Within a short span of a few months, COVID-19 changed the global healthcare landscape. The world looked to the WHO to play a leading role in navigating the largely unfamiliar territory that lay ahead. The Organization's burden was extraordinary, including in the Kazakhstan WHO Country Office (WCO).

The Kazakhstan WCO was asked to respond to this outbreak with limited resources and operational capacity. At the beginning of 2020, the team functioned with minimal funding and was confronted with staffing shortfalls. Additionally, new WCO leadership was developing relationship with the Ministry of Health (MoH) and was strengthening its relationship whilst engaging with the United Nations (UN), ambassadors and other key actors.

The first cases of COVID-19 in Kazakhstan were confirmed on 13 March 2020 in Nur-Sultan and Almaty, which became the most affected cities along with Shymkent. WHO responded during the critical first six months of the crisis to raise approximately US$6.2 million, and build WHO’s country level expertise and footprint.  WHO’s country office could better support the national government in implementing WHO guidance and build trusted relationships with key national health stakeholders. A key reason for this turnaround was taking a management perspective in response to COVID-19 at the national level. These actions can be summarized in five steps.

1. Fundraise with vision and values.  WCO made fundraising a top priority across the team. Centering fundraising around shared vision and values helped to quickly mobilize the required resources and allowed the team to promote values such as evidence-based knowledge sharing, neutrality and integrity in their work.
2. Architect a team.  WCO clearly articulated each team member's role, thus avoiding the overburdening of staff with work. It was crucial to recruit new highly qualified staff and to find time for existing staff to complete training programmes to acquire necessary skills. WCO also embedded opportunities for staff to raise issues regularly and discussed solutions, actively managed team dynamics and promoted an egalitarian management style so that everyone feels comfortable voicing their opinion and putting forward their ideas and proposing new solutions
3. Lay foundations with internal processes and communication.  WCO set up efficient remote methods of communication to reduce unnecessary email burden, encouraged video conferencing, and established video conferencing guidelines that enabled proper pacing, language, and management of interruptions. With the input from an external specialist, WCO reviewed internal working patterns and processes (e.g., remote communication methods and collaboration tools).
4. Read and contextualize.  WCO employed international experts for the contextualisation of WHO guidelines, thereby ensuring continuous and comprehensive conversations with national stakeholders and WHO experts in each field. When delivering contextualized training to healthcare professionals in Kazakhstan, WCO customized information to different groups' language and expertise so that WHO’s recommendations were practical and had a clear rationale. WCO regularly shared easily-to-understand risk communication materials with the general public on social media and supported the creation of a 24/7 call centre and chat-bot to answer pandemic-related questions. This was complemented by establishing a UN inter-agency risk communication group to regularly review the key messages and the public perception of any UN operational response.
5. Deliver.

Incident management. The WCO established its incident management system to operationalize the response, provide technical advice, and mobilize medical supplies. This fed into, and worked closely with, the incident management support teams established for COVID-19 at the regional and global levels to guide and operationalize WHO’s overall support to countries.

Resource management. The WCO promoted ethical discussions among the team to allocate resources fairly, thus strengthening the team’s cohesion and ensuring that operations were conducted with integrity. WHO’s country office led the UN's COVID-19 response in Kazakhstan, coordinated and oversaw the supply chain management with the UN Resident Coordinator by managing large scale relief operations and appointing coordinators for validating and prioritising national supply requests. To streamline logistics operations among the MoH and UN agencies, WHO and UN partners launched an innovative UN inter-agency logistics coordination platform. This mechanism allowed for the coordination of logistics and procurement for all UN agencies in Kazakhstan while filtering local authorities' requests and avoiding duplication. WCO served as the focal point for national authorities, partners, NGOs, and the COVID-19 Supply Chain System Control Tower. Lastly, the WCO supported private entities with advice on quality assurance regarding the supplies they intended to purchase.

Knowledge generation. WCO supported the MoH in its mission to generate additional knowledge through COVID-19 research. Approximately five research projects were ongoing, and findings will be shared globally to contribute to the overall knowledge generated on this current outbreak.  Investing in research is paramount during an ongoing outbreak, this is also true for sharing newly established knowledge in key technical areas such as infection prevention and control, case management and laboratories as well as in risk communications.

Through these strategies and activities with key partners, the WCO made several accomplishments in their COVID-19 response. Approximately 4000 healthcare workers trained on IPC, laboratory capacity, and case management (through over 40 webinars in Kazakh, Russian and English, delivered by experts), 2.5 million items of personal protective equipment (PPE) and 4000 tests were delivered, over 44 000 PCR tests and 12 000 hygiene kits distributed, and many new research were initiated. 

COVID-19 demonstrated that health systems must be well prepared to ensure access to essential health care services is not put at risk and that acquired health gains are not lost. Kazakhstan faced may barriers at the start of the crisis but has demonstrated its commitment to mitigate the impact of the COVID-19 outbreak. The combination of WHO’s continued work and the efforts from tireless health care workers and people in Kazakhstan (notably the rigour with which people adhere to the recommendations of hand hygiene, wearing of masks physical distancing) will play a key role in the continued fight against COVID-19.

The key takeaways from Kazakhstan’s experience of managing the COVID-19 pandemic are:

1. Promoting ethical decision making. Many decisions during an outbreak are rooted in ethical dilemmas. Distributing the resources equitably requires careful consideration, justification and transparency. Adhering to and abiding by clear shared values in a team fosters an ethical debate and leads to proper decision making.
2. Hire people who share the same values, not the same skill sets. A team sharing similar values will communicate well, trust each other and collaborate on difficult problems. A team with diverse skill sets will have the tools and knowledge at their disposal to find creative and efficient solutions.
3. Invest in your team’s professional development. Nurturing staff wellbeing and development will grow your team's expertise and increase wellbeing, loyalty, and motivation, ultimately reducing staff turnover.

Photo caption: WHO Representative in Kazakhstan Dr Caroline Clarinval with WHO Country office team members.

Photo credit: WHO