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

Consideration of the integration of preparedness and response across health system levels was lacking, with services and facilities tending to test their own response capabilities in isolation. PHC, despite being the likely first point of care in many PHEs, was rarely considered in the SimEx materials reviewed either in terms of supporting preparedness capacity or in terms of the effect of the PHE on PHC. 15 PHC plays a central role in surveillance which was highlighted within the EVD outbreak in West Africa, where failure to identify EVD when it first presented within the community in Guinea led to a significant delay in response with a concomitant lack of containment. Despite evidence from EVD West Africa that community linkages can support health system response in the face of PHEs, the current global pool of SimEx materials were unlikely to link with community aspects and where community preparedness materials existed they rarely linked with health systems. 16 17 The importance of integrating private healthcare facilities into emergency preparedness and response capabilities was highlighted by the recent dengue outbreak in Khyber Pakhtunkhwa in 2017. A private health facility, unfamiliar with emergency response protocols, failed to activate emergency response mechanisms in a timely manner. This, alongside a lack of case management guidelines, contributed to prolonged community transmission. 20 No evidence of integration of private healthcare facilities into health system preparedness and response was identified within the current pool of global SimEx materials.