Essential Public Health Functions Research Articles

Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy

Abstract Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity. Key messages • The EPHF framework as an innovative tool to strengthen public health in border regions. • Take the geographical living space of citizens in a border region into account to achieve health equity.

Large scale public health system transformation: Ireland

Abstract Ireland has coped comparatively well with the COVID-19 pandemic when considering excess mortality. The reasons are likely complex and multifaceted, but it may be, in part, attributable to a comparatively young population and progress on indicators related to premature mortality and preventable mortality on chronic diseases and lifestyle risk factors. “Healthy Ireland” is a national framework in place since 2013 and utilizes a settings based approach to promote health and wellbeing in communities. It aims to improve collaboration between government, institutions, local communities, and individuals. Sláintecare is an all’party long-term health reform initiative developed in 2017 aimed at delivering the right care, at the right time, in the right place by the right team. In addition, in 2018 Ireland embarked on an ambitious public health reform programme with the implementation of the recommendations of the Crowe Horwath review of Public Health. While challenges exist, including access to services and waiting times, the governments has put in place initiatives to address these and is committed to, amongst other things, promo ting the continued integration of services across a variety of domains including primary to quaternary prevention. As Ireland began to emerge from the COVID-19 pandemic it established “The Public Health Reform Expert Advisory Group” to identify learnings from the public health components of the response, with a view towards strengthening public health and health protection generally and, specifically, future public health pandemic preparedness. The group, made up of national and international public health experts, submitted its final report in September 2023 which outlined a series of recommendations focused on potential improvements to public health policy, structures and governance. The WHO analysis of the Essential Public Health Functions provided complementary results. More work is now ahead to consider and implement these recommendations and foster institutional reforms including at the Health Services Executive, the Department of Health, and at the Health Protection Surveillance Centre.

Integrating emergency preparedness competency frameworks in workforce development training

BackgroundPublic health and emergency workforce development have been major topics of interest during and after the COVID-19 pandemic. The fragile state of many healthcare systems worldwide during emerging outbreaks revealed the need for regular competency-based training. The training helps to equip and remind health professionals how to tackle huge obstacles that need to be handled in emergencies. ObjectiveThis paper will examine an emergency preparedness training course we have developed and delivered multiple times. The course involved development, delivery, case scenario training, participant assessment, and a programme evaluation. Study DesignA descriptive study based on the ten essential public health functions, with the competencies for each function examined. ResultsThe evaluation showed that the curriculum was well-received, and 55 % of the participants could apply what they learned through a survey. Furthermore, the evaluation indicated a need to hold this training course frequently. Designing such courses could fill the gaps that emerged during life-threatening previous outbreaks. All participants passed the assessment with a minimal score of 63 % and the highest score of 93 %. ConclusionThe curriculum's design based on competencies needed for planning and preparedness for effective response to emergencies was well received and proved practical. Regular reminders of the tools needed, and their application are crucial. Learning and practising are critically important to tackling disasters, including mass gatherings.

National public health institutes in the Eastern Mediterranean Region: Insights from experts in the field

National public health institutes (NPHIs) are crucial to the effectiveness of public health systems, including delivering essential public health functions and generating evidence for national health policies, strategies and plans....

Practical strategies to achieve resilient health systems: results from a scoping review

BackgroundThis paper presents the results of a systematic review to identify practical strategies to create the institutions, skills, values, and norms that will improve health systems resilience.MethodsA PRISMA 2020 compliant systematic review identified peer-reviewed and gray literature on practical strategies to make health systems more resilient. Investigators screened 970 papers to identify 65 English language papers published since 2015.ResultsPractical strategies focus efforts on system changes to improve a health system’s resilience components of collective knowing, collective thinking, and collaborative doing. The most helpful studies identified potential lead organizations to serve as the stewards of resilience improvement, and these were commonly in national and local departments of public health. Papers on practical strategies suggested possible measurement tools to benchmark resilience components in efforts to focus on performance improvement and ways to sustain their use. Essential Public Health Function (EPHF) measurement and improvement tools are well-aligned to the resilience agenda. The field of health systems resilience lacks empirical trials linking resilience improvement interventions to outcomes.ConclusionsThe rigorous assessment of practical strategies to improve resilience based on cycles of measurement should be a high priority.

“I think they should give primary health care a little more priority”. The primary health care in Caribbean SIDS: what can be said about adaptation to the changing climate? The case of Dominica— a qualitative study

BackgroundAdaptation to climate change (CC) is a priority for Small Island Developing States (SIDS) in the Caribbean, as these countries and territories are particularly vulnerable to climate-related events. Primary health care (PHC) is an important contributor to CC adaptation. However, knowledge on how PHC is prepared for CC in Caribbean SIDS is very limited. The aim of this paper is to discuss health system adaptation to climate change, with a focus on PHC.MethodsWe explored the perspectives of PHC professionals in Dominica on PHC adaptation to climate change. Focus group discussions (FGDs) were conducted in each of the seven health districts in Dominica, a Caribbean SIDS, between November 2021 and January 2022. The semi-structured interview guide was based on the Essential Public Health Functions: assessment, access to health care services, policy development and resource allocation. Data coding was organized accordingly.ResultsFindings suggest that health care providers perceive climate change as contributing to an increase in NCDs and mental health problems. Climate-related events create barriers to care and exacerbate the chronic deficiencies within the health system, especially in the absence of high-level policy support. Healthcare providers need to take a holistic view of health and act accordingly in terms of disease prevention and health promotion, epidemiological surveillance, and ensuring the widest possible access to healthcare, with a particular focus on the environmental and social determinants of vulnerability.ConclusionThe primary health care system is a key stakeholder in the design and operationalization of adaptation and transformative resilience. The Essential Public Health Functions should integrate social and climate and other environmental determinants of health to guide primary care activities to protect the health of communities. This study highlights the need for improved research on the linkages between climate events and health outcomes, surveillance, and development of plans informed by contextual knowledge in the SIDS.

Analysis of documents issued during two phases responding to COVID-19 in Thua Thien Hue province through matching against the set of essential functions of public health in Vietnam.

ABSTRACT The Thua Thien-Hue province study in 2022-2023 on "Analysis of Documents issued during the COVID-19 Pandemic Through Matching against the Essential Functions of Public Health" is one of a series of basic studies that the Public Health Association (VPHA) has conducted right during the COVID-19 pandemic in Vietnam. The main objective of these studies is to understand the gaps in the practical application of the functions and subfunctions of the EFPHs toolkit and to find effective complementaries to have a good preparedness for future health emergency response. The research series was divided into two phases: In phase one, the research object is documents issued during the pandemic, but only from agencies at the central level, including the government, the National Steering Committee, and the Ministry of Health. those default places are the most important decision-making bodies directly related to the pandemic. The second phase is conducted in three provinces of the Public Health Association in three regions of Vietnam, including Yen Bai, Hue, and Dong Thap. The main objective of this second phase study is to describe the epidemic pattern occurring at the provincial level and decisions made at the local levels through documents issued: the textual data from the Province, District, and Commune were also matched against the EFPHs toolkit to draw specific lessons at the grassroots level in responding to a real pandemic. These studies were conducted by the Yen Bai, Hue, and Dong Thap Public Health Associations with technical support from the Vietnam Public Health Association. Readers are invited to follow the specific research results of each province. Keywords: public health functions, directive documents, Covid-19, Thua Thien Hue

Analysis of documents issued during two phases responding to COVID-19 in Yen Bai province through matching against the set of essential functions of public health in Viet Nam.

ABSTRACT The Yen Bai province study in 2022-2023 on "Analysis of Documents issued during the COVID-19 Pandemic Through Matching against the Essential Functions of Public Health" is one of a series of basic studies that the Public Health Association (VPHA) has conducted right during the COVID-19 pandemic in Vietnam. The main objective of these studies is to understand the gaps in the practical application of the functions and subfunctions of the EFPHs toolkit and to find effective complementaries to have a good preparedness for future health emergency response. The research series was divided into two phases: In phase one, the research object is documents issued during the pandemic, but only from agencies at the central level, including the government, the National Steering Committee, and the Ministry of Health. those default places are the most important decision-making bodies directly related to the pandemic. This first study was conducted by the Office of the Vietnam Public Health Association. The second phase is conducted in three provinces of the Public Health Association in three regions of Vietnam, including Yen Bai, Hue, and Dong Thap. The main objective of this second phase study is to describe the epidemic pattern occurring at the provincial level and decisions made at the local levels through documents issued: the textual data from the Province, District, and Commune were also matched against the EFPHs toolkit to draw specific lessons at the grassroots level in responding to a real pandemic. These studies were conducted by Yen Bai, Hue, and Dong Thap Public Health Associations with technical support from the Vietnam Public Health Association. Readers are invited to follow the specific research results of each province. Keywords: public health functions, directive documents, Covid-19, Yen Bai

Analysis of documents issued during two phases responding to COVID-19 in Dong Thap through matching against the set of essential functions of public health in Viet Nam.

The Dong Thap province study in 2022-2023 on "Analysis of Documents issued during the COVID-19 Pandemic Through Matching against the Essential Functions of Public Health" is one of a series of basic studies that the Public Health Association (VPHA) has conducted right during the COVID-19 pandemic in Vietnam. The main objective of these studies is to understand the gaps in the practical application of the functions and subfunctions of the EFPHs toolkit and to find effective complementaries to have a good preparedness for future health emergency response. The research series was divided into two phases: In phase one, the research object is documents issued during the pandemic, but only from agencies at the central level, including the government, the National Steering Committee, and the Ministry of Health. those default places are the most important decision-making bodies directly related to the pandemic. This first study was conducted by the Office of the Vietnam Public Health Association. The second phase is conducted in three provinces of the Public Health Association in three regions of Vietnam, including Yen Bai, Hue, and Dong Thap. The main objective of this second phase study is to describe the epidemic pattern occurring at the provincial level and decisions made at the local levels through documents issued: the textual data from the Province, District, and Commune were also matched against the EFPHs toolkit to draw specific lessons at the grassroots level in responding to a real pandemic. These studies were conducted by Yen Bai, Hue, and Dong Thap Public Health Associations with technical support from the Vietnam Public Health Association. Readers are invited to follow the specific research results of each province. Keywords: public health functions, directive documents, Covid-19, Dong Thap

Voting with their feet: Primary care provider choice and its implications for public sector primary care services in India

Expanding networks of government primary health centers (PHCs) to bring health services closer to communities is a longstanding policy objective in LMICs. In pluralistic health systems, where public and private providers compete for patients, PHCs are often not the preferred source for care. This study analyzes the market for primary care services in the Indian state of Bihar to understand how choice of primary care provider is influenced by distance, cost and quality of care. This study is based on linked surveys of rural households, PHCs, and private primary care providers conducted in 2019 and 2020. Most rural residents lived in proximity to a primary care provider, though not a qualified one. Within a 5-km distance, 60% of villages had a PHC, 90% had an informal provider, 35% an Indian systems of medicine practitioner, and 10% a private MBBS doctor. Most patients sought care from informal providers irrespective of PHC distance; only 25% of patients living in the PHC's vicinity sought care there. Reducing distance to the PHC by 1 km marginally increased the likehood of the PHC being selected, and reduced the likelihood of private clinics being selected. Reducing patient's costs at PHCs increased the likelihood of the PHC being selected and reduced the likelihood of private clinics and private hospitals being selected. Improved clinical quality at PHCs had no effect on patient selection of PHCs, private clinics, or hospitals. Illness severity reduced the likelihood of PHCs or private clinics being selected, and increased the likelihood of private hospitals selected. Wealthier patients were marginally more likely to use PHCs, substantially more likely to use private hospitals, and less likely to use private clinics. Expanding PHC network coverage or improving their quality of care is not sufficient to make PHCs more relevant to local health needs. An orientation towards essential public health functions, as well as, a community-centered approach to the organization of primary health care system is necessary.

Climate change and public health in Germany - A synthesis of options for action from the German status report on climate change and health 2023.

This article represents the conclusion of the updated German status report on climate change and health, which was jointly written by authors from over 30 national institutions and organisations. The objectives are (a) to synthesise the options for action formulated in the report, (b) to combine them into clusters and guiding principles, (c) to address the success factors for implementation, and (d) to combine the options for action into target parameters. The options for action from the individual contributions of the status report were systematically recorded and categorised (n=236). Topical clusters were then formed with reference to Essential Public Health Functions, and options for action were assigned to them. Eight topical clusters of options for action and ten guiding principles were identified. These can be summarised in four overarching meta-levels of action: (a) cross-sectorally coordinated structural and behavioural prevention, (b) monitoring, surveillance, and digitalisation (including early warning systems), (c) development of an ecologically sustainable and resilient public health system, and (d) information, communication, and participation. The main success factors for implementation are the design of governance, positive storytelling and risk communication, proactive management of conflicting goals, and a cross-sectoral co-benefit approach. Based on the status report, systematically compiled target parameters and concrete options for action are available for public health.

In with the good, out with the bad – Investment standards for external funding of health?

In recent decades, external financing of health systems in low- and middle-income countries has helped achieve remarkable improvements across the world. However, these successes have not come without problems. There are a growing number of areas where external assistance can cause harm and even undermine the development of national health systems. Recent decades have seen a surge of knowledge on investing in health systems. We propose the setting up of investment standards for external assistance that aim to incentivize a more efficient evidence-based investment in a country’s health system, led by decision-makers in country. Using a more standardized process would lead to a better use of precious external assistance resources. The long-term goal would be fully functioning health systems with all the necessary essential public health functions in all countries.

Population health approach for health systems: public health organization, workforce and governance

Abstract Background The health systems have been evolving based on solely individual care of diseases, which is no longer sustainable. A combination of a public health and individual approach is needed, although how to deliver those population health services remains a challenge. This study explores how population health outcomes are determined by the organizational model and workforce capacity of public health services at local level. Methods Using publicly available data on organizational, geodemographic and population health characteristics of the total 55 public health units (PHU) in mainland Portugal, a fixed effects panel regression of three models was performed. The analysis considered synergies between public health workforce (medical doctors and nurses), organizational (considering a Local Health Unit (LHU) group, that includes both primary and secondary care, and non-LHU) and infrastructure characteristics, and population health outcomes (premature standardized mortality rate and life expectancy at birth (LE)). Confidence intervals (CI) at 95% and odds ratio (OR) were calculated. Results A lower premature standardized mortality rate and a higher life expectancy at birth were observed when there is one public health doctor per between 22 319.4 and 24 616.7 habitants and 25 382.5 and 27 680.0 habitants, respectively. The regression models that were run showed that PHU under a LHU model or disaggregated services are associated with an increase in the premature standardized mortality rate (OR = 1.23 [CI 95% 0.21-15.24]) and a decrease in the LE (OR = 0.50 [CI 95% 0.17-1.41]). Conclusions Health systems must promote public health services capable of delivering the essential public health functions, particularly at local level, where they must be concentrated and integrated at the same level of governance as individual levels of care, and equipped with a public health workforce adapted to the size of the population on which they must intervene. Key messages • Strengthening health systems resilience require a combination of public health and individual approaches to improve population health and tackle inequalities. • Essential public health functions require concentrated and integrated governance models and a public health workforce adapted to the size of the population.

7.L. Round table: Population health management in PHC: a proactive approach to improve health and well-being

Abstract Population Health Management (PHM) can play a critical role in strengthening Primary Health Care (PHC) by providing a data-driven, people-centred, and proactive approach to managing the health and well-being of a defined population. It entails data-driven assessment of the health status of a specific population followed by prediction of health outcomes and anticipating the resources needed to proactively address these. By identifying subgroups with similar characteristics and needs, PHM can enable PHC providers to move from a one-size-fits-all approach to targeted and tailored interventions that account for the needs of different groups. Moreover, by focusing on the social determinants of health and psychosocial needs, PHM can help PHC providers adopt a more holistic approach. PHM can provide a pragmatic framework to help PHC providers in operationalizing several essential public health functions, which are at the core of PHC. It can also help PHC deploy a proportionate universalism approach to address health inequalities at community level. By showcasing practical examples of how PHM is being used in PHC across Europe; discussing enabling factors for adopting a PHM approach; and presenting pragmatic policy recommendations; the workshop will inspire the public health community and help countries move towards the adoption of a PHM approach in PHC. The workshop will consist of an actively moderated panel discussion, short presentations by panelists and Q&A sessions. Key messages • Population health management rooted in PHC can help improve health outcomes for populations, reduce health inequalities, and strengthen health systems. • The relationship between PHM and PHC can be described as a virtuous circle; PHM helps make PHC more effective, and many elements of a strong PHC model are essential for effective PHM.

The approach to developing Ireland’s first national health protection strategy and lessons learnt

Abstract Health protection is recognised as an essential public health function by the World Health Organization. It includes the prevention and control of infectious disease, environmental and radiation risks, and the emergency response to major incidents. The COVID-19 pandemic has highlighted the importance of strengthening this function worldwide. To address this as a public health priority in Ireland, between January and October 2022 the first national first Health Protection Strategy (2022-2027) for the Health Service Executive (HSE) was developed. This was led by the then National Clinical Director for Health Protection supported by a Project Working Group (PWG), with governance and oversight from a multi-disciplinary Steering Committee (SC). Key steps in strategy formation included detailed stakeholder analysis, exploration of the policy context for the strategy, and development of a consultation plan with guidance of an external facilitator. Two SC consultation workshops were held (March and June 2022). Workshop 1 focused on defining strategic vision, aim, and objectives. Workshop 2 verified objectives and identified enablers. A subsequent e-consultation invited feedback from wider stakeholders (July 2022). The strategy, published 13th October 2022, outlines 10 strategic objectives and 11 associated enablers. Progression of strategy implementation will require further stakeholder engagement, development of implementation plans, and establishment of a monitoring and evaluation framework, including annual review of implementation. Strengths of the strategy development approach included multidisciplinary SC input and oversight, review of the national and international policy context, detailed stakeholder analysis and engagement, and the comprehensive consultation plan developed with external facilitator input. Lessons from our experience can support colleagues internationally to strategically set out their priorities for health protection beyond COVID-19. Key messages • The development of the first HSE Health Protection Strategy 2022-2027 is a critical step to ensure a clear framework for the delivery of national health protection functions going forward. • As the COVID-19 pandemic continues, public health bodies should strategically set out priorities for health protection beyond COVID-19 – lessons from our experience in doing so can inform this work.

PHONIC: Public Health OperatioNs for clImate aCtion-Development of a framework to identify priorities

Abstract Background Following decades of improving health and well-being, climate change constitutes the biggest threat to human health in the 21st century. Given the urgency of this topic, it is relevant to identify ways to prioritize those public health operations that will result in the greatest benefit for the population health in a changing climate, considering the vulnerabilities of different groups. The project's aim is to assess climate change mitigation and adaptation measures related to public health functions, thereby making them resilient to current and future challenges. Methods This will be done by i. identifying linkages between public health functions and climate change mitigation and adaptation measures; ii. developing an umbrella framework that allows overall classification of public health operations addressing climate change mitigation and adaptation based on a review; iii. developing a sub-framework for selected operations based on international good practice with indicators that allows for structured assessment and evaluation of the current state of practice; iv. piloting of the sub-framework in Germany and Kenya by comparing national actions from public health services against international good practices. All steps will be carried out in close cooperation with experts across multiple disciplines, institutions, and countries. Results Preliminary results of the project show that there are already frameworks existing that have merged environmental determinants and public health operations, such as the Essential Public Health Functions for Health, Environment and Climate from PAHO. These will be complemented by the outcomes of a scoping review on indicators and international good practice examples. The next phase will include the piloting of these tools in real life settings. Conclusions The PHONIC project aims to develop a practical guidance for decision makers in the context of public health to identify priorities for climate change action. Key messages • There is potential in combining public health operations and climate change action for identifying priority actions for decision makers and practitioners. • Practical guidance needs to be developed and implemented to link public health operations with climate action.

Essential Public Health Functions of Public Health Personnel in Subdistrict Health-promoting Hospitals, Thailand.

In Thailand, public health service roles have been defined by the Ministry of Public Health, while essential public health functions (EPHFs) were not assigned as necessity health-care service activities responding to the missions of primary care units. The aims were to determine the EPHFs and compare the necessity of performance and the actual performance according to the EPHFs of public health personnel in the subdistrict health-promoting hospitals (SHPHs). The exploratory sequential design of mixed methods was employed. The first phase consisted of three methods: a focus group discussion, a nominal group technique, and a cross-sectional survey used to determine the EPHFs. The second phase was to compare the necessity of performance and the actual performance according to the EPHFs of the personnel using a cross-sectional survey. The 285 SHPH directors in the second health region as samples were selected by random clusters. The findings revealed that 14 EPHFs and the necessity of performance average were higher than the actual performance average in the 14 EPHFs and 212 indicators with significance at a level of 0.05. The means of health assessment and primary medical care (EPHF3) presented the smallest difference, whereas Thai traditional and alternative medicines (EPHF11) indicated the largest average difference. EPHFs would be applied for setting a framework of working scope as policies and EPHFs could be recommended for use as individual guidelines or organizational assessment manuals to develop organizations efficiently.

The Field Epidemiology Training Program's Contribution to Essential Public Health Functions in Seven National Public Health Institutes.

Objective: This study explores how Field Epidemiology Training Programs (FETP) whose National Public Health Institutes (NPHI) are supported by U.S. Centers for Disease Control and Prevention (CDC) have contributed to strengthening essential public health functions. Methods: We conducted 96 semi-structured interviews with public health experts including NPHI staff, non-NPHI government staff, and staff from non-governmental and international organizations in Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda, and Zambia. We managed data using MAXQDA and employed direct content analysis to derive themes. Results: Three overarching themes emerged in relation to FETPs' role within the NPHIs' public health functions. These themes included contribution to improving country surveillance systems, role in providing leadership in outbreak responses, and strengthening countries' and the NPHIs' surveillance workforce capacity. Participants also shared challenges around FETPs' implementation and suggestions for improvement. Conclusion: The results demonstrate the value of FETPs in strengthening public health systems through building workforce capacity and improving surveillance systems. By identifying the successes of FETPs in contributing to essential public health functions, our findings might inform current and future FETP implementation and its integration into NPHIs.

Mapping of public health courses and training programs in Brazil.

To map public health courses and training programs in Brazil and identify, in their curricula and study plans, the level of linkage between the skills and competencies developed by them and the essential public health functions. Descriptive, exploratory study based on collection and analysis of information available on the websites of educational institutions that offer public health courses and training programs in Brazil. Data was collected within the scope of the I Mapeo de Cursos y Programas de Formación en Salud Pública de América Latina. A total of 1,222 public health courses and training programs offered in the country were identified, with unequal territorial distribution but taking place in all federation units. Results revealed a set of challenges to public health professionals' training, including lack of linkage both between training offer and demand in public health (unequal distribution of courses, concentration of training capacity in capitals and in certain regions, among others), and between theories and training practices (low levels of connection of developed skills and competencies with the essential public health functions, predominance of disciplinary method guided by professional competence centers, among others). Overcoming these challenges requires structural, political, and technological efforts, narrowing the gaps between public health training programs' availability and the demands of health services and programs in the country.

Recommendations for the development of resilient health systems in the AmericasRecomendações para o desenvolvimento de sistemas de saúde resilientes nas Américas

This article offers opinion and analysis outlining strategic lines of action to build resilient health systems while promoting recovery in the post-COVID-19 pandemic period, with a view to maintaining and protecting public health gains. It contextualizes the challenges and opportunities in the Region of the Americas and offers recommendations for implementation of the strategic lines.It is urgent to promote the development of resilient health systems through the implementation of four lines of action defined in the strategy adopted by the Member States of the Pan American Health Organization in September 2021. The transformation of health systems must be based on the adoption of an integrated model of primary health care, a priority focus on the essential public health functions, strengthening of integrated health service networks, and increased public funding, especially for the first level of care. Implementation of these lines of action is focused not only on consolidating immediate crisis response; it is also framed within efforts toward the recovery and sustainable development of health systems, reducing their structural vulnerabilities to better prepare the response to future crises.