COVID-19: Operational guidance for maintaining essential health services during an outbreak

Introduction and overview 

Health systems are being confronted with rapidly increasing demand generated by the COVID-19 outbreak. When health systems are overwhelmed, both direct mortality from an outbreak and indirect mortality from vaccine-preventable and treatable conditions increase dramatically. Analyses from the 2014-2015 Ebola outbreak suggest that the increased number of deaths caused by measles, malaria, HIV/AIDS, and 

tuberculosis attributable to health system failures exceeded deaths from Ebola.[1,2] A system’s ability to 

maintain delivery of essential health services will depend on its baseline capacity and burden of disease, and the COVID-19 transmission context (classified as no cases, sporadic, clusters, or community transmission). 

Maintaining population trust in the capacity of the health system to safely meet essential needs and to control infection risk in health facilities is key to ensuring appropriate care-seeking behavior and adherence to public health advice. A well-organized and prepared health system has the capacity to maintain equitable access to essential service delivery throughout an emergency, limiting direct mortality and avoiding increased 

indirect mortality. 

With a relatively limited COVID-19 caseload, health systems may have the capacity to maintain routine service delivery in addition to managing COVID-19 cases. When caseloads are high, and/or the health workforce is reduced due to infection of health workers, strategic shifts are required to ensure that increasingly limited resources provide maximum benefit for a population. 

Countries will need to make difficult decisions to balance the demands of responding directly to COVID-19, 

while simultaneously engaging in strategic planning and coordinated action to maintain essential health 

service delivery, mitigating the risk of system collapse. Many routine and elective services may be postponed or suspended. In addition, when routine practice comes under threat due to competing demands, simplified purpose-designed governance mechanisms and protocols can mitigate outright system failure. Establishing effective patient flow (including screening, triage, and targeted referral of COVID-19 and non-COVID-19 cases) 

is essential at all levels. 

Successful implementation of these strategic shifts will require transparency and frequent communication with the public, specific protections to ensure access for socially vulnerable populations, active engagement of communities and other stakeholders, and a high degree of cooperation from individuals. 

This document expands on the content of the Operational planning guidelines to support country preparedness and response . It provides guidance on a set of targeted immediate actions that countries 

should consider at national, regional, and local level to reorganize and maintain access to essential quality 

health services for all. It complements existing and forthcoming WHO guidance on the wider implications of 

COVID-19 for health systems and cross-government strategies for responding to the COVID-19 outbreak, including region-specific technical guidance being developed by WHO Regional Offices. 

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