Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage
Open accessAbstract
The COVID-19 pandemic has placed enormous strain on countries around the world, exposing long-standing gaps in public health and exacerbating chronic inequities. Although research and analyses have attempted to draw important lessons on how to strengthen pandemic preparedness and response, few have examined the effect that fragmented governance for health has had on effectively mitigating the crisis. By assessing the ability of health systems to manage COVID-19 from the perspective of two key approaches to global health policy-global health security and universal health coverage-important lessons can be drawn for how to align varied priorities and objectives in strengthening health systems. This Health Policy paper compares three types of health systems (ie, with stronger investments in global health security, stronger investments in universal health coverage, and integrated investments in global health security and universal health coverage) in their response to the ongoing COVID-19 pandemic and synthesises four essential recommendations (ie, integration, financing, resilience, and equity) to reimagine governance, policies, and investments for better health towards a more sustainable future.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
What is a resilient health system? Lessons from Ebola
Kruk, M. E., Myers, M. D., Varpilah, S. T., & Dahn, B. T. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60755-3 · Cited by 849 · see citing works
Are high-performing health systems resilient against the COVID-19 epidemic?
Legido-Quigley, H., Asgari, N., Teo, Y. Y., Leung, G. M., Oshitani, H., Fukuda, K., Cook, A. R., Hsu, L. Y., Shibuya, K., & Heymann, D. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30551-1 · Cited by 563 · see citing works
Self-citationGlobal health security: the wider lessons from the west African Ebola virus disease epidemic
Heymann, D. L., Chen, L., Takemi, K., Fidler, D. P., Tappero, J. W., Thomas, M., Kenyon, T. A., Frieden, T. R., Yach, D., Nishtar, S., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60858-3 · Cited by 561 · see citing works
Self-citationThe Italian health system and the COVID-19 challenge
Armocida, B., Formenti, B., Ussai, S., Palestra, F., & Missoni, E. (2020) · The Lancet Public Health · doi:10.1016/s2468-2667(20)30074-8 · Cited by 554 · see citing works
Building resilient health systems: a proposal for a resilience index
Kruk, M. E., Ling, E. J., Bitton, A., Cammett, M. C., Cavanaugh, K., Chopra, M., El‐Jardali, F., Macauley, R., Muraguri, M. K., Konuma, S., et al. (2017) · BMJ · doi:10.1136/bmj.j2323 · Cited by 357 · see citing works
Rapid Scaling Up of Covid-19 Diagnostic Testing in the United States — The NIH RADx Initiative
Tromberg, B. J., Schwetz, T. A., Pérez‐Stable, E. J., Hodes, R. J., Woychik, R. P., Bright, R. A., Fleurence, R., & Collins, F. S. (2020) · New England Journal of Medicine · doi:10.1056/nejmsr2022263 · Cited by 257 · see citing works
Gostin, L. O., & Friedman, E. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60644-4 · Cited by 241 · see citing works
Africa in the Path of Covid-19
El-Sadr, W. M., & Justman, J. E. (2020) · New England Journal of Medicine · doi:10.1056/nejmp2008193 · Cited by 199 · see citing works
Health systems strengthening, universal health coverage, health security and resilience
Kutzin, J., & Sparkes, S. P. (2016) · Bulletin of the World Health Organization · doi:10.2471/blt.15.165050 · Cited by 193 · see citing works
COVID-19: too little, too late?
Lancet, T. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30522-5 · Cited by 186 · see citing works
Kavanagh, M. M., Erondu, N. A., Tomori, O., Dzau, V. J., Okiro, E. A., Maleche, A. A., Aniebo, I., Rugege, U., Holmes, C. B., & Gostin, L. O. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31093-x · Cited by 167 · see citing works
Self-citationCOVID-19 gives the lie to global health expertise
Dalglish, S. L. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30739-x · Cited by 166 · see citing works
COVID-19: learning from experience
Lancet, T. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30686-3 · Cited by 148 · see citing works
Kluge, H. H. P., Martin-Moreno, J. M., Emiroğlu, N., Rodier, G. R., Kelley, E., Vujnovic, M., & Permanand, G. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2017-000656 · Cited by 141 · see citing works
Lal, A., Ashworth, H. C., Dada, S., Hoemeke, L., & Tambo, E. (2020) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2020.361 · Cited by 128 · see citing works
Self-citationCOVID‐19: A perspective on Africa's capacity and response
Dzinamarira, T., Dzobo, M., & Chitungo, I. J. B. (2020) · Journal of Medical Virology · doi:10.1002/jmv.26159 · Cited by 122 · see citing works
Symptoms of a broken system: the gender gaps in COVID-19 decision-making
van Daalen, K. R., Bajnoczki, C., Chowdhury, M., Dada, S., Khorsand, P., Socha, A., Lal, A., Jung, L., Alqodmani, L., Torres, I., et al. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-003549 · Cited by 100 · see citing works
Self-citationLessons from Italy's Response to Coronavirus
Pisano, G. P., Sadun, R., & Zanini, M. (2020) · Cited by 98 · see citing works
McBride, B., Hawkes, S., & Buse, K. (2019) · BMC Public Health · doi:10.1186/s12889-019-7114-5 · Cited by 91 · see citing works
The Global Health Security Index: what value does it add?
Razavi, A., Erondu, N. A., & Okereke, E. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-002477 · Cited by 86 · see citing works
Self-citationPower and politics: the case for linking resilience to health system governance
Topp, S. M. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-002891 · Cited by 82 · see citing works
Wenham, C., Katz, R., Birungi, C., et al. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2018-001145 · Cited by 77 · see citing works
Off the back burner: diverse and gender-inclusive decision-making for COVID-19 response and recovery
Bali, S., Dhatt, R., Lal, A., et al. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-002595 · Cited by 77 · see citing works
Self-citationErondu, N. A., Martin, J. L., Marten, R., Ooms, G., Yates, R., & Heymann, D. L. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32332-8 · Cited by 61 · see citing works
Self-citationCOVID-19: Lernen aus Erfahrung
Salzberger, B., & SCHELLONG, S. M. (2021) · Der Internist · doi:10.1007/s00108-021-01089-8 · Cited by 56 · see citing works
COVID-19 – An Opportunity to Redesign Health Policy Thinking
Sturmberg, J. P., Tsasis, P., & Hoemeke, L. (2020) · International Journal of Health Policy and Management · doi:10.34172/ijhpm.2020.132 · Cited by 46 · see citing works
The impact of COVID-19 on HIV financing in Nigeria: a call for proactive measures
Oladele, T. T., Olakunde, B. O., Oladele, E. A., Ogbuoji, O., & Yamey, G. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-002718 · Cited by 45 · see citing works
Ooms, G., Ottersen, T., Jahn, A., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32072-5 · Cited by 43 · see citing works
Human Capabilities and Pandemics
Venkatapuram, S. (2020) · Journal of Human Development and Capabilities · doi:10.1080/19452829.2020.1786028 · Cited by 25 · see citing works
Healthier societies for healthy populations
Healthier Societies for Healthy Populations Group (2020) · The Lancet · doi:10.1016/s0140-6736(20)31039-4 · Cited by 15 · see citing works
Modelling can only tell us so much: politics explains the rest
Wenham, C. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30814-x · Cited by 14 · see citing works
Torres, I., López‐Cevallos, D. F., & Sacoto, F. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-003063 · Cited by 10 · see citing works
Stenesh, J. (2016) · Cited by 6 · see citing works
Husain, J. (2016) · Palgrave Macmillan US eBooks · doi:10.1057/978-1-137-59962-9_2 · Cited by 4 · see citing works
Vietnam’s Low-Cost COVID-19 Strategy
Nguyen, H. T. (2020) · PhilPapers (PhilPapers Foundation) · Cited by 3 · see citing works
Primary Health Care and COVID-19
Vega-Romero, R. (2020) · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries
Haldane, V., De Foo, C., Abdalla, S. M., Jung, A.-S., Tan, M., Wu, S., Chua, A., Verma, M., Shrestha, P., Singh, S., et al. (2021) · Nature Medicine · doi:10.1038/s41591-021-01381-y · Cited by 1,264 · see citing works
The Lancet Commission on lessons for the future from the COVID-19 pandemic
Sachs, J. D., Karim, S. S. A., Aknin, L., Allen, J., Brosbøl, K., Colombo, F., Barron, G. C., Espinosa, M. F., Gaspar, V., Gaviria, A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01585-9 · Cited by 842 · see citing works
Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic
Abimbola, S., Asthana, S., Montenegro, C., Guinto, R. R., Jumbam, D. T., Louskieter, L., Kabubei, K. M., Munshi, S., Muraya, K., Okumu, F., et al. (2021) · PLOS Medicine · doi:10.1371/journal.pmed.1003604 · Cited by 271 · see citing works
- Authors
- Lal, A., Erondu, N. A., Heymann, D. L., Gitahi, G., & Yates, R.
- Affiliations
- London School of Economics and Political Science (GB)
- Chatham House (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Amref Health Africa (KE)
- Corresponding author
- Lal, Arush
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 397
- Issue
- 10268
- Pages
- 61-67
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC7834479
- OpenAlex
- W3107523442
- Cited by
- 536
- References
- 36
- Citations by year
- 2026: 43 · 2025: 57 · 2024: 102 · 2023: 91 · 2022: 157 · 2021: 84 · 2020: 2
- FWCI
- 15.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Legal, Health, Environmental and COVID-19 Challenges
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- COVID-19 pandemic, care fragmentation, global health security, universal health coverage, health governance, pandemic preparedness and response, health care financing, health system resilience, health equity, health system investment
- MeSH terms
- COVID-19, Delivery of Health Care, Humans, Global Health, Universal Health Insurance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
