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

SimEx are an effective approach used extensively within health security and emergency response sectors but is not yet adequately used to test health system resilience. Currently available SimEx materials lack an integrated health system perspective and have a limited focus on the quality of services delivered within the context of response to a public health emergency. to disease outbreaks. 1 Health workers were significantly more likely to be infected than the general population, with this increased risk largely attributable to the poor quality of infection prevention and control (IPC) practices and emergency preparedness. [1] [2] [3] Guinea, Liberia and Sierra Leone lost between 1.5% and 8.1% of their country's doctors, nurses and midwives to EVD, translating into significant reductions in the healthcare provision. 2 Ineffective surveillance systems enabled EVD to spread locally as well as across borders. 4 5 During an outbreak, as with any public health emergency (PHE), the resilience of a country's health system is tested in real time. The capacity to respond to an outbreak and maintain essential services creates a surge in demand for critical resources. Health system resilience has been defined as 'the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learned during the crisis, reorganize if conditions require it.' 4 Resilient health systems protect human life and are linked with positive health outcomes during a PHE as well as in its aftermath. 4 A lack of health system resilience is associated with excess morbidity and mortality due to the PHE as well as from other causes, which can be at least partially attributed to a reduction in access to quality health services. [6] [7] [8] It has been estimated that a 50% reduction in access to healthcare services during the West African EVD resulted in increased child and maternal mortality as well as increased mortality from other infectious diseases. 6 8 These indirect deaths-10 623-were not insignificant. 6 Thus, it is critical that a mechanism exists to test and build resilient health systems in order to reduce excess morbidity and mortality from future PHEs.