The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.
There was a pandemic response plan in place before the outbreak or COVID-19, but it was specific to pandemic flu. The Pandemic Preparedness Program 2019-2023 includes (1):
- Planning and coordination
- Situation monitoring and evaluation
- Prevention and localization
- Health system response
- Communication and public engagement
All the activities regarding response to COVID-19 are carried out following the Law on the Prevention and Control of Communicable Diseases in Humans (1996) (2), so there is no need for emergency legislation. Recent amendments only relate to expansion of social guarantees for employees working with emerging communicable diseases.
The Government is leading the national response to COVID-19. National Emergency Situation Centre and Government Emergency Commission are formed, and Minister of Health was designated as Head of the National Emergency Operations. (5,6) Also on 25 March the Prime Minister announced that Cabinet of Ministers decided to set up a special government committee to coordinate emergency management.
Information is communicated through the official government websites and via mass media. There are daily briefings from the Head of the National Emergency Situation Centre, the Prime Minister and other relevant Ministers and selected experts. State agencies may share information on the situation in agreement with the National Emergency Situation Centre.
The announcement of national quarantine was made on 14th March, with lockdown coming into force from 16th March. Measures included: closure of national borders, reduction in inter-city public transport, restrictions on export of certain goods, introduction of physical distancing measures for residents (section 1.2), changes to workplace requirements, prohibition on providing certain face-to-face services, closure of educational institutions (section 6.1), limitations on planned health services (section 3.3). Quarantine was extended several times (currently until 31st May). (4) First transition measures started to be introduced from 15th April (see below and Section 1.2)
TRANSITION MEASURES – Spring 2020
Lithuania started gradually lifting quarantine measures from 15th April. These are also described in sections 1.2 and 3.3.
On 6th May, the Government has released a draft strategy for easing the quarantine measures, while containing the spread and mitigating the risks.(3) It is aimed to be implemented in accordance with five key principles:
1) protection of persons belonging to high-risk or vulnerable groups;
2) proactive tracing of cases and rapid containment measures;
3) prompt and objective public information;
4) making decisions based on evidence and facts;
5) international cooperation, in particular at the level of the European Union.
The strategy is planned to be implemented over two years. To this end, an action plan is prepared, which sets out specific measures for each priority axis, identifies the intended results and the responsible authorities. Four priority directions of the strategy are envisaged:
1) development of an effective virus response monitoring mechanism (responsibility of MOH);
2) ensuring the preparedness of the health system and strengthening the physical and mental health of the society (responsibility of MOH);
3) implementation of quarantine regime conditions, taking into account the epidemiological situation in the country (responsibility of MOH);
4) ensuring stability of the country's social and economic sectors and adapting to new conditions (responsibility of the Ministry of Finance).
The implementation of the strategy is to be coordinated by the Government, and monitored by the Government's COVID-19 Management Committee, chaired by the Prime Minister. The designated coordinating bodies will assess the progress of the action plan for the implementation of the strategy and keep the Committee informed of developments. The results of the implementation of the strategy will be regularly discussed in the Government, and they will be presented in cooperation with the Office of the President, the Parliament, municipalities, as well as socio-economic partners and the public. A more detailed evaluation of the plan of measures for the implementation of the strategy will be carried out every 6 months - the effectiveness and appropriateness of the selected measures will be analyzed. The strategy and plan of measures for its implementation will be substantially reviewed in the event of the development of a vaccine, treatment or evidence of the immunity to the virus.
Reintroduction of measures (2nd wave)
From October 2020 some tightening, local quarantines and move to three-tier system according to rates of transmission were introduced (see section 1.2). The Parliamentary elections in October resulted in change of Government, with new Government expected to start its functioning by December 2020. In the meantime, the outgoing government announced a national quarantine from November 7th until November 29th 2020. It was later expended until 17th December, and again until 31st January 2021, with further restrictions. On 27th January it was extended again until 28th February, and later until 30th April, and then (with some relaxations) until 31st May 2021 (see section 1.2.3.).
On 29th of October the President formed Board of Health Experts to advice on COVID-19. (7)
Since the new Government took office (11th December), Board of Health experts played important role in providing advice for science based decision making. Outgoing Government dissolved the COVID-19 Management Committee, as its advisory body. (8) The new Government confirmed the extension of quarantine until 31st January 2021, and introduced further restrictions on mobility, socialising, retail and services sector for the festive period (see section 1.2.3).
On 16th December new Minister of Health was designated as Head of the National Emergency Operations. (10) New advisory body of the Government was formed on 18th December - Advisory Board of Independent Experts.(9)
In February 2021 the new government published the new COVID-19 management strategy called “Resilience – Recovery – Future”, with the main goal to minimise mortality from COVID-19. The strategy has four objectives:
- Reduce the spread of infection and prepare for ending the quarantine regime;
- Ensure the functioning of health care services;
- Achieve OVID-19 immunisation coverage of at least 70% of population;
- Prepare for effective management of future crises through conducting an enquiry into COVID-19 pandemic management, preparing early warning systems and strategic management plan, as well as potentially reorganising state agencies responsible for emergency response and crisis management.
The “resilience” stage of the strategy focuses on establishing a new model of pandemic management, better coordination of health provider network, effective information management and communication. The “recovery” stage aims to focus on expansion of testing for prompt contact tracing and isolation, timely data collection and analysis, and vaccination. The “future” stage includes the audit of COVID-19 response and adjusting future crisis management strategy accordingly; strengthening resilience of health and social care institutions; expanding e-health and scope for remote/digital health care service delivery and reducing avoidable hospitalisations. (11)