This document expands on the content of the essential health services and systems pillar of the COVID-19 strategic preparedness and response plan: operational planning guidelines to support country preparedness and response (4), supersedes the earlier Operational guidance for maintaining essential health services during an outbreak (7), and complements the recently released Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic (8). It supports country implementation of targeted actions at the national, subnational and local levels to reorganize and maintain access to safe and high-quality essential health services. It outlines the adaptations needed to keep people safe and maintain continuity of essential health services during the response to the COVID-19 pandemic. It is intended for decision-makers and managers at the national and subnational levels. Part 1 outlines basic principles and practical recommendations that support decision-making to ensure the continuity of select essential health services, highlighting key actions that countries should consider. Part 2 contains brief sections addressing specific adaptations and considerations for life course and disease programmes in the context of COVID-19. These sections are intended to be used in conjunction with — and do not replace — existing WHO programme guidance in these areas.