Resources to support COVID-19 responses in LMICs

Projections on disruptions to essential health services and non-COVID deaths: studies that estimate the effect of COVID-19 on essential health services and indirect deaths attributable to service disruptions.

Key technical and policy guidance for LMICs: key technical and policy guidance specific to LMIC settings, compiled from WHO, Africa CDC, and the UN.

To maintain essential health services: guidance and best practices for countries, facilities, and health care workers to protect and maintain the provision of essential health services during the pandemic.

To maintain population nutrition and food systems: documents that guide countries' ability to ensure food systems provide adequate nutrition to their populations during the complexities of the global COVID-19 crisis.

To support evidence-informed policymaking: existing evidence related to COVID-19 disease and interventions, which can be used to gather and weigh evidence to inform policies.

To support data-driven decision-making: guidance for program managers and M&E advisors on using data to inform decision-making, including identifying and tracking performance indicators.

To see what other countries are doing: a list of COVID-19 policy trackers that summarize the policies of a variety of international, government, and academic institutions relating to health, education, emergency declarations, travel or gathering restrictions, and fiscal/monetary measures.

This page last updated: May 4, 2020

These studies estimate the effect of COVID-19 on essential health services and indirect deaths attributable to service disruptions.

• Risks and benefits of sustaining routine childhood immunization programs in Africa during the COVID-19 pandemic - This paper from the Centre for Mathematical Modelling of Infectious Diseases estimates that for every 1 excess death attributable to a COVID-19 infection acquired during a child vaccination visit, sustained routine immunization programs would prevent 128 future deaths in children under five years old.

• Early Estimates of the Indirect Effects of the Coronavirus Pandemic on Maternal and Child Mortality in Low- and Middle-Income Countries - This study estimates the additional maternal and under-five child deaths resulting from weakened health systems and reduced utilization of routine services during the COVID-19 pandemic. The study finds that three scenarios in which coverage of basic lifesaving interventions is reduced over six months could increase under-five child deaths by 9.8% to 44.7%, and maternal deaths by 8.3% to 38.6%.

• Coronavirus: 30 million children’s lives at risk from secondary effects of deadly disease - World Vision reports that as many as 30 million children are in danger of negative secondary health impacts due to the COVID-19 pandemic, including lack of immunization, risk of malaria and other diseases, and malnutrition.

• Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries - This study from the Guttmacher Institute estimates that a 10% proportional decline in use of short- and long-acting reversible contraceptive methods in LMICs would result in an additional 49 million women with an unmet need for modern contraceptives and an additional 15 million unintended pregnancies over the course of one year.

• The potential impact of health service disruptions on the burden of malaria - A new modelling analysis by WHO and partners considers nine scenarios for potential disruptions in access to core malaria control tools during the pandemic in 41 countries, and resulting increases in cases and deaths. Under the worst-case scenario, in which all insecticide-treated net campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines, the estimated tally of malaria deaths in sub-Saharan Africa in 2020 would reach 769,000—twice the number of deaths reported in the region in 2018.

• Risk of hunger pandemic as COVID-19 set to almost double acute hunger by end of 2020 - New figures from the World Food Programme indicate that the spread of COVID-19 will put an additional 130 million people in danger of acute hunger by the end of 2020, mainly in Africa and the Middle East.

This set of resources features key technical and policy guidance specific to LMIC settings, compiled from WHO, Africa CDC, and the UN.

• World Health Organization Country & Technical Guidance - This site includes all WHO technical guidance for COVID-19 as it is released, ranging from guidance on Operational Planning, Risk Communication, and lists of essential COVID-19 medicines and supplies. It is arranged by topic, but to make it easier to navigate and use we have created an annotated summary of each document here.

• Africa CDC COVID-19 Resources - This CDC page includes COVID-19 resources including recommendations for social distancing, travel guidelines, hygiene, and stepwise response. A high percentage of the African population could be infected with COVID-19 in the next year, resulting in large number of deaths, particularly in people with advanced age and/or underlying illnesses. Additional guidance was provided by the Africa Joint Continental Strategy for COVID-19 Outbreak.

• Lifebox COVID-19 Resources - Lifebox has rapidly re-focused tools and training materials to help clinicians in low-resource settings respond to COVID-19. Available resources include a list of technical guidance documents and resources, a decision/triage tool (available in English, Spanish, French, Swahili, Amharic, and Hindi), training videos for using pulse oximeters to triage suspected COVID-19 patients, a checklist for surgical teams in the context of COVID-19, and interviews with front-line surgical and anesthesia partners.

• COVID-19 Guidance Note Protecting Residents of Informal Settlements - To prevent the spread of COVID-19, government leaders are asking people to ‘shelter-in-place'; thus, housing has become a major defense in fighting COVID-19. Those residing in over-crowded informal settlements or encampments are at a greater risk of contracting this life-threatening virus—partially because they lack access to on-site water or sanitation, and face constant fear of eviction. This document provides recommendations for state policies to protect those in precarious housing situations during COVID-19.

• Guidance for the prevention of COVID-19 infections among high-risk individuals in camps and camp-like settings - The Health in Humanitarian Crises Center has published a set of general principles and specific recommendations to implement a “targeted shielding” approach to protect communities where mass ‘stay-at-home’ orders are not appropriate. The proposed approach shields high-risk individuals from the rest of the community and is potentially transferable to other densely populated low-resource settings.

• Clinical care of severe acute respiratory infections - This toolkit is intended for clinicians working in acute care hospitals in low- and middle-income countries, managing adult and pediatric patients with acute respiratory infection, including severe pneumonia, acute respiratory distress syndrome, sepsis, and septic shock.

• Diagnosing malaria and other febrile illnesses during the COVID-19 pandemic - This commentary in the Lancet provides recommendations for health care in community and primary health care settings for differentiating febrile diseases in the short and long term.

• Principles of Health Systems Resilience in the Context of COVID-19 Response - This document from UKaid presents seven key principles and actions that countries can apply to strengthen their health system response to COVID-19.

• Addressing Human Rights as Key to the COVID-19 Response - This document provides key considerations for addressing stigma and discrimination, prevention of violence against women, support for vulnerable populations, quarantine and restrictive measures, and shortages of supplies and equipment. It also highlights human rights obligations with regards to global cooperation to address COVID-19.

• African Union and Africa Centres for Disease Control and Prevention Launch Partnership to Accelerate COVID-19 Testing: Trace, Test, and Track - The African Union Commission and the Africa Centres for Disease Control and Prevention (Africa CDC) have launched a new initiative, the Partnership to Accelerate COVID-19 Testing (PACT): Trace, Test & Track (CDC-T3). The partnership will facilitate implementation of the Africa Joint Continental Strategy for COVID-19, aiming to strengthen capacity to test for COVID-19 across Africa, with emphasis on countries that have only minimal capacity.

• Think Global Health - South Africa’s War on COVID-19 - A detailed account of key dates, interventions, and impacts of responses in South Africa. Sharing these accounts is helping to create a community of practice among African countries.

• Response strategies for COVID-19 epidemics in African settings: a mathematical modelling study - Study from the Centre for Mathematical Modelling of Infectious Diseases (CMMID) that models the evolution of COVID-19 in Mauritius, Niger, and Nigeria to evaluate strategies to reduce SARS-CoV-2 burden in African countries. These models seek to support decisions that balance minimizing mortality, protecting health services, and safeguarding livelihoods.

• The Conversation - Five criteria low income countries must have in place for lockdowns to work - This article proposes an index of lockdown readiness to assess the share of households in a country that could feasibly shelter in place for a long period of time, including access to safe drinking water in the home, adequate sanitation in the home, a source of reliable energy, access to information or communications technology, and having a permanent source of income or savings.

The following documents provide guidance and best practices for countries, facilities, and health care workers to protect and maintain the provision of essential health services during the COVID-19 pandemic. Topics covered in this section include overarching planning, response, and financing recommendations to prevent a broader health system collapse due to COVID-19, as well as strategies to tailor the provision of specific services like routine immunization and malaria interventions to the COVID-19 context.

• World Health Organization COVID-19: Operational guidance for maintaining essential health services during an outbreak - This document expands WHO’s content of the Operational planning guidelines to support country preparedness and response, and provides guidance on a set of targeted immediate actions that countries should consider at the national, regional, and local level to reorganize and maintain access to high-quality essential health services for all. This guidance will help countries 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.

• Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected - This is the first edition of guidance on infection prevention and control (IPC) strategies for use when infection with a novel coronavirus is suspected. Its implementation will support the protection and maintenance of other health services by keeping health workers and patients safe in facility settings.

• World Health Organization guiding principles for immunization activities during the COVID-19 pandemic - The global COVID-19 pandemic poses a risk of disruption to routine immunization activities, due to an overburdened health system and decreased demand for vaccination because of physical distancing requirements or community reluctance. Disruption of immunization services, even for brief periods, will result in increased numbers of susceptible individuals and will raise the likelihood of outbreak-prone vaccine preventable diseases (VPDs) such as measles. The high potential for VPD outbreaks makes it imperative that countries maintain continuity of immunization services wherever possible under safe conditions. Prior disease outbreaks and humanitarian emergencies have underscored the importance of maintaining essential health services such as immunization and effectively engaging communities in planning and service delivery. The complexity and global reach of the COVID-19 response with respect to mandatory physical distancing and economic impact is unprecedented for public health.

• FAQ: Immunization in the context of the COVID-19 pandemic - These FAQs accompany WHO’s guiding principles for immunization activities during the COVID-19 pandemic. While it is vital that countries commit to sustaining immunization systems, they should use approaches that respect the principle of "do-no-harm" and limit the risk of transmission of COVID-19 during immunization activities.

• Gavi COVID-19 page - A series of blogs by Gavi, the Vaccine Alliance, highlighting different aspects of the COVID-19 response, including disruption to routine vaccination services.

• World Health Organization recommendations on health financing during COVID-19 - WHO health financing experts from headquarters and regional offices published joint guidance and recommendations which can safeguard or improve financial access to essential services. The two major recommendations, with detail on implementation, include: increasing health budgets and investing in common goods such as public health and surveillance functions; and removing financial barriers to care, including user-fees, and adding cash transfers to enable care-seeking where other financial barriers continue to exist (e.g. transport costs).

• PMNCH compendium of COVID-19 related partner resources on women's, children's, and adolescents' health - Disruptions in reproductive health care, including access to contraception, is an inevitable consequence of mandatory physical distancing policies as part of a pandemic response. This resource provides the latest guidance and resources around COVID-19 and its effects on women’s, children’s, and adolescents’ health, from credible resources. This compendium will be developed as a living repository of the most up-to-date guidance from UN agencies, especially WHO, as well as PMNCH’s health care professional association members.

• Coronavirus Disease (COVID-19) Pandemic UNFPA Global Response Plan - This document outlines UNFPA’s strategic priorities to respond to COVID-19 including continuity of sexual and reproductive health services and interventions, addressing gender-based violence, and ensuring the supply of modern contraceptives and reproductive health commodities. Key accelerator interventions and results indicators for the three priority areas are also included.

• FP2020 COVID-19 and Family Planning - FP2020 has compiled resources related to the continuation of family planning programs and services during the COVID-19 pandemic on their website, including agency reports and statements, strategic guidelines and checklists, blogs and articles, and videos and webinars. They have also launched a social media campaign, “How are you working to protect #FPinCOVIDreponse?”

• Policy brief: the impact of COVID-19 on children - The United Nations Sustainable Development Group reports on impacts of COVID-19 for children including threats to child/infant survival and health, education, poverty, and safety. The brief also provides recommendations for how to mitigate these impacts.

• The Global Fund to Fight HIV, TB, and Malaria: COVID-19 technical guidance - This page links to frequently updated technical guidance from the Global Fund largely relating to maintenance of services for HIV, TB, and malaria programs (see “Information notes”) as well as key guidance from other partners. Each disease area has dozens of recommendations on how to maintain service continuity, including innovative approaches like telemedicine and community delivery of medicines and commodities.

• The United States President’s Emergency Plan for AIDS Relief: FAQs on PEPFAR’s HIV Response in the Context of COVID-19 - Two of PEPFAR’s priorities during COVID-19 are ensuring continuity of care for people living with HIV and reducing exposure of staff and HIV clients to COVID-19. PEPFAR is working to provide at least three months, and hopefully six months, of ART for clients, and is using community-based delivery options as much as possible.

• UNAIDS calls for increase in health spending and social protection as an essential part of the economic response to COVID-19 - UNAIDS Executive Director Winnie Byanyima’s statement on the economic response to COVID-19 during an online event held on 16 April 2020.

• COVID-19 Response Mechanism Update for Implementing Countries - The COVID-19 Response Mechanism, announced by the Global Fund Board on April 9, 2020, authorizes funding of US$500 million to support countries to respond to COVID-19 and mitigate its impact on HIV, TB, and malaria programs. This fund is an addition to previously announced Global Fund grant flexibilities up to US$500 million.

• GFF leaders warn of emerging secondary global health crisis from disruptions in primary health care due to COVID-19 - As the COVID-19 pandemic escalates in low- and lower-middle income countries, Global Financing Facility leaders warn of the growing risk of widespread disruptions in access to reproductive, maternal, newborn, child, and adolescent health and nutrition services, and urge immediate steps to prevent a secondary global health crisis. A rapid survey of the 36 countries currently supported by the GFF found that nearly half are already reporting life-threatening service disruptions.

• Tailoring malaria interventions in the COVID-19 response - On April 10, WHO’s Global Malaria Program released this guidance for health ministries and national malaria control programs during COVID-19, affirming the need to maintain malaria programs while also contributing to COVID-19 response efforts. Countries should continue to provide core preventive and case management interventions, which may require innovations that help maintain physical distancing of implementers and beneficiaries.

• COVID-RHR-HUB: Family Planning and Reproductive Health Community-Contributed COVID-19 Resources - COVID-19 is expected to cause disruptions in access to family planning services. The Gates Institute has created a live database with a wide range of resources including calls to action, op-eds, health and safety advice, best practices, community experience and insight, action initiatives, government initiatives, research and academic publications, news/media, multilateral initiatives, publications, and online events and webinars. This compilation of resources was developed to inform decision-making crucial to effective outbreak response by the public, governments/policymakers, donors and philanthropists, health care providers, researchers, advocates, etc.

• Community Health Impact Coalition: Priorities for the Global COVID-19 Response - In addition to recommending general actions governments can take to protect the poorest and maintain existing health services, the Community Health Impact Coalition recommends steps to protect and leverage community health workers (CHWs) including: ensuring they are included in PPE forecasting; endorsing a protocol for CHWs as part of the COVID-19 response; and mobilizing and training existing community health teams.

These documents guide countries' ability to ensure food systems provide adequate nutrition to populations during the global COVID-19 crisis. These guidance documents are key to ensuring ongoing health for all, especially as economic downturns and supply chain issues threaten nutrition systems.

• UNSCN Resource list on Food Systems and Nutrition responses - The United Nations System Standing Committee on Nutrition has compiled a comprehensive list of guidance, technical briefs, articles, blog posts, tools, and agency responses to disruptions in the global food supply and effects on nutrition caused by COVID-19.

• Q&A: COVID-19 pandemic – impact on food and agriculture - Answers from FAO on the impacts of COVID-19 on global food security, demand, and prices.

• UNICEF Nutrition COVID-19 newsletter - A knowledge dissemination tool to share programmatic guidance, position papers, technical notes, emerging research, and other evidence being developed by UNICEF and partners around understanding and mitigating the pandemic's impact on maternal and child nutrition.

• Global Nutrition Cluster COVID-19 resources - This page on the Global Nutrition Cluster website compiles resources for integrating COVID-19 preparedness and response into humanitarian nutrition efforts--including guidance documents, online training materials, and webinars to assist Nutrition in Emergencies practitioners and coordination teams.

• 2020 Global Report on Food Crises - A joint consensus-based assessment of acute food insecurity situations around the world by 16 partner organizations. The report, which was prepared before the COVID-19 pandemic became a global crisis, includes an alert on the impact of COVID-19 in food-crisis countries.

The following resources collate existing evidence related to COVID-19 and interventions. This section includes systematic reviews, modeling analyses, and other studies, as well as examples and experiences of evidence use to inform policymaking on the African continent. These resources can be used to gather and weigh evidence to inform policymaking.

• African Evidence Network: EIDM during COVID-19 - This resource is an opportunity to curate new evidence, examples of evidence use, and experiences of evidence use on the African continent during COVID-19. Content includes: 1) rapid reviews for best practices relevant to certain sectors; 2) content from multisectoral task forces to address key concerns; 3) responding to demand-led syntheses of best available information to advise decision-making; 4) providing creative ways to address critical challenges in EIDM at this time; 5) guidelines that have considered as much as possible the best available evidence; 6) news media highlights on EIDM during COVID-19 in various African countries; and 7) blogs by AEN members on key "EIDM during COVID" topics.

• Norwegian Institute for Public Health (NIPH): Live map of COVID-19 evidence - Evidence gap maps are tools to provide an overview of research by specific topics and sub-groups. NIPH has created this evidence map which collates systematic reviews, modeling analyses, and other studies related to the disease and interventions. LMIC studies will be included as they become available. We recommend looking at the Africa Evidence Network for a faster selection of LMIC-specific evidence.

• Cochrane Library COVID-19 Special Collection - Cochrane–the global leader in systematic review and other evidence products–has developed a COVID-19 library that includes relevant existing systematic reviews to answer policymaker and health manager questions. This page also links to rapid reviews and will continue to add new content as it is available. We recommend looking at the Africa Evidence Network for a faster selection of LMIC-specific evidence.

• N95DECON - A scientific consortium for data-driven study of N95 filtering facepiece respirator decontamination, N95DECON’s website includes recent research and publications, fact sheets, and technical reports on methods of decontaminating N95 masks prior to reuse.

These resources provide guidance on best practices for using data to inform decision making around COVID-19. The following documents can help program managers and M&E advisors identify key indicators in the monitoring and tracking of disruptions in essential service provision due to COVID-19. These resources help show how data can be used to inform realistic and effective policy responses.

• World Health Organization’s Analysis and Use of Health Facility Data - This toolkit is a set of resources to optimize the analysis and use of data collected through routine health facility information systems, also known as health management information systems (HMIS). The comprehensive toolkit includes a series of integrated modules which can be used individually or together, according to country needs. Routine tracking of data can help identify spill-over or negative consequences of COVID-19 on other health care service needs.

• Demographic Health Survey: COVID-19 Mitigation - The current World Health Organization’s guidelines call for a public focus on handwashing, social distancing, communication with medical providers, and staying informed to help mitigate the spread of COVID-19. However, such guidance may be more aspirational than actionable for millions at risk of exposure to the virus in lower- and middle- income countries as revealed by recent demographic and health surveys. This article provides guidance on using these surveys to inform realistic approaches for COVID-19 policy practices. It also provides recommendations for tracking non-COVID related measures to capture the potential negative consequences of focused efforts of COVID-19 response on other health care service needs.

• PATH’s guidance for monitoring essential health services during COVID-19 using data from routine health information systems - The World Health Organization recommends monitoring access, availability, and coverage of essential health services during COVID-19 in “COVID-19: Operational guidance for maintaining essential health services during an outbreak.” Building on WHO’s toolkits for analysis and use of health facility data, we identify core indicators to monitor disruptions in essential health services, guidance on how to visualize and interpret time trends, and link to external guidance on what to do and how to act. This resource is meant for program managers, mid-level (e.g. district) managers, M&E advisors, and partners who support the monitoring of health programs.

• F2P - On Covid-19 Social Science can save lives: where do we start? - Blog posts by Heather Marquette on Using Graphics to Cut Through COVID’s Complexity and COVID-19’s Social and Political Impacts.

To get a sense of country responses across the world, this list of COVID-19 policy trackers summarizes the actions of a variety of international, government, and academic institutions. These resources monitor, compile, and update country COVID-19 policies relating to health, education, emergency declarations, travel or gathering restrictions, and fiscal/monetary measures.

Note: As of last update, we have not identified a database of LMIC policy responses.

• Tackling Coronavirus (COVID-19): Key policy responses from OECD - This database is a compilation of data, analysis, and recommendations on emerging health, economic, and societal crises to facilitate coordination around this collective challenge. This new series brings together policy responses spanning a large range of topics, from health to education and taxes, providing guidance on the short-term measures needed in affected sectors with a specific focus on the vulnerable sectors of society. Beyond the immediate response effort, the content aims to provide analysis on the longer-term consequences and impacts, paving the way to recovery with coordinated policy responses across countries.

• IMF COVID-19 Policy Tracker - This database includes the key economic responses and policies for 193 economies. These include different measures in taxation and spending, loans and guarantees, monetary instruments, and foreign exchange operations. IMF notes that the information included is not meant for comparison across members, as responses vary depending on the nature of the shock and country-specific circumstances.

• Oxford COVID-19 Government Response Tracker - The Oxford Government Response Tracker (OxCGRT) collects information on several common policy approaches governments have taken, scores the stringency of such measures, and aggregates these scores into a common Stringency Index. OxCGRT collects publicly available information on 11 indicators of government response (S1-S11). The first seven indicators (S1-S7) record policies such as school closures, travel bans, etc. on an ordinal scale; the remainder (S8-S11) are financial indicators such as fiscal or monetary measures.

• Global Dashboard on COVID-19 Government Policies - The U.S. Chamber of Commerce is pleased to provide the Global Dashboard on COVID-19 Policies to stay informed of the ever-changing regulatory landscape in response to this pandemic. Policy topics address government aid, stimulus, emergency declarations, guidance on infrastructure, trade issues, travel restrictions, and privacy guidance.

• COVID-19 Civic Freedom Tracker - The International Center for Not-For-Profit Law monitors government responses to the COVID-19 pandemic that affect civil freedoms and human rights, focusing on emergency laws. This tracker compiles policies from 115 countries, including 32 countries in sub-Saharan Africa.

• COVID-19 distancing policies that have been implemented in African countries - A GitHub repository including a file that tracks the social distancing policies that have been implemented in all 54 African countries.

• BMJ Blog: Domestic health financing for COVID-19 response in Africa - This article explores the extent to which budgetary measures have been embraced in 23 WHO Africa Region member states (for which data are available), focusing on domestic funding.

• Global Monitoring of School Meals During COVID-19 School Closures - This map from WFP tracks countries with school closures where school-age children will be affected by the disruption to WFP and other school feeding programs.