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IntroductionGlobal Health Security borders on prevention, detection and response to public health threats like the novel coronavirus disease 2019 (COVID-19). Global Health Security Index (GHSI) of 2019 and 2021 revealed the world remains ill-prepared to deal with future pandemics, evident in the historic impact of COVID-19 on countries. As at 7th December 2022, COVID-19 has infected over 600 million people and claimed over six million lives, mostly in countries with higher GHSI scores.ObjectiveDetermine whether the GHSI scores of countries have a correlation with COVID-19 cases, deaths and vaccination coverage, while adjusting for country level dynamics.MethodsThis paper utilizes GHSI database of 195 countries. Data consists of 171 questions grouped into 37 indicators across six overarching categories on health security and COVID-19. Multivariate multiple regression analysis with robust standard errors was conducted to test the hypothesis that high GHSI ratings do not guarantee better COVID-19 outcomes like cases, deaths and vaccination coverage. Also, avplots STATA command was used to check outliers with potential negative effect on outcome and predictor variables.ResultsGlobal average GHSI score for all 195 countries was 38.9. United States of America recorded the highest GHSI score of 75.9 but also recorded one of the highest COVID-19 cases and deaths; Somalia recorded the worst GHSI score of 16.0 and one of the lowest COVID-19 cases and deaths. High GHSI scores did not associate positively with reduction in COVID-19 cases (Coef=157133.4, p-value=0.009, [95%CI 39728.64 274538.15]) and deaths (Coef=1405.804, p-value=0.047, [95%CI 18.1 2793.508]). However, high GHSI ratings associated with increases in persons fully vaccinated per 100 population (Coef=0.572, p-value=0.000, [95%CI.272.873]).ConclusionIt appears the world might still not be adequately prepared for the next major pandemic, if the narrative remains unchanged. Countries that recorded higher GHSI scores, counter-intuitively, recorded higher COVID-19 cases and deaths. Countries need to invest more in interventions towards attaining Universal Health Coverage (UHC) including integrated health systems and formidable primary health care to enhance preparedness and response to pandemics.

IntroductionSevere acute respiratory syndrome coronavirus 2 also called coronavirus disease 2019 was first reported in the African continent on 14 February 2020 in Egypt. As at 18 December 2020, the continent reported 2,449,754 confirmed cases, 57,817 deaths and 2,073,214 recoveries. Urban cities in Africa have particularly suffered the brunt of coronavirus disease 2019 coupled with criticisms that the response strategies have largely been a 'one-size-fits-all' approach. This article reviewed early evidence on urban health nexus with coronavirus disease 2019 preparedness and response in Africa.MethodsA rapid scoping review of empirical and grey literature was done using data sources such as ScienceDirect, GoogleScholar, PubMed, HINARI and official websites of World Health Organization and Africa Centres for Disease Control and Prevention. A total of 26 full articles (empirical studies, reviews and commentaries) were synthesised and analysed qualitatively based on predefined inclusion criteria on publication relevance and quality.ResultsOver 70% of the 26 articles reported on coronavirus disease 2019 response strategies across Africa; 27% of the articles reported on preparedness towards coronavirus disease 2019, while 38% reported on urbanisation nexus with coronavirus disease 2019; 40% of the publications were full-text empirical studies, while the remaining 60% were either commentaries, reviews or editorials. It was found that urban cities remain epicentres of coronavirus disease 2019 in Africa. Even though some successes have been recorded in Africa regarding coronavirus disease 2019 fight, the continent's response strategies were largely found to be a 'one-size-fits-all' approach. Consequently, adoption of 'Western elitist' mitigating measures for coronavirus disease 2019 containment resulted in excesses and spillover effects on individuals, families and economies in Africa.ConclusionAfrica needs to increase commitment to health systems strengthening through context-specific interventions and prioritisation of pandemic preparedness over response. Likewise, improved economic resilience and proper urban planning will help African countries to respond better to future public health emergencies, as coronavirus disease 2019 cases continue to surge on the continent.

The COVID-19 pandemic has triggered several changes in countries' health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine). We use secondary data assembled by country teams, as well as applied thematic analysis to examine the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems and governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access in the long run. [ABSTRACT FROM AUTHOR]