Framework for the Response of Integrated Health Service Delivery Networks to COVID-19

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Pan American Health Organization · Interim document, 10 May 2020

Operational framework for health service networks to prepare, contain, respond and mitigate COVID-19 outbreaks using integrated care approaches.

In one sentencePAHO framework for reorganizing integrated health service networks to respond to COVID-19, prioritizing older adults (60+) and high-risk groups through activated primary care, progressive hospital expansion, and intersectoral coordination.

Issuer: Pan American Health Organization
Edition: Interim document, 10 May 2020
Audience: PAHO/WHO advisors, incident command members, national health authorities, directors of health services and networks
Evidence: Expert consensus from PAHO workshop
Reviewed: 21 Oct 2026 · GMJ

Read the original on PAHO Download PDF

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 21 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This PAHO/WHO framework adapts the integrated health service delivery networks (IHSDNs) model to guide health systems’ response to COVID-19. Released as an interim document during the early pandemic (10 May 2020), it was developed following a March 2020 workshop with health service experts and PAHO Emergency Operations Center advisors.

The framework is structured around 14 attributes across four domains: Model of Care (population risk identification, facility mapping, first-level care, specialized services, care coordination, person-centred care), Governance (governance system, community participation, intersectoral action), Organization and Management (supply management, human resources, information systems, accountability), and Financial Allocations. Each attribute includes essential actions, specific interventions, and verification tools.

Six key principles guide the response: saving lives through early identification and management; containing transmission to close contacts and health workers; progressively reorganizing services while maintaining capacity for other emergencies; protecting health worker health; activating the entire service network from primary care through hospitals; and ensuring communication to authorities, health workers and the population.

Key points

For clinicians — doses and thresholds as stated in the guideline

Prioritize high-risk populations: older adults (60 years and over), patients with chronic diseases, institutionalized populations (prisons, nursing homes), and vulnerable groups (overcrowded conditions, disabilities, isolated older adults)
First-level care teams must ensure availability of protocols for: identification of suspected cases, ambulatory management, home visits and follow-up, triage, referrals based on patient condition, and isolation at home for mild cases
Establish progressive activation plans by phases in accordance with projected epidemic evolution for specialized services including intensive care units, hospitalization and isolation rooms
Define criteria for domiciliary isolation management and requirements for safe home environment, with mechanisms for community information and caregiver training
Ensure personal protective equipment for health workers: surgical masks, N95/FFP2 respirators, surgical gloves, eye protection, and robes according to occupational exposure risk
Verify critical equipment and supplies: ventilators, oxygen, pulse oximeters, laboratory diagnostic capacity, and maintain supply chain for medications and infection control supplies
Establish data generation mechanisms tracking: susceptible population, patients with respiratory symptoms, suspect and confirmed cases, hospital and ICU admissions, home isolation cases, deaths, expenditures, and bed occupation
Map community leaders and intersectoral actors (education, local governments, police, military, churches) and define their roles in epidemic response including information, communication and community monitoring

Integrated Health Service Networks Interventions in Response to COVID-19 Outbreak

Table extracted from the guideline

Domain	Attributes	Essential Actions	Interventions	Tools
Model of care	Definition of population and territory	Identify population groups most at risk (older adults 60+, chronic diseases, institutionalized, vulnerable)	Verify first-level care participation; intensify health education; perform monitoring of risk groups; develop visiting programme	WHO operational considerations, laboratory testing guidance
Model of care	Network of healthcare facilities	Map health facilities defining COVID-19 response capacity; identify private services; inventory equipment and human resources	Verify response capacity of designated facilities; verify availability of supplies, reagents, equipment; verify human resources planning	IHCN COVID-19 tool
Model of care	First level of care	Ensure deployment of teams; guarantee worker safety; availability of protocols (identification, ambulatory management, home visits, triage, referrals, isolation)	Verify team deployment; verify safety conditions and PPE; verify protocol implementation and infrastructure	IHCN tool, advice on masks, infection prevention guidance, occupational safety manual
Model of care	Delivery of specialized services	Identify mechanisms for accessing consultations; progressive activation plan by phases	Verify referral protocols; verify reorganization capacity (ICU, hospitalization, isolation)	Clinical management guidance, infection prevention, laboratory specimen shipping
Organization & Management	Human resources	Determine essential human resource levels; identify resources outside network; ensure required training	Verify recruitment planning; verify lists of external professionals; define reallocation and task shifting options	Occupational safety manual, health worker rights and responsibilities, mental health considerations, exposure risk assessment

Source: Pan American Health Organization, Framework for the Response of Integrated Health Service Delivery Networks to COVID-19. Reproduced in summary form.

From the guideline

Verbatim

“To Save Lives: through early identification, diagnosis and appropriate management of cases; Containment of transmission by reducing secondary transmission to close contacts and health workers.”

— Pan American Health Organization, Framework for the Response of Integrated Health Service Delivery Networks to COVID-19, Introduction, Key principles (2020)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

This PAHO framework offers Georgian health authorities a structured approach to pandemic preparedness that complements our Universal Health Care programme's emphasis on primary care gatekeeping. The framework's prioritization of populations aged 60 years and over is particularly relevant given Georgia's demographic ageing, with over 15% of our population in this age group and significant numbers of isolated older adults in rural mountain communities. I would stress to Georgian clinicians the framework's emphasis on domiciliary isolation protocols and home visiting programmes, which align with our community-oriented primary care model but require significant workforce capacity that remains constrained in many regions. The practical implementation challenge for Georgia and neighbouring South Caucasus countries lies in the intersectoral coordination mechanisms: while the framework appropriately identifies key partners including local governments, police and community leaders, operationalizing these relationships requires navigating complex governance structures and building trust across sectors that have historically operated in silos, particularly in conflict-affected areas of the region.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026

Applicability

Georgia and the South Caucasus

This framework remains relevant for Georgia and South Caucasus health systems in preparing for respiratory pandemic threats and strengthening integrated service delivery. Georgian health authorities would need to adapt the risk stratification to local population demographics and the extensive rural–urban divides characteristic of the region. The emphasis on primary health care activation aligns with Georgia’s ongoing primary care strengthening under its Universal Health Care programme, though implementation would require addressing workforce distribution challenges in mountainous and remote areas. Countries in the region should consider how the framework’s intersectoral coordination mechanisms can be operationalized within their specific governance structures, and how community participation approaches can be culturally adapted for diverse ethnic and linguistic populations across the South Caucasus.

Questions this guideline answers

Quick answers

Which population groups should be prioritized for COVID-19 monitoring and interventions?

Older adults aged 60 years and over, patients with chronic diseases, populations living in institutions (prisons, nursing homes, children's homes), and people in vulnerable conditions including those in overcrowded housing, some disabilities, older adults living alone, and caregivers of patients.

What protocols must first-level care facilities implement for COVID-19 response?

Protocols for identification of suspected cases, ambulatory management of cases, home visit and follow-up of cases, triage, referrals based on patient conditions, and isolation at home for mild cases. They must also ensure proper diagnosis, communication and transfer of patients, with defined triage and isolation conditions for patients with respiratory symptoms.

What personal protective equipment is essential for health care workers responding to COVID-19?

Surgical masks, N95/FFP2 respirators, surgical gloves, eye protection, and robes. The availability and appropriate use of PPE must be verified according to health worker exposure risk levels, along with hand hygiene supplies and infection control materials.

What data must health systems collect to monitor COVID-19 response?

Susceptible population, patients treated for respiratory symptoms, suspect cases, confirmed cases, hospital admissions, home isolation cases, ICU hospitalizations, deaths, expenditures, occupation of beds and length of stays, consumption and resource needs, and service provider capacity.

Framework for the Response of Integrated Health Service Delivery Networks to COVID-19

What this guideline says

Key points

Integrated Health Service Networks Interventions in Response to COVID-19 Outbreak

From the guideline

Editor’s perspective

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Applicability

Questions this guideline answers

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What this guideline says

Key points

Integrated Health Service Networks Interventions in Response to COVID-19 Outbreak

From the guideline

Editor’s perspective

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Applicability

Questions this guideline answers

Related on GMJ

Dictionary of Public Health

GMJ News coverage

Quality & accreditation

Other guidelines on this topic

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