COVID-19 Series: The role of government and COVID-19 - Maintains

A female doctor with the International Medical Corps examines a woman patient at a mobile health clinic in Pakistan. Credit: DFID/Russell Watkins.
A female doctor with the International Medical Corps examines a woman patient at a mobile health clinic in Pakistan.
Credit: DFID/Russell Watkins

Lessons from a recent literature review of governance and the role of the state in responding to COVID-19

COVID-19 is a global crisis and has led to a range of responses from governments around the world. The success of a country in managing and recovering from COVID-19 depends on effective governance of the response. This requires management of complex interactions between state and non-state actors, coordinating across multiple sectors, and planning to ensure that short, medium- and long-term considerations are properly balanced.

How can governments in low- and middle-income countries best respond, and are there relevant lessons from recent pandemics? This note draws upon a recent literature review of governance and state capabilities undertaken for the DFID Maintains programme.

The importance of leadership and coordination

An overarching theme from recent health outbreaks such as SARS and Ebola, but also more recently from COVID-19, is that the institution of the state is most important at times of crisis. At such times, citizens look to their governments to effectively deploy authority and resources to respond. This is a challenge for governments that have low capability or are in the process of building capability. The pressure to minimise direct and indirect loss of life, as well as to cushion the economic shock for households, businesses, and the wider economy, can overwhelm state capability, especially where such capability is already weak.

It is essential that management of the response is led by government. There is no substitute for national leadership – it cannot be replaced by external support. Indeed, international support, while obviously welcome, should only ever augment and support nationally led efforts.

Leaders need to make decisions quickly and adaptively, revisiting decisions to account for new information. There is no perfect response to the crisis: the biggest mistake is to wait for perfection. ‘There is so much you need to do, and you need to move fast, so don’t be held up by the need to ‘be right’ or perfect’ (lessons learned from Ebola, Michael Ryan, WHO).

COVID-19 affects every aspect of life and every sector of the economy; it cannot be addressed in silos. It is therefore crucial that the different parts of the response at different stages work in close alignment. This is the primary challenge for effective governance of the crisis – coordination to ensure that interconnected problems are addressed from multiple angles. A ‘whole-of-society’ approach is required, involving coordination across government and the private sector, with civil society and local communities, and with global institutions.

Three policy dimensions

Experience shows that tackling COVID-19 requires governments to respond to three overlapping policy dimensions as the crisis evolves. Although these dimensions are sequential in time, governments need to address all of them from the beginning:

Three policy dimensions

Dimension Description Goal
Response This lasts until cases abate or are low and under control. It requires coordinated actions to stop the spread of the virus, and to mitigate the immediate negative economic and social impacts. Minimise direct and indirect loss of life, and cushion the economic shock for households, businesses, and the wider economy.
Recovery Development of a coordinated strategy to ensure that the country, and each different sector, is positioned to recover and address the medium- to long-term negative impacts. Minimise indirect loss of life, maximise the return to normal, and leverage opportunities for system strengthening.
Reform Longer-term reform measures to ensure that the country and affected sectors are better able to withstand similar future shocks. Maximise preparedness for future crises and opportunities for system and economy strengthening.

The immediate requirement is for a strong and effective healthcare response, to adapt rapidly to the emerging crisis, while parallel measures are put in place to manage and limit the speed by which disease transmission occurs. Failure to do this will result in healthcare facilities – which may already be poorly resourced – quickly becoming overloaded and unnecessary deaths occurring either directly as a result of the disease or indirectly as resources are reprioritised away from other healthcare needs.

Even during the initial response, a team within government should also be planning for the recovery phase. A coordinated strategy will be required to support economic recovery and address long-term social protection needs.

Building on the notion that ‘a crisis is too good an opportunity to waste’, COVID-19 also provides an opportunity for governments to implement reforms that strengthen future resilience and avoid the ‘cycle of neglect and panic’, for example by putting in place properly resourced health security actions plans.

More fundamentally, it is also an opportunity to consider the role of the state and the social contract governments have with their citizens. In particular, COVID-19 presents an opportunity for change on a global scale. A new paradigm is needed that better equips governments to respond to the challenges of globally connected societies, as well as fundamentally complex issues such as climate change and equity.

While it may be tempting to wait until after the crisis is resolved, now is the right time for change. Responses to COVID-19 demonstrate government and society’s willingness to take drastic measures to mitigate an existential threat.

The full rapid literature review can be found here.

All Maintains evidence and articles relating to COVID-19 can be found here.

About Maintains

Maintains aims to save lives and reduce suffering for people in developing countries affected by shocks such as pandemics, floods, droughts, and population displacement. This five-year programme, spanning 2018–2023, is building a strong evidence base on how health, education, nutrition, and social protection systems can respond more quickly, reliably, and effectively to changing needs during and after shocks, whilst also maintaining existing services. With evidence gathered from six focal countries – Bangladesh, Ethiopia, Kenya, Pakistan, Sierra Leone, and Uganda – Maintains is working to inform policy and practice globally. It also provides technical assistance to support practical implementation.

This output has been funded by UK aid from the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies. Maintains is implemented through a consortium led by Oxford Policy Management www.opml.co.uk.

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