Strategies to Promote Health System Strengthening and Global Health Security at the Subnational Level in a World Changed by COVID-19

Structural weaknesses in national health systems have led to huge variations in responses to COVID-19. This calls for a unified approach to health security and essential health services as public health threats and the expectation for health care systems to provide improved access and services at affordable cost increases. Achieving strong, resilient health systems that reach both global health security and universal health coverage goals requires a unified approach to how we work across the system. We propose the following 3 key overarching approaches: Strengthen comprehensive district planning (i.e., to be successful, district planners must understand how various public health programs come together within their communities, the range of stakeholders who have a role to play in health efforts, and how public and private funding and information systems can be leveraged at the local level to achieve their objectives). Support flexibility of district health systems to break the silos of vertical programs and take on new roles as circumstances warrant. Use the ongoing roll-out of COVID-19 interventions as an opportunity to address management, coordination, and integration challenges at the district level.