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Learning from Exemplars in Global Health: a road map for mitigating indirect effects of COVID-19 on maternal and child health
  1. David E Phillips1,
  2. Zulfiqar A Bhutta2,
  3. Agnes Binagwaho3,
  4. Ties Boerma4,
  5. Matthew C Freeman5,
  6. Lisa R Hirschhorn6,
  7. Raj Panjabi7
  8. On behalf of the Exemplars in Global Health Partnership
    1. 1Health and Life Sciences, Gates Ventures, Seattle, Washington, USA
    2. 2Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
    3. 3Office of the Vice Chancellor, University of Global Health Equity, Kigali, Rwanda
    4. 4Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
    5. 5Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
    6. 6Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
    7. 7Last Mile Health, Boston, Massachusetts, United States
    1. Correspondence to Dr Zulfiqar A Bhutta; zulfiqar.bhutta{at}

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    Summary box

    • To minimise these negative indirect effects, countries will need to consider all domains of health systems, including demand, supply, resources and social determinants.

    • To this end, learning from countries that have improved health outcomes amid other crises could provide helpful strategies.

    • Some of the strategies used by these positive outlier countries include clear national leadership, data-driven targeting, community-focused health services and a strong emphasis on equity.

    • Studying positive outlier countries to find lessons applicable for other settings is the focus of the recently launched Exemplars in Global Health programme.

    Introduction - Indirect effects of COVID-19 threaten greater maternal and child health losses than direct effects

    The effect of COVID-19 on health and health systems around the world has been unprecedented. Now with over 15 million confirmed cases and 618 000 confirmed deaths globally, the toll on human health has been a tragedy.1 Daily cases continue to increase as well; the 3-day rolling average of new confirmed cases was 246 597 on July 18, up from 223 597 one week prior.2 And while daily confirmed deaths have levelled off from their peak in April,3 hospital resource use is at risk of returning to levels that exceed intensive care unit capacity in 92 out of 160 countries with available projections in 2020.4

    This excess resource use across health systems threatens to impact more patients than just those suffering from coronavirus disease. The strain it places on medical staff, supplies and facility capacity could cause enormous disruptions to primary healthcare in general, limiting the ability to adequately respond to and prevent infectious disease, non-communicable disease and injuries alike.

    The policy and funding response to the COVID-19 pandemic, necessary as it is, creates further challenges than health system strain, however. Financial resources have already begun diverting away from routine services and interventions, as financial channels such as the Global Fund allow the reprogramming of funds originally intended for other purposes. …

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