Covid 19 pandemic outbreak has resulted in unrest, medical emergency, uncertainty and global economic slowdown. It has also resulted in wide open gap and unforeseen inadequacy in investment in pandemic preparedness and response. Though a number of guidelines, protocols, panel and commissions have been set up for recommendations and preparedness on how to better identify, handle, prevent, respond in such cases, government seems to struggle to reconcile and take the advantage edge out of the lockdown as at the primary stage if preparedness and response was taken, it would have not created conflict between health, economy and livelihoods. A citizen centric support to government interventions and protocols given if followed by the citizens shall strengthen government machinery and planning.

1. Financial Preparedness
and Investing during
Pandemics
A Primer on Prioritizing preparedness in lieu of pandemics
Dr. Prachi Ugle Pimpalkhute,
Founder, Eco Endeavourers Network
Sachin Pimpalkhute,
Co-Founder, Eco Endeavourers Network
14/6/2020
Eco Endeavourers Network
Striving for the Planet in Peril
Email : prachiugle@gmail.com
Contact Number: 9819098068

2. Preface
Covid 19 pandemic outbreak has resulted in unrest, medical emergency, uncertainty and global
economic slowdown. It has also resulted in wide open gap and unforeseen inadequacy in
investment in pandemic preparedness and response. Though a number of guidelines, protocols,
panel and commissions have been set up for recommendations and preparedness on how to
better identify, handle, prevent, respond in such cases, government seems to struggle to
reconcile and take the advantage edge out of the lockdown as at the primary stage if
preparedness and response was taken, it would have not created conflict between health,
economy and livelihoods. A citizen centric support to government interventions and protocols
given if followed by the citizens shall strengthen government machinery and planning. A
budgetary allocation for health and its spending with regard to pandemic preparedness is often
neglected and allocation in most of the times is with regard to economic progress. A healthy
workforce adds to the productivity of the economy; this attribute is of utmost importance.
Investing in health through financial preparedness and investing is a high cost effective way to
protect lives and at the same time protect livelihoods/employment and communities. Though
a measured proportion of human lives saved and economic slowdown avoided via fund
allocation is being done, the return on investments (ROI) in pandemic preparedness and
response is extremely high.
A task force to fight against pandemics when set up allows government and implementing
agencies to ensure adequate and sustainable financing actions to strengthen financial
preparedness enabling compliance with international health regulations. Such task force iswell
in place, however strengthening it with extra workforce of expertise shall allow financing of
critical capacities such as disease surveillance systems, medical testing, and emergency
operations. As regard to UN Sustainable Development Goals (UNSDG) one of notable mention
is Universal Health Coverage (UHC) and Indian government in 2017 was a signatory to its
incorporation in NITI Ayog under UN SDG 3 goal good health and wellbeing. However, it was
applied under any of the health schemes projected by the government and also not included
under the Ayushman Bharat and Arogya Setu.
This primer is a guideline on financial preparedness and investing during pandemics and how
prioritizing funding allocation help strengthen preparedness and response.

3. Introduction
In lieu of the pandemic Covid 19 - a big question has come up as to are we prepared to handle
such medical emergencies? The answer is viral threats to the extent of epidemic and pandemic
is inevitable, however a better preparedness action plan is most possible. Preparedness can be
anything be it medical interventions, community interventions, IT based interventions, capacity
building and capabilities at global, regional, community and local levels. According to World
Bank, estimates suggest that pandemics could destroy over 1.0 % of global GDP, as compared to
other global threats like climate change. Even smaller outbreaks cause loss of lives and economic
disruption, however pandemics such as COVID 19 whose outbreaks and onset happen sudden
and with such intensity and increased fatalities opens a challenge of public health and medical
emergency neglect and uncertainty. Developed countries have a well-structured health coverage
system which covers low income to higher income strata for health coverage and investment
protecting it. World Bank addresses a notable mention of Universal Health Security with the
priority being reaching everyone. Achieving it is a key component of Universal Health Coverage
(UHC) under the cadre of UN SDG 3: Good health and wellbeing. Stakeholder engagement and
coordinating with relevant implementing agencies to develop country specific investment
becomes pertinent in such cases. Find out way and means of generating monetary resources for
preparedness from taxes without undue burdening the citizens. Regulating private sector
investment in preparedness can play a major role – here if we can harness incentives from
business entities and financial markets it will etch out implementation action plans which
ultimately shall trickle down in strengthening health machinery, however when medical
emergencies onset happens sudden and with such intensity, business entities too have lessened
recoup capacity to support the cause as they themselves are in loss. Insurance companies
discounting and incentivizing provide immediate benefits though not for longer duration but of
valued importance, and these incentives shall help government combat intrinsic risks, measure
the extent of state of preparedness and economic vulnerability.
According to World Bank:
 By 2017, all national governments were supposed to commit to participate in, and were by
the end of 2019 supposed to conduct a Joint External Evaluation (JEE) to assess their capacity
to comply with the requirements of the International Health Regulations 2005 (IHR) to
prevent, detect, and rapidly respond to public health threats.
 By 2017, all national governments were supposed to commit to participate in, and by the end
of 2019, conduct an evaluation of Performance of Veterinary Services (PVS) to assess their
capacity to comply with the World Organization for Animal Health (OIE) standards.
 WHO had developed Guidelines for Development of a National Action Plan for Health Security
(NAPHS) in 2017. The Guidelines outline steps for situation analysis, strategic planning and
prioritization, costing, budget allocation and implementation of the NAPHS.
“Can India prepare and develop guidelines as per the guidelines for development of
National Action Plan for Health Security (NAPHS)?
 Once a complete costing and prioritized plan has been created for developing preparedness
plan, the next phase shall be how to finance it and how it can be implemented.
 Include robust and achievable health security benefits via inclusion of domestic budgets,
sustained support for improvising preparedness.

4.  Government should develop investment case scenarios for pandemic preparedness, also
mention of integrating the costed plan into national budget cycles
 In developing countries and countries with maximum low income population, the challenge
is inadequate resource mobilization.
 Improving tax strategy, insurance companies need to help individuals for loan rebate by
providing discounts.
 According to World Bank, government should include private sector in strategy and
preparedness as such outbreaks affects the business entities the most and in turn creates
imbalance in the entire supply chain. Keeping in mind from the futuristic point of view, to
protect and empower from such outbreaks and lockdown that happen during this time
pandemic emergency funding provision and allocation shall save from immediate economic
crisis.
 Incorporate economic risks associated with outbreaks into market assessments and
macroeconomics.
 Emphasize Universal Health Coverage (UHC): WHO defines UHC as access to broad range of
services, which would include services that contribute to preparedness. From this
perspective, preparedness is the output indicator, and is a subset of UHC.
Key stimulus as regard to stakeholders in nutshell:
Ensuring Economic Stability and Growth of the Country
Universal Health Coverage
Improved Social Security
Managing Externalities

5. For development and implementation – Financial instruments points requirement are as
follows:
Diagnostic
Strategy and action planning costing
Budgeting and Implementation
Situation Analysis
Strategic planning and proritization
Developing local, regional and country plan (Transforming
priorities into action and challenges into opportunities)
Resource and operational planning
Implementation of local, regional and country action plan
Empowering local, regional and country core capacities and
capabilities

6. How to initiate and create the case for investing?
The current Covid 19 crisis whose surge started sudden and with severe intensity has brought
in prior outbreaks to recall to draw lessons. Be it with regard to Ebola crisis that began in
West Africa in 2013, Zika outbreak, swine flu of 2009, China’s outbreak of SARS in 2003, a
series of reports have recommended strengthening and scaling up investments in global
health security as a priority (World Bank). Before putting forth the case for investing and how
preparedness be planned and implemented, what happens when outbreaks of such intensity
happen needs to pointed. Though it’s a medical emergency, its underlying causes affects
economy, social unrest and overall wellbeing and growth, so before putting forth the case for
investing and how it can be initiated and created, a brief detailing on the problem with the
onset of pandemics, its linkage with SDGs to strengthen the very purpose of investing.
Problem with the onset of pandemics:
Linkage of UN SDGS and Health System
Health
Impact
• Sickness
• Fatalities
• Citizens facing long term impact on overall wellbeing
Economic
Impact
• Productivity loss
• Jobs lost
•Loss from lockdown and lack of consumer confidence
Social
Impact
• Disruption of social fabric
• Panic/fear/anxiety
• Inequality
SDG 1: No
Poverty
SDG 3: Good
Health and
Wellbeing
SDG 8: Decent
work and
Economic growth
SDG 9: Industry,
Innovation and
Infrastructure
SDG 2:
Sustainable
Agriculture
SDG 11:
Sustainable Cities
and Communities
SDG 10: Reduced
Inequality
SDG 12: Responsible
Production and
Consumption
SDG 4: Quality
Education
SDG 13: Climate
Action
Health System
Strengthening
Financial incentives and
funds for emergency
facilitation

7. Designing and Implementing the Investing Case
Source: Based on Word Bank, Health Security Assessment Tool
What should Preparedness Costing Workout Include:
Health Security Financial Assessment tool, World Bank mentions seven sections to organize health
security and help strengthen public health:
 Gathering: current health care and security efforts as is done by Joint External Evaluation (JEE)
so as to define the boundary of scoping necessary for identifying and creating financial
provisions information data is required.
 Mapping Stakeholders: Identifying key players in health care and security providers
Situational
Analyis
Strategic
planning and
prioritization
Developing
country
plan
Resource
and
Operational
planning
Implementa-
tion of action
plan
Local,
regional and
Country core
capacity and
capabilitis
Plan
Prevent
Detect
Cross
cutting
CostingDiagnostic Strategy and Action Plan Budgeting and Implementation
Cost each of requirement
activity in the plan
assessment and identify the
financial constraints /gaps
Include allocation
process
Create buy-in-and
commitment for sustainable
financing and effective
implementation
Creating a buy in platform and open window option for financial commitment and implementation
Baseline financial capabilities and constraints

8.  Assessment: Institutional assessment examines the functionality and appropriateness of
coordinating mechanisms and implementation arrangements.
 Fiscal Space:Information on country’s overall fiscal space to address health security financing
is required.
 Resource Allocation and Budgeting: Financing for health security
 Specific health care requirements: As defined in the Joint External Evaluation, varied
packages components for funding specific health care needs assessment
 Efficiency, efficacy and sustainability: Examines issues with regard to allocation, technical
feasibility, efficacy and economic upward swing with sustainability as core tool in application
The health security tool while seeking financing options for preparing from pandemics should include
low income states, fragile and conflict affected states and middle and high income states. This shall
strengthen preparation allocation as per the requirement.
Key benchmarks:
1.Ensuring economic stability and growth
2. Fund for Universal Health Coverage per individual, which include pandemics
3.Managing social security amidst public health emergency
4.Managing externalities
Mobilizing Allocation
1. Domestic Resource Mobilization
2. Benchmarking taxes to financial preparedness
3. Priorities for donor investments at every stage of preparedness
4. Donors here reflect contributing significant amount to strengthening prevention, preparedness
and response capacities, OECD’s Creditor Reporting Survey (CRS) can be used as a benchmark
in mobilizing allocation
Leveraging insurance in Financial Preparedness
The fast delivery of money, coupled with a pre-determined contingency plan, can be very
effective in saving lives and livelihoods, and reducing the negative economic impact of the crisis
(Clarke and Hill 2013).
Risk management in Public Health Security
Alongside insurance a system of risk identification, risk assessment, risk modelling, risk
monitoring, risk preparedness, risk management, and contingency planning is required in public
health security.

9. Citizen
Concern
Citizen
Ensuring
economic
health and growth of
the country
Strengthening
the health system
Improving
health
security and
protecting
social stability
Managing
externalities
to regional and
global
community
Ministry of Finance Prevent future
productivity &
financial losses
Enabling health
Security systems
through low cost initiatives
and higher externalities like
private sector
Improving
lending
terms
Parliament Policies that
strengthen
economy
through investment
Workforce
resilience
Strengthening the health
system policies shall
improve
livelihood opportunities
and enhance productivity
and workforce resilience
Executive Improve
reputational
value with
international
donors
Ministry of Health Improving the lives through
stronger workforce system
Private Sector Reduce the impact
on productivity and
bottom line
Improve workforce security in case
of pandemics
Source: Based on World Bank

10. Who, Why and When of Using this Primer
Critical change management levers for assessment, planning and implementation process based
on World Bank
Critical Management Levers ⁺
WHO ?
Country, regional and local level preparedness personnels (Ministry of Health,
Representatives from Public Health Department, Hospital Managament, NGOs,
Municipalities and other key stakeholders like investors who are involved in allocate
resources to planning, costing and financing preparedness activities
AIM?
Provide preparedness personnels an list of formal and non-formal activities planner that
shall strengthen preparedness action
Provide tools that shall help them prepare investment case for preparedness
WHEN TO USE?
As a starter or initiater document to catalyze critical areas ith dense population to
prepareness action and also as a precautionary document to citizens at large from
pandemics from futuristic perspective - along with key stakeholders
For communication and management planning processes while creating and implementing
the National Action Plans for Health Security (NAPHS) as per World Bank
Phase 1 :
Diagnostic
Phase 2 :
Strategy and
Action
Planning
Phase 3 :
Costing
Phase 4 :
Budgeting and
Implementation
Challengers
and
Sponserers
Platform for
placing
investment
case
Expertise,
Capacities
and
Capabilities
Formal
Mechanisms
Challengers and Sponserers –
from key influencers
The platform for investment case should be
timely placed with critical parameters to cover
The expertise, capacities and capabilities
should be combination of health care
professionals, scientists, researchers, social
scientists and other
Formal Mechanisms – Include processes,
Tools, systems, financial incentives – these
shall be key to support implementation
at Country level, regional and local level

11. Key Players for role play in critical change management in implementing preparedness for
Pandemics
Change Management Leader : Change management process and
shepherds it through the complex world of priority-setting and decision-
making in government
Monitoring Committee : Team managed by the change leader that serves
as a steering unit. The team or committee shall include senior
representatives of all sectors involved as well as the main donors and
regional/global entities
Project Manager : The person responsible for the logistics, planning and
activities related to the change management plan (e.g., ensuring regular
engagement of key stakeholders, scheduling monitoring committee
meetings, managing government approval processes)
International public health community : Local members of international
institutions who may be able to provide technical project expertise,
process and planning input (e.g., members of WHO, World Bank, Gates
Foundation, Red Cross, CDC etc.)
Preparedness Team Lead : Individuals selected during the planning
process to lead planning and execution of preparedness activities
including surveillance. Individuals may include members from private
and public sector as well.
Country Leader : Key government decision-makers, including members of
the legislative and executive members
Private Sector : Representatives from key industries that could contribute
to preparedness activities or could push the Government to implement
preparedness as they would be affected by sudden onset of outbreak of
pandemics
Technical Group Experts : Regional and local team of experts with
capacities, capabilities and skills important for preparedness execution

12. Drivers who shall steer the preparedness action as per World Bank guidelines:
 Ensure involvement of country leadership: involvement of top leadership and key ministries will
allow prior emergency preparedness.
 Engage top influencers across all sectors (e.g., NGOs, media, political & business leaders, etc.)
 Identify & mobilize people with the right expertise to drive the implementation process
 Integrate the preparedness process in the existing core processes
 Preparedness capacity development as part of the national health sector plan
 Preparedness costing and financing process integrated in the country planning and financing
regular process
 Create a governance structure and assign accountabilities – A governing body to manage plan
implementation
 Specific responsibilities and accountabilities for each activity in the plan
 Separate monitoring body regularly evaluates and reports back on plan effectiveness
 Preparedness be a clear priority for the country, agenda and need to be regularly discussed and
communicated from global public health institutions and donors to the country leadership
 Integrate the preparedness process: Preparedness capacity development as part of the national
health sector plan – Preparedness costing and financing process integrated in the country
planning and financing regular process.
Across all levers, adopt a multi-stakeholders approach according to World Bank:
 Inclusive mechanisms in place for involvement of public, private sector and civil society
 Multi-sectoral coordination
 Partnership-based plan
 Coordination with neighbouring countries
High Level Critical Change Management for Pandemic Preparedness at country level
- What, Who and When
Formal Mechanism
Activity What Who When
Assign accountability
to each intervention
Each intervention/action
plan should have a
person accountable for
its implementation
Change
Management
leader
Multi – sector
stakeholder
Phase 2
Design governance
structure
for coordination of
implementation & appoint
monitoring committee/
body
Due to the multi-sectoral
nature of the plan
and the
fragmented
accountabilities across several
actors, a project manager
Change Manage
-ment leader
Project Manager
Monitoring
committee
Phase 3

13. should be appointed to
track and regularly
follow-up on the
implementation of the plan and to
coordinate actions across
sectors
Design tracking &
monitoring process
The implementation of
activities against the initial
plan should be regularly
tracked and monitored:
this shall be done by the
project
manager and through the
monitoring committee
Change Manage
-ment leader
Project Manager
Phase 3
Integrate action plan
activities into regular
plans
(e.g., national health
sector plan)
Once the preparedness
activities are defined in the
plan and each of them has a
responsible person, this
person should make
sure that activities are
integrated into regular plans
Preparedness activity
Team Lead
Project Manager
Phase 4
Integrate costing in
country budgeting
Costs that are determined to
be funded through
local or domestic funds
should be
included in the next
review of the country
budgeting, following the
inclusion in each of the
different plans
Relevant country
budgetary
Team of the
Parliament,
Financial
experts,
advisors,
Finance
Minister
Phase 4
Challengers and
Sponserers
Identify change leader among
political leadership
The change leader’s role is to
promote the topic of
preparedness, drive the
engagement of political
leadership and other
stakeholders and advocate in the
legislature to get dedicated
funding
International public
health
community and
preparedness
advocates in
country
Phase 1
Map key influencers across sectorsKey influencers may be
found across different sectors
(political leadership,
private sector, civil society,
partners, both national and
international entities);
although sometimes these
people do not have a formal
role in the preparedness
agenda, they are key to
influence key stakeholders
Change
management
leader
Starts in
Phase
1 and
Continu
es
until
Phase 2
Engage country
leadership
The change leader plays a
key role in engaging the
rest of the country
Change
management
leader
Starts in
Phase
1 and

14. leadership and identifying
potential champions amongst
them of the preparedness
activities
(Heads of government
ministries, Prime Ministers)
Continues
until
Phase 3
Engage identified
influencers and
make them
“champion or
challenger”
The change leader can start
engaging the key
influencers and stakeholders,
to make them further
champion the agenda (e.g.,
parliamentarians,
project leaders with high
reach)
Change
management
leader
Starts in
Phase
2 and
continues
until
Phase 4
Create stakeholder
map
A stakeholder map includes a
list of all key
stakeholders for
preparedness planning &
execution, that could include:
Minister of Finance,
Parliament, the Executive,
Ministry of Health, other
relevant Ministries,
private sector,
donors and international
partners For each
stakeholder, it should be
clarified: role in the
preparedness planning &
execution, main
motivations and concerns,
objectives of the
communication
Change
management
leader
Starts in
Phase 1
continues
Until
Phase 2
Trainings for appointed people
and ad hoc support on specific
activities
Trainings could be
provided by
regional/global
entities that already have
experience from
implementation in other
countries Ad hoc
support may include
rotations across partner
countries, consultants for a certain
period of time
Private
sector
Regional/ global
entities
Technical groups
Other
countries
Starts in
Phase 3
and
continues
until
Phase 4