In 2022, Pakistan witnessed unprecedented flooding, submerging one-third of the country under-water, ruining millions of houses, taking lives, afflicted injuries, and displacing scores of people. Our study documents not only the public health problems that have arisen due to this natural calamity but also the state of health systems’ response.

We conducted a qualitative study asking key questions around prevalent health problems, health-care seeking, government’s response, resource mobilization, and roadmap for the future. We purposively selected 16 key frontline health workers for in-depth interviews.

Waterborne and infectious diseases were rampant posing huge public health challenges. Disaster mitigation efforts and relief operations were delayed and not at scale to cover the entire affected population. Moreover, a weak economy, poverty, and insufficient livelihoods compounded the tribulations of floods. Issues of leadership and governance at state level resulted in disorganized efforts and response.

Pakistan is famous for its philanthropy; however, lack of transparency and accountability, the actual benefits seldom reach the beneficiaries. Such climatic disasters necessitate a more holistic approach and a greater responsiveness of the health system. In addition to health services, the state must respond to financial, social, and infrastructural needs of the people suffering from the calamity.

The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach.

The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations.

Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions.

The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.

Running exercise courses in different sectors of the health system is one of the important steps to prepare and deploy disaster risk management programs. The present study aimed to identify and explain the components affecting the design of preparedness exercises of the health system in disasters.

This study was a qualitative content analysis. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 25 health professionals in disasters who had experience in designing, implementing, and evaluating an exercise. The data were analyzed using the content analysis method.

The data analysis resulted in the production of 50 initial codes, 12 subcategories, 4 main categories of “Coordination, Command, and Guidance of Exercise,” “Hardware and Software Requirements of Exercise,” “Organizational Exercise Resources,” and “Communication and Exercise Public Information” with the original theme of “Exercise Design.”

This study provides a clear picture and rich, constructive information on the concept of designing health system preparedness exercises in disasters. The findings of this study can greatly increase the attention of senior managers in all areas of health, especially managers of prehospitals and hospitals who are in the front line of the response to disasters to design standard and scientific preparedness exercises.

The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH).

Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings.

A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis.

The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

The recent Covid-19 pandemic has burdened the healthcare facilities, especially in the presence of limited infrastructure. We aimed at applying a queuing model to the Covid-19 screening area so as to optimize the screening services and ensuring that no patient is refused the service.

The mean arrival time of patients, number of physicians, mean screening time and queue characteristics were observed and entered in the M/M/c/K queuing model using R programming to optimize the number of physicians required in the screening area.

Considering the mean arrival of 7 patients in 10 minutes and screening of 3 patients in 10 minutes by 1 physician, 2 physicians were assigned. At this capacity, the probability of saturation of the system was 15% with patient loss rate of 1.05 per 10 minutes. Queuing simulation with 3 physicians reduced the patient loss rate to 0.013 per 10 minutes and a saturation probability of 0.2%. However, an increase of arrival rate from 10 to 20 led to an early saturation of the system.

Queuing models offer an opportunity for the healthcare providers and hospital administrators to optimize patient care services, especially in critical areas with an ever-changing situation such as the current pandemic.

Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal.

Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.

Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients.

Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics.

The outbreak of coronavirus disease 2019 (COVID-19) has exerted unprecedented pressure on healthcare systems throughout the world. This study was designed to develop a national health emergency management program based on risk assessment for COVID-19.

Mixed-methods research was used. Based on recommendations of the national epidemiology committee, 2 risk scenarios were used as basic scenarios for risk assessment. Two rounds of Focus Group Discussions (FGDs) were conducted between January and May 2020 with 30 representatives of the health system. The data were collected, analyzed, and integrated by the research team.

In the risk matrix, “contamination of environment and individuals” and “burnout of medical staff” occupied the red zone (intolerable risk). “Defects in screening and admissions,” “process disruption in medical care and rehabilitation,” “increased mental disorders,” “social dissatisfaction,” “the decline in healthcare services,” and “loss of medical staff” were identified as the orange zone (significant risk) of the matrix.

The avoidance of environmental and individual contamination and healthcare worker burnout are the priorities in Iran. Attention to intersectoral cooperation, the involvement of non-governmental organizations and private center capacities, integration of information health systems, and developing evidence-based protocols are other measures that can improve the health system’s capacity in the response COVID-19.

To gauge the level of preparedness of health system of Pakistan in the wake of Corona Virus Disease 2019 (COVID-19) pandemic.

The global COVID-19 outbreak and its subsequent repercussions and implications, after being declared as a pandemic by the World Health Organization (WHO), exposed all the inherent, lingering, and acute shortcomings of the health systems in many developing countries and Pakistan was no exception.

A detailed literature review was done which included peer-reviewed articles on COVID-19 and health system, published in local and international journals, WHO and World Bank’s publications, and the documents and official reports of the government. Focus was to glean and cite strategies adopted by the developing countries in response to COVID-19 and to see the applicability of those which are feasible for Pakistan.

Level of preparedness was minimal and the response to manage the outbreak was weak. Based on toll of the cases and number of deaths, this public health threat turned out to be a catastrophe beyond the controlling authority and capacity of the health system, and hence other sectors and agencies had to be engaged for devising a concerted and integrated response to deal with the emergency. Governance was disorderly, financing was inadequate, human resources were not trained, supplies and logistic were not stocked, information system was patchy, and research capacity was limited, and most of all the service delivery was in a biggest chaos of times. COVID-19 demanded to re-configure the health system of Pakistan.

Improving the emergency preparedness of the hospitals is the foremost and an urgent need. A strong national public health system in Pakistan is needed to rapidly investigate and analyze the reports, assess the magnitude of the public health risk, share real-time information, and implement public health control measures in a concerted and systematic demeanor.

Implementing disaster exercises in different parts of the health system is one of the important steps in providing and developing disaster risk management plans. Considering the importance of promoting health system preparedness through exercise, the present study aimed to identify and explain necessary and original components for successful implementation of preparedness exercises of the health-care system in disaster.

The study was a qualitative content analysis. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 25 health professionals in disaster. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis.

The data analysis resulted in the production of 100 initial codes, 14 subcategories, 6 main categories of “coordination and information management,” “standards and indicators,” “conduction and control of the process,” “logistic management and supplies,” “management of treatment operation,” and “management of health operation,” under the original theme of “implementation of exercise.”

The findings of this study can greatly increase the attention of senior managers to preparedness in all areas of the health system, especially managers of prehospitals and hospitals who are the forefront of the response to the disaster. The findings of this study can be considered as a guideline for the implementation of principle and standardized health system preparedness exercises.