Why a Systems Response to COVID-19 is Critical

April 26, 2020

Alliance Magazine | Olivia Leland

I’m inspired by the number of funders who want to ramp up their support in light of the COVID-19 pandemic. Despite the urgency, we must not lose focus on how that support is deployed.

Diverting funding from building a national teacher training curriculum to make space for a portfolio of small emergency grants might feel right, but it will require a new operating model and a lot of people’s time. Why not leverage the network of thousands of teachers you are already supporting to play a meaningful role in the crisis? Donating masks to African countries may appear a sensible way to help, but what if the logistics are more costly than the masks, and the process distracts the attention of key managers throughout the emergency response? Why not instead support the health system to procure the items or equipment they most need?

There is no question that immediate relief efforts are essential during times of crisis. When faced with a global pandemic, many countries around the world have urgent needs. The question for funders is not about whether relief efforts are needed, but about how we support those efforts – and, equally importantly, how to do so in a way that will have a lasting impact.

As international funders, we believe that the most effective way we can deploy our support is through a systems response – investing in the entities which have the legal mandate and capacity to reach large numbers of people through established protocols, budget and personnel– and in the locally rooted people and organisations who have the expertise, relationships and contextual knowledge to lead response efforts. And because the impact of Covid-19 will be gendered, it is particularly important to listen to women leaders.

Investing in systems is both the best way to respond to the crisis now, and help countries be more resilient to future epidemics and shocks. This is especially urgent in places where systems were already under strain prior to the COVID-19 outbreak. Well-functioning systems are often best at early detection of infection, and that data can help to mount timely and focused responses where they are needed the most. Creating well-intended but parallel efforts only creates additional burdens and fragments a country’s capacity and response.

A systems response engages and leverages tools that are already in place. Project ECHO – a simple yet powerful model which helps to move specialised medical knowledge from academic centres to frontline healthcare providers through video-conferencing technology – is one example of this. In building the knowledge and capacity of hundreds of thousands of frontline medical staff, while at the same time learning from practical cases on the ground, expertise is strengthened even in hard to reach areas. Already present in approximately 40 countries, Project ECHO is now being called upon by India’s Ministry of Health, the US Center for Disease Control and Prevention, and the World Health Organisation to support a global COVID-19 response.

A systems response recognises that COVID-19 needs to be tackled in a manner that builds country capacity to provide essential services. During the Ebola epidemic, for example, untreated malaria cases are estimated to have risen by 140 per cent in Liberia, while the three most affected countries – Guinea, Liberia and Sierra Leone, experienced a 75 per cent increase in maternal mortality. The Liberian Ministry of Health, together with a coalition of actors including Last Mile Health and the Global Fund to Fight AIDS, Tuberculosis and Malaria, is working to train and equip a country-wide network of Community Health Workers, who are on the frontlines of providing primary healthcare, and indispensable in responding to COVID-19.

A systems response understands that there will be severe and far-reaching effects of this pandemic on other systems – and the need to shore these up over the long term. As the global economy slows down dramatically all over the world, supporting governments to strengthen social protection systems, for example, becomes more critical than ever. Meanwhile, the fact that more than 1.5 billion children and young people are now out of school highlights a need to strengthen education systems to be able to adapt and ensure that children are able to learn over the long term. Now is not the time to divert resources away from these and other important fields.

I’ve been heartened by the response of so many funders who are committing to standing by the organisations they support, to listening to what their partners need at this difficult time, relaxing restrictions on funding, making reporting less burdensome, and generally treating partners with more empathy, remembering the people behind the organisation. We’ve joined nearly 600 funders in signing a pledge spearheaded by the Council on Foundations and 300 who have joined the London Funders pledge. Others, such as the Center for Effective Philanthropy and co-signatories, have called on funders to increase their support at this critical time.  We hope more funders will do the same, and that these shifts in funding approaches will ultimately become the norm.

In the face of crisis, our instinct is to care and respond. This is a wonderful human impulse. Let’s channel that impulse toward asking what would be most helpful to the organisations and practitioners closest to the communities we seek to serve. Through them, we can ensure a response which is not only more effective in fighting this pandemic, but one which will shore up systems now and for the long term.

Olivia Leland is Founder and CEO of Co-Impact