The global pool of simulation exercise materials in health emergency preparedness and response: a scoping review with a health system perspective

McDarby, Geraldine; Reynolds, Lindy; Zibwowa, Zandile; Syed, Shams; Kelley, Ed; Saikat, Sohel

While there is international consensus of the need to focus on quality in healthcare, the focus on the quality of services delivered in the context of a PHE was lacking. 21 22 Where materials did focus on service quality, they tended to focus on clinical aspects of care. System and process measures were only identified in drills that tested mass dispensing capabilities in the context of a pandemic or biological attack. These capabilities represented parallel BMJ Global Health response structures and their linkages with appropriate health system structures were not tested, nor was the communication required to divert individuals from normal health services tested. 23 24 No materials identified included measures to test the maintenance of or quality of essential health services during the response to a PHE. Evidence from West Africa shows that the indirect mortality and morbidity associated with discontinuity of health services as well as poor quality health services was significant across the three countries, with the biggest impact on maternal and child health. 6 The current global pool of SimEx materials are limited in its ability to test health service resilience alongside preparedness and response. This in turn limits the opportunity to practically bridge health security and health systems at different administrative levels. Special attention is required in using SimEx approaches to drive sustainability of investment in health security preparedness or disease-specific programmes to proactively position available scarce resources into sector-wide development of health systems for all public health hazards per IHR (2005).