Health Coordination Research Articles

Did court dismiss employee's Title IX retaliation claim?

A part‐time community health coordinator worked for a nonprofit affiliated with the University of Arkansas at Little Rock. She claimed she was subjected to sexual harassment from her supervisor during the five years of her employment.

Addressing the UHC Challenge Using the Disease Control Priorities 3 Approach: Lessons Learned and an Overview of the Pakistan Experience.

Pakistan developed its first national Essential Package of Health Services (EPHS) as a key step towards accelerating progress in achieving Universal Health Coverage (UHC). We describe the rationale, aims, the systematic approach followed to EPHS development, methods adopted, outcomes of the process, challenges encountered, and lessons learned. EPHS design was led by the Ministry of National Health Services, Regulations & Coordination. The methods adopted were technically guided by the Disease Control Priorities 3 Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes. The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$29.7. The EPHS also includes an additional set of 12 population-based interventions at US$0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP. Key ingredients for a successful EPHS design requires a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.

Community Health Nursing Education in Austria-The Need for Competences in Planning, Management and Collaboration: A Problem-Centered Qualitative Study.

(1) Background: The Austrian health care system is extremely fragmented. Primary care is mainly provided by self-employed GPs. Other health professionals are rarely integrated into primary care. But, according to the political plans of the Austrian government, a system of community nurses and community health nurses should be implemented and several pilot projects have already been started. (2) Objective: The present study explores the skills and competences needed in the planning, management and collaboration for the change in the system and gives recommendations for community health nurse education in Austria. (3) Methodology: Fifteen qualitative, problem-centered interviews were conducted with experts in the field of community health nursing and analyzed using qualitative content analysis. (4) Results: The skills and competences often and widely mentioned are interprofessional collaboration, cooperation with other actors, systems thinking, project and change management, and basic management skills, including strategic planning, communication, accounting and finance. Areas such as health planning and lobbying are also highlighted. The main competences are broken down into subcompetences, making it possible to create a detailed competence grid. Competences in planning, management and collaboration are particularly important in the initial stages of the first implementation of a community health nursing system. (5) Conclusions: Skills and competences in these areas occupy a central position. A multilayered breakdown of these competences is required in order to create a targeted requirements profile. Due to the small-scale fragmentation of the Austrian health care system, collaboration and coordination are more difficult and costly, but all the more important. The aforementioned skills and competences represent an essential expansion of nursing education in Austria.

Use of Information Technology Systems for Regional Health Care Information-Sharing and Coordination During Large-Scale Medical Surge Events.

Medical surge events require effective coordination between multiple partners. Unfortunately, the information technology (IT) systems currently used for information-sharing by emergency responders and managers in the United States are insufficient to coordinate with health care providers, particularly during large-scale regional incidents. The numerous innovations adopted for the COVID-19 response and continuing advances in IT systems for emergency management and health care information-sharing suggest a more promising future. This article describes: (1) several IT systems and data platforms currently used for information-sharing, operational coordination, patient tracking, and resource-sharing between emergency management and health care providers at the regional level in the US; and (2) barriers and opportunities for using these systems and platforms to improve regional health care information-sharing and coordination during a large-scale medical surge event. The article concludes with a statement about the need for a comprehensive landscape analysis of the component systems in this IT ecosystem.

When abusive supervision affects creative idea sharing: Understanding the role of employee cheating and organizational justice

Getting employees to share their creative ideas has long been recognized as a vital source of organizational effectiveness. This research uses the conservation of resources theory to investigate how employee's creative idea sharing is affected by abusive supervision. Data for this research was collected from 209 employees and their immediate supervisors of generic nurses and medical dispensers of Southern Punjab public sector hospitals working under the Ministry of national health services regulation and Coordination. Data were then analyzed with the AMOS software package for simple regression and moderated mediation. This study found that with the increase in abusive supervision, employees develop cheating behavior, diminishing probability of sharing their creative ideas with coworkers. Along these lines, organizational justice moderates this relationship and attenuates the negative indirect effect of abusive supervision on creative idea sharing. The researchers recommended that organizations should develop training programs or coaching sessions for leaders to make them equip with essential interpersonal skills that can eradicate abusive supervision. Research implications, limitations, and future research directions are also discussed.

Challenge of Managing Hospitals during the COVID-19 Pandemic: A Qualita-tive Study

Background: The COVID-19 pandemic has posed many challenges on the health system and hospitals to provide services. This study investigated the difference between factors affecting hospital management which considered in preparing a disaster management plan for hospital in the face of a pandemic based on the experiences of hospital managers.
 Methods: This qualitative research was conducted on selected hospitals affiliated in Alborz University of Medical Sciences in 2021. Data were gathered with purposive sampling and semi-structured interviews with 16 hospital managers. MAXQDA 10 and framework analysis were used to analyze the data.
 Results: The results were categorized in four categories: 1) Mitigation including staffing, bed capacity, enough space for quarantines, protective equipment, diagnosis and treatment equipment, funding, medicines, patient follow-up, management and leadership; 2) Preparedness such as crisis committee, preparedness and response plan, measures, action plan; 3) Response including motivating health workers, cooperation and coordination; 4) Recovery and lessons learned including providing facilities, expediting patient processes, control, economic conditions, and planning better, passive defense, regular crisis committee meetings, human resources, documentation and use of information systems in planning.
 Conclusion: In addition to providing the necessary infrastructure, it is important to plan for fair distribution of resources and effective supply chain management. A mechanism should also be developed at the national level to anticipate future health crises and to prevent and control diseases in the most effective way.

Abstract C076: Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions

Abstract Background: In Puerto Rico, colorectal cancer (CRC) is the leading cause of cancer deaths. Patients with CRC often present with multiple chronic conditions (MCC), making it difficult for oncologists to coordinate their care. This qualitative study explores oncologists' perspectives of care among patients with CRC and MCC in Puerto Rico. Methods: Semi-structured interviews (n=9) were conducted with oncologists providing care for Hispanic older adults with CRC in Puerto Rico. Thematic analysis was employed to identify key themes and subthemes. Results: We identified several key themes related to social determinants of health, diagnosis pathways, treatment decisions, survivorship, end-of-life care, and care coordination. Oncologists reported a high prevalence of MCC, including comorbidities such as diabetes, high blood pressure, cholesterol problems, and hypothyroidism. Limited social support was identified as a care coordination challenge, as many patients undergo treatments without adequate support networks. Access to healthcare providers was a noted concern, due to a provider shortage and the absence of specialized cancer care. The health insurance system has been identified as having several issues, particularly concerning the requirement of pre-authorization for different procedures and treatments. These challenges can be especially problematic for older adults, who often lack a strong support system and may experience difficulties comprehending the process. Transportation issues and a lack of nearby services were noted as barriers for patients requiring specialized care. Diagnosis pathways varied, with some patients having undergone routine screenings when CRC was identified, while others presented with suspected CRC symptoms. Oncologists noted that the cancer stage was the most important factor when making treatment decisions, in addition to the diagnosis of MCC and the patient's ability to tolerate treatment. Other factors influencing treatment decisions included the patient's age, physical condition, and appointments attendance. For patients in advanced stages, end-of-life planning and palliative care were crucial for ensuring a dignified and comfortable transition, with discussions around hospice care and managing pain and symptom relief being essential components. Care coordination and communication were identified as challenging to manage when multiple providers and procedures were needed, often requiring patients to schedule appointments with different specialists themselves. Inter-provider communication and collaboration relied on various methods; however, phone calls or notes sent through the patient were the primary methods. Conclusions: Oncologists caring for Hispanic older adults with CRC and MCC face multiple, complex challenges influenced by social determinants of health and the presence of comorbidities. Tailored approaches to address disparities, culturally sensitive care, and improved coordination among healthcare providers are needed to enhance the quality of care in this patient population. Citation Format: Maira A. Castaneda-Avila, Daniela Latoni, Meagan J. Sabatino, Karen J. Ortiz-Ortiz, Kate Lapane. Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C076.

Implementation of a digital tool for population management in Primary Health Care.

Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups. Descriptive analyses were conducted by calculating absolute and relative frequencies to treat quantitative data. Qualitative data were subjected to content analysis. Three hundred thirty-four professionals participated in the study. In the first step, territory management's main challenges were filling out various instruments, system failures, data inconsistency, internet infrastructure/network, and lack of time. Therefore, a digital tool was developed consisting of 1) a spreadsheet recording the number of family members and markers of health conditions, date of visit, and number of return visits; 2) a spreadsheet with a summary of families visited, not visited, and refusals; and 3) a panel with a summary of the data generated instantly. In the evaluation, after the initial use of the tool, the themes that emerged were integration of the tool into daily work, evaluation of the digital tool implementation process, and improvement and opportunities for improvement. Faced with the challenges faced by family healthcare teams when filling out systems and managing the territory, the tool developed provided greater reliability and agility in data visualization, reduced the volume of instruments, and optimized the work process.

Mapping Collaboration and Coordination of Health and Care Services for Older People with Dementia: A Scoping Review

Responsibility for health and care services for people with dementia is often divided between various professionals, agencies, and authorities, causing a fragmentation of care and an unclear division of responsibility between different stakeholders. In relation to this, collaboration and coordination of health and care services are often described as vital for catering to diverse needs and to provide adequate support. The aim of this scoping review was to map how different health and care agencies collaborate and coordinate services for older people with dementia. Joanna Briggs Institute’s proposed methodology for scoping reviews was used, and systematic searches were carried out in six databases. A total of 59 articles published within the last 10 years were included based on certain eligibility criteria. The Research Pyramid was used to critically appraise these articles, suggesting that available research is of moderate quality. The descriptive content analysis of the articles revealed eight categories describing the characteristics of collaboration and coordination for people with dementia, as presented in previous articles. These characteristics are described in terms of different barriers, the function of the care coordinator, assessment and planning to provide services, interprofessional collaboration, information sharing, knowledge needed to navigate a complex health and care system and understanding of dementia, and personalisation of care. Engaging care coordinators with diverse competencies to address both medical and social care needs is essential, especially since people with dementia experience multiple and complex needs. It is also important to explain and visualise available services and when these services are suitable for implementation. Knowledge about dementia is necessary to empower people with dementia in everyday life situations.

Costing Interventions for Developing an Essential Package of Health Services: Application of a Rapid Method and Results From Pakistan.

The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards universal health coverage (UHC) by 2030 by providing an Essential Package of Health Services (EPHS). Starting in 2019, the Disease Control Priorities 3rd edition (DCP3) evidence framework was used to guide the development of Pakistan's EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process. A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, and bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out. Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing. We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.

Population Health Management Tools to Support School-Based Oral Health Partnerships and Address Disparities.

Dental caries (cavities) experience is prevalent in US children, and national data show rates to be increasing among young children. Disparities are found for those in the low-income and non-Hispanic Black and Hispanic/Latinx groups. Use of caries prevention, specifically dental sealants, is low, even among school-based programs. A population health management (PHM) framework may support targeted school-based case management to reduce oral health disparities. PHM-oriented tools were applied to a school-based oral health intervention and developed into a conceptual model. From 2014 to 2019, Chicago-based Oral Health Forum (OHF) developed a case management intervention in schools, utilizing PHM tools. Through programmatic and school-based partnerships, the PHM tools informed intervention to incorporate community-based organizations, case management staffing, oral health education, targeted community outreach, and Community Dental Health Coordinators' training. Through a PHM framework, school-based oral health partnerships targeting high-need children was implemented. Use of PHM tools in school-based health programs should be considered in other high caries schools.

A mixed methods partner-focused cost and budget impact analysis to deploy implementation strategies for school-based prevention

BackgroundObtaining information on implementation strategy costs and local budget impacts from multiple perspectives is essential to data-driven decision-making about resource allocation for successful evidence-based intervention delivery. This mixed methods study determines the costs and priorities of deploying Enhanced Replicating Effective Programs (REP) to implement the Michigan Model for Health™, a universal school-based prevention intervention, from key shareholder perspectives.MethodsOur study included teachers in 8 high schools across 3 Michigan counties as part of a pilot cluster randomized trial. We used activity-based costing, mapping key Enhanced REP activities across implementation phases. We included multiple perspectives, including state agencies, regional education service agencies, lead organization, and implementers. We also conducted a budget impact analysis (BIA, assessing the potential financial impact of adopting Enhanced REP) and a scenario analysis to estimate replication and account for cost variability. We used an experimental embedded mixed methods approach, conducting semi-structured interviews and collecting field notes during the trial to expand and explain the cost data and the implications of costs across relevant perspectives.ResultsBased on trial results, we estimate costs for deploying Enhanced REP are $11,903/school, with an estimated range between $8263/school and $15,201/school. We estimate that adding four additional schools, consistent with the pilot, would cost $8659/school. Qualitative results indicated misalignment in school and teacher priorities in some cases. Implementation activities, including training and implementation facilitation with the health coordinator, were sometimes in addition to regular teaching responsibilities. The extent to which this occurred was partly due to leadership priorities (e.g., sticking to the district PD schedule) and organizational priorities (e.g., budget).ConclusionsPrevious research findings indicate that, from a societal perspective, universal prevention is an excellent return on investment. However, notable misalignment in cost burden and priorities exists across shareholder groups. Our results indicate significant personal time costs by teachers when engaging in implementation strategy activities that impose an opportunity cost. Additional strategies are needed to improve the alignment of costs and benefits to enhance the success and sustainability of implementation. We focus on those perspectives informed by the analysis and discuss opportunities to expand a multi-level focus and create greater alignment across perspectives.Trial registrationClinicalTrials.gov NCT04752189. Registered on 12 February 2021.

Leveraging Technology and Workflow Optimization for Health-Related Social Needs Screening: An Improvement Project at a Large Health System

The collection of health-related social needs (HRSN) data at one large health system has historically been inconsistent. This project was aimed to increase annual HRSN screening rates by standardizing data collection in the electronic health record (EHR) through optimized clinical workflows. The authors designed a standard screening questionnaire in alignment with the Accountable Health Communities model, and they conducted interviews with eleven US-based health systems and one medical center on best practices for ambulatory HRSN screening and interventions, which identified five possible methods to administer the questionnaire. After testing, the authors opted to send questionnaires to patients through the patient portal three days prior to an ambulatory visit. For inpatients, in-person interviews were implemented. Staff implementing the updated processes included registered nurses, social workers, preventive health coordinators, and community health workers. The annual screening rate for all active ambulatory patients increased from 0.4% to 15.9% (p < 0.001), and 10.7% of all patients had at least one health-related social need. The annual screening rate for inpatients was estimated to be zero at baseline and increased by 66 percentage points (p < 0.001). The most prevalent health-related social need in both settings was financial resource strain, followed closely by food insecurity. Well-designed interventions and technology support were effective in achieving improved screening and data collection. Leadership support, building interventions within preexisting workflows, and ensuring standard data capture in the EHR were key factors leading to successful process improvement.

Perceptions of Service Recipients on the Roles of Community Health Nurses in Children's Primary Care During the COVID-19 Outbreak in Northeastern Thailand

To understand the roles of community health nurses in providing services to children in primary health care units during the COVID-19 pandemic. Qualitative research was employed. Data was obtained from documents, observations, and in-depth interviews. Eighty-five key informants were recruited in the study from seven groups: public sector officers, Local Administrative Organization (LAO), community leaders, teachers in child development centers, community organizations, civil groups, and family caregivers. Data was analyzed using the content analysis method. Findings showed the roles of community health nurses in primary care units categorized into eight themes: health care provider, health educator, manager, health collaborator, health coordinator, advocator, consultant, and data collector and reporter. The research reflects the crucial roles of community health nurses in caring for children, skills, knowledge gained, and preparation and engagement of community networks during COVID-19.

One Health Systems Assessments for Sustainable Capacity Strengthening to Control Priority Zoonotic Diseases Within and Between Countries.

One Health is increasingly recognized as an important approach for health systems, particularly with respect to strengthening prevention, detection and response to zoonotic and other emerging disease threats. While many global health security frameworks reference the importance of One Health, there are fewer existing methodologies, tools, and resources for supporting countries and other regional or sub-national authorities in systematically assessing their One Health capabilities. We describe here two methodologies, One Health Systems Assessment for Priority Zoonoses (OHSAPZ) and One Health Transboundary Assessment for Priority Zoonoses (OHTAPZ), which have been developed to assist with creating consensus lists of priority zoonotic diseases for cross-sectoral consideration; identification of current strengths and gaps in One Health communication and coordination between sectors (and, in the case of OHTAPZ, between countries); and the development and dissemination of prioritized recommendations for future capacity strengthening. Implemented to date in seven diverse countries in Africa and the Eastern Mediterranean regions, these tools provide a modular, flexible and easily adaptable approach to One Health systems assessment that can support national capacity strengthening, regional epidemic preparedness, and compliance with international frameworks.

Regional Health Coordination: An evaluation of the first pilot training program in Lower Austria

Abstract Background Starting from 2018, the University of Krems and ‘Tut gut!’ Gesundheitsvorsorge GmbH have jointly implemented the two-year academic program ‘Regional Health Coordination’, which trains students to become a Regional Health Coordinator (RHC). It is funded by the Lower Austrian Health and Social Fund. We evaluated the pilot-program and the work of the RHC in the first two years after graduation. The objectives of the evaluation were to provide 1) a basis for further development of the academic program and 2) an assessment of the achievement of the program objectives. Methods The evaluation ran from 2018 to 2022 and followed a mixed-methods approach. Qualitative interviews and focus groups with stakeholders, document analyses of annual RHC activity reports and repeated written community surveys in 13 municipalities were conducted. Results The evaluation showed that RHCs already bundled health promotion (HP) activities and worked on their HP network within the municipalities during the practical training period. HP was given a higher priority in some municipal administrations. The pilot program was consistently rated positively, and the curriculum was optimized. In the first two years after graduation, the RHCs developed and implemented HP measures and endeavoured to engage citizens. However, genuine involvement was rare. The results showed that future HP interventions should especially target older people, less educated and male citizens. RHCs were seldomly involved in health policy decisions, although they often worked with mayors. Personal characteristics, an existing network in the community and support from the local government were success factors for the work of the RHCs. Conclusions RHCs play an important role in the coordination of community HP but should be stronger included in local policy decision-making. Citizens should be more involved in planning and implementing HP measures. Key messages • An academic training program for regional health coordination helped to improve community health promotion. • An existing network and the involvement in the local government facilitated the work of graduated regional health coordinators.

Implementation of small side games in the learning process education physical sports and health at SMK Padang

The low ability of teacher creativity in creating interesting learning can cause a decrease in student learning outcomes both related to low motivation, inappropriate learning methods and unfulfilled facilities and infrastructure. The purpose of this study is to determine how the quality of teachers, student motivation, facilities and infrastructure towards the implementation of small side games in the learning process of Physical Education, Sports and Health at SMK Padang, students in the city of Padang. This type of research is descriptive research. This study involved all 163 students of SMK Padang, and 24 people were taken from class representatives based on the scores of Physical Education, Sports and Health subjects. Sampling is done by purposive sampling. The sample was taken as many as 24 people from each class representative. The research instrument used is a questionnaire sheet. The results of the study are; 1) Obtained the quality of teachers for the implementation of small side games in the learning process of Sports and Health Physical Education at SMK Padang is still not good, 2) Student motivation is obtained for the implementation of small side games in the learning process of Sports and Health Physical Education in the SMK Padang is quite good, 3) Facilities and infrastructure are obtained for the implementation of small side games in the learning process Physical Education, Sports and Health at SMK Padang is not good. Keywords: Learning; Health Coordinator; Small Side Games

Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system

BackgroundMental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using administrative health databases in Italy and evaluate, manage and monitor care pathways and costs. A second objective explores the feasibility of changing the payment system from fee-for-service to a value-based system (e.g., increased care integration, bundled payments) to introduce performance measures and guide improvement in outcomes.MethodsSince diagnosis alone may poorly predict condition severity and needs, we conducted a retrospective observational study on a 9,019-patient cohort assessed in 2018 (30.5% of 29,570 patients with SMDs from three Italian regions) using the Mental Health Clustering Tool (MHCT), developed in the United Kingdom, to stratify patients according to severity and needs, providing a basis for payment for episode of care. Patients were linked (blinded) with retrospective (2014–2017) physical and MH databases to map resource use, care pathways, and assess costs globally and by cluster. Two regions (3,525 patients) provided data for generalized linear model regression to explore determinants of cost variation among clusters and regions.ResultsSubstantial heterogeneity was observed in care organization, resource use and costs across and within 3 Italian regions and 20 clusters. Annual mean costs per patient across regions was €3,925, ranging from €3,101 to €6,501 in the three regions. Some 70% of total costs were for MH services and medications, 37% incurred in dedicated mental health facilities, 33% for MH services and medications noted in physical healthcare databases, and 30% for other conditions. Regression analysis showed comorbidities, resident psychiatric services, and consumption noted in physical health databases have considerable impact on total costs.ConclusionsThe current MH care system in Italy lacks evidence of coordination of physical and mental health and matching services to patient needs, with high variation between regions. Using available assessment tools and administrative data, implementation of an episodic approach to funding MH could account for differences in disease phase and physical health for patients with SMDs and introduce performance measurement to improve outcomes and provide oversight.

Cross-border collaboration and capacity-building for improved health emergency response planning in Southern Africa

Background Many countries were ill prepared for the COVID-19 pandemic and the sudden border closures introduced to stem contagion. To address this planning and response gap, Health Systems Trust and the US Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine jointly implemented a capacity-building project among eight Southern African countries during 2022. The intention was to strengthen collaboration among the countries in implementing public health emergency response strategies. Shared analysis of cross-border movement patterns, and building neighbouring countries’ capacity to identify priority areas for such response planning, strengthened relationships for communicating health risks and events. Approach This chapter presents findings from project participants’ perspectives on whether and how the project supported improved regional collaboration for emergency responses to public health events, and their perceptions of how the project strengthened their border health systems. Country delegates were convened in multi-sectoral regional and sub-regional meetings and workshops to facilitate cross-border public health information-sharing and co-ordination, and to align surveillance for emergency preparedness and response. They drafted procedures to: strengthen cross-border and multi-sectoral communication; prioritise points of entry for cross-border co-ordination; map population movement patterns; and identify national and regional border health priorities. Training focused on points of entry to enhance planning for future disease outbreaks by introducing the Population Connectivity Across Borders Toolkit for analysing population movement data to guide the design of public health interventions. Conclusions Collaboration with global and regional institutions strengthened the countries’ ability to comply with International Health Regulations in responding to communicable disease outbreaks. The outcomes indicate that sustained engagement, refinement of standard operating procedures, and multilateral agreements that ensure balancing of country priorities with global health requirements, can be achieved. Continued analysis of and reflection on country work plans are needed to assess similarities and differences in priority identification, which will guide future training and development of regional strategies to build stronger border health systems.

TECHNICAL EFFICIENCY OF POST-DISASTER HEALTH SERVICES INTERVENTIONS: THE 2023 KAHRAMANMARAŞ EARTHQUAKE IN TURKEY

Purpose – In order to meet the most urgent needs of the regions affected by the biggest earthquake of the century, government, national and international actors have made enormous efforts. However, some international studies evaluating the effectiveness of previous disaster relief efforts have expressed that inefficient use of resources in the disaster relief process should be a matter of concern. The main purpose of this study is to obtain evidence to support post-earthquake healthcare interventions and to establish a reference on earthquake relief.&#x0D; Design/methodology/approach – The data of the study covers the period from 6 February to 16 February 2023 and was obtained from the official daily reports of the Health Disaster and Coordination Centre Unit (SAKOM) of the Ministry of Health. The data consisted of allocations of rescue units, human resources, workload and other information recorded in official daily reports. In addition, Data Envelopment Analysis (DEA) method was used to evaluate the technical efficiency of health services provided in 10 provinces affected by the earthquake in the first emergency period of the Kahramanmaraş-centered earthquake&#x0D; Findings – The technical efficiency scores of the health services provided in the earthquake-affected provinces are analysed, it is seen that while the average technical efficiency was 52% (SD: 0.30) on the 5th day of the earthquake, it increased significantly to 80% (SD: 0.21) on the 10th day. This result shows that health services in earthquake zones have started to be provided more efficiently over time. The rapid normalisation of health services in earthquake zones is an important indicator for the performance of disaster management and crisis response teams.&#x0D; Originality/value – Despite the extensive research on earthquake response and health services individually, there's a noticeable gap in literature explicitly exploring the relationship between the two. This lacuna in research is particularly evident when it comes to examining the efficiency of health services during seismic disasters.