Health systems are being confronted with rapidly increasing demand generated by the COVID-19 outbreak. When health systems are overwhelmed, both direct mortality from an outbreak and indirect mortality from vaccine-preventable and treatable conditions increase dramatically. Analyses from the 2014-2015 Ebola outbreak suggest that the increased number of deaths caused by measles, malaria, HIV/AIDS, and
tuberculosis attributable to health system failures exceeded deaths from Ebola.[1,2] A system’s ability to maintain delivery of essential health services will depend on its baseline capacity and burden of disease, and
the COVID-19 transmission context (classified as no cases, sporadic, clusters, or community transmission). Maintaining population trust in the capacity of the health system to safely meet essential needs and to
control infection risk in health facilities is key to ensuring appropriate care-seeking behavior and adherence to public health advice. A well-organized and prepared health system has the capacity to maintain equitable
access to essential service delivery throughout an emergency, limiting direct mortality and avoiding increased ndirect mortality.

With a relatively limited COVID-19 caseload, health systems may have the capacity to maintain routine service delivery in addition to managing COVID-19 cases. When caseloads are high, and/or the health workforce is
reduced due to infection of health workers, strategic shifts are required to ensure that increasingly limited resources provide maximum benefit for a population.