this scope for COVID-19 specifically) for assessing the level of and supporting national health systems to further bolster their preparedness during the pandemic.

Guidance for health systems, highlighted in this WHO manual, centers on the objective of minimizing morbidity and mortality caused by the pandemic by ensuring that health services are kept functioning for as long as possible. Of the 18 tasks identified across the four categories for maintaining essential health services, the most recent SDI surveys provide some evidence to support planning for seven tasks concerning procurement, coordination and management related to health facilities, personnel, and supplies (Appendix Table 1). The existing SDI data do not inform any activities related to management of excess mortality resulting from the pandemic.

For instance, the SDI data allow estimation of numbers of health care workers by professional group at the facility level, which can be extrapolated to gauge availability at the national, provincial or local level. These data can also inform coordination of patient flow between health care facilities by providing insight on resources available across facilities, including provision of emergency transport and seamless communication. Furthermore, the SDI can shed light on availability of basic, yet critical, medicine, equipment and supplies for infection prevention, treatment and control, especially during respiratory pandemics. These include availability of a functioning thermometer, stethoscope and sphygmomanometer for diagnosis and monitoring; unexpired antibiotics for treatment of patients; and personal protective equipment like gloves and masks to protect frontline health care workers. This report delves into the details of what can be learned about these pandemic preparedness indicators from the SDIs.

# Ready or not? Findings from the SDIs on facility preparedness for a pandemic situation

The demand for health care increases unexpectedly and usually exponentially during disease outbreaks and pandemics. The same is true for COVID-19. Leading epidemiological models indicate that despite stringent suppression measures, the spread of COVID-19 will overwhelm most health care systems. Careful planning involving systematic assessment of the capacity of available facilities, and their utilization for treating and supporting patients based on the severity of the case, is crucial for ensuring effective delivery of routine care and for serving the additional demand for care, including timely referral and hospitalization. The SDI survey offers useful insight for this planning by providing data that are not reliably available through administrative sources. The sections below describe findings from three SDI surveys on pandemic preparedness, as defined by the WHO guidelines described above.

## Hospitalization capacity

In the current pandemic, evidence from high-income and high-capacity countries indicates that the demand for hospitalization due to severe cases far outpaces health system capacity. Once a surge in infection is noted, low- and middle-income countries are likely to face a similar, if not a worse, mismatch of supply with demand. In such a scenario, it may be helpful for health authorities and planners to assess and identify health facilities, particularly non-hospitals, that could temporarily be used for inpatient care. The SDI survey indicates that many non-hospitals have hospitalization capacity, including 14% of nonhospitals in Kenya, 11% in Sierra Leone and 17% in Tanzania. However, it is worth noting here that the survey in Kenya indicates that only slightly over 50% of facilities have the capacity to diagnose and treat chronic obstructive pulmonary disease (COPD), a proxy for overall capacity to manage respiratory diseases (Appendix Table 2). As expected, this is higher in hospitals than in non-hospitals (Appendix Table 3) and is worse in rural areas where the percentage of facilities that can diagnose and treat COPD is 14 percentage points lower than in urban areas (Appendix Table 4). Relatedly, these data also indicate that only about 5