Comparative content analysis of national health strategies before and after COVID-19: a systematic policy analysis among OECD and BRICS countries

Background We aimed to evaluate the National Health Policies, Strategies and Plans (NHPSPs) of the Organization for Economic Cooperation and Development (OECD) and BRICS before and after the COVID-19 pandemic to explore nations' commitment to strengthen their health systems in defense of health threats and analyze the specific changes. Methods We systematically searched NHPSP documents from the WHO document repository and official governmental websites. Data was then extracted using a standardized extraction template. A coding framework was inductively developed to sort qualitative responses into categories, with frequencies calculated and weighting evaluated, followed by organizing underlying content into subthemes. Results The search yielded 154 documents, with 36 retained after screening, encompassing 14 OECD countries and 3 BRICS countries. The most predominant theme was prevention (88.9% pre-pandemic, 99.4% post-pandemic), which was addressed as a primary theme in 26 included NHPSPs. After the COVID-19 pandemic, 6 out of 14 analyzed themes saw higher occurrences, among which infection prevention and control (22.2–50.0%) and resilience to health crisis (22.2–44.4%) increased most significantly. Themes mainstreamed in post-pandemic NHPSPs included prevention (94.4%), health research and technology (61.1%), and One Health (66.7%). Primary healthcare emerged as the most concerned subtheme under prevention. Notably, OECD countries displayed more increased occurrences of themes (13 out of 14) or increased emphasis on themes with similar occurrences before and after COVID-19, while BRICS countries only differed in infection control. The two sets of countries also varied in subthemes and action plans under the same primary theme. Conclusion Many countries are endeavoring to move towards more robust health systems by optimizing NHPSPs, yet only about half of OECD and BRICS countries have introduced new NHPSPs after COVID-19. We hope our findings attract attention to the necessity of global health system reforms and provide other countries with actionable recommendations for NHPSP formulation.