Table 3.

Issues of health systems response according to the building blocks.

Building Block: Leadership and Governance
Domains	Issues/Areas for Improvements
Key stakeholders	1. Challenge in identifying key stakeholders in designing the national action plan and policy
	2. The need for a multi-sectorial council with involvement of private agencies, industries, non-governmental organisations, experts of various backgrounds, community representatives
	3. Timely involvement of key stakeholders
Collaboration and coordination	1. Expansion of coordination, engagement and input generation across ministries and industries
	2. The need for multisectoral simulations
Systems design	1. Call for development of a more comprehensive and adaptive national preparedness plan as many decisions in current pandemic management were seen made on impromptu basis
	2. Some existing national policies and past implementations are not reviewed and pursued in current outbreak
	3. Need for clear protocols and guidelines beyond case management and prevention control
	4. Lack of standardisation on coordination of instructions and implementations across ministries as well as between federal and regional authorities within the ministry
	5. Confusing, frequently changing instructions and lack of monitoring leading to breach of protocols among staff in both public and private healthcare facilities
	6. Effectiveness of centralised approach in managing the outbreak is debatable
Leadership	Leaders must have strategic vision
Accountability	Credibility and trustworthiness—call for evidence-based dissemination of information and enforcement, and addressing data ownership and confidentiality as means to extend collaboration with experts from other sectors
Transparency	Lack of transparency in planning, implementation and performance measures
Responsiveness	Call for the government to attend urgently to the following needs:
	1. Obtaining essential items in handling the outbreak
	2. Limited infrastructures to handle COVID-19 in many healthcare facilities
	3. Lack of human resources to manage COVID-19
Equity	Attending to the health needs of the marginalised and vulnerable groups during the outbreak
Building Block: Health Information
Domains	Issues/Areas for Improvements
Epidemiological data	1. Inaccurate epidemiological data in informing decision makers of public health intervention
	2. Lack of adherence to epidemiological principle in surveillance data, analysis and interpretation determines the quality of information
	3. Lack of data sharing among the experts (e.g., epidemiologist, public health experts) leads to unoptimised expertise utilisation
Health information technology	Need for advanced health information technology for disease surveillance in contact tracing, enforcement and disease modelling activities to automate data generation with higher accuracy
Risk communication	1. Accuracy of information provided by the authorities on the outbreak status and progression is debatable
	2. Lack of channel/platform for information dissemination which should be timely, accessible, sufficient, consistent, and transparent
Operational information	Need for clear and updated information to support the health workforce and frontliners at the ground to implement effective interventions
Building Block: Health Financing
Domains	Issues/Areas for Improvements
Funding mechanisms	Current financial resources for outbreak management depended on ad hoc funding which might not be sustainable for future crisis
Resource allocations	1. Urgent allocations were needed for various infection control activities, putting more strain to the healthcare budget
	2. Prioritisation of government budget for outbreak management was needed to support efficient implementation
Building Block: Health Workforce
Domains	Issues/Areas for Improvements
Manpower optimisation and support	1. More effort needed to recruit volunteers and retired staff, as well as mobilising workforce from less affected areas to epicentres
	2. Need to strengthen the primary care and public health to ease the burden of surveillance and contact tracing
	3. Lack of adequate support and appropriate incentives to healthcare workers
	4. Need for whole-of-country approach with a task force consisting of subject matter experts from various fields with the required knowledge, skills, and expertise from within and outside of the government agencies
	5. Community representatives inadequately involved with lack of coordination and communication between the government agencies and the representatives
Training and competency	No regular training in outbreak management for diverse group of healthcare workers performing critical functions often due to the lack of resources
Building Block: Medical Products, Vaccines and Technology
Domains	Issues/Areas for Improvements
Supply chain	Ensuring adequacy and access to medical products through proper planning and forecasting with consideration of both the public and private healthcare facilities
Vaccination coverage and technology utilisation	1. Investing in the required infrastructure to develop the necessary technology locally
	2. Prioritising high-risk groups to be vaccinated, along with economic evaluation
Building Block: Service Delivery
Domains	Issues/Areas for Improvements
Quality	1. Health systems must be responsive to outbreak without compromising the core functions and service delivery quality
	2. Need for quality service delivery during the outbreak: efficient, reliable and comprehensive
Infrastructure	Urgent need to optimise and upscale existing infrastructures and swiftly open up temporary units such as quarantine centres
Accessibility	Lack of service outreach to vulnerable population