COVID-19 and beyond: how lessons and evidence from implementation research can benefit health systems' response and preparedness for COVID-19 and future epidemics.

Early in the COVID-19 pandemic-and based on limited data on the novel coronavirus-it was projected that African countries will be ravaged and the health systems overwhelmed. Fortunately, Africa has so far defied these dire predictions. Many factors account for the less dramatic outcome, in particular the local know-how gained through dealing with previous epidemics, such as Ebola, and the early and coordinated political and public health response, applying a combination of containment and mitigation measures. However, these same measures, exacerbated by existing inequalities, have had negative impacts on vulnerable populations, notably women and children. Furthermore, the observed deterioration of access to and provision of essential health services will likely continue and worsen in countries experiencing future waves of COVID-19 and lacking access to vaccines. The impact of the pandemic on health systems may be one of Africa's main COVID-19 challenges and women and children its greatest victims. In this article, we argue that just as learning from previous epidemics and coordinated preparation informed Africa's response to COVID-19, knowledge, innovations and resources from recent implementation research can be leveraged to mitigate the pandemic's effects and inform recovery efforts. As an example, we present the proven model and multifaceted approach of the Innovating for Maternal and Child Health in Africa Initiative and describe how such a model could be readily applied to building the robust and equitable systems needed to tackle future stresses and shocks, such as epidemics, on health systems while maintaining essential routine services.

The COVID-19 Pandemic: Effects on Civil Registration of Births and Deaths and on Availability and Utility of Vital Events Data.

The complex and evolving picture of COVID-19-related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registration of births and deaths associated with COVID-19 related restrictions.We found considerable intercountry variation and grouped countries according to the level of disruption to birth and particularly death registration. Only a minority of the 66 countries were able to maintain service continuity during the COVID-19 restrictions. In the majority, a combination of legal and operational challenges resulted in declines in birth and death registration. Few countries established business continuity plans or developed strategies to deal with the backlog when restrictions are lifted.Civil registration systems and the vital statistics they generate must be strengthened as essential services during health emergencies and as core components of the response to COVID-19.