Decoding the Health Matrix: The Interplay of Health Systems, International Health Regulations (IHR), Universal Health Coverage (UHC), and Health-related Sustainable Development Goals (SDGs) (preprint)

Background The COVID-19 pandemic highlighted the importance of strong health systems and raised questions about achieving Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This study explores the connections between Health Professional Density (HPD), International Health Regulation (IHR) core capacities, UHC, and SDGs, it investigates how these elements interact, proposing that higher HPD and compliance with IHR can significantly impact UHC and SDG achievement. Through statistical analysis, the study aims to clarify these relationships, contributing to the understanding of global health dynamics and informing policy decisions.Methods This study employed a quantitative analysis of data from 194 countries to investigate the interrelations among International Health Regulations (IHR) core capacities, health system strengthening, Universal Health Coverage Index (UHCSCI), and the Sustainable Development Goals (SDG) Index. Utilizing WHO reports and online databases, the study concentrated on four primary variables: Health Professional Density (HPD), IHR compliance score, UHCSCI, and SDG Index Score. Linear regression and a serial mediation model were applied for statistical evaluation, facilitated by SPSS software, to elucidate the dynamics between these global health indicators.Results Our analysis uncovered strong positive relationships between Health Professional Density (HPD), International Health Regulation (IHR) compliance, Universal Health Coverage (UHC) service coverage, and sustainable Development Goals (SDG) performance. Key findings include the significant impact of higher HPD on better IHR compliance and wider UHC service coverage, which in turn correlate with improved SDG outcomes. This highlights the critical role of health professional availability and international health regulation adherence in enhancing global health and achieving sustainable development objectives.Conclusions This study confirms the significant links between Health professional Density (HPD), International Health Regulation (IHR) compliance, Universal Health Coverage (UHC) service coverage, and Sustainable Development Goals (SDGs). Using a serial mediation model. It shows a clear progression from PHD to improved SDG outcomes via better IHR compliance and UHC coverage. Despite potential limitations like information bias, the research provides valuable insights for policymakers and healthcare professionals. It suggests that enhancing HPD and IHR compliance can directly contribute to achieving UHC and SDG targets, offering a roadmap for addressing global health challenges and promoting sustainable health development.

Association between health systems and universal health coverage and COVID-19 testing rates in 194 countries: Cross-sectional ecological study (preprint)

Background The COVID-19 pandemic exposed the vulnerabilities of health systems worldwide, underscoring the critical need for robust and resilient healthcare infrastructure in effectively responding to disease outbreaks. This study aimed to address this need by examining the impact of health system indicators and universal health coverage (UHC) on COVID-19 testing rates.Method The study used secondary data from international organizations, peer-reviewed journals, and statistical portals. The primary outcome measure was COVID-19 testing rates, and the independent variables encompassed various health system indicators, including healthcare workforce density, the Healthcare Access and Quality Index (HAQ), UHC Coverage Index, and UHC Effective Coverage. The statistical analyses included simple and multiple regression models to determine the effects of these variables on COVID-19 testing rates while accounting for potential covariates.Findings: The findings revealed positive associations between health system indicators, UHC, and COVID-19 testing rates. Notably, the HAQ index exhibited the strongest positive correlation with COVID-19 testing rates. Multiple regression models further confirmed the positive relationships between UHC and health system indicators, and COVID-19 testing rates.Conclusion The study interpreted the results and underscored the significance of well-functioning health systems and UHC in achieving higher COVID-19 testing rates. This suggests that countries with well-structured health systems, advanced infrastructure, and adequate healthcare workforce are better equipped to conduct efficient testing. Moreover, the study emphasized the link between UHC and COVID-19 testing rates, noting that countries with greater UHC tend to exhibit higher testing rates. These findings contribute to our understanding of the association between health systems, UHC, and diagnostic testing for infectious diseases like COVID-19.

Evaluation of Joint External Evaluation to COVID-19 and other infectious diseases mortality outcomes in 96 countries (preprint)

Background This study assessed the association between Joint External Evaluation (JEE) scores and Covid-19 and other infectious diseases performance in 96 countries. To propose a revised JEE tool, potential JEE indicators were also examined.Methods The JEE scores were extracted across 96 countries from 2016 to 2019. We used Covid-19, fatality rate, infections per million, and deaths per million as main outcomes. Influenza, pneumonia, HIV, tuberculosis, malaria, Hepatitis B, and childhood vaccinations were included as other infectious diseases performance. Sustainable Development Goals (SDGs), Universal Health Coverage (UHC) index and others were reviewed as potential JEE indicators. We used multiple regression to assess the association between JEE scores and Covid-19 and infectious diseases performance. Then, Covid-19 outcomes and influenza and pneumonia mortality rates were regressed on potential JEE indicators.Results An average JEE score was 2.70 (SD = 0.92) in 96 countries. The detection (3.23) and other areas (2.30) sections received the highest and the lowest score, respectively. A positive association between the Covid-19 outcomes and the JEE scores was found. However, JEE scores and the other infectious diseases performance showed a negative association. The SDGs 2,4, and 8 were strongly associated with Covid-19 outcomes.Conclusion The JEE scores showed poor predictive value against the Covid-19 mortality outcomes in 96 countries. Thus, a revised JEE tool is needed to better prepare for future public health crisis.

Network study of responses to unusualness and psychological stress during the COVID-19 outbreak in Korea

The dramatic changes in people's daily lives caused by the 2019 coronavirus (COVID-19) pandemic have had a huge impact on their emotions and behaviors. This study aimed to examine psychosocial responses to COVID-19 using network analysis. A total of 1,500 urban residents of South Korea, selected from an online public panel, were surveyed using self-rating questionnaires addressing daily life changes, fear of infection, and distress related to COVID-19. Participants also completed a 10-item Perceived Stress Scale survey. We constructed regularized partial correlation networks, estimated global and local network metrics, tested network accuracy and stability, and compared the estimated networks between men and women. The network of the psychosocial responses consisted of 24 nodes that were classified into five groups: 'fear of infection', 'difficulty with outside activities', 'economic loss', 'altered eating and sleeping', and 'adaptive stress'. The node centralities indicated that 'distress in obtaining daily necessities' and 'concern about harming others' were the most important issues in people's responses to COVID-19. These nodes were connected by a negative edge, reflecting individual- and community-level issues, respectively. The overall level of perceived stress was linked to the network by the connection node 'anger toward others or society', which was associated with economic problems in men, but with distress from changes in daily activities in women. The results suggest that two contrasting feelings - personal insecurity regarding basic needs and a collectivistic orientation - play roles in the response to unusual experiences and distress due to COVID-19. This study also showed that public anger could arise from the psychological stress under the conditions imposed by COVID-19.