Table 3. Enablers and barriers to health systems response to COVID-19.

Thematic areas	Enablers	Barriers
Preparedness context for disease Emergency Response	Laboratory capacityDisease surveillance mechanism planResources from Polio eradicationUN emergency cluster	Chronic under-resourcing of disease preparednessPoorly functional IHR forumsAbsence of risk management strategy
Building surge capacity to manage critical emergency: Expansion in ICU and hospital bed capacity Cross-referrals Testing sites Surveillance and edata Triage and data Risk communication	Public–private coordinationStrong laboratory capacityDigital capacityMarket facilitationStandard operating procedures	Insufficient market regulation for access to affordable quality services
Maintaining essential health services Introduction of telemedicine services Reopening of outpatient services, maternity, other services Resumption of outreach preventive activities	Large community workforce,Digital infrastructure for telemedicine	Insufficient resourcingLack of integration of private primary care providersUneven menu of services
Community engagement and empowerment Digital risk communication Contact tracing WASH, PPE, nutrition, livelihood support	Multipronged risk communicationStrong digital capacityVolunteerismEstablished humanitarian networks for Polio control and disaster reliefs	Inconsistent, short-lived measuresDifficulty with contact tracingAbsence of longer-term community recovery support
Multisectoral stewardship of pandemic control Health, societal and economic operational decisions, legislations, public guidance Facilitation of supplies production and imports Economic support to health sector Enforcement of public safety measures across sectors Vaccinations	Multisector stewardshipDigital data for decision-makingResource coordination across vertical programme and sectorsSupply chain protection	Weak pre-existing disease control platformsAbsence of continued investment in disease response platformsGuidance from public health experts

PPEpersonal protective equipmentWASHwater-sanitation-hygiene