equal allocation of emergency supplies is not the optimal solution to improve the efficiency of emergency relief, and it is simpler to achieve the goal of maximizing social benefits by allocating limited emergency resources to the demand points that match the degree of urgency. For example, in Corona Virus Disease 2019, emergency medical supplies should be prioritized for allocation to government-designated fever hospitals that are have a greater need for medical supplies and greater treatment capacity.

COVID-19-specific adult basic life support guideline strategies for chiropractors and other healthcare providers to maximize the safety and efficacy of resuscitation: a commentary.

BACKGROUND: The emergence of an unprecedented novel severe acute respiratory syndrome coronavirus-2 (SARS-C0V-2), which causes the coronavirus disease 2019 (COVID-19) pandemic, has created new scenarios in basic life support (BLS) management. According to current evidence, SARS-CoV-2 can be transmitted airborne in aerosol particles during resuscitation. Research evidence found an alarming global increase in out-of-hospital cardiac arrests during the COVID-19 pandemic. Healthcare providers are legally obliged to respond to cardiac arrest as soon as possible. Chiropractors will likely encounter potential exercise-related and non-exercise-related cardiac emergencies at some point in their professional lives. They have a duty of care to respond to emergencies such as cardiac arrest. Chiropractors are increasingly involved in providing care, including emergency care, for athletes and spectators at sporting events. Also, exercise-related cardiac arrest in adult patients may occur during exercise testing or rehabilitation with exercise prescriptions in chiropractic and other healthcare settings. Little is known about the COVID-19 BLS guidelines for chiropractors. Knowledge of the current COVID-19-specific adult BLS guidelines is essential to developing an emergency response plan for the on-field and sideline management of exercise-related cardiac arrest and non-athletic, non-exercise-related cardiac arrest. MAIN TEXT: Seven peer-reviewed articles on the COVID-19-specific BLS guidelines, including two updates, were reviewed for this commentary. Responding to the COVID-19 pandemic, the national and international resuscitation organizations recommended interim COVID-19-specific BLS guidelines with precaution, resuscitation, and education strategies. BLS safety is paramount. A precautionary approach with the bare minimum of appropriate personal protective equipment for resuscitation is recommended. There was disagreement among the COVID-19 BLS guidelines on the level of personal protective equipment. All healthcare professionals should also undergo self-directed BLS e-learning and virtual skill e-training. The summarized COVID-19-specific adult BLS guideline strategies and protocols are tabled, respectively. CONCLUSIONS: This commentary provides a practical overview and highlights current evidence-based intervention strategies of the COVID-19-specific adult BLS guidelines that may help chiropractors and other healthcare providers reduce BLS-related exposures to SARS-CoV-2 and the risks of SARS-CoV-2 transmission and maximize the efficacy of resuscitation. This study is relevant to and impacts future COVID-19-related research in areas such as infection prevention and control.

Mental Health Needs Due to Disasters: Implications for Behavioral Health Workforce Planning During the COVID-19 Pandemic.

Public health emergencies impact the well-being of people and communities. Long-term emotional distress is a pervasive and serious consequence of high levels of crisis exposure and low levels of access to mental health care. At highest risk for mental health trauma are historically medically underserved and socially marginalized populations and frontline health care workers (HCWs). Current public health emergency response efforts provide insufficient mental health services for these groups. The ongoing mental health crisis of the COVID-19 pandemic has implications for the resource-strained health care workforce. Public health has an important role in delivering psychosocial care and physical support in tandem with communities. Assessment of US and international public health strategies deployed during past public health emergencies can guide development of population-specific mental health care. The objectives of this topical review were (1) to examine scholarly and other literature on the mental health needs of HCWs and selected US and international policies to address them during the first 2 years of the pandemic and (2) to propose strategies for future responses. We reviewed 316 publications in 10 topic areas. Two-hundred fifty publications were excluded, leaving 66 for this topical review. Findings from our review indicate a need for flexible, tailored mental health outreach for HCWs after disasters. US and global research emphasizes the dearth of institutional mental health support for HCWs and of mental health providers who specialize in helping the health care workforce. Future public health disaster responses must address the mental health needs of HCWs to prevent lasting trauma.

Orthodontic care in orthodontic patients during the COVID-2019 pandemic: emergency, emergency response and orthodontic treatment preference.

BACKGROUND: The objective of this study was to investigate the characteristics of emergencies and the requirement for emergency treatment after the suspension of orthodontic appointments. The attitude towards orthodontic treatment preference was evaluated as well, including receiving orthodontic treatment and the preference for orthodontic appliances. SUBJECTS AND METHODS: An electronic questionnaire was distributed to the patients, including 4 sections: Section 1 - demographic and basic information; Section 2 - the characteristics of emergencies and emergency treatment requirements; Section 3 - the NRS-11 for pain and Manchester Orofacial Pain Disability Scale used to evaluate the intensity of orofacial pain and disability; and Section 4 - attitudes towards receiving orthodontic treatment and appliance preference. Descriptive statistics, Pearson's chi-square test, Wilcoxon's rank-sum test and stepwise generalized linear model (GLM) were performed with significance set at P < 0.05. RESULT: Most participants' (91.61%) follow-up appointments were suspended. The emergency rate and emergency treatment requirements were not different between the fixed appliance (FA) and clear aligner (CA) groups. Patients who reported emergencies (P < 0.01) in the FA group (P < 0.05) and some emergencies in the FA (P < 0.05) suffered worse pain and disability. More FA participants preferred alternative appliances (P < 0.05) due to pain and disability (P < 0.05). CONCLUSION: FA patients' emergencies caused worse pain and disability when orthodontic appointments were suspended. Pain and disability were not the causes of emergency treatment requirements. The CA group seemed to show a tendency towards orthodontic appliance preference, which was an ideal modality to weather the epidemic, combined with telemedicine.

Research on urban country parks based on emergency medical facilities for public health emergencies-a case study of Guangzhou, China.

As COVID-19 has swept across the world, the escalating number of confirmed and suspected cases overwhelmed the admission capacity of the designated hospitals. Faced with such a grim situation, governments made a quick decision to build emergency medical facilities to address the outbreak. However, the emergency medical facilities faced a huge risk of epidemic spread and improper site could lead to serious secondary transmission. Using the disaster prevention and risk avoidance function of urban green space can solve the problem of selecting the location of emergency medical facilities to a certain extent, with country parks having a high degree of compatibility with the latter. Based on the location requirements of emergency medical facilities, using Analytic Hierarchy Process and Delphi method, through analyzing the type of country parks, effective risk avoidance area, spatial fragmentation, distance from water sources, wind direction, and distance from the city, quantification of 8 impact factors such as hydrogeology and traffic duration was conducted to comprehensively compare 30 country parks in Guangzhou. The results showed that the overall quality of country parks approximated a normal distribution, with Lianma Forest Country Park having the highest comprehensive score and the most balanced distribution of scores for various impact factors. Considering safety, expandability, rehabilitation, convenience, pollution prevention, and fecal isolation, it is a preferred destination for emergency medical facility construction.

Telehealth services for global emergencies: implications for COVID-19: a scoping review based on current evidence.

INTRODUCTION: The availability of low-cost computing and digital telecommunication in the 1980s made telehealth practicable. Telehealth has the capacity to improve healthcare access and outcomes for patients while reducing healthcare costs across a wide range of health conditions and situations. OBJECTIVE: This study compares the adoption, advantages, and challenges of telehealth services between high-income (HICs) and low-and-middle-income countries (LMICs) before and during the COVID-19 pandemic. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The key search terms were: "Telehealth", "Telehealth in HICs", "Telehealth in LMICs", "Telehealth before COVID-19", "Telehealth during COVID-19". We searched exhaustively ProQuest, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE databases from 2012. Booleans OR/AND were combined with key search terms to increase relevant search results. The literature search and selection process followed the Sample, Phenomena of Interest, Design, Evaluation, and Research (SPIDER) question format. RESULTS: The adoption of telehealth before COVID-19 was generally low in both HICs and LMICs. The impact of COVID-19 accelerated the adoption of telehealth at the facility level but not nationwide in both high-income countries and LMICs. The rapid adoption of telehealth at the facility level in both high-income and LMICs introduced several challenges that are unique to each country and need to be addressed. CONCLUSION: The lack of national policies and regulations is making the adoption of telehealth at the national level challenging in both high and low-middle-income countries. Governments and Stakeholders of healthcare must consider telehealth as a healthcare procedure that should be deployed in clinical working procedures. Primary quantitative and qualitative studies must be conducted to address challenges encountered during the pilot implementation of telehealth services in both high-income countries and LMICs before and during pandemics.

Multisectoral action towards sustainable development goal 3.d and building health systems resilience during and beyond COVID-19: Findings from an INTOSAI development initiative and World Health Organization collaboration.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. As the world faces global health crises such as pandemics, epidemics, climate change and evolving disease burdens and population demographics, building strong and resilient public health systems is of critical importance. The need for an integrated approach to building health system resilience; the widening of inequalities; and fears of vulnerable populations being left behind are critical issues that require Supreme Audit Institutions (SAIs) enquiry as independent public oversight bodies. Each country has a Supreme Audit Institution with a remit to audit public funds as an effective, accountable, and inclusive institution. Government audits are key components of effective public financial management and Good Governance. SAIs contribute to the quality of government engagement and better state-society relations through their work. As SAIs provide independent external oversight and contribute to follow up and review of national targets linked to the Sustainable Development Goals (SDGs) in their respective countries, they can play an important role in national recovery efforts. WHO and INTOSAI Development Initiative (IDI) have been collaborating in facilitating SAIs' audits of strong and resilient national public health systems linked to the national target of SDG 3.d in 40 countries across Africa, Americas, Asia and Oceania between 2021 and 2022. This paper aims to convey key lessons learned from the joint multisectoral collaboration for facilitating the 3.d audits that can contribute to building health systems resilience in ongoing recovery efforts. The collaboration included facilitation of the audits through professional education and audit support using a health systems resilience framework. The 3.d audits are performance audits and follow IDI's SDG Audit Model (ISAM). Following the ISAM implies that the SAI should focus on a whole-of-government approach, policy coherence and integration, and assess both government efforts at 'leaving no one behind' and multi-stakeholder engagement in implementing the chosen national SDG target linked to 3.d. WHO's Health Systems Resilience team has supported IDI and SAIs by delivering training sessions and reviewing working papers and draft reports of the SAIs from a health systems resilience perspective. IDI has provided the technical expertise on performance audits through its technical team and through in-kind contributions from mentors from many SAIs in the regions participating in the audit. In the 3.d audit, SAIs can ask how governments are acting to enhance capacity in some or all of the following, depending on their own national context and risk: forecasting, preventing and preparing for public health emergencies (PHEs) and threatsadapting, absorbing and responding to PHEs and threatsmaintaining essential health services in all contexts (including during emergencies/crises). The audits are expected to highlight current capacities of health systems resilience; the extent to which a whole-of-government approach and policy coherence have been utilised; and government efforts related to multistakeholder engagement and leaving no one behind in building health systems resilience related to progressing towards achieving the national target linked to 3.d by 2030. An overall positive achievement noted was that undertaking a complex health audit in the middle of a pandemic is possible and can contribute to building health systems resilience and recovery efforts. In their review of audit plans, draft summaries, and other work by the SAIs, both WHO and IDI have observed that SAIs have used the training and supplementary materials and applied various parts of it in their audits. This collaboration also demonstrates key considerations needed for successful partnership across multisectoral partners at global, regional and national levels. Such considerations can be applied in different contexts, including socioeconomic and health system recovery, to ensure whole-of-society and whole-of-government action in building health systems resilience and monitoring and evaluation to maintain and accelerate progress towards the national target linked to SDG3.d, health security and universal health coverage (UHC), as well as broader socioeconomic development.