Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges.

This paper conducts a comparative review of the (curative) health systems' response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the 'Health System Response Monitor' platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy "flexible" intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.

Participatory approaches to reaching the Sustainable Development Goals: Malta: leaving no one behind: participatory development of policy on health services for transgender people

In 2018, Malta took concrete steps in the development of health services for transgender people. A high level of political commitment, the strong leadership of the Minister of Health and the adoption of a human rights-based, gender-responsive approach were important factors in the design and planning of these services, which led to the opening of the Gender Wellbeing Clinic in November 2018. The Clinic provides gender-affirmative health care services, tailored to the needs of the users by a multidisciplinary team, including an array of psychosocial and medical professionals. Malta’s health services policy for transgender people addresses Sustainable Development Goal (SDG) 3 (good health and well-being) and SDG 10 (reduced inequalities).