The COVID-19 pandemic continues to disrupt essential health services in almost all countries in the world.

The disruptions are due to lack of investment in primary health care and universal health coverage (UHC) in combination with inadequate health-care resources, insufficient workforce availability, suspension or reduction of services due to the pandemic, and hesitancy in seeking health care.

All health systems are responding to overcome the service disruptions and to recover high-quality health services, and all countries are taking action to mitigate the consequences and to promote service delivery. The mitigation strategies include home care, self-care, telemedicine, role delegation, recruiting and training health workers, procuring key health products, novel ways for renewing prescriptions and dispensing medications, community engagement and communication and innovative health financing strategies such as funding care in private facilities with public funds, removing user fees and cash transfers to vulnerable populations.

The main lessons learnt are the importance of improving the resilience of essential health services for any humanitarian emergency and the need to strengthen primary health care and UHC for health security and to scale up helpful innovations.

Despite the challenges presented by the COVID-19 pandemic, many countries and areas have been able to make progress and reach new milestones in achieving the health-related Sustainable Development Goals with support from WHO. Years of work have led to the following achievements.

• WHO has made the historic recommendation for widespread use of the first malaria vaccine, which could save tens of thousands of young lives each year. China and El Salvador were certified as malaria free.

• National malaria programmes showed resilience in the face of the COVID-19 pandemic disruptions; 18 countries completed insecticide-treated net campaigns in 2020, distributing 159 million nets; other countries caught up with net distribution in 2021. An additional 8 million children were protected by seasonal malaria chemoprevention in 2020 as compared with 2019.

• Eight countries achieved the 90–90–90 targets for HIV testing, treatment access and viral suppression by the end of 2020. and a further 20 countries are close to the targets. One country achieved the 95-95-95 targets for 2025.

• Fifteen countries eliminated mother-to-child transmission of HIV and/or syphilis, and, in 2021, Botswana became the first high-burden country in Africa to achieve “silver tier” certification on the path to elimination of mother-to-child transmission of HIV.

• WHO is validating the criteria for elimination of hepatitis B and C as a public health threat in six countries, and several countries are nearing validation.

• All Member States sustained elimination of rubella and congenital rubella syndrome, and 33 of 35 Member States sustained elimination of measles.

• Implementation of kangaroo mother care, for which WHO helped to generate evidence, is now accelerating globally. The approach results in a 40% higher survival rate of unstable babies.

• 33 countries reached the 2020 End TB Strategy milestone of a 35% reduction in the absolute number of TB deaths between 2015 and 2020. 86 countries reached the milestone of a 20% reduction in the incidence rate from that in 2015.

• More than 757 million people benefitted from at least one intervention against a neglected tropical disease in 2020.

• Five countries eliminated a neglected tropical disease: Gambia and Myanmar eliminated trachoma, Côte d’Ivoire and Togo eliminated human African trypanosomiasis, and Malawi eliminated lymphatic filariasis. Only 15 human cases of Guinea worm disease were reported last year in four countries, bringing the world closer than ever to eradication.

• 120 countries are integrating interventions for hypertension, diabetes and other noncommunicable diseases into primary health care with support from WHO.

Building resilient health systems

For many governments, the pandemic has provided clear opportunities to invest more resources to improve access to services now and in the future. In response, WHO produced a position paper on Building health Building health systems resilience for UHC and health security resilience for UHC and health security during the COVID-19 pandemic and beyond. This is an important guide for countries in building health system resilience, integrating UHC and health security, and it positions health as central to socioeconomic recovery, even if equitable access of services continues to be a challenge for vulnerable populations such as children, older people and people with disabilities.

In the global pulse survey, 90% of countries reported investments for longer-term recovery of their health systems, including new mental health and psychosocial support services and resources. Half of all countries plan to build longer-term resilience of their health services and preparedness for future pandemics; and more than two-thirds of countries have allocated additional funding for longer-term health system recovery, most commonly through increasing access to medicines and building workforce capacity.

WHO has provided support by reviewing strategies and standards for human resources for health in the context of the COVID-19 pandemic, particularly for essential public health functions and delivery of services closer to communities. The Universal Health Coverage Partnership has supported more than 115 countries in maintaining essential health services during the response and has intensified support to strengthening primary health care strategies and emergency preparedness.