A recent study of the global COVID-19 response showed that one third of countries had limited operational capacity, with most being low- and middle-income countries (LMICs). Understanding how best to advocate for and support healthcare organizations (HCOs) and the healthcare workforce in LMICs is important for optimal response to the ongoing pandemic.

Methods:

We developed and disseminated a 29-item survey to 40 HCOs in 15 LMICs to assess the readiness, responses, and challenges of addressing COVID-19. We developed readiness and response scores (RRS) comprising an overall score and subcategories of preventing community spread, preventing spread in HCOs, and providing intensive medical care. T-tests and chi square tests were used to evaluate differences in RRSs based on GDP per capita or physician availability per 1000 persons. We also conducted qualitative analysis of a free response question on COVID preparedness and response.

Results:

HCOs reported insufficient ICU beds (80%), ventilators (75%), and PPE (72%) and inadequate testing for patients (70%) and staff (77%). For preventing community spread, 60% reported communities were able to adopt hand-washing practices and 50% reported communities could practice social distancing. Qualitative analysis supported these results.

Compared to LMICs with higher GDP per capita, RRSs for LMICs with lower GDP per capita were lower overall (5.9 vs 7.6; p<0.047) and in the subcategory of intensive medical care (0.2 vs 0.7; p<0.029). Fewer LMICs with lower GDP per capita reported adequate ICU capacity (p<0.039). RRS was lower in the subcategory of intensive medical care for LMICs with lower physician availability compared to those with higher physician availability (0.2 vs 0.7, p<0.044). More LMICs with higher physician availability reported having adequate PPE (p<0.007) or a strategic plan to respond to COVID-19 (p<0.027).

Conclusions:

LMICs face expected resource limitations, particularly in PPE and ICU capacity, which is related in part to availability of economic and medical resources in their country. Despite resource limitations, HCOs in LMICs can strengthen capacity for isolating COVID-19 patients, protecting vulnerable groups, and supporting healthcare workers. We provide recommendations for HCOs, LMIC governments, and the international community to increase pandemic response and readiness against future pandemics.