COVID-19 intra-action reviews: potential for a sustained response plan

We echo Landry Ndriko Mayigane and colleagues’ call (December, 2020)¹ for countries to plan and conduct intra-action reviews regularly throughout the COVID-19 response. An intra-action review is a country-led process that reviews past response actions to identify crucial gaps and optimise response plans going forward. WHO guidance for conducting a country COVID-19 intra-action review includes more than 300 discussion questions that can be adapted to a country’s context.²

However, given that 26 of 33 countries that have already completed an intra-action review are experiencing ongoing SARS-CoV-2 transmission at the time of writing,³ the retrospective intra-action review process does not sufficiently address ongoing and protracted response planning. Within this context, we advocate for the inclusion of a prospective response examination in the intra-action review process—ie, examining how to sustain response measures to ensure resiliency and plan effectively for the future.

For prospective response planning, we propose additional intra-action review questions that address two thematic areas: first, workforce resiliency, defined as the physical and mental wellbeing of responders; and second, operational resiliency, defined as the ability to deliver crucial ongoing response operations. The US Centers for Disease Control and Prevention has released COVID-19 sustainable response planning guidance for non-US settings,⁴ which “aims to identify critical considerations for response leaders developing sustainable and effective COVID-19 response plans. The document defines key factors underlying the monitoring and evaluating of both workforce and operational performance”. Additionally, the questions aim to elicit discussion on the strategy for transitioning COVID-19 response-driven operations to public health programmes during a protracted response. This operational resiliency strategy can: “1) distribute the responsibilities and response efforts across the public health system to [alleviate] the demands on the response coordination unit; and 2) ensure long-term sustainability of these operations with early incorporation [in] the public health system.”⁴ This guidance includes more than 60 prospective response planning questions aligned with the current WHO COVID-19 strategic preparedness and response plan’s nine public health response pillars.⁵

As 25 countries are currently planning an intra-action review, we urge countries to focus the review on crucial, immediately implementable activities and to expand the review questions to include workforce and operational resiliency considerations. Including a retrospective review of lessons learned from the response thus far and preparing for an ongoing COVID-19 response through prospective planning are both crucial components to ensure a sustained and effective response strategy. The complementary approach of linking immediate response needs and anticipating future response requirements is crucial for any public health emergency and should be considered in future protracted responses as a standardised approach for intra-action reviews.