Given their comprehensive nature, the survey results can provide an overall health system diagnostic, shedding light on the system’s ability cope with and recover from unexpected shocks, such as the COVID19 pandemic.

The three most recently completed health SDI surveys are from Kenya, Sierra Leone, and Tanzania. Kenya’s survey is the largest to date, with a sample of 3,094 facilities, and was conducted between March and July 2018. Of the sampled facilities, 1,781 are public and 1,313 are private. The survey team observed 13,026 workers for absenteeism and assessed 4,430 health workers for competence using patient case simulation. The data collected are representative of the 47 counties, facility location (urban/rural areas), facility ownership (public/private), and level of facility (first level hospital/health center/dispensary and clinic).

The SDI survey in Sierra Leone was conducted between January and April 2018 and consists of a sample of 547 health facilities, 501 public and 46 private facilities. The survey team observed 1,700 workers for absenteeism and assessed 818 health workers for clinical competence. The data collected are representative of the 14 districts, facility location (urban/rural), facility ownership, and level of facility (hospital/health center/health post).

The survey in Tanzania took place between August and September 2016 and is comprised of a sample of 400 health facilities, which included 273 public and 127 private facilities. The survey included an assessment of 2,093 health care workers for absenteeism and 563 for clinical competence. The data collected are representative at the national level and by location (Dar es Salaam, other urban areas, and rural areas).

Each of these three surveys adheres to a core set of questions that are standardized across all SDIs, ensuring international comparability of results. However, in response to specific country contexts and policy interests, the surveys also have questions that differ. This report presents the results from analyzing data from these three most recent surveys (from the last five years) to examine the SDI survey’s capacity to date to surface insights on COVID-19 preparedness in these three contexts. Because of country-specific differences in the surveys, the availability of pandemic preparedness–related indicators varies slightly by country. The calculations use survey weights to generate nationally representative estimates for each country.

# International pandemic guidelines and the SDIs

The World Health Organization (WHO) offers an extensive set of guidelines relating to pandemic preparedness, covering a wide range of topics from international cooperation and national governance to maintenance of essential services at the community or health facility level. The Joint External Evaluation (JEE), for example, takes a whole-of-government, multisectoral approach to assessing country capacity to prevent, detect and rapidly respond to public health risks occurring naturally or due to deliberate or accidental events.<sup>9</sup> In the recent years, responding to the potential of an influenza outbreak, the WHO has developed specific guidelines relating to influenza pandemic preparedness.<sup>10</sup> Given the present context of the COVID-19 pandemic, this set of guidelines is most relevant (in the absence of guidelines of

> 9 Joint External Evaluation Tool and Process Overview. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO.

> 10 World Health Organization. WHO checklist for influenza pandemic preparedness planning. 2005. Accessed April 8, 2020 https://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_4/en/

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