Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review

Building resilience of the Ghanaian healthcare... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/13-1203" }, "headline": "Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for...", "datePublished": "2024-10-10T15:38:04", "dateModified": "2024-10-10T15:38:04", "author": [ { "@type": "Person", "name": "Martin Ankomah" }, { "@type": "Person", "name": "Patience Aseweh Abor" }, { "@type": "Person", "name": "Humphrey Karamagi" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background The coronavirus disease (COVID-19) pandemic has underscored the need for resilient health systems. However, Ghana does not seem to achieve commensurate results, suggesting potential gaps in critical interventions. This study examines these gaps by drawing on global experiences to guide Ghana's preparedness for future emergencies. Methods A scoping review based on the synthesis of published journal articles and grey literature was used to gather relevant evidence to address the study’s objective. Peer-reviewed literature searches were conducted in databases, including Medline, Scopus, and Health Sources, supplemented by searches on organizational websites to identify grey literature. We adopted the Organization for Economic Co-operation and Development (OECD) framework to explore how health systems responded to the COVID-19 pandemic globally and draw lessons for strengthening Ghana's health system resilience. We analyzed policy responses in three main areas: pandemic preparedness, crisis management, and response and recovery. Results Ten strategies emerged from the study as critical in strengthening health system resilience against future pandemics. These strategies include whole-of-government engagement, financing for preparedness, community engagement and trust, robust surveillance systems, emergency medical care, diverse workforce development, digital health integration, critical health infrastructure, well-planned commodities/products, and social capital. Each strategy plays a vital role in enhancing preparedness, response, and recovery efforts, highlighting the multifaceted approach needed to mitigate the impact of future pandemics on health systems. Conclusions The identified strategies align with the attributes of a resilient healthcare system. By adopting these strategies, Ghana can build a resilient healthcare system that effectively addresses future challenges, guided by global insights and experiences. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-1203/v1", "name": "Building resilience of the Ghanaian healthcare system: Lessons from..." } } ] } Home Browse Building resilience of the Ghanaian healthcare system: Lessons from... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Ankomah M, Abor PA and Karamagi H. Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :1203 ( https://doi.org/10.12688/f1000research.143051.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Systematic Review Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review [version 1; peer review: awaiting peer review] Martin Ankomah https://orcid.org/0009-0003-7262-2327 1 , Patience Aseweh Abor https://orcid.org/0000-0001-6342-8184 1 , Humphrey Karamagi 2 Martin Ankomah https://orcid.org/0009-0003-7262-2327 1 , Patience Aseweh Abor https://orcid.org/0000-0001-6342-8184 1 , Humphrey Karamagi 2 PUBLISHED 10 Oct 2024 Author details Author details 1 Department of Health Services Management, University of Ghana Business School, University of Ghana, Accra, Greater Accra Region, Ghana 2 Office of the Assistant Regional Director, Regional Office for Africa, World Health Organisation, Djoue, Brazzaville, Congo Martin Ankomah Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Patience Aseweh Abor Roles: Supervision, Writing – Review & Editing Humphrey Karamagi Roles: Project Administration, Resources, Validation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW Abstract Background The coronavirus disease (COVID-19) pandemic has underscored the need for resilient health systems. However, Ghana does not seem to achieve commensurate results, suggesting potential gaps in critical interventions. This study examines these gaps by drawing on global experiences to guide Ghana's preparedness for future emergencies. Methods A scoping review based on the synthesis of published journal articles and grey literature was used to gather relevant evidence to address the study’s objective. Peer-reviewed literature searches were conducted in databases, including Medline, Scopus, and Health Sources, supplemented by searches on organizational websites to identify grey literature. We adopted the Organization for Economic Co-operation and Development (OECD) framework to explore how health systems responded to the COVID-19 pandemic globally and draw lessons for strengthening Ghana's health system resilience. We analyzed policy responses in three main areas: pandemic preparedness, crisis management, and response and recovery. Results Ten strategies emerged from the study as critical in strengthening health system resilience against future pandemics. These strategies include whole-of-government engagement, financing for preparedness, community engagement and trust, robust surveillance systems, emergency medical care, diverse workforce development, digital health integration, critical health infrastructure, well-planned commodities/products, and social capital. Each strategy plays a vital role in enhancing preparedness, response, and recovery efforts, highlighting the multifaceted approach needed to mitigate the impact of future pandemics on health systems. Conclusions The identified strategies align with the attributes of a resilient healthcare system. By adopting these strategies, Ghana can build a resilient healthcare system that effectively addresses future challenges, guided by global insights and experiences. READ ALL READ LESS Keywords Health systems resilience, COVID-19 pandemic, global experiences, emergency preparedness, crisis management, response and recovery, Ghana's health system Corresponding Author(s) Patience Aseweh Abor ( [email protected] ) Close Corresponding author: Patience Aseweh Abor Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Ankomah M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Ankomah M, Abor PA and Karamagi H. Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :1203 ( https://doi.org/10.12688/f1000research.143051.1 ) First published: 10 Oct 2024, 13 :1203 ( https://doi.org/10.12688/f1000research.143051.1 ) Latest published: 10 Oct 2024, 13 :1203 ( https://doi.org/10.12688/f1000research.143051.1 ) Introduction Globally, health systems face various public health risks and safety threats that impede progress toward achieving universal health coverage and health security goals ( Emami et al ., 2023 ; Fridell et al ., 2020 ; Olu, 2017 ). Urgent action is advocated by the World Health Organization (WHO) to establish more robust health systems that can effectively anticipate and respond to health challenges ( Ghebreyesus et al ., 2022 ; WHO, 2022a , 2022b ). The necessity for resilient health systems is underscored by past shocks, such as the H1N1 influenza, Ebola outbreaks, and Zika, which exposed vulnerabilities and emphasized the need for reform ( Elston et al ., 2016 ; Kruk et al ., 2015 ; Olu, 2017 ; Tumusiime et al ., 2019 ). The recent COVID-19 pandemic has reinforced the critical importance of resilient health systems ( Forsgren et al ., 2022 ; Haldane et al ., 2021 ; Karamagi et al ., 2022 ; Rajapaksha et al ., 2022 ). As a global pandemic, COVID-19 wreaked havoc on health systems, economies, and societies worldwide ( WHO, 2021a ; Yang et al ., 2021 ). It tested health systems globally, exposing gaps in emergency preparedness and response, even in systems previously deemed strong ( El Bcheraoui et al ., 2020 ; Haldane et al ., 2021 ; Sagan et al ., 2021 ). Ghana confirmed its first cases in March 2020, triggering a national emergency ( Sarkodie et al ., 2021 ). Responding to the outbreak, Ghana adopted a coordinated, centralized approach under the Inter-Ministerial Coordinating Committee chaired by the President. The response centered on five themes: limiting virus importation, containment, care provision, socio-economic impact mitigation, and domestic capacity expansion ( Ayee, 2022 ; Fenny & Otieku, 2020 ; Republic of Ghana, MOH, 2020a , 2020b , 2022 ; Sarkodie et al ., 2021 ). Challenges such as shortages of personal protective equipment (PPE), testing limitations, delayed test results, and staffing inadequacies initially hindered Ghana’s COVID-19 management ( Osei-Boateng & Vlaminck, 2021 ; World Bank, 2020 ; Sarkodie et al ., 2021 ). To mitigate these issues, the government implemented a range of policy measures such as, travel restrictions, public gathering bans, closure of schools, relief packages, healthcare worker support, infrastructure enhancement, and vaccination campaigns. Preventive strategies like handwashing, mandatory mask-wearing, and social distancing were actively promoted through media and helplines ( Issahaku & Abu, 2020 ; Osei-Boateng & Vlaminck, 2021 ). The Ghana Health Service (GHS) played a crucial role in coordinating efforts across various sectors to enhance contact tracing, testing, and surveillance. Other strategic efforts involved local production of PPE, expanding testing through public and private labs, expanding infrastructure, converting facilities to treatment centers, and increasing bed capacity. Funding was sourced from the World Bank and other development partners, NGOs, and private donations to the COVID-19 trust funds ( Antwi-Boasiako et al ., 2021 ; Ayee, 2022 ; Fenny et al ., 2016 ; Sarkodie et al ., 2021 ). However, concerns were raised regarding adherence to safety protocols and transparency in vaccine procurement ( Ayee, 2022 ). Risk communication and social mobilization strategies featured presidential broadcasts, press briefings, and message dissemination through media and helplines. Case management involved isolation at treatment centers or home isolation supported by protocols, staff training, and infrastructure expansion. To address infrastructure challenges, Ghana initiated “Agenda 111,” aiming to build hospitals in underserved districts ( Antwi-Boasiako et al ., 2021 ; Issahaku & Abu, 2020 ; Republic of Ghana, MOH, 2021a ; Sarkodie et al ., 2021 ). Despite progress, Ghana’s health system resilience remains insufficient for potential emergencies ( Asiedu-Berkoe et al ., 2022 ; Ayee, 2022 ; Republic of Ghana, MOH, 2020c ). Shortages persist in infrastructure, equipment, and skilled personnel for emergency care leading to exhaustion of healthcare providers and patient care challenges ( Yevoo et al ., 2023 ). Despite improvements in the health workforce, significant shortages remain, especially in critical areas such as surgery, obstetrics, trauma, and anesthesia care ( Jumbam et al ., 2022 ). Specialist gaps are evident, with only 24% of GHS hospitals having surgeons in 2018, and primary hospitals lacking essential specialists, such as pediatricians and psychiatrists ( Asamani et al ., 2021 ; Jumbam et al ., 2022 ). Peripheral facilities struggle with emergency and non-emergency care as skilled professionals are concentrated in regional centers ( Yevoo et al . 2023 ). Limited IT integration, aging and inadequate equipment, frequent stock-outs, lack of training, professional migration, and underfunded ambulance services further impede emergency care ( Ankomah et al ., 2015 ; Republic of Ghana, MOH, 2021b ; Okyere, 2018 ; Piersson & Gorleku, 2017 ). Ghana’s efforts to enhance resilience in the health system are evident. However, the country does not seem to achieve commensurate results, suggesting potential gaps in critical interventions. This study examines these gaps by drawing on global experiences to guide Ghana’s preparedness for future emergencies. The principal aim of this study was to extract and synthesize global experience and learn valuable lessons from the COVID-19 pandemic to strengthen Ghana’s health system resilience. Given the broad and exploratory nature of the objective and the need for a comprehensive approach, we chose a scoping review for this study. This methodology, known for its flexibility and inclusivity, enables thorough exploration and synthesis of diverse sources, aligning with the study’s objectives ( Anderson et al., 2008 ; Levac et al., 2010 ; Arksey & O’Malley, 2005 ). Review question This scooping review sought to address the following research question: What are the critical gaps in Ghana’s health system resilience, as evidenced by its response to the COVID-19 pandemic, and how can global experiences inform strategies to strengthen its preparedness for future emergencies? The concept of health system resilience Health system resilience is a vital concept that encompasses the capacity of health actors, institutions, and populations to effectively prepare for, respond to, and recover from crises and shocks, while maintaining essential functions and services ( Kruk et al ., 2015 ). This concept has evolved to include strategies for minimizing exposure, managing risks, and addressing potential stressors, such as population aging ( Paschoalotto et al ., 2023 ). Recent definitions of health system resilience emphasize proactive elements, encompassing anticipation, absorption, and adaptation to sudden shocks and structural changes, extending beyond acute events to encompass continuity in health improvement and the ability to respond effectively to emerging health needs ( Grimm et al ., 2022 ; Karamagi et al . 2022 ; Sagan et al ., 2021 ). Despite various definitions, resilience in health systems is understood as the collective ability to mitigate, respond, and recover from disruptions, maintain essential services, and learn for improvement. Methods Analytical framework The study adopted the OECD Framework to explore how health systems responded to COVID-19 on a global stage and the lessons that can be drawn to guide Ghana’s efforts toward strengthening the resilience of its health system ( OECD, 2022 ). The Framework focuses on three main policy responses corresponding to the different phases of the risk management cycle: pandemic preparedness, crisis management, and response and recovery (see Figure 1 ). Figure 1. Framework for evaluating COVID-19 responses. (Figure 1 has been reproduced with permission from [OECD (2022). First lessons from government evaluations of COVID-19 responses: A synthesis https://www.oecd.org/ ]. Pandemic preparedness involves anticipating and developing the capacity to respond to potential pandemics. It entails risk-anticipation capacities, critical sector preparedness, and pandemic management protocols. Crisis management refers to the policies and actions implemented during the COVID-19 pandemic. It involves risk-anticipation capacities, critical sector preparedness, and pandemic management protocols. Response and recovery are related to strategies to mitigate pandemic effects, support economic recovery, and protect vulnerable groups. These measures include lockdowns and restrictions to prevent the spread of the virus; financial assistance to households, companies, and markets to lessen the effects of the economic downturn; health initiatives to safeguard and treat the populace; and social initiatives to protect the most vulnerable groups. Guided by the framework, this paper examined publications, reports, and policy documents related to the health system’s resilient response to COVID-19 in three main thematic areas: preparedness, crisis management, and response and recovery. Design A scoping review based on the synthesis of published journal articles and grey literature was used to gather relevant evidence to address the research question. This approach allowed us to explore the extensive literature on the global response to the COVID-19 pandemic. The scoping review process followed the methodological framework proposed by Arksey and O’Malley (2005) . In reporting the outcomes of the scoping review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) checklist (Figure S2 attached as Extended Data) ( Tricco et al. , 2018 ). Eligibility criteria The primary inclusion criteria were papers that were published in English and focused on health system resilience related to COVID-19. Other inclusions were papers that discussed strategies for health emergencies or pandemic preparedness and response. The exclusion criteria included papers not marched with the research design, papers unrelated to healthcare system resilience (e.g., climate, environment, food security), those solely focused on the delivery of health services without considering the broader health system, clinical trials, or protocols as well as disease-specific conditions other than COVID-19. To ensure that the literature was contemporary with the emergence of the COVID-19 pandemic, papers published in English from 2020 onwards were considered. Information sources Online searches were conducted from May to June 2023 for relevant journal articles and gray literature related to health system preparedness and response to the COVID-19 pandemic. Journal articles were accessed from Medline, Scopus, Health Sources, and WHO databases. Websites of national and local organizations and Google Advanced Search were used to search for grey literature. Search strategy We used the Joana Briggs Institute (JBI) three-step search process to identify records for the review ( Peters et al. , 2015 ). The search strategy was developed in consultation with, and refined based on input from a librarian. First, we conducted a preliminary search using Medline and Google Scholar to gather background information and identify previous studies relevant to our topic. The analysis of these materials and their reference lists guided the authors in deciding to include journal articles, policy briefs, commentaries, editorials, and reports in the review process. In the second step, the first two authors searched across all four included databases using the search strategy, which had been refined based on all identified keywords and index terms from the first step. In the third step, the reference list of all the identified papers and reports was searched for additional sources. The search queries were structured at three levels. Level 1 included terms related to health system resilience, such as “resilient,” “health system resilience,” “coping COVID-19,” “health system adaptation,” and “health system preparedness.” Level 2 terms focused on COVID-19, including “coronavirus,” “COVID,” “SARS-CoV-2,” “COVID-19,” “COVID-19 pandemic,” and “COVID-19 response strategies.” Level 3 terms denoted public health events, such as “health emergency,” “health emergency preparedness,” “health emergency response,” “shock,” and “health security.” During the search, we employed Boolean operators such as AND/OR to combine the search terms. The search strategy included the application of truncation and wild cards to broaden the search. Screening and selection process The screening involved reviewing the title and abstract of papers identified for inclusion in the study. The first two authors independently screened the titles and abstracts to identify potential articles for full-text assessment. They then assessed the selected full-text articles to confirm that the studies met the inclusion criteria. Where necessary, the authors sought additional clarity regarding article eligibility from the third author, who served as an impartial arbitrator. We used the PRISMA flow diagram (See Extended data; Ankomah et al ., 2024 ) to show how the study progressed at each stage of the review process. Data extraction A Microsoft Excel , version 2403, spreadsheet was used to systematically capture the characteristics from the included studies. These characteristics included the source (author(s) and year of publication) document type (articles and reviews, editorials and commentaries, conference and meeting reports, policy briefs), focus areas, and intervention (response strategies). Retrieved references were managed using Mendeley Reference Manager , version 2.98.0. The elements in our analytical framework guided the process of data extraction. Given the exploratory nature of scoping reviews, we focused on mapping the existing literature. No critical evaluation of the quality of individual articles was done, as this is not part of the standard methodology of scoping reviews. All three authors independently charted the data to enhance reliability. Data analysis and reporting We adopted a thematic content analysis approach to analyze the data extracted from the literature review. We structured our data analysis and reporting using the OECD framework’s main policy response areas: pandemic preparedness, crisis management, and response and recovery (see Figure 1 ). Within this framework, we systematically analyzed each theme and its elements (sub-themes), identifying key areas of focus and synthesizing the strategies implemented. Additionally, we provided illustrative examples from various countries to showcase the diverse approaches adopted globally to address the COVID-19 pandemic. This approach allowed us to organize and present our findings in a structured and cohesive manner. Results The initial database searches yielded 1,768 online materials. After removing duplicates, 1,744 unique records proceeded to the title and abstract screening phase. Following this screening process, 305 records were left for full-text review. From these, 80 studies met the inclusion criteria as illustrated in Figure 2 . Figure 2. The PRISMA flow chart for systematic reviews was used to illustrate the selection processes. The 80 publications retained for the analysis were published between January 2020 and June 2023. The majority of these documents consisted of original articles and reviews (n=71, 88.8%). Editorials and commentaries constituted 3.8% (n=3), conference and meeting reports 2.5% (n=2), and policy briefs 5% (n=4) of the total. Table 1 summarizes the results of the thematic analysis. Table 1. Summary of the thematic analysis. Sub-theme Key areas of focus Response strategies Sources 1. Emergency preparedness Disaster Risk Anticipation and Foresight Strengthening monitoring, surveillance, and early warning systems • Conducting risks and vulnerability assessment • Promoting research and development and investing in essential public health functions including those needed for all-hazards emergency risk management • Enhancing surveillance strategies (early case detection, investigation, isolation, and referrals; alert and rumor management, contact tracing, and community-based surveillance) • Decentralizing contact tracing and supporting regional and district teams • Training of Rapid Response Teams for effective operational response • Leveraging technology to facilitate contact tracing efforts and real-time electronic data analysis and transmission • Enhancing data stewardship and data governance systems • Lanyero et al ., 2021 • Williams, Fahy, et al ., 2022 • Talisuna et al. , 2022 • Okeke, et al. , 2022 • Haldane et al ., 2021 • Chua et al ., 2020 • Arabi et al ., 2021 • Kuguyo et al ., 2020 • Abubakar et al ., 2022 • Gebremeskel, et al ., 2021 • Aisyah et al ., 2022 • Chang et al ., 2020 • Fawole et al ., 2023 • Wang et al ., 2021 • Moonasar et al ., 2021 • Sundararaman et al ., 2021 • Binagwaho et al ., 2020 • Dzinamarira et al ., 2021 • Mghamba et al ., 2023 Emergency protocols Procedures and guidelines to follow in the event of pandemics or emergencies • Development and implementation of emergency protocols including: - Emergency Preparedness and Response Plans (EPRPs), checklists and protocols - Clinical tools and guidelines for infectious disease case management - Guidelines for personal hygiene, surveillance, contact tracing, quarantine, diagnosis, and laboratory tests - Disaster response/management toolkit for scalability and surge capacities - Public health emergency contingency plans for Ports of entry • Dzinamarira et al ., 2021 • Hunte et al ., 2020 • Zikargae, 2020 • Mghamba et al ., 2023 Preparedness of critical sectors National critical infrastructure in anticipation of epidemics and pandemics • Strengthening logistics and supply chain management • Expanding national ICU capacity. • Creating strategic reserves of essential equipment and health products • Developing the capacity to produce medical countermeasures for epidemic-prone diseases. • Prioritizing domestic production capacity for medical equipment, pharmaceuticals, vaccines, and drug discovery. • Investing in integrated health infrastructures • Establishing public policies and regulatory frameworks for healthcare digitization • Arabi et al ., 2021 • Williams, Scarpetti, et al ., 2022 • Balde et al. , 2022 • Gouya et al ., 2023 • Ven Ginneken et al ., 2022 • Gebremeskel, et al ., 2021 2: Management of crisis Crisis Communication Communication and engagement with the public and communities • Timely, transparent, and accurate government communication • Establishment of dedicated hotlines and communication channels • Development of communication materials and apps • Social mobilization and sensitization campaigns through partnerships with CSOs • Monitoring and addressing misinformation • Stakeholder participation and engagement, involving community influencers • Forming partnerships with social media companies and mobile network providers to disseminate key health messages. • Addressing stigma and resistance through intensive social awareness campaigns • Tailoring messages and campaigns to specific populations • Chua et al ., 2020 • Dzinamarira et al ., 2021 • Talisuna et al. , 2022 • Lanyero et al ., 2021 • Okeke, et al. , 2022 • Ha et al ., 2020 • Mghamba et al ., 2023 • Thomas et al ., 2020 • Abubakar et al . 2022 • Al Siyabi et al ., 2021 • Alami et al ., 2021 • Alava & Guevara, 2021 • Bloomstone et al ., 2022 • Chhim et al ., 2023 • Corbin et al ., 2021 • Thu et al ., 2022 • Zikargae, 2020 • Moonasar et al ., 2021 • Akande et al ., 2023 Governance arrangements Country-level response coordination • High-level political leadership and sustained commitment • Establishment of the National Steering Committee (NSC) for COVID-19 • Activation of NPHEOC • Clear chain of command, accountability, and strategic direction • Regular media briefings and communication through television, radio, websites, and social media • Data-driven decision-making, evidence-informed guidelines, and efficient information management • Strengthening coordination platforms and involving relevant sectors (a whole-of-government approach) • Development of COVID-19 Preparedness and Response Plans aligned with the National Response Framework • Effective governance frameworks emphasizing transparency and accountability • Coordinating response beyond national borders • Talisuna et al. , 2022 • Lanyero et al ., 2021 • Thomas et al ., 2020 • Chua et al ., 2020 • Sagan et al ., 2022 • Forsgren et al ., 2022 • Fleming et al ., 2022 • Gouya et al ., 2023 • Ha et al. , 2020 • Haldane et al ., 2021 • Hunte et al ., 2020 • Mghamba et al ., 2023 • Alami et al ., 2021 • Assefa, Woldeyohannes, et al ., 2022 • Bigoni et al ., 2022 • Burke et al ., 2021 • Coccia, 2022 • Desson, Lambertz, et al ., 2020 • Desson, Weller, et al ., 2020 • Djalante et al ., 2020 • Tille et al ., 2022 • Thu et al ., 2022 Whole-of-Society Response Institutionalising mechanism for multi-sectoral and multidisciplinary response • Fostering multi-sectoral and multi-disciplinary response - Collaborating with the private sector, academia, civil societies, etc - Partnership with international agencies and organizations - Inclusive engagement of communities through partnership with local leaders and influencers - Transparent communication, collaboration within the health system, and partnerships with external groups • Lanyero et al. , 2021 • Dzinamarira et al ., 2020 • Dzinamarira et al ., 2021 • Okeke, et al. , 2022 • Aisyah et al ., 2022 • Bloomstone et al ., 2022 • Lanyero et al ., 2021 • Haldane et al. , 2021 3. Response and recovery Lockdown and restrictions Implementation of containment, isolation, and mitigation measures to reduce the spread of infection • Declaration of a state of emergency and implementation of stringent lockdown measures • Intensive testing and case confirmation • Contact tracing and isolation of infected persons • Enforcement of non-pharmaceutical measures (social distancing, confinement, personal hygiene, handwashing, hand sanitizing, and use of masks in public places). • Environmental disinfection • Ban on public and mass social gatherings • Travel bans (air, road, and sea transportation) • Closure of businesses, industries, and schools • Workplace monitoring and screening for COVID-19 symptoms • Provision of mandatory WASH materials at entrances of work and commercial places • Khanna et al ., 2020 • Kavanagh, et al . 2021 • Talisuna et al. , 2022 • Dzinamarira et al ., 2020 • Dzinamarira et al ., 2021 • Amin Tabish, 2020 • Kuguyo et al ., 2020 • Emahi et al ., 2021 • Beesley et al ., 2023 • Binagwaho et al ., 2020 • Chang et al ., 2020 • Desson, Weller, et al ., 2020 • Džakula et al. , 2022 • Tille et al ., 2022 • Webb, Winkelmann, et al ., 2022 • Moonasar et al ., 2021 Ports of Entry (PoEs) • Closure of national borders • Ensuring compliance with WHO IHR at the PoEs • Strengthening screening and surveillance at PoEs • Case detection, mandatory quarantine, and surveillance reporting for international arrivals • Availability of information, education, and communication materials at PoEs, including thermal scanners and infrared thermometers • PCR tests and rapid antigen tests conducted for inbound and outbound travelers • Dzinamarira et al ., 2020 • Dzinamarira et al ., 2021 • Lanyero et al ., 2021 • Kuguyo et al ., 2020 • Alava & Guevara, 2021 • Binagwaho et al ., 2020 • Tabish, 2020 • Chua et al ., 2020 • Wang et al ., 2021 • Wang, et al ., 2020 Economic and Financial Support Financing mechanisms to provide stability of health system and relief for businesses and households • Ensuring the uninterrupted flow of funds to support outbreak preparedness and response • Implementation of tax-based measures including tax relief, deferred tax reporting, and income tax payment for individuals and small enterprises • Reduction in interest rates for citizens and businesses and soft loans to local manufacturing companies • Drawing on financial reserves, budget reallocations, and borrowing • Funding support from development partners • Creation of a special fund for COVID-19 response • Increasing budgetary allocations to the health sector • Adapting payment systems to the new environment • Minimizing opportunities for corruption • Bhatia & Abraham, 2022 • Thomas et al ., 2020 • Alami et al ., 2021 • Sagan et al ., 2022 • Chua et al ., 2020 • United Nations Economic Commission for Africa, 2020 • Fakher & Abiari, 2020 • Haldane et al ., 2021 • Okeke, et al. , 2022 • Desson, Lambertz, et al ., 2020 • Desson, Weller, et al ., 2020 • Adebis et al ., 2021 • Djalante et al ., 2020 • Dzinamarira et al ., 2021 • United Nations, 2021 Social policies Social protection measures • Social assistance: cash and other in-kind transfer • Social insurance: health protection, social security, unemployment insurance • Labour market subsidies (special allowances or grants, wage subsidies, leave benefits) • Access to basic services (housing, water, sanitation electricity, education, etc) • Hunte et al ., 2020 • Baptista et al ., 2021 • United Nations Development Programme, 2021 • United Nations, 2021 • Béland et al ., 2021 • Aidukaite et al ., 2021 • Chua et al ., 2020 • Webb, Winkelmann, et al ., 2022 • Banda Chitsamatanga & Malinga, 2021 Health Measures Human Resources • Mobilizing and recruiting additional health workers and volunteers: - Increasing recruitment quotas. - Utilising final-year medical and nursing students for support. - Bringing back retired health professionals. - Seeking assistance from other countries or organizations. • Scaling-up capacity among the existing health workforce - Extending working hours and changing contracts. - Temporarily canceling leave and modifying registration requirements. • Protecting health workers from physical, mental, and financial pressures - Implementing hygiene measures in healthcare facilities. - Regular testing to identify and control infections. - Providing financial and social support • Sagan et al ., 2022 • Chua et al ., 2020 • Kavanagh et al ., 2021 • Williams, Maier, et al ., 2022 • Williams, Scarpetti, et al ., 2022 • Ginneken et al ., 2022 • Fleming et al ., 2022 • Okeke, et al. , 2022 • Gouya et al ., 2023 • Burau et al ., 2022 • Haldane et al ., 2021 • Hunte et al. , 2020 • Winkelmann, Panteli et al. , 2022 • Winkelmann, Webb, et al. , 2022 • Alami et al ., 2021 • Assefa, Gilks, et al ., 2022 • Buchan et al ., 2021 • Džakula et al ., 2022 Tille et al ., 2022 Maintaining essential health service delivery • Skill-mix changes to shift primary care tasks to nurses • Leveraging primary health care for essential services • Introducing new care pathways to reach patients • Providing guidelines for service continuity during outbreaks, • Utilizing the private sector to augment capacity • Implementing teleconsultations and digital health tools to support service delivery • Assaye & Shimie, 2022 • Webb, Lenormand, et al ., 2022 • Thomas et al ., 2020 • Gouya et al ., 2023 • Mghamba et al ., 2023 • Williams, Fahy, et al ., 2022 • Alami et al ., 2021 • Assefa, Gilks, et al ., 2022 Case management • Deployment of experts, training, and SOPs • Increasing critical care capacity • Establishing centers for effective clinical management of COVID-19 cases • Home-based isolation and management of COVID-19 cases • Postponing elective treatments and surgeries • Establishing hospital networks, both within countries and across borders • Talisuna et al. , 2022 • Olu et al ., 2022 • Lanyero et al ., 2021 • Ha et al ., 2020 • Hunte et al. , 2020 • Winkelmann, Panteli et al. , 2022 • Winkelmann, Webb, et al. , 2022 • Khanna et al ., 2020 • Okeke et al. , 2022 Facility-based infection prevention and control (IPC) • Limiting healthcare facility visits • Conducting screening for COVID-19 symptoms • Strengthening IPC through capacity building and environmental control. • Developing and implementing IPC response plans and guidelines • Improving access to WASH services • Talisuna et al. , 2022 • Olu et al ., 2022 • Khanna et al ., 2020 • Dzinamarira et al ., 2021 • Balde et al ., 2022 • Chua et al ., 2020 • Abu & Elliott, 2022 Operational support and logistics • Block-booking private hospital beds, equipment, and staff to increase capacity • Repurposing non-health facilities and establishing temporary facilities to accommodate mild cases • Repurposing surgical rooms, anesthesia machines, and clinics for critical care • Refurbishing designated hospitals as COVID-19 isolation centers • Building purpose-built facilities with integrated functions for infectious disease management • Ensuring the appropriate distribution of resources (consumables, devices, and pharmaceuticals) • Leveraging technology for efficient resource management • Utilizing dedicated global platforms for procurement and logistic support to secure essential equipment, medicines, and supplies • Securing support, including donations from local and international organizations • Olu et al ., 2022 • Williams, Fahy, et al ., 2022 • ven Ginneken et al ., 2022 • Lanyero et al ., 2021 • Okeke, et al. , 2022 • Haldane et al ., 2021 • Mghamba et al ., 2023 • Winkelmann, Panteli et al. , 2022 • Winkelmann, Webb, et al. , 2022 • Chua et al ., 2020 • Hunte et al ., 2020 • Alava & Guevara, 2021 • Bhaskar et al ., 2021 • Džakula et al ., 2022 • Wang et al ., 2020 • Wasswa et al ., 2023 • Webb, Winkelmann et al ., 2022 • Moonasar et al ., 2021 • Khanna et al ., 2020 Laboratory diagnosis and management • Establishing and strengthening in-country laboratory networks • Implementing a robust system of large-scale testing for epidemic control • Leveraging existing laboratory infrastructure and diagnostics industry to expand testing capacity • Repurposing research facilities and resources to expand laboratory centers during the pandemic • Collaborating with the private sector to enhance testing capabilities • Decentralizing laboratory capacity through peripheral district laboratories • Shifting from manual RNA extraction to an automated system for quicker results using a pooling system • Leveraging technology to deploy rapid diagnostic tests • Talisuna et al. , 2022 • Dzinamarira et al ., 2021 • Lanyero et al ., 2021 • Tabish, 2020 • Balde et al ., 2022 • Okeke, et al. , 2022 • Aisyah et al ., 2022 • Tessema et al ., 2021 • Tille et al ., 2022 • Webb, Winkelmann, et al ., 2022 Vaccine management • Developing and implementing vaccination plans and programs • Prioritizing high-risk groups in the initial phase of vaccination efforts • Utilizing the existing primary healthcare supply chain to boost vaccination efforts • Leveraging existing immunization structure to expand vaccination • Fostering partnerships with various stakeholders to expand coverage and enhance vaccine equity • Domestic production of COVID-19 vaccines • Massive advocacy and risk communication to minimize vaccine hesitancy • Utilising digital health tools for the effective rollout of vaccination programs • Olu et al ., 2022 • Williams, Fahy, et al ., 2022 • Gouya et al ., 2023 • Alava & Guevara, 2021 • Amani et al ., 2023 • Bloomstone et al ., 2022 • Zhang et al ., 2022 Global health systems response to COVID-19 pandemic In the following paragraphs, we delve into the strategies implemented by various countries in addressing the challenges posed by the COVID-19 pandemic. These strategies are analyzed through the lens of the OCED’s comprehensive framework encompassing three main domains: preparedness for emergencies, crisis management, and response and recovery. Emergency preparedness Emergency preparedness encompasses three sub-themes: disaster risk anticipation and foresight, emergency protocols, and preparedness of critical sectors ( Table 1 ). Disaster risk anticipation and foresight Disaster risk anticipation and foresight involve understanding hazards, developing risk-assessment capacities, and employing response strategies ( OECD, 2022 ). Risk and vulnerability assessments were noted to be crucial for preparedness and response in Ethiopia and Malawi during the COVID-19 pandemic ( Lanyero et al. , 2021 ; Mghamba et al. , 2023 ). Robust surveillance systems with early detection mechanisms were effectively implemented in South Korea, Vietnam, Singapore, China, and Australia, leading to the timely implementation of containment measures ( Chua et al. , 2020 ; Sundararaman et al. , 2021 ; Wang et al. , 2021 ; Williams, Fahy, et al. , 2022 ). A comprehensive range of surveillance approaches, including case investigation, contact tracing, community-based initiatives, laboratory-based sentinel surveillance, serological studies, telephone hotlines, and genomic sequencing, also improved disease detection and response in Congo, Nigeria, Senegal, and Uganda ( Okeke et al. , 2022 ; Fawole et al. , 2023 ). Digital health tools such as Big Data in Singapore and Taiwan and the Surveillance Outbreaks Response Management and Analysis System (SORMAS) in Nigeria enhanced monitoring. China, Israel, India, South Korea, Singapore, Rwanda, and Tanzania employed GPS tracking, credit card records, surveillance videos, and mobile applications ( Chang et al. , 2020 ; Kuguyo et al. , 2020 ; Mghamba et al. , 2023 ; Okeke et al. , 2022 ; Wang et al. , 2021 ). European countries adapted digital health tools, such as France’s “TousAntiCovid” app. New Zealand, Sweden, and the US used syndromic surveillance, while China, Fiji, India, Japan, and Vietnam utilized real-time reporting systems for COVID-19 cases ( Haldane et al. , 2021 ; Williams, Fahy, et al. , 2022 ). Data governance was vital; South Africa used epidemiological data for interventions ( Moonasar et al. , 2021 ) and the Eastern Mediterranean region employed collaborative surveillance ( Abubakar et al. , 2022 ). Investment in research and development contributed to preparedness, as exemplified by Rwanda, while Indonesia’s health system foundations enabled proactive responses ( Aisyah et al. , 2022 ; Binagwaho et al. , 2022 ). These examples emphasize the importance of risk assessment, surveillance, and digital technology in disaster response. Emergency protocols Emergency protocols provide a structured framework for coordinated responses during emergencies ( OECD, 2022 ). Countries, including Rwanda, Trinidad and Tobago, Iran, and Sri Lanka, developed national policies and guidelines for COVID-19 prevention, clinical tools, and healthcare provider guidelines to ensure an effective response ( Dzinamarira et al. , 2020 ; Gouya et al. , 2023 ; Hunte et al. , 2020 ; Mghamba et al. , 2023 ). Ethiopia also developed comprehensive standards, guides, and protocols to effectively respond to the COVID-19 pandemic. These documents covered various aspects, such as quarantine, infection prevention and control, border control, case management, and home-based care ( Lanyero et al. , 2021 ; Zikargae, 2020 ) and are vital for strenthening health system resilience by ensuring coordinated and effective responses to crisis. Preparedness of critical sectors The analysis revealed various strategies to enhance preparedness in critical sectors during the COVID-19 pandemic. These include maintaining strategic reserves of PPEs, ICU devices, consumables, and pharmaceuticals, optimizing supply chains and utilization protocols, and providing adequate healthcare professional training ( Arabi et al. , 2021 ; Williams, Fahy, et al. , 2022 ). Public-private partnerships, research and development, and the continued use of digital health tools were also identified as crucial for building resilience and response capabilities during pandemics ( Coccia, 2022 ). Additionally, improving the healthcare infrastructure, especially in the production and delivery of oxygen and therapeutics, was vital for better preparedness and management of future public health emergencies ( Gebremeskel et al. , 2021 ; Gouya et al. , 2023 ). These measures are critical in preparing for and effectively managing future public health emergencies. Management of crisis Crisis management involves timely and coordinated policies and actions implemented by governments to effectively respond to and address crises ( OECD, 2022 ). This encompasses crisis communication, government arrangements, and a whole-of-society response. Crisis communication Transparent communication with the public during the COVID-19 pandemic fostered trust and compliance with containment measures ( Thomas et al. , 2020 ). Countries such as Singapore, Trinidad, Tobago, and Vietnam utilized regular media briefings and transparent information sharing through official and social media ( Chua et al. , 2020 ; Ha et al. , 2020 ; Hunte et al. , 2020 ). Ecuador provided reliable information and practical hygiene measures ( Alava & Guevara, 2021 ), whereas New York’s local health departments used various channels and trusted messengers to reach underserved communities and boost vaccination rates ( Bloomstone et al. , 2022 ). Community engagement proved crucial for enhancing disease control and promoting health literacy during the pandemic, facilitating collaboration and adaptability in response strategies. The Eastern Mediterranean region emphasized active community engagement and transparent communication to promote public health measures and acceptance of COVID-19 vaccination ( Abubakar et al. , 2022 ). Oman used community participation through organizations, health committees, and volunteers, while Cambodia’s Ministry of Health implemented risk communication and engagement campaigns ( Al Siyabi et al. , 2021 ; Chhim et al. , 2023 ). African countries like Rwanda, South Africa, Zimbabwe, Nigeria, and Malawi utilized diverse channels, including SMS, WhatsApp, radio, television, and hotlines, to disseminate verified information, debunk rumors, and raise awareness about COVID-19( Akande et al. , 2023 ; Dzinamarira et al. , 2020 ; Mghamba et al. , 2023 ; Moonasar et al. , 2021 ; Okeke et al. , 2022 ; Talisuna et al. , 2022 ). Community-based programs and capacity-building initiatives strengthened responses in Congo and Uganda ( Corbin et al. , 2021 ; Thu et al. , 2022 ). CHWs in South Africa and Tanzania play a vital role in bridging communities and health systems, emphasizing community buy-in and addressing the social determinants of health ( Gebremeskel et al ., 2021 ). These examples underscore the importance of transparent communication and active community engagement in enhancing public trust, promoting health literacy, and facilitating adaptable and inclusive response efforts during crises. Governance arrangements Countries adopted various governance approaches during the pandemic, each with distinct outcomes. Germany’s decentralized approach empowered regional authorities, while Austria and Switzerland relied on centralized decision-making and effectively managed the health crisis. France’s centralized approach facilitated resource coordination but caused delays in testing policies. Canada’s decentralized setting resulted in varying success rates, and Belgium faced challenges due to the shared responsibilities between national and regional governments. Federated countries such as the US, Spain, and Australia witnessed governance variations, with states taking the lead. In Southeast Asia, responses were marked by controversies, power asymmetries, and political instability ( Desson, Lambertz, et al. , 2020 ; Desson, Weller, et al. , 2020 ; Djalante et al. , 2020 ; Ha et al. , 2020 ; Kavanagh et al. , 2021 ). Strong high-level political leadership was crucial in coordinating stakeholders and strengthening health systems ( Thomas et al ., 2020 ). Ethiopia, Trinidad, and Tobago demonstrated strong leadership through coordination structures, such as the PHEOC and the COVID Plan ( Hunte et al ., 2020 ; Lanyero et al ., 2021 ). Countries utilized multi-ministerial coordination platforms, such as task forces and committees, for a whole-of-nation response. Ethiopia, Singapore, Iran, Guyana, and Sri Lanka implemented such approaches ( Chua et al ., 2020 ; Gouya et al ., 2023 ; Mghamba et al ., 2023 ). Coordinated responses, including regional collaborations such as the Africa CDC and the European Union’s joint vaccine procurement, were crucial ( Beesley et al. , 2023 ; Lanyero et al. , 2021 ). Effective governance involved transparency, accountability, and informed decision-making. Denmark, Switzerland, Italy, and Ethiopia exemplified these practices ( Lanyero et al., 2021 ; Tille et al. , 2022 ). Collaborative leadership and stakeholder involvement fostered trust ( Assefa, Woldeyohannes, et al. , 2022 ; Bigoni et al. , 2022 ; Burke et al. , 2021 ; Tille et al. , 2022 ; Thu et al. , 2022 ). Flexibility in decision-making, and addressing challenges such as misinformation was crucial ( Djalante et al. , 2020 ; Forsgren et al. , 2022 ). These examples suggest that strong leadership, transparent governance, and multi-sectoral coordination are essential for strengthening future health system resilience. Whole-of-society response Whole-of-society response involved stakeholder engagement and partnerships among government agencies, communities, NGOs, and CSOs to collectively implement preventive measures, mobilize and manage resources to minimize the pandemic impact ( Aisyah et al. , 2022 ). Several strategies emerged from the analysis of this area. Rwanda, South Africa, Zimbabwe, and Nigeria successfully engaged stakeholders from various sectors in their COVID-19 response ( Dzinamarira et al ., 2021 ; Okeke et al ., 2022 ). In Ethiopia, private partnerships expanded emergency response capacity through collaboration with university institutions, private hospitals, and laboratories ( Lanyero et al ., 2021 ). Strategic partnerships with international agencies and organizations enhanced COVID-19 response and management, such as the collaboration between the Pasteur Institute of Dakar and a UK-based biotech laboratory, leading to a rapid diagnostic test in Ethiopia ( Dzinamarira et al ., 2020 ). Community engagement through partnerships with local leaders and CHWs played a pivotal role in supporting non-pharmaceutical interventions, maintaining essential health services, and providing medication in countries such as Thailand, Singapore, Liberia, and the US ( Haldane et al ., 2021 ; Bloomstone et al ., 2022 ). Response and recovery The response and recovery policies aimed at mitigating the impacts of the pandemic and economic crisis on citizens and businesses, supporting economic recovery, and reducing welfare losses ( OECD, 2022 ). These policies encompassed lockdown and restriction measures, economic and financial support, social policies, and health measures. Lockdown and restrictions Many countries implemented various travel restrictions and bans. Germany, Australia, and Singapore enforced strict measures such as cruise line bans, quarantine requirements, and limited overseas travel ( Kavanagh et al ., 2021 ). Bulgaria, Croatia, and Romania initially imposed border closures, flight suspensions, and educational institution closures, which led to societal and economic consequences ( Džakula et al. , 2022 ). Estonia, Latvia, and Lithuania implemented early and effective lockdown measures, clear communication, and strengthened testing and contact tracing efforts ( Webb, Winkelmann et al ., 2022 ). Asian countries such as China, Singapore, Taiwan, Hong Kong, and South Korea successfully flattened their curves through lockdowns, testing, and rapid responses ( Khanna et al. , 2020 ; Tabish, 2020 ). Some European and American countries faced challenges owing to delayed containment measures, leading to devastating surges and lockdowns ( Desson, Weller, et al. , 2020 ; Khanna et al. , 2020 ). In Africa, most countries responded swiftly to strict lockdowns, providing PPE, testing, and isolating infected individuals ( Talisuna et al. , 2022 ; Dzinamarira et al. , 2020 , 2021 ; Emahi et al. , 2021 ). Rwanda and Uganda demonstrated exemplary responses by prioritizing social distancing and travel restrictions even before registering their first cases ( Binagwaho et al ., 2020 ). Countries also implemented strategies to scale up contact tracing during the COVID-19 pandemic, redirecting health workers, digitalizing tracing operations, and contracting with outsourcing corporations. Germany allocated €50 million to digitalization and hiring tracers, while Austria’s local health offices led contact tracing. Inadequate support for isolating individuals, especially those with low incomes or precarious jobs, led to continued normal activities ( Tille et al ., 2022 ). Port of entries (PoEs) Countries implemented various strategic responses to enhance preparedness at PoE in managing the COVID-19 pandemic, including enhanced health screening, information gathering, and contact tracing for arriving passengers. African countries adhered to WHO International Health Regulations (IHR) with measures such as mandatory negative COVID-19 PCR tests for travellers. Rwanda implemented repeat testing and 24-hour quarantine, whereas South Africa and Zimbabwe conducted pre-arrival testing. Stricter measures addressed the challenges of fake certificates ( Dzinamarira et al. , 2020 , 2021 ). Ethiopian Airlines played a crucial role in training staff and transporting medical supplies ( Lanyero et al ., 2021 ). Taiwan and Hong Kong employed passenger screening, flight suspensions, and mandatory quarantine for travellers from Wuhan ( Tabish, 2020 ). Singapore, Israel, and South Korea used mobile apps for contact tracing and enforced various travel restrictions ( Chua et al. , 2020 ; Kuguyo et al. , 2020 ; Wang et al. , 2020 ; Wang et al. , 2021 ). Ecuador closed its borders to exposed countries and established testing and tracing capacities ( Alava & Guevara, 2021 ). International collaboration addressed cross-border economic challenges ( Binagwaho et al. , 2022 ). These strategic responses highlight the importance of comprehensive screening, testing, and international collaboration at points of entry in strengthening health system resilience against future pandemics. Economic and financial support COVID-19 required sustained funding for outbreak response, and countries employed various strategies. Health financing policies were crucial in resource-constrained settings, with competing priorities ( Bhatia & Abraham, 2022 ). Public funds were used for testing, treatment, vaccines, and supporting businesses and low-income households ( Haldane et al. , 2021 ). Countries tapped into reserves, reallocated budgets, and borrowed funds to manage increased health expenditure and economic impact ( Sagan et al. , 2022 ). In Europe, Germany, Austria, Switzerland, France, and Belgium introduced substantial support packages, with Germany allocating €156 billion to the MOH ( Desson, Lambertz, et al ., 2020 ; Desson, Weller, et al ., 2020 ). Spain and Ireland utilized private-sector capacity ( Thomas et al ., 2020 ). Canada implemented wage subsidies and financial aid ( Alami et al. , 2021 ; Desson, Weller, et al. , 2020 ). In Asia, Singapore committed 60 billion SGD to support businesses and livelihoods, and Thailand implemented stimulus packages totalling 217 billion baht ( Chua et al ., 2020 ; Djalante et al ., 2020 ). In Africa, Morocco, Algeria, Egypt, Libya, Mauritania, and Sudan implemented various measures, including a USD 3.3 billion COVID-19 Fund in Morocco and an IMF Rapid Credit Facility disbursement of $130 million in Mauritania ( United Nations Economic Commission for Africa, 2020 ; Fakher & Abiari, 2020 ). Nigeria mobilized funds from the 2020 budget and special intervention funds, while South Africa allocated $10.6 million for aid and relief ( Adebisi et al. , 2021 ; Okeke et al. , 2022 ; United Nations, 2021 ). Addressing corruption within governments was crucial, with Rwanda’s anti-corruption model serving as an exemplar ( Dzinamarira et al ., 2021 ). Flexibility in payment systems and incentivizing telemedicine were also observed ( Sagan et al ., 2022 ; Thomas et al ., 2020 ). These strategies emphasize that sustained and flexible financing, alongside anti-corruption measures, is essential for strengthening health system resilience against future emergencies. Social policies The analysis identified several social protection measures implemented by various countries to address social disparities and mitigate the impact of the COVID-19 pandemic. African countries introduced several social protection measures, primarily focusing on non-contributory programs such as special allowances, food, nutrition protection, and health support. However, aspects such as access to education, sickness benefits, and family benefits received less attention. Women’s needs were also overlooked, with only 16% of interventions specifically targeting them ( United Nations, 2021 ). Access to essential services such as water and sanitation posed challenges, hindering viral control, especially in vulnerable communities in South Africa and Zimbabwe ( Banda Chitsamatanga & Malinga, 2021 ). European countries provided extensive job and enterprise protection, coupled with solidaristic policies to care for the most vulnerable, including strengthened minimum income schemes, but access remained challenging for non-standard workers. ( Baptista et al. , 2021 ). Arab countries used digital delivery methods for social protection targeting informal workers, foreign workers, persons with disabilities, and refugees ( United Nations Development Programme, 2021 ). Canada and the US addressed housing, employment, and social assistance challenges with various measures ( Béland et al. , 2021 ). Several countries enhanced their health services to make them accessible to all, including non-nationals in Trinidad and Tobago, Estonia, Latvia, and Lithuania ( Hunte et al. , 2020 ; Webb, Winkelmann, et al. , 2022 ). Singapore’s private insurers extended coverage for COVID-19 hospitalization, but noncompliance with travel advisories resulted in ineligible subsidies at public hospitals ( Chua et al ., 2020 ). Health measures Health measures encompass human resource strategies, maintenance of essential services, case management, facility-based infection prevention and control (IPC), logistics and operational support, laboratory diagnosis and management, and vaccine management. Human resource The COVID-19 pandemic exacerbated health workforce shortages in many countries, leading to the adoption of various HR response strategies to address the surge in demand, protect healthcare workers, and scale-up capacity ( Assefa, Gilks, et al. , 2022 ; Džakula et al. , 2022 ; Fleming et al. , 2022 ; Haldane et al. , 2021 ; Hunte et al. , 2020 ; Williams, Maier, et al. , 2022 ; Williams, Scarpetti, et al. , 2022 ). Several countries, including Germany, Russia, Spain, the UK, Vietnam, the Netherlands, Austria, Portugal, and Trinidad and Tobago, increased recruitment quotas and enlisted medical and nursing students using emergency legislation ( Assefa et al ., 2022a ; Burau et al ., 2022 ; Džakula et al ., 2022 ; Haldane et al ., 2021 ; Hunte et al ., 2020 ; Williams, Maier, et al ., 2022 , Williams, Scarpetti, et al ., 2022 ). International collaborations facilitated the deployment of health professionals in regions with high COVID-19 cases ( Williams, Maier, et al ., 2022 ). Countries have simplified registration and hiring processes to include foreign-trained health professionals in their workforce. England extended visas for frontline workers from abroad, and France mobilized a “medical care reserve” consisting of various health professionals ( Winkelmann, Panteli, et al. , 2022 ). Iran utilized military staff, volunteers, and post-graduate students to support frontline healthcare providers ( Gouya et al ., 2023 ). Canadian Armed Forces and Canadian Red Cross reinforced CHSLDs ( Alami et al ., 2021 ). Scaling up capacity involved extending work hours, modifying schedules, and redeploying primary care workers in emergency care wards and ICUs in countries like Croatia, Estonia, Lithuania, Malta, the Netherlands, Portugal, Romania, Italy, and Spain ( Haldane et al ., 2021 ; Tille et al ., 2022 ; Williams, Maier, et al ., 2022 ). Skill mix changes allowed various professionals to administer vaccinations, and non-health personnel were engaged to support the non-clinical aspects of testing and vaccination programs ( Buchan et al. , 2021 ; Williams, Maier, et al. , 2022 ). Canada authorized private sector physicians to practice in the public sector alongside their private practice and engaged private clinics and physicians to address procedure delays caused by COVID-19 ( Alami et al. , 2021 ). Protecting health workers involved implementing hygiene protocols, providing sufficient PPEs, and offering remote consultation. Vaccination, infection control policies, and regular testing were also prioritized to safeguard healthcare workers ( Chua et al ., 2020 ; Džakula et al ., 2022 ; Haldane et al ., 2021 ; Hunte et al ., 2020 ; Tille et al ., 2022 ; Williams, Scarpetti, et al ., 2022 ). Maintaining essential health service delivery Countries adopted diverse approaches to sustain essential healthcare amid COVID-19. For instance, Slovenia made a task shift from GPs to nurses to reduce the GP workload in primary care ( Thomas et al ., 2020 ). Sri Lanka ensured routine care for non-communicable diseases while managing COVID-19 through a whole-of-society approach ( Mghamba et al ., 2023 ). In some countries, the private sector was utilized to maintain essential health services. To mitigate disruptions in service delivery, triaging and alternative care models such as home-based care and telemedicine were adopted. Care pathways were adjusted within hospital facilities to segregate COVID-19 patients and ensure safe treatment. Telehealth and digital consultations were widely adopted to maintain essential care and minimize exposure risks ( Assaye & Shimie, 2022 ; Assefa, Gilks, et al. , 2022 ; Webb, Lenormand, et al., 2022 ; Williams, Fahy, et al., 2022 ). The pandemic emphasized the need to strengthen long-term resilience and capacity in the health sector, particularly in primary care and public health ( Alami et al ., 2021 ). Case management Prompt deployment of experts and guidelines to guide the clinical management of COVID-19 cases was observed in most countries ( Talisuna et al ., 2022 ; Okeke et al ., 2022 ). Vietnam established a center for managing clinical support for COVID-19 patients, while Trinidad and Tobago increased their healthcare capacity by screening and isolating suspected cases ( Ha et al ., 2020 ; Hunte et al ., 2020 ). Some countries adopted home-based and community case management models to reduce pressure on the health system, but challenges arose due to the lack of specialized hospitals and technical expertise for severe cases. Shortages of critical supplies strained case management, prompting countries like South Sudan and Ethiopia to establish specialized treatment facilities ( Talisuna et al ., 2022 ; Olu et al ., 2022 ; Lanyero et al ., 2021 ). Countries managed acute care and ICU capacity by postponing elective treatments, designating specific hospitals, and utilizing private ICUs and field hospitals, while hospital networks and cross-border cooperation were crucial for effective management ( Khanna et al ., 2020 ; Winkelmann, Panteli et al ., 2022 ; Winkelmann, Webb, et al. , 2022 ). Facility-based IPC Facility-based IPC measures were critical in managing the spread of COVID-19. The analysis identified several strategies implemented by various countries in this area. In Singapore, strict IPC measures were enforced, including temperature checks, mandatory PPE usage, and visitor controls. Innovative solutions like the ‘SG SAFE’ booth were implemented for large-scale screening ( Chua et al ., 2020 ). African countries focused on capacity building, guidelines, and environmental controls to reduce the spread of COVID-19 ( Balde et al. , 2022 ; Dzinamarira et al. , 2021 ; Olu et al. , 2022 ). Some countries faced challenges with poor adherence and enforcement of IPC measures, leading to shortages of PPEs and irrational use. Additionally, inadequate water supply in health facilities compromised IPC measures, and the indiscriminate disposal of surgical masks was observed ( Abu & Elliott, 2022 ; Dzinamarira et al., 2021 ; Talisuna et al., 2022 ). Operational support and logistics Globally, countries employed diverse strategies to boost healthcare capacity during the COVID-19 pandemic. Some nations (Ireland, England, Italy, North Macedonia, Spain, and Russia) block-booked private hospitals, while others (Switzerland and Italy) enacted emergency legislation to acquire private facilities. Some countries also established field hospitals. Innovative procurement and international collaborations addressed equipment shortages ( Khanna et al. , 2020 ; Winkelmann, Webb et al. , 2022 ). Japan, the UK, the US, South Korea, and Ecuador employed various approaches, including resource distribution and domestic production encouragement. Europe utilized digital tools for telemedicine, streamlined administrative procedures, and real-time monitoring through digital registries and dashboards ( Džakula et al ., 2022 ; Winkelmann, Webb, et al ., 2022 ; Winkelmann, Panteli et al ., 2022 ). Several EU countries planned investments in digital infrastructure, ( Bhaskar et al. , 2021 ; Van Ginneken et al. , 2022 ; Webb, Winkelmann, et al. , 2022 ; Williams, Fahy, et al. , 2022 ) and in the Asia-Pacific region, Taiwan regulated mask distribution and encouraged domestic production. Singapore’s National Center for Infectious Diseases coordinated outbreak management ( Chang et al ., 2020 ; Chua et al ., 2020 ). African nations effectively utilized digital solutions; Uganda leveraged eELMIS to track and distribute COVID-19 supplies; and Rwanda used a national command post for surveillance and contact tracing. Ethiopia and South Sudan utilized global platforms for procurement, and Nigeria improved its healthcare infrastructure ( Lanyero et al. , 2021 ; Mghamba et al. , 2023 ; Moonasar et al. , 2021 ; Okeke et al. , 2022 ; Wasswa et al. , 2023 ). Trinidad and Tobago collaborated with regional partners for procurement and relied on local manufacturers for supplies ( Hunte et al ., 2020 ). Laboratory diagnosis and management The COVID-19 pandemic highlighted the critical importance of rapid and accurate laboratory diagnostic testing in various countries. The analysis identified various strategies implemented by countries in this area. Indonesia established 685 referral laboratories for COVID-19 testing, despite facing challenges with staff, reagent supply, and PPE shortages. South Korea’s large-scale testing program tested over 270,000 people ( Aisyah et al ., 2022 ; Tabish, 2020 ). In Europe, Germany used robust laboratory infrastructure to expand its testing. Denmark adapted its testing strategy over time, including milder symptoms and asymptomatic individuals. Smaller European nations utilized repurposed labs and sent samples abroad. Estonia, Latvia, and Lithuania established separate testing locations and flexible mobile sites ( Tille et al ., 2022 ; Webb, Winkelmann, et al ., 2022 ). In the WHO African region, early testing faced challenges due to reagent shortages. However, progress was made with rapid antigen tests and the COVID-19 sequencing laboratory network. Community-based surveillance using Ag-RDT reached over 7 million people. African countries such as Nigeria, Rwanda, South Africa, and Ethiopia expanded testing centers through collaborations with the private sector, repurposing research facilities, and establishing networks of existing labs ( Balde et al. , 2022 ; Dzinamarira et al. , 2021 ; Lanyero et al. , 2021 ; Okeke et al. , 2022 ; Talisuna et al. , 2022 ; Tessema et al. , 2021 ). Vaccine management Several countries, including Singapore and China, implemented effective COVID-19 vaccination plans through policy measures and transparent communication to build public trust ( Zhang et al. , 2022 ). Iran utilized its primary healthcare supply chain and mass vaccination centers, achieving a primary vaccination coverage rate of approximately 75% by January 2022. They developed local production capacity for domestic COVID-19 vaccines with WHO support ( Gouya et al ., 2023 ). Ecuador, the Central African Republic, and New York, USA, efficiently distributed vaccines through task shifting, community engagement, and partnerships with stakeholders. Digital health tools played a vital role in successful vaccine rollout ( Alava & Guevara, 2021 ; Amani et al. , 2023 ; Bloomstone et al. , 2022 ; Williams, Fahy, et al. , 2022 ). South Sudan utilized existing immunization systems for COVID-19 vaccination, straining health workers ( Olu et al ., 2022 ). Discussion Ghana’s COVID-19 response saw successes. However, there were challenges such as sporadic PPE shortages, geographical limitations in testing for COVID-19, delayed test deliveries, understaffed treatment centers, and insufficient COVID-19 lab supplies. Other concerns included safety protocol adherence, equipment readiness, healthcare infrastructure, funding, human resources, transparent vaccine procurement, and equitable healthcare ( Ayee, 2022 ; Sarkodie et al ., 2021 ). These challenges encountered during the pandemic have ignited a growing interest in strengthening Ghana’s healthcare system resilience. However, a dearth of comprehensive studies that synthesize global experiences and provide evidence-based insights for fortifying the nation’s health system resilience persists. Thus, despite Ghana’s commendable handling of the pandemic, learning from worldwide experience can further enhance its readiness for future emergencies. This review extracted pandemic-derived strategies to guide Ghana in building its health system resilience From our review, ten critical response strategies emerged, where Ghana can draw valuable lessons to enhance its preparedness for future health emergencies. These strategies align closely with Kruk et al .’s (2017) five core attributes of health system resilience, which include system awareness, integration, self-regulation, diversity, and adaptability. Whole-of-government engagement The findings of this study suggest that decisive and committed political leadership, demonstrated in various countries ( Hunte et al ., 2020 ; Lanyero et al ., 2021 ; Thomas et al ., 2020 ; Haldane et al ., 2021 ), is crucial for effective responses to health crises. This corresponds to the system awareness attribute, which underscores the importance of tracking health and mapping resources for effective response. Additionally, engaging multiple sectors beyond the health sector through whole-of-government efforts ( Chua et al ., 2020 ; Gouya et al ., 2023 ; Mghamba et al ., 2023 ) demonstrates integration, highlighting the need for coordinated efforts and societal engagement. Embracing pluralistic and adaptive leadership supported by an expanded governance framework ( Alami et al ., 2021 ; Assefa, Woldeyohannes, et al ., 2022 ; Lanyero et al ., 2021 ; Tille et al ., 2022 ; Thu et al ., 2022 ) also aligns with the adaptability attribute. It demonstrates the importance of flexible responses and evidence-based decision-making in different situations. Ghana can draw from these strategies to build a resilient health system, address the social determinants of health, and prepare for future health emergencies. Financing for preparedness The sustained funding strategies adopted by countries during the COVID-19 response highlight the critical role of health financing policies, especially in resource-constrained settings with competing priorities ( Bhatia & Abraham, 2022 ). These efforts align with the self-regulation and adaptability attributes of health system resilience. Self-regulation was evident in the reallocation of budgets, tapping into reserves, and borrowing funds to manage increased health expenditure and economic impact. Adaptability was demonstrated by countries like Germany, Austria, Switzerland, France, and Belgium ( Desson, Lambertz, et al ., 2020 ; Desson, Weller, et al ., 2020 ) introducing substantial support packages. This underscores the flexibility needed to address unforeseen challenges. Ghana can learn from these strategies to strengthen the financial capacity of its health system. This will allow it to self-regulate and adapt swiftly to changing circumstances, ultimately enhancing its ability to withstand and effectively manage health crises. Robust surveillance system The findings of this study underscore the importance of a robust surveillance system in enhancing health system and societal resilience. Effective surveillance systems, as seen in South Korea, Vietnam, Singapore, China, and Australia ( Chua et al ., 2020 ; Sundararaman et al ., 2021 ; Wang et al ., 2021 ; Williams, Fahy, et al ., 2022 ) enabled timely containment measures. This reflects the significance of system awareness and integration attributes of health system resilience. The enhanced disease detection in Congo, Nigeria, Senegal, and Uganda through diverse surveillance approaches during the pandemic as noted in this study ( Okeke et al ., 2022 ; Fawole et al ., 2023 ) underscores the critical role of diversity in fostering health system resilience. Integrating digital health tools like Big Data and Nigeria’s SORMAS enhances monitoring ( Chang et al ., 2020 ; Kuguyo et al ., 2020 ; Mghamba et al ., 2023 ; Okeke et al ., 2022 ). The use of various tools such as GPS tracking, credit card records, surveillance videos, and mobile apps to enhance their surveillance system ( Wang et al ., 2021 ) aligns with adaptation attributes of the health system’s resilience. By incorporating these lessons, Ghana can reinforce its health system resilience against future health emergencies. Emergency medical care The diverse strategies employed in emergency care during the pandemic, as noted in this study, provide valuable lessons for Ghana’s health system resilience. Involving the private sector and alternative care models can enhance emergency capacity ( Assefa, Gilks, et al ., 2022 ; Thomas et al ., 2020 ; Webb et al ., 2022 ). This reflects diversity and integration in health system resilience. Effective case management, timely expert deployment, and cross-border collaboration for acute care and ICU surge capacity are crucial components in emergency preparedness, as highlighted by various studies ( Khanna et al ., 2020 ; Olu et al ., 2022 ; Talisuna et al ., 2022 ; Winkelmann, Panteli et al ., 2022 ; Winkelmann, Webb, et al. , 2022 ). These strategies align with system awareness and adaptation attributes of health system resilience. Again, improving laboratory testing capabilities, decentralizing testing through regional networks, and reinforcing infection prevention measures ( Abu & Elliott 2022 ; Balde et al ., 2022 ; Chua et al ., 2020 ; Dzinamarira et al ., 2021 ; Lanyero et al ., 2021 ; Okeke et al ., 2022 ; Talisuna et al ., 2022 ; Tessema et al ., 2021 ; Tille et al ., 2022 ; Webb, Winkelmann et al ., 2022 ) are crucial for system awareness, self-regulation, and adaptation. Ghana can strengthen its emergency medical care and health system resilience by applying these lessons. Community engagement and trust The vital role of community engagement and trust during the COVID-19 pandemic is underlined by the findings of this study. Involving communities and promoting transparent communication fosters collaboration and strengthens response adaptability and legitimacy ( Al Siyabi et al ., 2021 ; Chhim et al ., 2023 ; Corbin et al ., 2021 ; Thu et al ., 2022 ). For future pandemics, Ghana should prioritize community involvement, leveraging trusted local messengers for risk communication. This approach fosters integration, strengthens adaptability, and ensures systems awareness, self-regulation, diversity, and legitimacy in responses, which are integral to a resilient health system. Diverse workforce development The COVID-19 pandemic, as noted in this review, intensified health workforce shortages globally, prompting the adoption of diverse human resources strategies to cope with increased demand and protect healthcare workers ( Assefa, Gilks, et al ., 2022 ; Džakula et al ., 2022 ; Fleming et al ., 2022 ; Haldane et al ., 2021 ; Hunte et al ., 2020 ; Williams, Maier, et al ., 2022 ; Williams, Scarpetti, et al ., 2022 ). Implementing emergency legislation by several countries to increase recruitment quotas and changing schedules, redeploying workers, and engaging a diverse workforce to scale up capacity demonstrated adaptability and integration while international collaborations and simplified registration processes showcased system awareness and diversity. Protection measures, including hygiene protocols and adequate PPE, illustrated self-regulation. To enhance its health system resilience, Ghana can learn from these lessons by strategically addressing workforce shortages, fostering international collaborations, adapting to changing demands, and prioritizing the well-being and protection of its healthcare workers. Digital health integration This review underscores the importance of digital health solutions in the pandemic response. Leveraging digital health technology such as big data, telemedicine, GPS tracking, credit card records, surveillance videos, mobile applications, syndromic surveillance, eELMIS for supply tracking, and SORMAS for real-time monitoring, were evident in managing COVID-19 impact and strengthening healthcare systems ( Chang et al. , 2020 ; Haldane et al. , 2021 ; Kuguyo et al. , 2020 ; Lanyero et al. , 2021 ; Mghamba et al. , 2023 ; Moonasar et al. , 2021 ; Okeke et al. , 2022 ; Wasswa et al. , 2023 ; Williams, Fahy, et al. , 2022 ). Using digital tools for standardized detection and response enhances system awareness, expanding access demonstrates diversity, and the integration of digital solutions with healthcare practices underscores integration. Ghana should prioritize investment in digital health solutions, expand access to underserved areas, and ensure robust training, supportive policies, and regulatory frameworks to enhance its preparedness to cope with future emergencies. Critical health infrastructure The need to enhance healthcare infrastructure, particularly maintaining critical ICU devices in strategic reserves for rapid response, outfitting emergency units, establishing robust laboratory networks to expand testing centers, establishing well-equipped infectious treatment centers, and oxygen and therapeutics production and delivery, emerged as a critical factor for future public health emergency preparedness and management ( Gebremeskel et al ., 2021 ; Gouya et al ., 2023 ). A resilient health system entails diverse and well-equipped healthcare facilities. Continuous investment and improvement in critical healthcare infrastructure can enhance adaptability and allow the health system to transform its operations, respond flexibly to various situations, and strengthen its overall ability to withstand and manage health crises. Ghana can draw lessons from global insights to prioritize critical health infrastructure investments. Engaging the private sector through public-private partnerships can be beneficial in critical health infrastructure investment, but effective regulatory capacity is essential to ensure successful collaborations ( Gebremeskel et al ., 2021 ). Well-planned commodities/products Innovative procurement and international collaborations were crucial in addressing shortages of equipment, logistics, and vaccines during the COVID-19 response ( Khanna et al ., 2020 ; Winkelmann, Webb et al ., 2022 ). Countries implemented diverse strategies, including resource distribution and encouragement of domestic production. Iran’s development of local production capacity for domestic COVID-19 vaccines with WHO support and their accomplishment of a 75% primary vaccination coverage ( Gouya et al ., 2023 ) demonstrated adaptability and self-regulation. Drawing lessons from these successful strategies, Ghana should vigorously pursue its aspiration to develop local pharmaceutical and vaccine production capacity. This will strengthen the country’s medical supplies capacity, enhance self-reliance, and support global health security. Social capital Social protection responses to the COVID-19 pandemic varied widely across the globe. African nations focused on non-contributory programs such as special allowances, food, nutrition protection, and health support, but gaps persisted in education and gender-specific interventions ( United Nations, 2021 ). Some African countries also faced challenges in accessing essential services, particularly water and sanitation, hindering effective viral control in vulnerable communities. A key lesson for Ghana to improve healthcare for its citizens, particularly in vulnerable communities is the strategic use of social capital. Ghana can leverage social capital to activate networks across rural and urban areas. This approach allows for effective collaboration between individuals and organizations, addressing crisis-related needs, gender-specific concerns, and socio-cultural factors that influence health outcomes. Additionally, prioritizing sustainable financing for diverse social protection schemes and improving access to essential services like water, sanitation, and healthcare will further strengthen the health system's resilience against future. emergencies. Limitations This review is not without limitations. The review examined an extensive range of studies and grey literature. Although beneficial, exploring a wide array of studies in this review posed a challenge in synthesizing findings across various methodologies within the study framework. Besides, the study’s reliance solely on existing literature could restrict its ability to fully capture countries’ specific context. This could potentially limit the lessons that could be drawn to enhance Ghana’s health system resilience against future emergencies. Furthermore, the study’s exclusive focus on the COVID-19 pandemic might neglect other factors impacting Ghana’s readiness for future emergencies. Future research could broaden its focus beyond COVID-19 to include other health emergencies or crises. This will allow a more comprehensive analysis of Ghana’s resilience across various contexts. Despite the constraints highlighted above, the review offers valuable insights for informing health system resilience strategies in Ghana. Conclusions Ghana’s response to the COVID-19 pandemic revealed challenges despite some successes. This underscores the need to enhance the country’s healthcare system resilience against future health emergencies. This study extracts valuable lessons from global experiences during the COVID-19 pandemic to guide Ghana’s future health emergency preparedness. The findings of this study emphasize the critical role of whole-of-government engagement, financing for preparedness, community engagement and trust, robust surveillance systems, emergency medical care, diverse workforce development, digital health integration, critical health infrastructure, well-planned commodities/products, and social capital in fostering a resilient health system. These critical response areas align with the attributes of a resilient healthcare system such as awareness, integration, self-regulation, diversity, and adaptability. By adopting these strategies, Ghana can build a resilient healthcare system that effectively addresses future challenges, guided by global insights and experiences. Data availability Underlying data All underlying data are available as part of the article and no additional source data are required. Extended data Zenodo: Extended data for ‘Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review’, https://doi.org/10.5281/zenodo.11154359 ( Ankomah et al. , 2024 ). Reporting guidelines Zenodo: PRISMA-ScR checklist for ‘Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic’, https://doi.org/10.5281/zenodo.11154359 ( Ankomah et al. , 2024 ) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References Abu TZ, Elliott SJ:The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya. Health and Place. 2022; 76 : 102841. PubMed Abstract | Publisher Full Text | Free Full Text Abubakar A, Khan W, Abou El Naja H, et al. : COVID-19 pandemic response in the WHO Eastern Mediterranean Region. BMJ Global Health 2022; 7 : e008782. PubMed Abstract | Publisher Full Text | Free Full Text Adebisi YA, Ekpenyong A, Ntacyabukura B, et al. :COVID-19 highlights the need for inclusive responses to public health emergencies in Africa. American Journal of Tropical Medicine and Hygiene. 2021; 104 (2): 449–452. American Society of Tropical Medicine and Hygiene. PubMed Abstract | Publisher Full Text | Free Full Text Aidukaite J, Saxonberg S, Szelewa D, et al. :Social policy in the face of a global pandemic: Policy responses to the COVID-19 crisis in Central and Eastern Europe. Social Policy and Administration. 2021; 55 (2): 358–373. PubMed Abstract | Publisher Full Text | Free Full Text Aisyah DN, Mayadewi CA, Budiharsana M, et al. :Building on health security capacities in Indonesia: Lessons learned from the COVID-19 pandemic responses and challenges. Zoonoses and Public Health. 2022; 69 : 757–767. PubMed Abstract | Publisher Full Text | Free Full Text Akande OW, Disu Y, Kaduru C, et al. :Risk communication during health emergencies in Nigeria: What are its challenges? Journal of Public Health in Africa. 2023; 14 (1). PubMed Abstract | Publisher Full Text | Free Full Text Al Siyabi H, Al Mukhaini S, Kanaan M, et al. :Community Participation Approaches for Effective National COVID-19 Pandemic Preparedness and Response: An Experience From Oman. Frontiers in Public Health. 2021; 8 . PubMed Abstract | Publisher Full Text | Free Full Text Alami H, Lehoux P, Fleet R, et al. :How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada). Frontiers in Public Health. 2021; 9 : 671833. NLM (Medline). PubMed Abstract | Publisher Full Text | Free Full Text Alava JJ, Guevara A:A critical narrative of Ecuador’s preparedness and response to the COVID-19 pandemic. Public Health in Practice. 2021; 2 : 100127. PubMed Abstract | Publisher Full Text | Free Full Text Amani A, Atuhebwe P, Mboussou FF, et al. :A rapid increase in coverage of COVID-19 vaccination, Central African Republic. Bulletin of the World Health Organization. 2023; 101 (6): 431–436. PubMed Abstract | Publisher Full Text | Free Full Text Amin Tabish S:COVID-19 pandemic: Emerging perspectives and future trends. Journal of Public Health Research. 2020; 9 . Anderson S, Allen P, Peckham S, et al. :Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services. Health Research Policy and Systems. 2008; 6 . PubMed Abstract | Publisher Full Text | Free Full Text Ankomah J, Stewart BT, Oppong-Nketia V, et al. : Strategic assessment of the availability of pediatric trauma care equipment, technology, and supplies in Ghana. Journal of Pediatric Surgery. 2015; 50 : 1922–1927. PubMed Abstract | Publisher Full Text | Free Full Text Ankomah MP, Aseweh Abor PA, Karamagi H:Extended data for ‘Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review.2024. Publisher Full Text Antwi-Boasiako J, Abbey COA, Ogbey P, et al. :Policy responses to fight covid-19; the case of Ghana. Revista de Administracao Publica. 2021; 55 (1): 122–139. Publisher Full Text Arabi YM, Azoulay E, Al-Dorzi HM, et al. :How the COVID-19 pandemic will change the future of critical care. Intensive Care Medicine. 2021; 47 (3): 282–291. Springer Science and Business Media Deutschland GmbH. PubMed Abstract | Publisher Full Text | Free Full Text Arksey H, O’Malley L:Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005; 8 (1): 19–32. Publisher Full Text Asamani JA, Ismaila H, Plange A, et al. : The cost of health workforce gaps and inequitable distribution in the Ghana Health Service: an analysis towards evidence-based health workforce planning and management. Human Resources for Health. 2021; 19 (1): 43. PubMed Abstract | Publisher Full Text | Free Full Text Asiedu-Berkoe F, Chandi GM, Akosua Bandoh D, et al. :State of Public Health Emergency Preparedness and Response Capacity of Ghana.2022. Publisher Full Text Assaye BT, Shimie AW:Telemedicine use during COVID-19 pandemics and associated factors among health professionals working in health facilities at resource-limited setting 2021. Informatics in Medicine Unlocked. 2022; 33 : 101085. PubMed Abstract | Publisher Full Text | Free Full Text Assefa Y, Gilks CF, Reid S, et al. :Analysis of the COVID-19 pandemic: lessons towards a more effective response to public health emergencies. Globalization and Health. 2022; 18 (1): 10. PubMed Abstract | Publisher Full Text | Free Full Text Assefa Y, Woldeyohannes S, Cullerton K, et al. :Attributes of national governance for an effective response to public health emergencies: Lessons from the response to the COVID-19 pandemic. Journal of Global Health. 2022; 12 : 05021. PubMed Abstract | Publisher Full Text | Free Full Text Ayee RA:Reflections on Ghana’s Public Policy Space and Wicked Problems Today. GIMPA Quarterly. 2022; 2 (5): 22–30. Béland D, Dinan S, Rocco P, et al. :Social policy responses to COVID-19 in Canada and the United States: Explaining policy variations between two liberal welfare state regimes. Social Policy and Administration. 2021; 55 (2): 280–294. Publisher Full Text Balde T, Oyugi B, Byakika-Tusiime J, et al. :Transitioning the COVID-19 response in the WHO African region: a proposed framework for rethinking and rebuilding health systems. BMJ Global Health. 2022; 7 (12): e010242. PubMed Abstract | Publisher Full Text | Free Full Text Banda Chitsamatanga B, Malinga W:A tale of two paradoxes in response to COVID-19’: Public health system and socio-economic implications of the pandemic in South Africa and Zimbabwe. Cogent Social Sciences. 2021; 7 (1). Publisher Full Text Baptista I, Marlier E, Spasova S, et al. : Title Authors Social protection and inclusion policy responses to the COVID-19 crisis An analysis of policies in 35 countries. 2021. Beesley LJ, Patelli P, Kaufeld K, et al. :Multi-dimensional resilience: A quantitative exploration of disease outcomes and economic, political, and social resilience to the COVID-19 pandemic in six countries. PLoS One. 2023; 18 (1 January): e0279894. PubMed Abstract | Publisher Full Text Bhaskar S, Nurtazina A, Mittoo S, et al. :Editorial: Telemedicine During and Beyond COVID-19. Frontiers in Public Health. 2021; 9 . Frontiers Media S.A. PubMed Abstract | Publisher Full Text | Free Full Text Bhatia R, Abraham P:COVID-19 pandemic: Current & future perspectives. Indian Journal of Medical Research. 2022; 155 (5–6): 445–449. Wolters Kluwer Medknow Publications. PubMed Abstract | Publisher Full Text | Free Full Text Bigoni A, Malik AM, Tasca R, et al. :Brazil’s health system functionality amidst of the COVID-19 pandemic: An analysis of resilience.2022. Publisher Full Text Binagwaho A, Frisch M, Ntawukuriryayo T, et al. : Changing the COVID-19 Narrative in Africa: Using an Implementation Research Lens to Understand Successes and Plan for Challenges Ahead. Annals of Global Health. 2020; 86 : 104. PubMed Abstract | Publisher Full Text | Free Full Text Binagwaho A, Hirwe D, Mathewos K:Health system resilience: withstanding shocks and maintaining progress. Global Health: Science and Practice. 2022; 10 (Supplement 1). Bloomstone S, Fleming M, Arana M, et al. :COVID-19 Vaccine Administration: Phase 2 of an in Progress Review in New York State Local Health Departments. International Journal of Environmental Research and Public Health. 2022; 19 (20). PubMed Abstract | Publisher Full Text | Free Full Text Buchan J, Williams GA, Zapata T, et al. :GOVERNING HEALTH WORKFORCE RESPONSES DURING COVID-19.2021; 27 (1). Burau V, Falkenbach M, Neri S, et al. :Health system resilience and health workforce capacities: Comparing health system responses during the COVID-19 pandemic in six European countries. International Journal of Health Planning and Management. 2022; 37 (4): 2032–2048. PubMed Abstract | Publisher Full Text | Free Full Text Burke S, Parker S, Fleming P, et al. :Building health system resilience through policy development in response to COVID-19 in Ireland: From shock to reform. The Lancet Regional Health – Europe Series Health Policy. 2021; 9 . 100223. Publisher Full Text Chang CM, Tan TW, Ho TC, et al. :COVID-19: Taiwan’s epidemiological characteristics and public and hospital responses. PeerJ. 2020; 8 (6): e9360. PubMed Abstract | Publisher Full Text | Free Full Text Chhim S, Ku G, Mao S, et al. :Descriptive assessment of COVID-19 responses and lessons learnt in Cambodia, January 2020 to June 2022. BMJ Global Health. 2023; 8 (5). PubMed Abstract | Publisher Full Text | Free Full Text Chua AQ, Tan MMJ, Verma M, et al. :Health system resilience in managing the COVID-19 pandemic: lessons from Singapore. BMJ Global Health. 2020; 5 (9): e003317. PubMed Abstract | Publisher Full Text | Free Full Text Coccia M:Preparedness of countries to face COVID-19 pandemic crisis: Strategic positioning and factors supporting effective strategies of prevention of pandemic threats. Environmental Research. 2022; 203 : 111678. PubMed Abstract | Publisher Full Text | Free Full Text Corbin JH, Oyene UE, Manoncourt E, et al. :A health promotion approach to emergency management: effective community engagement strategies from five cases. Health Promotion International. 2021; 36 : I24–I38. PubMed Abstract | Publisher Full Text | Free Full Text Desson Z, Lambertz L, Peters JW, et al. :Europe’s Covid-19 outliers: German, Austrian and Swiss policy responses during the early stages of the 2020 pandemic. Health Policy and Technology. 2020; 9 (4): 405–418. PubMed Abstract | Publisher Full Text | Free Full Text Desson Z, Weller E, McMeekin P, et al. :An analysis of the policy responses to the COVID-19 pandemic in France, Belgium, and Canada. Health Policy and Technology. 2020; 9 (4): 430–446. PubMed Abstract | Publisher Full Text | Free Full Text Djalante R, Nurhidayah L, Van Minh H, et al. :COVID-19 and ASEAN responses: Comparative policy analysis. Progress in Disaster Science. 2020; 8 : 100129. PubMed Abstract | Publisher Full Text | Free Full Text Džakula A, Banadinović M, Lovrenčić IL, et al. :A comparison of health system responses to COVID-19 in Bulgaria, Croatia and Romania in 2020. Health Policy. 2022; 126 (5): 456–464. PubMed Abstract | Publisher Full Text | Free Full Text Dzinamarira T, Dzobo M, Chitungo I:COVID-19: A perspective on Africa’s capacity and response. Journal of Medical Virology. 2020; 92 (11): 2465–2472. John Wiley and Sons Inc. PubMed Abstract | Publisher Full Text | Free Full Text Dzinamarira T, Mapingure MP, Rwibasira GN, et al. :COVID-19: Comparison of the response in Rwanda. South Africa and Zimbabwe. MEDICC Review. 2021; 23 (3): 15–20. PubMed Abstract | Publisher Full Text El Bcheraoui C, Weishaar H, Pozo-Martin F, et al. :Assessing COVID-19 through the lens of health systems’ preparedness: time for a change Globalization and Health. 2020; 16 (1): 112. BioMed Central Ltd. PubMed Abstract | Publisher Full Text | Free Full Text Elston JWT, Moosa AJ, Moses F, et al. :Impact of the Ebola outbreak on health systems and population health in Sierra Leone. Journal of Public Health (United Kingdom). 2016; 38 (4): fdv158–fdv678. PubMed Abstract | Publisher Full Text Emahi I, Watts MC, Azibere S, et al. :COVID-19 in Africa: Rethinking the tools to manage future pandemics. African Health Sciences. 2021; 21 (4): 1509–1517. PubMed Abstract | Publisher Full Text | Free Full Text Emami SG, Lorenzoni V, Pirri S, et al. : What are the characteristics of a resilient healthcare system: A Scoping Review. 2023. Fakher H, Abiari EL: MOROCCO’S COVID-19 AFRICAN INITIATIVE: A MIRROR OF COMPLEX ASPIRATIONS. 2020. Fawole OI, Bello S, Adebowale AS, et al. :COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons. BMC Public Health. 2023; 23 (1): 835. PubMed Abstract | Publisher Full Text | Free Full Text Fenny AP, Asante FA, Arhinful DK, et al. :Who uses outpatient healthcare services under Ghana’s health protection scheme and why? BMC Health Services Research. 2016; 16 (1): 174. PubMed Abstract | Publisher Full Text | Free Full Text Fenny AP, Otieku E:The Impact of Covid-19 on the Health Sector in Ghana. Institute of Statistical, Social and Economic Research (ISSER). College of Humanity, University of Ghana. Policy Brief.2020. Fleming P, O’Donoghue C, Almirall-Sanchez A, et al. :Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries—A systematic review. Health Policy. 2022; 126 (12): 1195–1205. Elsevier Ireland Ltd. PubMed Abstract | Publisher Full Text | Free Full Text Forsgren L, Tediosi F, Blanchet K, et al. :Health systems resilience in practice: a scoping review to identify strategies for building resilience. BMC Health Services Research. 2022; 22 (1): 1173. PubMed Abstract | Publisher Full Text | Free Full Text Fridell M, Edwin S, von Schreeb J , et al. :Health system resilience: what are we talking about? A scoping review mapping characteristics and keywords. International Journal of Health Policy and Management. 2020; 9 (1): 6–16. PubMed Abstract | Publisher Full Text | Free Full Text Gandhi PA, Hemmati P:An overview of Iran’s actions in response to the COVID-19 pandemic and in building health system resilience.n.d. Reference Source Gebremeskel AT, Otu A, Abimbola S, et al. :Building resilient health systems in Africa beyond the COVID-19 pandemic response. BMJ Global Health. 2021; 6 (6): e006108. BMJ Publishing Group. PubMed Abstract | Publisher Full Text | Free Full Text Ghebreyesus TA, Jakab Z, Ryan MJ, et al. :WHO recommendations for resilient health systems. Bulletin of the World Health Organization. 2022; 100 (4): 240–240A. World Health Organization. PubMed Abstract | Publisher Full Text | Free Full Text Gouya M, Seif-Farahi K, Hemmati P:An overview of Iran’s actions in response to the COVID-19 pandemic and in building health system resilience. Community Case Study. Frontiers in Public Health. 2023; V. 11 : 2296–2565. PubMed Abstract | Publisher Full Text | Free Full Text Grimm PY, Oliver S, Merten S, et al. :Enhancing the Understanding of Resilience in Health Systems of Low-and Middle-Income Countries: A Qualitative Evidence Synthesis. International Journal of Health Policy and Management. 2022; 11 (7): 899–911. Kerman University of Medical Sciences. PubMed Abstract | Publisher Full Text | Free Full Text Ha BTT, Quang LN, Mirzoev T, et al. :Combating the COVID-19 epidemic: Experiences from Vietnam. International Journal of Environmental Research and Public Health. 2020; 17 (9). PubMed Abstract | Publisher Full Text | Free Full Text Haldane V, De Foo C, Abdalla SM, et al. :Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nature Medicine. 2021; 27 (6): 964–980. PubMed Abstract | Publisher Full Text Hunte SA, Pierre K, Rose RS, et al. :Health systems’ resilience: COVID-19 response in Trinidad and Tobago. American Journal of Tropical Medicine and Hygiene. 2020; 103 (2): 590–592. American Society of Tropical Medicine and Hygiene. Publisher Full Text Issahaku H, Abu BM:Bringing Rigour and Evidence to Economic Policy Making in Africa COVID-19 in Ghana: Consequences for Poverty, and Fiscal Implications.2020. Jumbam DT, Amoako E, Blankson PK, et al. :The state of surgery, obstetrics, trauma, and anaesthesia care in Ghana: a narrative review. Global Health Action. 2022; 15 (1). Taylor and Francis Ltd. PubMed Abstract | Publisher Full Text | Free Full Text Karamagi HC, Titi-Ofei R, Kipruto HK, et al. :On the resilience of health systems: A methodological exploration across countries in the WHO African Region. PLoS One. 2022; 17 (2 February): e0261904. PubMed Abstract | Publisher Full Text | Free Full Text Kavanagh KT, Pontus C, Pare J, et al. :COVID-19 lessons learned: a global perspective. Antimicrobial Resistance and Infection Control. 2021; 10 (1): 125. PubMed Abstract | Publisher Full Text | Free Full Text Khanna RC, Cicinelli MV, Gilbert SS, et al. :COVID-19 pandemic: Lessons learned and future directions. Indian Journal of Ophthalmology. 2020; 68 (5): 703–710. Wolters Kluwer Medknow Publications. Publisher Full Text Kruk ME, Myers M, Varpilah T, et al. : What is a resilient health system? Lessons from EVD. The Lancet. 2015; 1910 . Publisher Full Text Kruk ME, Ling EJ, Bitton A, et al. : Building resilient health systems: A proposal for a resilience index. BMJ (Online). 2017; 357 . PubMed Abstract | Publisher Full Text Kuguyo O, Kengne AP, Dandara C:Singapore COVID-19 Pandemic Response as a Successful Model Framework for Low-Resource Health Care Settings in Africa? OMICS A Journal of Integrative Biology. 2020; 24 (8): 470–478. Mary Ann Liebert Inc. PubMed Abstract | Publisher Full Text Lanyero B, Edea ZA, Musa EO, et al. :Readiness and early response to COVID-19: Achievements, challenges and lessons learnt in Ethiopia. BMJ Global Health. 2021; 6 (6). PubMed Abstract | Publisher Full Text | Free Full Text Levac D, Colquhoun H, O’brien KK:Scoping studies: advancing the methodology. Scoping Studies: Advancing the Methodology. 2010; 5 . Publisher Full Text Reference Source Mghamba J, Gilmour E, Robinson L, et al. :The use of innovative approaches to strengthen health system resilience during the COVID-19 pandemic: case studies from selected Commonwealth countries. Frontiers in Public Health. 2023; 11 : 1115415. PubMed Abstract | Publisher Full Text | Free Full Text MOH:Ghana COVID-19 Emergency Response on Vaccines. Third Additional Financing (P178054) Stakeholder Engagement Plan.2022. Reference Source MOH: COVID-19 Emergency Preparedness and Response Project and Additional Financing: Environmental and Social Management Framework. Ghana:Ministry of Health;2020b. Reference Source MOH: Ghana Health Sector, 2021 Annual Programme of Work. Ministry of Health;2021a. MOH: Health Sector Medium Term Development Plan, 2022-2025. Ghana:Ministry of Health;2021b. MOH: National Health Policy: Ensuring Health Lives for All. 2020c. Revised Edition. P.6. Reference Source MOH: National Strategic COVID-19 Response Plan: July 2020 -December 2024. 2020a. Moonasar D, Pillay A, Leonard E, et al. :COVID-19: Lessons and experiences from South Africa’s first surge. BMJ Global Health. 2021; 6 (2). PubMed Abstract | Publisher Full Text | Free Full Text OECD:First lessons from government evaluations of COVID-19 responses: A synthesis.2022. Reference Source Okeke C, Uzochukwu B, Onyedinma C, et al. :An assessment of Nigeria’s health systems response to COVID-19. Ghana Medical Journal. 2022; 56 (3): 74–84. PubMed Abstract | Publisher Full Text | Free Full Text Okyere E:Assessing Policies and Strategies to Reduce the Impact of Health Worker Shortages in Primary Health Care Facilities in Ghana.2018. Olu O:Resilient Health System As Conceptual Framework for Strengthening Public Health Disaster Risk Management: An African Viewpoint. Frontiers in Public Health. 2017; 5 . PubMed Abstract | Publisher Full Text | Free Full Text Olu OO, Waya JLL, Bankss S, et al. :Integrated approaches to COVID-19 emergency response in fragile, conflict-affected and vulnerable settings: a public health policy brief. Journal of Public Health Policy. 2022; 44 : 122–137. PubMed Abstract | Publisher Full Text | Free Full Text Osei-Boateng C, Vlaminck Z:COVID-19 in Ghana A Looking Glass into Structural Inequalities and Political Distrust.2021. Paschoalotto MAC, Lazzari EA, Rocha R, et al. :Health systems resilience: is it time to revisit resilience after COVID-19? Social Science and Medicine. 2023; 320 : 115716. PubMed Abstract | Publisher Full Text | Free Full Text Peters M, Godfrey CM, Mcinerney P, et al. :Methodology for JBI Scoping Reviews.2015. Reference Source Piersson AD, Gorleku PN:Assessment of availability, accessibility, and affordability of magnetic resonance imaging services in Ghana. Radiography. 2017; 23 (4): e75–e79. PubMed Abstract | Publisher Full Text Rajapaksha RMNU, Khatri R, Endalamaw A, et al. :Health System Resilience for Pandemic Management and Lessons Learned: A Scoping Review Protocol.2022. Sagan A, Webb E, Azzopardi-Muscat N, et al. :Lessons for building back better Health Policy Health Policy Series Series.2021; 56 . Reference Source Sagan BA, Scott L, Webb E, et al. :Strengthening health system resilience in the covid-19 era.2022; 28 (1): 4–8. Saikat S, Dumitra G, Winkelmann J, et al. : Perspective: Lessons from COVID-19 of countries in the European region in light of findings from the health system response monitor. n.d. Reference Source Sarkodie B, Asiedu-Bekoe F, Laryea DO, et al. :Overview of preparedness and response to COVID-19 in Ghana. Ghana Medical Journal. 2021; 55 (2): 38–47. PubMed Abstract | Publisher Full Text | Free Full Text Sundararaman T, Muraleedharan VR, Ranjan A:Pandemic resilience and health systems preparedness: lessons from COVID-19 for the twenty-first century. Journal of Social and Economic Development. 2021; 23 (Suppl 2): 290–300. PubMed Abstract | Publisher Full Text | Free Full Text Tabish AS:COVID-19 pandemic: Emerging perspectives and future trends. In Journal of Public Health Research. 2020; 9 : jphr.2020.1786. PubMed Abstract | Publisher Full Text | Free Full Text Talisuna A, Iwu C, Okeibunor J, et al. :Assessment of COVID-19 pandemic responses in African countries: Thematic synthesis of WHO intra-action review reports. BMJ Open. 2022; 12 (5). BMJ Publishing Group. PubMed Abstract | Publisher Full Text | Free Full Text Tessema GA, Kinfu Y, Dachew BA, et al. :The COVID-19 pandemic and healthcare systems in Africa: A scoping review of preparedness, impact and response. BMJ Global Health. 2021; 6 (12): e007179. PubMed Abstract | Publisher Full Text | Free Full Text Thomas S, Sagan A, Larkin J, et al. :Strengthening health systems resilience POLICY BRIEF 36 Key concepts and strategies HEALTH SYSTEMS AND POLICY ANALYSIS.2020. Reference Source Thu KM, Bernays S, Abimbola S:A literature review exploring how health systems respond to acute shocks in fragile and conflict-affected countries. Conflict and Health. 2022; 16 (1): 60. BioMed Central Ltd. PubMed Abstract | Publisher Full Text | Free Full Text Tille F, van Ginneken E , Winkelmann J, et al. :Perspective: Lessons from COVID-19 of countries in the European region in light of findings from the health system response monitor. Front. Public Health, Sec. Public Health Policy. 2022; 10 : 2022. PubMed Abstract | Publisher Full Text | Free Full Text Tricco AC, Lillie E, Zarin W, et al. :PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine. 2018; 169 (7): 467–473. American College of Physicians. PubMed Abstract | Publisher Full Text Tumusiime P, Nabyonga-Orem J, Karamagi H, et al. :Resilient health systems for attaining universal health coverage. BMJ Global Health. 2019; 4 : e002006. PubMed Abstract | Publisher Full Text | Free Full Text United Nations: Social policy and social protection measures to build Africa better post-COVID-19. Department of Economics and Social Welfare: Policy brief No 2021. 93. Reference Source United Nations Development Programme:Social Protection System and the Response to COVID-19 in the Arab Region. RBAS Working Papers Series. 2021. Reference Source United Nations Economic Commission for Africa: COVID-19 Crisis in North Africa: The Impact and Mitigation Responses.2020. Reference Source Van Ginneken E, Siciliani L, Reed S, et al. :ADDRESSING BACKLOGS AND MANAGING WAITING LISTS DURING AND BEYOND THE COVID-19 PANDEMIC. Eurohealth. 2022; 28 (1). Wang X, Shi L, Zhang Y, et al. :Policy disparities in response to COVID-19 between Singapore and China. International Journal for Equity in Health. 2021; 20 (1): 185. PubMed Abstract | Publisher Full Text | Free Full Text Wang Z, Duan Y, Jin Y, et al. :Coronavirus disease 2019 (COVID-19) pandemic: how countries should build more resilient health systems for preparedness and response. Global Health Journal. 2020; 4 (4): 139–145. PubMed Abstract | Publisher Full Text | Free Full Text Wasswa JH, Oundo H, Oteba MO, et al. :Leveraging electronic logistics management information systems to enhance and optimize supply chain response during public health emergencies: lessons from COVID-19 response in Uganda. Journal of Pharmaceutical Policy and Practice. 2023; 16 (1): 6. PubMed Abstract | Publisher Full Text | Free Full Text Webb E, Lenormand M, Schneider N, et al. : Transforming delivery of essential health services during the COVID-19 pandemic.Eurohealth2022; 28 (1), 14–18. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/351078 Webb E, Winkelmann J, Scarpetti G, et al. :Lessons learned from the Baltic countries’ response to the first wave of COVID-19. Health Policy. 2022; 126 (5): 438–445. PubMed Abstract | Publisher Full Text | Free Full Text WHO: Health systems resilience toolkit: a WHO global public health good to support building and strengthening of sustainable health systems resilience in countries with various contexts. Geneva:World Health. Organization;2022b. 2022. Licence: CC BY-NC-SA 3.0 IGO. Reference Source WHO: World health statistics 2021: Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2021. License: CC BY-NC-SA 3.0 IGO. Reference Source WHO: World health statistics 2023: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva:World Health Organization;2022a. 2023. Licence: CC BY-NC-SA 3.0 IGO. Reference Source Williams F, Oke A, Zachary I:Public health delivery in the information age: the role of informatics and technology. Perspectives in Public Health. 2019; 139 (5): 236–254. PubMed Abstract | Publisher Full Text | Free Full Text Williams GA, Fahy N, Aissat D, et al. :COVID-19 AND THE USE OF DIGITAL HEALTH TOOLS: OPPORTUNITY AMID CRISIS THAT COULD TRANSFORM HEALTH CARE DELIVERY. Eurohealth. 2022; 28 (1). Williams GA, Maier CB, Scarpetti G, et al. :Health Workforce and Service Delivery. Eurohealth. 2022; 28 (1). Williams GA, Scarpetti G, Langins M, et al. :HUMAN RESOURCES FOR HEALTH DURING COVID-19: SUPPORTING AND PROTECTING HEALTH WORKERS. Eurohealth. 2022; 28 (1). Winkelmann J, Panteli D, et al. :Have we learnt the right lessons? Intensive care capacities during the COVID-19 pandemic in Europe. Eurohealth. 2022; 28 (1): 41–45. World Health Organization. Regional Office for Europe. Reference Source Winkelmann J, Webb E, Williams GA, et al. :European countries’ responses in ensuring sufficient physical infrastructure and workforce capacity during the first COVID-19 wave. Health Policy. 2022; 126 (5): 362–372. PubMed Abstract | Publisher Full Text | Free Full Text World Bank:The World Bank Ghana COVID-19 Emergency Preparedness and Response Project (P173788).2020. (2020). Yang QC, Chen X, Chang CP, et al. :What is the relationship between government response and COVID-19 pandemics? Global evidence of 118 countries. Structural Change and Economic Dynamics. 2021; 59 : 98–107. PubMed Abstract | Publisher Full Text | Free Full Text Yevoo LL, Amarteyfio KA, Ansah-Antwi JA, et al. :The “No bed syndrome” in Ghana — what, how and why? A literature, electronic and print media review. Frontiers in Health Services. 2023; 3 . PubMed Abstract | Publisher Full Text | Free Full Text Zhang J, Yang H, Yang M, et al. :The role of vaccines in COVID-19 control strategies in Singapore and China. Health Policy and Technology. 2022; 11 (2): 100620. PubMed Abstract | Publisher Full Text | Free Full Text Zikargae MH:Covid-19 in Ethiopia: Assessment of how the ethiopian government has executed administrative actions and managed risk communications and community engagement. Risk Management and Healthcare Policy. 2020; 13 : 2803–2810. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 10 Oct 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Health Services Management, University of Ghana Business School, University of Ghana, Accra, Greater Accra Region, Ghana 2 Office of the Assistant Regional Director, Regional Office for Africa, World Health Organisation, Djoue, Brazzaville, Congo Martin Ankomah Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Patience Aseweh Abor Roles: Supervision, Writing – Review & Editing Humphrey Karamagi Roles: Project Administration, Resources, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 10 Oct 2024, 13:1203 https://doi.org/10.12688/f1000research.143051.1 Copyright © 2024 Ankomah M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Ankomah M, Abor PA and Karamagi H. Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :1203 ( https://doi.org/10.12688/f1000research.143051.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: AWAITING PEER REVIEW AWAITING PEER REVIEW ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 10 Oct 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status AWAITING PEER REVIEW Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Building resilience of the Ghanaian healthcare...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/13-1203/v1" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/13-1203/v1&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/13-1203/v1" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Ankomah M et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/13-1203/v1/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/13-1203", templates : { twitter : "Building resilience of the Ghanaian healthcare system: Lessons.... Ankomah M et al., published by " + "@F1000Research" + ", https://f1000research.com/articles/13-1203/v1" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/143051/156667") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "156667"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "331909": 0, "331911": 0, "331910": 0, "331917": 0, "331916": 0, "331918": 0, "331913": 0, "331912": 0, "331915": 0, "331914": 0, "337301": 0, "337303": 0, "337302": 0, "337309": 0, "337308": 0, "337310": 0, "337305": 0, "337304": 0, "337307": 0, "337306": 0, "347821": 0, "347820": 0, "347823": 0, "347822": 0, "347819": 0, "347818": 0, "347824": 0, "340541": 0, "340540": 0, "340543": 0, "340542": 0, "340549": 0, "340548": 0, "340545": 0, "340544": 0, "340547": 0, "340546": 0, "356300": 0, "343503": 0, "343509": 0, "343508": 0, "343511": 0, "343510": 0, "343505": 0, "343504": 0, "343507": 0, "343506": 0, "355173": 0, "355172": 0, "355175": 0, "355174": 0, "402422": 0, "402423": 0, "402420": 0, "402421": 0, "402419": 0, "402428": 0, "402426": 0, "402427": 0, "402424": 0, "402425": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "6bd2554a-2983-4233-a24d-c9a576635beb"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });