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Abstract
The aim of the paper is to talk about the risk management system especially today in pandemic time. The authors would like to analyze the issue of risk management in an economic and healthcare context. taking into account that there are strong relationships between society and health such as the question of social responsibility and organization, social responsibility and social impact and social responsibility and competitiveness. The correlation between economy and health is highlighted in the healthcare sector, where the risk profile is in fact considered complex and extremely dynamic.

Susan Costello School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia Abstract: Female genital mutilation/cutting (FGM/C) is a traditional practice originating in Africa. Its worst forms cause irreparable harm to girls and women and have no medical justification. Based on a literature review of global responses to FGM/C and conversations with Australian women who migrated from FGM/C practicing countries, this paper provides some background on FGM/C and its epidemiology, outlining its prevalence, types, and health risks and complications for women and girls. It discusses risk-prevention strategies, first, for health practitioners in identifying, screening, and supporting women affected by FGM/C and, second, for welfare and social workers and health care professionals to identify, work with, and prevent girls from being cut. Consistent with international trends in addressing the risks of FGM/C, the paper suggests practice responses for coordinated responses between professionals, communities from practicing countries, and governments of different countries. Keywords: female genital mutilation, female genital cutting, female circumcision, child protection, risk management

Ruby Dhar,1,* Babban Jee,2,* Subhradip Karmakar1 1Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India; 2Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India*These authors contributed equally to this workCorrespondence: Subhradip KarmakarAll India Institute of Medical Sciences, New Delhi, IndiaEmail subhradip.k@aiims.eduAbstract: With its 1.3 billion population and faced with the COVID-19 pandemic, India is at the junction of two crucial decisions, balancing healthcare and the economy. To prevent the community spread of the virus, the Indian Government imposed a nationwide lockdown. Though initially successful to some extent in containing the disease spread, the extended lockdown eventually leads to a spiraling out effect resulting in the slowdown of the economy, which, in turn, lead to widespread consequences affecting the lives of millions of people, mostly those at the base of the social pyramid. We investigated the implications of few government policies taken during this pandemic and their impact on society, thereby suggesting short-term crisis management with long-term solutions. Here, we present a comprehensive account of Indian policy in dealing with the COVID-19 crisis, balancing both economic and public health. We also explored a future contingency plan for risk mitigation along with few recommendations. This viewpoint will be useful for effective healthcare management and the economy in Asia's populous nation in the COVID-19 and prepare for a future crisis of this nature.Keywords: COVID-19, India, economic crisis, healthcare, vaccination, management

Rafael Guimarães dos Santos,1– 3 José Carlos Bouso,1,3,4 Juliana Mendes Rocha,1 Giordano Novak Rossi,1 Jaime E Hallak1,2 1Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; 2National Institute of Science and Technology – Translational Medicine, Ribeirão Preto, Brazil; 3ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain; 4Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, SpainCorrespondence: Rafael Guimarães dos SantosDepartamento de Neurociências eCiências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Hospital das Clínicas, Terceiro Andar, Av. Bandeirantes, 3900, Ribeirão Preto, SP, BrazilEmail banisteria@gmail.comAbstract: Psychedelics or serotonergic hallucinogens are a group of substances that share the agonism of serotonergic 5-HT2A receptors as their main mechanism of action. Its main effects include changes in perception, cognitive process, and mood. Despite being used for centuries by different cultures in ritual contexts, these substances have currently aroused the interest of science and industry for their promising antidepressant, anxiolytic, and anti-addictive effects. Considering this evidence, this article aims to explore some of the possible health policy challenges to integrate these therapeutic tools into broad and heterogeneous health systems. As a main benefit, these substances produce rapid and enduring effects with the administration of single or few doses, which could lead to new treatment possibilities for patients with severe mental disorders resistant to the usual medications. The main challenge is associated with the fact that these substances remain scheduled in most countries and are associated with social stigma related to their recreational use (especially LSD and psilocybin). This situation makes it exceedingly difficult to conduct clinical trials, although international conventions allow such research. Ethically, this could be interpreted as a violation of human rights since thousands of people are prevented from having access to possible benefits. Interestingly, ritual ayahuasca use is more acceptable to the public than the use of psilocybin-containing mushrooms or LSD. The controlled, clinical use of LSD and psilocybin seems to be less criticized and is being explored by the industry. Rigorous scientific evidence coupled with industrial interests (LSD and psilocybin), together with respect for traditional uses (ayahuasca) and international conventions, seems to be the best way for these drugs to be integrated into health systems in the next years. Which highlights the need for an urgent dialogue between science, health system, society, and politics.Keywords: hallucinogens, psychedelics, healthcare

Anat Gesser-Edelsburg,1 Mina Zemach,2 Rana Hijazi1 1School of Public Health and the Health and Risk Communication Research Center, University of Haifa, Haifa, 3498838, Israel; 2Midgam Research & Consulting Ltd, Bnei Brak, 5126112, IsraelCorrespondence: Anat Gesser-EdelsburgSchool of Public Health and the Health and Risk Communication Research Center, University of Haifa, Mount Carmel, Haifa, 3498838, IsraelTel +972 544 243530Fax +973 3 6322143Email ageser@univ.haifa.ac.ilBackground: The uncertainty surrounding the COVID-19 crisis and the different approaches taken to manage it have triggered scientific controversies among experts. This study seeks to examine how the fragile nature of Israeli democracy accommodated differences of opinion between experts during the COVID-19 crisis.Objective: To map and analyze the discourse between experts surrounding issues that were the topic of scientific controversy. To examine the viewpoints of the public regarding the positions of the different experts.Methods and Sample: A sequential mixed study design. The qualitative research was a discourse analysis of 435 items that entailed mapping the voices of different experts regarding controversial topics. In the quantitative study, a total of 924 participants answered a questionnaire examining topics that engendered differences of opinion between the experts.Results: The results showed that there was no dialogue between opposition and coalition experts. Moreover, the coalition experts labeled the experts who criticized them as "coronavirus deniers" and "anti-vaxxers." The coalition changed its opinion on one issue only—the issue of lockdowns. When we asked the public how they see the scientific controversy between the coalition and the opposition experts, they expressed support for opposition policies on matters related to the implications of the lockdowns and to transparency, while supporting government policy mainly on topics related to vaccinations. The research findings also indicate that personal and socio-demographic variables can influence how the public responds to the debate between experts. The main differentiating variables were the personal attribute of conservatism, locus of control, age, and nationality.Conclusion: Controversy must be encouraged to prevent misconceptions. The internal discourse in the committees that advise the government must be transparent, and coalition experts must be consistently exposed to the views of opposition experts, who must be free to voice their views without fear.Keywords: COVID-19, health risk management, Israeli public, sequential mixed study design, discourse between experts, viewpoints of the public

Binyam Minuye Birihane, Wubet Alebachew Bayih, Abebaw Yeshambel Alemu, Demeke Mesfin Belay College Health Sciences, Debretabor University, Debretabor, EthiopiaCorrespondence: Binyam Minuye Birihane Tel +251 921574025Email biniamminuye@yahoo.comBackground: Healthcare professionals are at the frontline facing the pandemic. Since the pandemic is new with sophisticated needs of resources, identifying perceived barriers of the healthcare institutions has an important input for the government in slowing the viral spread and prevents healthcare professionals from infection.Objective: The study was aimed to assessperceived barriers and preventive measures of corona virus disease among healthcare providers in Debretabor Town, north central Ethiopia.Methods: An institution-based cross-sectional survey was conducted among healthcare providers working in Debretabor town, north central Ethiopia from May 1 to 15, 2020. Data were collected using a self-administered questionnaire. Data were coded, entered, cleaned, and checked using Epi data statistical software version 4.2.0.0 and analysis using STATA Version 14 statistical software. Descriptive statistics of different variables were presented in figures, text, and tables. Chi-square (chi2) test of independence was considered to examine the nonparametric association of factors with preventive practice, and association was considered at a P-value of less than 0.05.Results: A total of 183 healthcare providers participated in the survey, of which 67.76% were males, and 80.87% were in the age range of 25– 35 years. About 45% of participants were nurses. In the current study, overall preventive practice was 68.3%. Despite recommendations by the World Health Organization, avoidance of outdoor, physical distancing, and avoiding meeting a person with a coughwere not implemented by 32.24%, 24.18%, and 13.11% of healthcare providers, respectively. Insufficient training, lack of policy, less commitment to infection control, and limitations of resources were perceived as major barriers for practicing preventive measures during the pandemic.Conclusion: Preventive measures taken by healthcare providers were poor. Multiple barriers, such as insufficient training related to the pandemic, limitation of resources, and less commitment of healthcare providers to infection prevention measures were reported. So, the government should work on reducing the pandemic propagation by fulfilling the barriers using different means or strategies.Keywords: COVID-19, barriers, preventive practice, Ethiopia, health care providers

Mihajlo Jakovljevic,1– 3 Takuma Sugahara,2 Yuriy Timofeyev,4 Nemanja Rancic5,6 1Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 2Institute of Comparative Economics, Hosei University, Tokyo, Japan; 3N.A.Semashko Department of Public Health and Healthcare, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; 4National Research University Higher School of Economics, Moscow, Russia; 5Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia; 6Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, SerbiaCorrespondence: Mihajlo JakovljevicDepartment of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, SerbiaTel +381 34306 800Email sidartagothama@gmail.comPurpose: The goal of this study was to assess the effectiveness of healthcare spending among the leading Asian economies.Methods: We have selected a total of nine Asian nations, based on the strength of their economic output and long-term real GDP growth rates. The OECD members included Japan and the Republic of Korea, while the seven non-OECD nations were China, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand. Healthcare systems efficiency was analyzed over the period 1996– 2017. To assess the effectiveness of healthcare expenditure of each group of countries, the two-way fixed effects model (country- and year effects) was used.Results: Quality of governance and current health expenditure determine healthcare system performance. Population density and urbanization are positively associated with a healthy life expectancy in the non-OECD Asian countries. In this group, unsafe water drinking has a statistically negative effect on healthy life expectancy. Interestingly, only per capita consumption of carbohydrates is significantly linked with healthy life expectancy. In these non-OECD Asian countries, unsafe water drinking and per capita carbon dioxide emissions increase infant mortality. There is a strong negative association between GDP per capita and infant mortality in both sub-samples, although its impact is far larger in the OECD group. In Japan and South Korea, unemployment is negatively associated with infant mortality.Conclusion: Japan outperforms other countries from the sample in major healthcare performance indicators, while South Korea is ranked second. The only exception is per capita carbon dioxide emissions, which have maximal values in the Republic of Korea and Japan. Non-OECD nations' outcomes were led by China, as the largest economy. This group was characterized with substantial improvement in efficiency of health spending since the middle of the 1990s. Yet, progress was noted with remarkable heterogeneity within the group.Keywords: Asia, health expenditure, healthy life expectancy, infant mortality, nutrition, population health outcomes

Surya Gaire, Rafael Castro Delgado, Pedro Arcos González Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Campus del Cristo, Oviedo, Asturias, SpainAbstract: Nepal has a complicated geophysical structure that is prone to various kinds of disasters. Nepal ranks the most disaster-prone country in the world and has experienced several natural calamities, causing high property and life losses. Disasters are caused by natural processes, but may be increased by human activities. The overall objective of this paper is to analyze the disaster risk profile and existing legal framework of Nepal. The paper is based on secondary data sources. Major causative factors for floods and landslides are heavy and continuous rainfall, outburst floods, infrastructure failure, and deforestation. Historical data of natural disasters in Nepal show that water-induced disasters have killed hundreds of people and affected thousands every year. Likewise, properties worth millions of US dollars have been damaged. There is an increasing trend toward landslides and floods, which will likely continue to rise if proper intervention is not taken. A positive correlation between water-induced disasters and deaths has been observed. Nepal has a poor Index for Risk Management (INFORM). There are fluctuations in the recording of death data caused by flood and landslides. The Government of Nepal focuses more on the response phase than on the preparedness phase of disasters. The existing disaster management act seems to be weak and outdated. There is a gap in current legal procedure, so the country is in dire need of a comprehensive legal framework. The new proposed act seems to take a much broader approach to disaster management. With a long-term vision of managing disaster risk in the country, the Government of Nepal has begun the Nepal Risk Reduction Consortium (NRRC) in collaboration with development and humanitarian partners. In order to improve the vulnerability of Nepal, an early warning system, mainstreaming disasters with development, research activities, community participation and awareness, and a rainfall monitoring system must all be a focus. Keywords: risk, vulnerability, risk factors, natural hazards, natural disasters, monsoon rainfall

Teng Ma,1 Bao Guo,2 Ju Xu3 1Law School & Intellectual Property School, Jinan University, Guangzhou, 510632, People's Republic of China; 2School of Law, Xiamen University, Xiamen, 361005, People's Republic of China; 3Library, Longyan University, Longyan, 364012, People's Republic of ChinaCorrespondence: Ju Xu, Library, Longyan University, 1# Dongxiaobei Road, Longyan, 364012, People's Republic of China, Tel +86 18613048699, Email josephine.xu@foxmail.comBackground: The system studied in this article is set in the development and reform of China's healthcare insurance, the time mentioned in this article is during the COVID-19 period and the issues are about healthcare insurance fiscal subsidy policies for COVID-19 patients' medical costs.Methods: Method of comparison and method of case study are used. This article compares the healthcare insurance systems, fiscal subsidy policies during the COVID-19 period and takes Yulin's healthcare insurance reform and Nanjing healthcare insurance administration's measures to fight against COVID-19 pandemic as specific cases to analyze.Aim: This article presents the advantages of the coverage of China's healthcare insurance as well as the insufficiency of the commercial healthcare insurance and market-oriented medical institutions to show the persistence and change in China's healthcare insurance reform.Conclusion: Soon after the outbreak of COVID-19 pandemic, the National Healthcare Security Administration and the Ministry of Finance of PRC jointly issued an announcement on how to guarantee the medical security of the novel coronavirus pneumonia pandemic. More specific policies were made by each province to secure that the total medical costs of the COVID-19 confirmed and suspected patients were almost borne by healthcare insurance and government finance subsidy. These policies reveal two basic points ahead China's healthcare reform: one is that China shall persist in positively promoting the universal healthcare insurance coverage program, which will ...

Ruby Dhar,1 Karthikeyan Pethusamy,1 Babban Jee,2 Subhradip Karmakar1 1All India Institute of Medical Sciences, New Delhi, India; 2Department of Health Research, Ministry of Health and Family Welfare Government of India, New Delhi, 110001, IndiaCorrespondence: Subhradip Karmakar Email subhradip.k@aiims.eduAbstract: With about 0.4– 0.5 million COVID cases diagnosed every single day in a row over the past three weeks back in May 2021, India was at the epicenter of the global viral rampage. The catastrophe of this crisis was unprecedented, pushing the health care system to its breaking point. Although significant progress has been made in identifying these highly transmissible variants, what is somewhat lacking is the competence to exploit this information for risk mitigation and effective disease management through an integrated nationwide coordinated approach. With a positivity rate of 15– 20% (April–May 2021) and the healthcare system pushed to its limit, accompanied by increased mortality, the situation was rather grim then. Though the central command scrambled all its resources and logistics to streamline the supply chain, the efforts were insufficient in response to the ongoing crisis due to a disproportionate rise in the case. We examined the current scenario emerging from this 2nd COVID wave and identified the possible lacunae. We also suggested few recommendations that may be adopted to avoid similar failures in the future.Keywords: COVID-19, pandemic, India, healthcare, economy, vaccine

Mulatu Ayana Hordofa,1 Abdulhafiz Hussen Hassan2 1Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia; 2City Administration of Addis Ababa Health Bureau, Addis Ababa, EthiopiaCorrespondence: Mulatu Ayana Hordofa P.O. Box.19 Tel +251911549352Fax +25111235227Email mulatuayana@gmail.comBackground: People at high risk for hepatitis B virus include healthcare workers in contact with blood and human secretions. Hepatitis B virus is unique compared to other sexually transmitted infections because a highly efficacious vaccine exists. However, there have been few studies conducted around the vaccination status of hospital healthcare workers in Ethiopia. Little is known about vaccination penetration among healthcare professionals working in health centers in Ethiopia.Objective: To assess hepatitis B vaccination status and associated factors among healthcare professionals working in health centers of Akaki Kality, Addis Ababa, Ethiopia.Methods: A facility-based cross-sectional study was conducted. Using simple random sampling, 528 healthcare workers were selected. Data were collected using a pre-tested, structured self-administered questionnaire. Data were entered into Epi-data and analyzed using SPSS version 20. Multivariable binary logistic regression analysis was used to identify the significant associations. Adjusted odds ratios were computed to measure the strength of association, with statistical significance considered at p< 0.05.Results: Among 505 respondents, only 244 (48%) had ever received a hepatitis B vaccine. Monthly income, religion, age, working unit and educational level were found to be statistically associated with vaccinated status.Conclusion: This study showed that the percentage of healthcare professionals who had received a hepatitis B vaccination was very low. This is a serious public health concern and a challenge for a country with high prevalence of hepatitis B infection. There is a need to promote hepatitis B screening and vaccination among healthcare professionals. The government must play its part by increasing healthcare budgets and prioritize hepatitis B prevention by establishing a national awareness campaign, and making screening and vaccination services available at all public health centers.Keywords: hepatitis B, vaccination, healthcare professional, heath center, Addis Ababa

Aisha A Towhari,1,2 Bussma A Bugis3 1Respiratory Care Department, Prince Sultan Military College of Health Sciences, Al-Dhahran, Kingdom of Saudi Arabia; 2Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Kingdom of Saudi Arabia; 3Department of Public Health, College of Health Sciences, Saudi Electronic University, Dammam, Kingdom of Saudi ArabiaCorrespondence: Aisha A Towhari Respiratory Care Department, Prince Sultan Military College of Health Sciences, Dhahran P.O. Box 946, 31932, Saudi ArabiaTel +966 13 8440000, EXT: 3603 Email Atowhari@psmchs.edu.saPurpose: Healthcare professionals are one of the most vulnerable groups subjected to verbal and physical violence daily while carrying out their duties; such violence is a worldwide concern. This study aimed to explore the awareness of a violence reporting system among healthcare providers and the impact of the new Ministry of Health (MOH) violence regulations at one of the Eastern Region hospitals in Saudi Arabia.Methods: A cross-sectional study was conducted from January to February 2020. The study included 210 healthcare providers from different specialties working in critical care units. A sample of 137 healthcare providers was selected randomly, and a self-administered questionnaire was distributed accordingly.Results: In this study, 31.4% of participants were not aware of whether they had a specific system for reporting violent incidents, while 68.6% had no training on these systems. Experiences of violence among the staff decreased from 78.6% before the MOH regulations to almost 20% after the MOH regulations.Conclusion: The majority of victims did not report incidents because there is a lack of system privacy, and the workers felt that the incidents of violence were a part of their daily jobs. In addition, this study revealed that the majority of healthcare workers did not receive training on the reporting system, which explains their lack of knowledge about the formal reporting system. Finally, the MOH initiative and penalties for controlling workplace violence have resulted in a significant drop in the prevalence of violence among healthcare workers.Keywords: Saudi Arabia, violence penalties, Ministry of Health, reporting of violence, healthcare workers

Daniel Simonet Management Department, School of Business and Management, American University of Sharjah, Sharjah, United Arab EmiratesCorrespondence: Daniel SimonetManagement Department, School of Business and Management, American University of Sharjah, PO Box 26666, Sharjah, United Arab EmiratesTel +971 6 515 2373Fax +971 6 558 4065Email dsimonet@aus.eduContext: France has undergone major changes in social policy that made an impact on the health-care sector. The paper reminds readers of the application and shortcomings of the concept of New Public Management (NPM) in the French health system.Problem: The paper investigates NPM health reforms in France. Reforms aimed at containing costs. What administrative restructuring was implemented? What were reform idiosyncrasies? What were their limitations? Which critical public health emergencies remain?Methods: We examine the political and economic context of health-care reforms, the rise of the regulatory state, and its core element: the diagnostic-related group (DRG) scale. We critically examine the recentralization of health policy decisions and its impact on care providers and provide an international perspective on reforms.Results: Reforms put priority on the use of yardsticks and also emphasized regulation and competition but rejected public–private partnerships on the Anglo-Saxon model. Central health authorities regain their authority over health policy decisions, and decentralization was weakened.Conclusion: Restrictions in public service delivery triggered a general discontent among the population. The political repercussions of reforms eventually crystallized into the Yellow Vest movement.Keywords: health care reform, health policy, management department, France

John Alimamy Kabba,1– 3 Peter Bai James,4,5 Zongjie Li,1– 3 Christian Hanson,6,7 Jie Chang,1– 3 Chenai Kitchen,1– 3 Minghuan Jiang,1– 3 Mingyue Zhao,1– 3 Caijun Yang,1– 3 Yu Fang1– 3 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, People's Republic of China; 2Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, People's Republic of China; 3Shaanxi Center for Health Reform and Development Research, Xi'an, People's Republic of China; 4Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 5Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia; 6Pharmacy Board, Ministry of Health and Sanitation New England, Freetown, Sierra Leone; 7Pharmacy Department, Well Star Atlanta Medical Centre South, East Point, GA, USACorrespondence: Yu FangDepartment of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an 710061, People's Republic of ChinaTel +86 29 82655132Email yufang@mail.xjtu.edu.cnPurpose: Rational use of medicines is a necessary constrict towards increasing access for those that desperately need them in society. In this study, we assess medicines prescribing patterns in healthcare facilities implementing free healthcare policy for pregnant women, lactating mothers and children under the age of five in Sierra Leone.Materials and Methods: Using WHO drug use indicators, we evaluated prescription records from the pharmacies of four hospitals; one from each of the four regions in Sierra Leone. To study prescribing indicators, we systematically sampled 1200 prescriptions overall (300/hospital) retrospectively spanning a year, from June 2017 to July 2018. In evaluating patients care indicators, we randomly sampled 120 (30/hospital) patients encounter prospectively. We used MS Excel 2016 and IMB SPSS in data analysis, and p< 0.05 was considered significant for associational analysis.Results: The average drug per prescription was 3.6 (SD=1.3) overall, 3.5 (1.3) for children under five and 3.4 (1.4) for pregnant women/lactating mothers. Eighty-seven percent of prescriptions for under-five children contains antibiotics as opposed to 68.4% of prescriptions for pregnant women/lactating mothers. More injections were prescribed per encounter for pregnant women/lactating mothers 23.2% than for children under five 18.1%. Overall, generic prescribing and prescribing from the National Essential Medicines List were 74.9% and 73.8%, respectively. None of the studied health facilities dispensed all of the prescribed medicines. The most prescribed pharmacological class of drugs were antibiotics, and paracetamol was the most commonly prescribed drug.Conclusion: Following WHO drug use indicators used in this study, drugs were irrationally prescribed within government hospitals providing free healthcare in Sierra Leone. Sustainability of the free healthcare scheme will require efficient medicine supply and management strategies. Therefore, the formulation of stewardship programs and/or an active Drug and Therapeutics Committee may be necessary to optimise drug use in these hospitals.Keywords: prescribing pattern, rational drug use, drug utilisation, free healthcare, Sierra Leone

Hui Zhang,1,2 Yingxiang Li,1 Chris Dolan,3 Zhijun Song1 1School of Public Administration, Guangzhou University, Guangzhou, People's Republic of China; 2Institute for Risk & Disaster Reduction, University College London, London, UK; 3Institute of Advanced Studies, University College London, London, UKCorrespondence: Chris DolanInstitute of Advanced Studies, University College London, London, UKTel +44 0 20 7679 2000Email Chris.Dolan@cantab.netPurpose: With the rapid spread of COVID-19 across the world, the consideration of effective communication strategies from Wuhan can provide valuable insight to other countries in how to manage their risk response. This study analyzes the building of a risk communication system in Wuhan, China, to aid cross-country comparison from a policy and academic perspective.Methods: We use complex adaptive systems theory (CAS) to theorize the communication strategy adopted by the government – led by the Hubei Province COVID-19 Epidemic Prevention and Control Headquarters. Using ethnographic fieldwork and discourse analysis, we observed and analyzed the online and offline communication process to formulate an overview of the communications platforms used in Wuhan.Results: Wuhan's adaptive crisis communication system was backed by digital and offline infrastructure, human resources support, policy development, as well as access to scientific and technological expertize. The Wuhan municipal government adapted its communication strategy in response to public feedback, and created mechanisms to ensure that two-way communication was used to drive policy and integrate feedback from the government, enterprises, social organizations and the public. Wuhan's risk and crisis communication strategy aimed to meet emergency commitments, recover trust, regulate the public's emotions and build consensus, operating within a complex adaptive system (CAS).Conclusion: By using complex adaptive system (CAS) theory, we argue that Wuhan quickly built an adaptive communication system consisting of five elements: 1) non-linear information output, 2) online and offline continuous support systems, 3) a public emotional support system, 4) multi-subject information interaction platforms and 5) a context-based approach.Keywords: epidemic, complex adaptive system, Wuhan, lockdown, pandemic, COVID-19