Exploring the relationship between national governance indicators and speed of initial government response to COVID-19 in low- and middle-income countries.

Objectives: This study aimed to explore the relationship between national governance and country response to the COVID-19 pandemic in low- and middle-income countries, to support preparedness for the next pandemic. We conducted a statistical analysis of 116 countries, examining the relationship between speed of initial response and measures of national governance. Study design: Observational study, with individual countries as the unit of analysis. Methods: We used logistic regression to look for associations between quicker initial government response and four national governance indicators: Government Effectiveness, Political Stability and Absence of Violence/Terrorism, Voice and Accountability, and Corruption Perceptions Index. Results: A quicker initial government response was associated with countries with higher Government Effectiveness (OR 13.92 95% CI 3.69-52.48, p < 0.001) and lower Political Stability and Absence of Violence/Terrorism (OR 0.23, 95% CI 0.09-0.57, p = 0.002). There was no relationship observed between speed of initial government response and Voice and Accountability or Corruption Perceptions Index. Other factors associated with quicker initial response were small population size, experiencing first COVID-19 case after the pandemic declaration, not having previous experience with SARS-CoV1 or MERS and not being an island nation. Conclusions: This study shows that having higher state policy and implementation capacity, and lower political stability was associated with a quicker initial pandemic response. Limitations of this study include the use of crude national level indicators and broad categorisations of countries into quicker and slower responders. Deeper enquiry into the early decision-making processes taken at the national executive level within individual countries may help clarify the observed associations further.

Leadership Politics and the Evolution of the Universal Health Insurance Reform in Peru.

Peru is now on a path toward achieving universal health coverage (UHC), with 87% of its population covered by health insurance. This paper describes the politics surrounding the agenda setting and policy formulation process that led up to the adoption of Peru's Universal Health Coverage Act in 2009, which has been instrumental in expanding coverage. This reform established a mandatory health insurance system, which includes an Essential Health Benefit Package (Plan Esencial de Aseguramiento en Salud-PEAS) that is financed by three health insurance schemes (subsidized, contributory and semi-contributory). Collectively these schemes are intended to cover the entire population of Peru. In exploring the politics of the health reform process, the commentary applies the Political Economy of Health Financing Framework, presented in this special issue. It does so from the point of view of a participant in the reform process. Some broader lessons emerge that extend beyond Peru regarding the changing nature of the leadership roles in each phase of the policy cycle. In particular, the analysis highlights the importance of a consensus building process across a range of political stakeholders to set the health reform on the policy agenda and as well as to preemptively identify and resolve disagreements that might arise in the legislative phase.