Health Authorities Research Articles

Lesson learned from a co-designed vaccination initiative with undocumented people in the Netherlands

Abstract Issue/ problem ‘The coronavirus does not take document status into account’. The COVID-19 pandemic highlighted the importance of equal healthcare access for all. Yet, undocumented people face numerous personal and practical barriers in accessing health. Ensuring the protection of the most vulnerable is a global concern. Description of the problem In 2021, a regional initiative aimed to remove barriers and create a trusted environment for undocumented people to receive vaccinations. This collaborative effort included public health departments, NGO’s, community groups, (self) organized migrant organizations, GP’s and embassies. Regular meetings identified the population’s needs. A medical doctor was made available 24/7 to address questions and concerns. Actions were undertaken to build trust, foster collaborations between health authorities and communities and to improve vaccine service access and design. Results Working in partnership fostered trusted, multi-sectorial relationships, resulting in a vaccination initiative that met the diverse needs of the undocumented people. Widespread community-driven outreach through flyers and social media reached those who normally are not reached. Supported by over 40 volunteers, three vaccination events were organized in which 693 doses were administered. All parties made their contribution, e.g. with different migrant communities providing hot meals. The initiative began at the grassroots level in the communities and was then executed in partnership with the involved parties, making it highly successful. Lessons Inclusive engagement, addressing concerns and sharing clear information not only supports trusted relationships but also strengthens social cohesion. Collaborating directly with the communities ensured the initiative was tailored to their needs, thereby lowering the barriers for accessing healthcare. Achieving this success required a foundation of trust, mutual respect and a collective commitment from all involved. Key messages • Codesigning vaccination initiatives with the communities is essential for success. • Trusted partnerships, community involvement and mutual commitment were key elements for lowering barriers to accessing health.

Developing regional Diabetes Registries in Italy: pilot projects implementation within JACARDI

Abstract Issue/Problem In Italy a National Diabetes registry is planned but not yet set up at the Ministry; JACARDI is contributing to speed up the process so that critical gaps in health data availability can be filled. While some regional registries exist, the lack of cohesion and standardization hinders the tracking of prevalence, incidence, and sequelae, crucial for evidence-based policymaking amidst rising diabetes rates. Description of the Problem The JACARDI project, supported by EU funding and running for four years, engages 76 partners from 21 countries and includes 142 national-level projects. Among its focus areas is enhancing data availability, aiming to establish harmonized regional Diabetes registries in Italy to tackle this issue. These efforts aim to create a scalable model enabling data linkage, diabetes type differentiation, and socio-demographic integration. Collaboration with health authorities and societies, drawing insights from existing registries, informs the development process. Results A total of 11 regional Diabetes registries are currently in the design phase of implementation. They adhere to a clearly defined methodology, with established essential parameters and data linkage. Consensus on these parameters and linkage was reached through stakeholder discussions, drawing on past registry experiences. The primary goal of the registries is to monitor diabetes prevalence, stratify incidence by demographics, and track sequelae to inform targeted interventions and resource allocation. While scalability beyond Italy may encounter administrative challenges, standardized protocols facilitate transferability. Data Protection stands out as a significant implementation obstacle. Lessons Standardized data collection, stakeholder collaboration, and sustainability are vital in registry development. Leveraging data availability for surveillance demonstrates adaptability and scalability, offering valuable insights for enhancing diabetes management. Key messages • Standardized data collection and stakeholder collaboration are pivotal in establishing effective diabetes registries, fostering equity and improving health outcomes. • Leveraging data availability for surveillance offers a scalable and sustainable approach to diabetes management, facilitating informed policymaking and interventions.

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.

Whooping cough – a recurrent epidemic

Abstract Background Whooping cough (WC), or Pertussis, is a vaccine-preventable and highly contagious infectious disease. Although it has a relatively low fatality rate, approximately 13% of reported cases develop secondary bacterial pneumonia. This was because of several recurrent epidemics across Europe in the last decades, with the latest beginning in mid-2023 and still ongoing. The Central Region of Portugal is currently being affected, and this study aims to describe the current epidemic at the regional level. Methods Data from epidemiological inquiries of confirmed and probable cases of WC pertaining to the Central Region of Portugal from January 2020 till April 2024 was gathered from the mandatory report national epidemiological surveillance system (SINAVE). Both a temporal comparison of number of cases and a statistical space-time scan with permutation were conducted (software SaTScan v10.) Results A comparison by month of reported cases shows an increase in cases from September 2023 until December 2023 followed by an exponential increase from January 2024 until April 2024 denoting an ongoing epidemic. In the statistical space-time analysis of 107 reported cases between September 2023 and April 2024, 8 nonsignificant clusters were identified with different locations involved in non-overlapping periods. Conclusions The finding of several unrelated clusters, even though nonsignificant, during a short time period indicates that Pertussis transmission is ongoing at the local level probably through asymptomatic or barely symptomatic cases that act as reservoirs. Clinicians must hold a high clinical suspicion for a timely diagnosis, treatment and report and health authorities must reinforce control measures to limit the spread of this disease. Key messages • Pertussis remains a disease of significant concern recurrent outbreaks across Europe show that public health local authorities have an important role in timely management of cases and outbreaks. • Local level transmission and intervention may play a pivotal role in the epidemiologic dynamic of Pertussis.

Time-dependent networks for the treatment of acute coronary syndrome in South East Tuscany

Abstract Introduction The importance of timely reperfusion therapy in Cardiovascular diseases is crucial, leading to the creation of time-dependent networks for Acute Coronary Syndrome treatment. The ACS-STEMI treatment network in Tuscany operates across three health authorities (LHAs),including South-East Tuscany. The network ensures ACS-STEMI treatment in 12 hospitals integrating new territories such as Piombino and Elba into the network. Aim of the study is to assess the impact of an analytical monitoring system of the times to reperfusion treatment and the actions to improve the performance of the network. Methods In this retrospective study an analytical evaluation of the network’s performance was conducted. We utilized data on patient transport, symptom onset to medical contact times, and outcomes from the National Outcomes Program (PNE).Analytical evaluations in 2021 measured the network’s performance, identifying main delay causes. The treatment process is divided into periods from symptom onset to coronary reperfusion, and interventions like public campaigns, ECG transmission and fast-track transfers have been implemented. Results South East Tuscany LHU had the lowest 30-day mortality rate for ACS patients in Italian hospitals with 300 cases annually in 2020 and 2021.Improvements continued into 2022 and 2023, further reducing mortality rates in patients initially admitted to SPOKE hospitals. For Piombino and Island of Elba residents,30-day mortality decreased from 8.8% (2017-2020) to 5.7% in 2022. The Grosseto hub treated 80% of STEMI patients within 90 minutes in 2022. Conclusions The establishment of a well-organized time-dependent network for ACS-STEMI treatment in Tuscany has significantly improved patient outcomes, demonstrating the critical role of timely and efficient care pathways. The network’s success is attributed to several factors, including improved accessibility, enhanced coordination among healthcare facilities, and effective use of technology and resources. Key messages • Treatment networks for ACS/STEMI can improve health outcomes in peripheral areas. • Structured clinical-care pathways in delivering high-quality care for ACS patients reduces ACS mortality.

Assessing contextual factors influencing scale-up: a interactive approach involving stakeholders

Abstract Issue Pilot interventions are not always put into practice at scale. When they are, effectiveness is often highly reduced in the field due to contextual factors. To effectively implement a scale-up, stakeholders’ involvement is crucial. Curema is an international research evaluating an intervention aiming to reduce malaria transmission by distributing RDTs and treatments in mobile hard-to-reach populations. This intervention might be scaled-up in Brazil, Suriname, and French Guiana as a tool of national malaria programs for specific areas and populations. Description of the problem An interactive pre-planning assessment was conducted involving key stakeholders -implementers, decision-makers, and researchers - in working sessions, semi-structured interviews, and formal meetings. Mendelow’s Power/Interest Matrix was used to map stakeholders and a SWOT analysis was conducted using ExpandNet/WHO Framework to evaluate contextual factors and identify levers and obstacles influencing the scale-up. Results A total of 23 participants were involved. Health authorities had high power and generally high interest, while implementers and recipients had lower power and different interest levels. National engagement for WHO E2025 or E2030 enhanced scalability and represented a main opportunity in the three countries. Nevertheless, several regulatory and administrative aspects were identified as potential obstacles to be addressed to make scale-up realistic. Funding was also a major concern for sustainability. The need for regional cooperation was emphasized to achieve malaria elimination. Lessons Despite financial and regulatory challenges, a window of opportunity is open to scale-up Curema. Identifying and involving stakeholders in a pre-planning assessment and advocating for foster regional cooperation are crucial steps to support the scale-up. Stakeholder analysis should be refined during the scaling-up to capture further changes in factors that might influence the process. Key messages • Engagements with WHO represent windows of opportunity to enhance Curema scale-up. • Stakeholder involvement and regional cooperation are crucial for scaling up Curema in Brazil, French Guiana and Suriname.

Assessment of heavy metal contamination in groundwater of rural areas of Kurdistan Province Iran: A comprehensive study

This study focuses on the contamination of groundwater by heavy metals (HMs) in the Kurdistan Province of Iran, an area heavily reliant on these water resources, especially in rural regions. This research aimed to quantify the concentrations of 20 HMs in groundwater sources and assess the associated health risks, including both carcinogenic and non-carcinogenic effects, for different age groups. The study was conducted in 2024. We collected 155 groundwater samples from water resources of the villages in Kurdistan Province, west of Iran. The study encompassed comprehensive sampling of groundwater from various wells and springs throughout the province, which was subsequently subjected to thorough laboratory analysis utilizing Inductively Coupled Plasma Mass Spectroscopy (ICP-MS) for the quantification of heavy metal (HM) concentrations. The highest concentrations of As, Co, Cu, and Mo were 7.90, 0.22, 2.48, and 1.68 μg/l, respectively. It was related to the cities of Qorveh, Sanandaj, Baneh, and Qorveh respectively. A Health Risk Assessment (HRA) was performed, indicating that, while the concentrations of most HMs were within the thresholds established by national and international standards, certain metals, such as arsenic and lithium, presented notable non-carcinogenic risks, especially to children. These metals were responsible for over 48 % of the cumulative hazard index (HI) across all ten cities evaluated. Furthermore, the HI for the adult demographic exceeded 1.0 (specifically 1.23) exclusively in Qorwe city. The study also identified a high carcinogenic risk associated with lead across the province, which has a carcinogenic risk of 7.3 × 10−03 in 10 studied cities, which is more than the guideline value of 10−04. The findings underscore the urgent need for continuous monitoring and the implementation of preventive measures to safeguard public health. The results provide crucial insights for policymakers and health authorities, facilitating informed decisions to mitigate the health risks posed by HM contamination in the region's groundwater.

Assessing primary healthcare quality through avoidable hospitalizations: a systematic review

Abstract Background Avoidable hospitalization (AH) for ambulatory care sensitive conditions (ACSC) has been widely used as a measure of the performance of primary health care. However, the lack of a standardized definition of these conditions and the absence of conclusive evidence regarding their efficacy across diverse healthcare settings remain significant challenges. This review aims to systematically identify and synthesize the utilization of AH for ACSCs as a metric for evaluating the quality of primary healthcare (PHC) and factors influencing such quality. Methods We conducted a systematic search for peer-reviewed studies on 3 electronic databases. Studies that used AH for ACSCs to investigate the quality of PHC were included. The following characteristics were extracted: study design, ACSCs definition, AH rates, intervention if applicable, PHC and or patients’ characteristics associated to AH rates, such as accessibility, continuity of care, demographics, socio-economic status, and comorbidities. Results 73 relevant articles were identified, published between 1994 and 2023 and mostly in USA. Preliminary findings based on 56 articles indicate that the majority (48.2%) employed the list of ACSCs from the AHRQ (i.e. the prevention quality indicators) (48.2%). Meanwhile, 12 studies (17.9%) used lists developed or modified by the authors, and another 7 (12.5%) adopted lists previously utilized in other research. Studies conducted in Brazil, Canada and USA employed lists issued by relevant national institutions. Conclusions Although preliminary, these findings highlight two main trends. Firstly, in countries where health authorities have established a standardized set of ACSCs, a notable uniformity is observed. Conversely, in the absence of such standards, variability in defining these conditions is likely to increase. This variation could hinder the comparability across different Primary Health Care (PHC) service organizations and affect the analysis of care quality. Key messages • Most studies used established indicators for the measuring of primary healthcare quality. • Diverse ACSC definitions across countries impair the generalizability of healthcare quality analysis.

The politics of medical expertise and substance control: WHO consultants for addiction rehabilitation and pharmacy education in Thailand and India during the Cold War.

This paper explores the role of World Health Organization (WHO) medical experts in ambitious projects for substance control during the Cold War in Thailand and India. The circumstances surrounding opium production in these two nations were very different, as were the reasons for requesting expert assistance from the United Nations. Whereas the Thai military regime was concerned with controlling illicit traffic to secure its borders, the Indian government wanted to direct its opium raw materials towards domestic pharmaceutical production. Overlapping and sometimes competing agendas of country governments and international agencies converged upon each project, complicating the consultants' work and requiring careful navigation. In both cases, medicine as a science concerned with human health and well-being was subordinated to more pressing agendas. At the same time, the article argues that WHO consultants left an important impact, though not necessarily due to their skills and training in medicine. Instead, they provided exemplars of sound governance and delivery of public health in a politically stable and economically developed country.

7.I. Skills building seminar: Beyond the jargon: an interactive workshop for effective risk communication

Abstract Risk communication plays a central role in epidemiology to provide information for disease surveillance and outbreak control. It is one of the of the eight core functions that WHO Member States must comply with as part of the International Health Regulations (2005) ensuring national and global preparedness for health threats. It refers to the timely and accurate exchange of information between public health experts or authorities and individuals who are confronted with a threat to their survival, health, economic or social well-being. At its core, risk communication is about empowering people exposed to a risk to make well-informed decisions in order to mitigate potential risks and adopt preventive actions and measures. Risk communication considers political, social, and economic factors; it analyses risk and risk perception; and it places a great emphasis on dialogue with impacted and targeted populations to help them make the best decisions they can. Therefore, it requires an understanding of stakeholders’ perceptions, concerns, and beliefs, as well as their knowledge and practices. In the context of the COVID-19 pandemic, the need for effective and efficient risk communication has become even more evident than before. Risk communication should be able to recognise and deal with rumours and disinformation, and reach the most vulnerable groups, who have a higher risk of contracting the virus and suffering from COVID-related consequences. Lately, increasing attention has been given to this topic. The WHO set-up, in April 2023, a technical Advisory Group for Risk Communication, Community Engagement and Infodemic management (TAG-RCCE-IM) to provide independent review and technical advice in the context of emergency preparedness and response in Europe. The Joint Action PreventNCD aims to also build a framework for country-specific communication strategies for non-communicable diseases (NCD) patients in health crises in one of the Work Packages, by collecting and analysing health communication strategies in different European countries targeting NCDs. In this interactive skills-building seminar, we will share with the participants the knowledge, skills, and process of effective risk communication by using case studies from experts in the field. The session will start with a presentation on the core elements of risk communication followed by examples from the field. This workshop will foster an inclusive interactive environment where participants will hear from panellists sharing their experiences from different settings such as international organisations and national public health institutes. Participants will be split into groups and will be provided with a piece of scientific output, such as a research study or epidemiological report and encouraged to translate this technical message into a clear, concise message that can effectively communicate the key points to the general public. Key messages • Risk communication is essential to fight disinformation while empowering the public to make informed decisions related to their health and well-being. • Epidemiologists and researchers should be encouraged to employ efficient and targeted communication strategies when disseminating their findings. Speakers/Panelists Stefan Schaub Bundeszentrale für gesundheitliche Aufklärung (BZgA, Cologne, Germany Federica Rossetti Sciensano, Brussels, Belgium Stefan Adrian Voinea WHO/Europe, Copenhagen, Denmark

Promoting active ageing: The positive impact of older people’s participation in Urban Gardens

Abstract Background The socio-health and economic consequences of the progressive population ageing constitute a global challenge for public health, which is committed to the promotion of active and healthy ageing as a strategy to mitigate these consequences. The European project U-GARDEN has evaluated from a comprehensive and innovative approach the impact of urban gardens on the promotion of active ageing through the participation of older people in urban agriculture. Methods A qualitative methodology was designed and implemented in order to analyse the information provided by people over 65 years of age, who actively participated in urban gardens, from a personal and subjective perspective through semi-structured in-depth interviews. The benefits obtained from participation in urban gardens were analysed, considering the different dimensions that make up the paradigm of active ageing: physical, psychological, economic, health, behavioural and personal impact. A total of 20 interviews were used to reach the saturation point. Results Qualitative analysis showed multiple benefits of active and healthy aging. Participants reported increased physical activity and psychosocial improvements such as higher personal satisfaction, reduced stress, and enhanced self-esteem, strengthening community connections and fostering a sense of belonging. Economically, they reported savings on food costs and increased food security. Overall, respondents noted improvements in general health and quality of life, highlighting urban gardening as valuable for well-being and social-economic integration. Conclusions The findings reported in the framework of the U-GARDEN project support the importance of implementing innovative strategies that encourage participation in urban gardens as a tool to improve the overall wellbeing and health of older people, effectively addressing some of the main challenges of ageing such as loneliness unwanted frailty and disability. Key messages • The U-GARDEN project is an example of good practice in the use of urban gardens as a platform for promoting active and healthy ageing. • The promotion of green spaces through the establishment of urban gardens should be considered by health and political authorities for their ability to promote the general well-being of society.

The future of public health in Europe

Abstract EuroHealthNet - in collaboration with the Copenhagen Institute for Futures Studies - has conducted a Foresight study to collect insights and identify risks and opportunities. The study investigates the role of public health by 2035 in achieving health equity through health promotion and prevention, in the context of the digital and green transition. The multi-round study ran from June to November 2023. It consisted of a workshop, a kick-off meeting, two rounds of surveys using the Delphi method, and a final back-casting expert panel. The Foresight exercise involved 35 experts across Europe and covered six themes: public health policy and governance; public health financing and spending; sustainability and the green transition; health promotion and disease prevention; equity and society; digitalisation in public health. The presentation will highlight some of the outcomes, recommendations as well as experiences from this Foresight exercise and how it can be applied in practice.

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.

7.O. Skills building seminar: Initiating change: Mainstreaming equity and diversity in public health

Abstract Background Consideration of the increasing population cultural and ethnic diversity and the widening of social gaps is essential for narrowing health inequities. While tailored and targeted measures for populations at risk of social disadvantage are needed, mainstreaming and integration of diversity and inclusion perspectives in all public health measures are required. To our knowledge, the EU Joint Action for Cardiovascular diseases and diabetes (JACARDI) is the first large-scale program to apply a systematic and harmonized approach for integrating equity and diversity perspectives. Objectives The main objective of the workshop is skills building in integration of equity and diversity perspectives in practice through: 1) Introducing the key requirements for achieving EU-wide programme change, drawing from several decades of experience in projects conducted in over 30 countries, including those partnered with the World Health Organization, governments and industry. 2) Outlining a practical tool in the format of an equity and diversity matrix designed for integrating equity and diversity perspectives developed within the JACARDI project to support implementation of 142 sub-projects in 21 partner countries. 3) A practical participatory group work based on the JACARDI equity and diversity maturity matrix, followed by a moderated discussion. The workshop acts as a valuable platform for sharing and building collaborative knowledge across European countries and empowering participants as initiators for sustainable, more equitable, and diversity inclusive public health actions. It provides practical and concrete skills on equity and diversity that participants can apply in their work and disseminate within their organizations. The presentations will build knowledge, while group work and the moderated discussion will build skills among participants on the workshop topic. Format of the workshop Two presentations followed by participatory group work and a moderated discussion among workshop participants and presenters. Key messages • Population diversity should be systematically mainstreamed in public health to effectively and sustainably narrow persisting health inequities. • An equity and diversity maturity matrix can be used as a practical tool for systematic integration and monitoring of diversity perspectives in practice.

Key requirements for achieving EU-wide programme change

Abstract Issue Across the world, thousands of projects aim for equitable improvement in health for people who are experiencing ongoing avoidable stigma, discrimination and disadvantage however very little change is often achieved. Description of the problem In this presentation we explore key requirements for project-level change to ensure EU-wide programme change is achieved. Results The two most common causes of project failure are a) the innovation is not suitable, needed or wanted (also called theory failure) or b) implementation failure. This presentation shares strategies to mitigate risks of project failure through co-design processes and communication, drawing from 30 years of experience from the entire implementation process from ideation to scale up. These experiences include projects from over 30 countries, including partnerships with the World Health Organization, governments and industry focused on health literacy, self-management, care pathways, workplace health, hospital services redesign, First Nations health and migrant health. Common success factors include balancing top-down needs with co-designed inputs and with previous preferred or good practice (which may have come from controlled trial evidence generated in different contexts). The intervention must co-implemented to serve stakeholder’s needs at all levels, from citizens to decision makers. Lessons The United Nations (UN) and private sector apply system-wide approaches to affect large scale change. This knowledge is valuable for large public health programmes aiming to integrate equity and diversity in project processes to minimize implementation failure.

The primary healthcare workforce crisis: a comparative assessment of the European region

Abstract Background The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts. Methods A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England. Results Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark and the Netherlands, and to a lesser extent also Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. The WHO primary healthcare model only marginally informs policy decisions, but it may receive some more attention in Kazakhstan. Conclusions We conclude that aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas. Speakers/Panelists Tiago Correia NOVA IHMT, Lisbon, Portugal Viola Burau Aarhus University, Aarhus C, Denmark Marius-Ionuț Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Anna Sagan WHO European Centre for Primary Health Care, Almaty, Kazakhstan

9.L. Round table: “What” and “How” for building competencies for effective policy making in and for public health

Abstract Policymakers operating within the field of public health must regularly draw on their skills or competencies to facilitate engagement in and between policy sectors and with the public, to navigate the larger landscape of public health institutions and governance levels across the policy cycle, to generate, understand, and apply evidence for decision making, as well as to negotiate the demands of diverse stakeholders. What exactly are the competencies needed and how can they be cultivated to enhance the collective capacity of policymaking institutions? The increasing strain placed on public health systems worldwide, owing specially to challenges in population ageing, the burden of non-communicable diseases, and the exigencies introduced by pandemics, environmental disasters, and geo-political instabilities push us to expand the scope of public health. A look to the policy environs and outcomes seen within and across countries demonstrates that the quality of policy is both highly variable and exceedingly subject to the quality of public health leadership itself. These developments shed light on the need for greater investment in the development of competencies needed by policymakers to engage in effective decision making on key issues impacting population health and the resilience of public health systems. This includes efforts to strengthen the abilities of policymakers to identify problems, recognize opportunities, and put forth solutions in line with robust data and evidence, principles of public health ethics, gaps and priorities in public health needs, and in accordance with financial and political realities. The proposed roundtable will examine the state-of-the-art on policymaking competencies in public health, and how to build them by examining the barriers and opportunities. The panel will convene leading experts in the field of public health research and practice to explore: 1) the conceptual definition of competencies for policymaking at different levels of governance and across the policy cycle; 2) the strengths and limits of competency frameworks and their utility in guiding assessment and training tools, as well as policy practice; 3) the challenges associated with developing, maintaining and transferring competencies in fast-changing, multi-level policy making environments; 4) the challenges for public health experts and institutions to be trusted advisors both by policy makers and other stakeholders and the population; and 5) the opportunities to harness the unexploited power of professional networks in some countries of Europe. Key messages • An enhanced research agenda and investment are needed for the development of competencies - individual and collective - for effective public health policy-making and stronger governance. • Innovative approaches to policy-making are needed, and this requires building competencies, including leadership, for addressing the complex nature of public health.

Mental health support for healthcare workers: what is it about governance and policy implementation

Abstract Background We adopt a health system and governance perspective to address the mental health needs of healthcare workers, considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and exploring strategies to effectively increase mental health support. Methods A qualitative comparative methodology is applied based on a case study design utilising a multi-level intersectoral governance matrix. The assessment matrix comprises four key categories: health policy and data, social policy and psycho-social conditions, organisation of work, and job and professional conditions. We conducted a rapid assessment of healthcare workforce developments in the European context, drawing on secondary sources and country experts. The country sample comprises Germany, Portugal, Romania, Switzerland and the United Kingdom. Results Awareness of mental health threats among healthcare workers increased, but policy discourse is driven by service delivery and labour market demands. The attention to healthcare workers’ needs is stronger on the international level especially supported by WHO action, and weakest at national/regional levels. Although organisations and professions demonstrate varying degrees of activity, their efforts are scattered and lack sustainability. Similar challenges were identified across healthcare systems, including limited action, disconnected actors, missing coordination, and a lack of attention to governance gaps and system weaknesses. Conclusions There are similar problems across countries. Mental health policy is driven by labour market needs and ignores research evidence and the individual needs. Successful mental health policy implementation needs multi-level governance and coherent coordination mechanisms, and generally greater attention to the ‘human side’ of the healthcare workforce. Speakers/Panelists Sara Alidina Central Administration of the Health System, Lisbon, Portugal Tomas Zapata WHO/Europe, Copenhagen, Denmark

4.A. Skills building seminar: Waves of community health engagement and governance: innovating through a design-as-policy approach

Abstract In this workshop we will engage our participants in a practice oriented exercise to experiment with a collaborative design-as-policy approach for a community health action plan. The exercise will be based on the lessons learned in two large evaluation projects: 1) an 8-year evaluation of the Dutch All about Health (AaH) platform of social health initiatives on the local, regional and national level; and 2) a comparative multiple case study, including Portugal, building a framework for sustainable citizen engagement, published in the WHO Handbook ‘Voice, Agency, Empowerment: The Handbook on Social Participation for UHC’. Both projects show striking similarities in findings, and developed guidance for devising collaborative action through (a) the use of community platforms, (b) concrete engagement mechanisms and (c) mediating civil society organizations. These will be brought together in a Guidance Tool that participants will work with in the exercise. The aim of the tool is to support initiatives to bring together both top-down participatory efforts and bottom-up grassroots movements in order to anchor community and minority voices into policy decision-making for a more level playing field for policy influence. The aim of the workshop is to let participants experiment with the Guidance Tool and develop collaborative design-as-policy skills. The outline of the skills building exercise: 1. Group introductions using Mentimeter and invitation to pick a particular complex health issue from participants’ own work or community setting (5 mins). 2. Three pitches on the projects, the Portugal case and the Guidance Tool (10 mins). 3. Exercise instructions (5 mins). 4. Exercise (35 mins) a. Upon room entrance participants receive a colored badge based on their professional background: public health professional/practitioner, community resident, researcher or policymaker; b. Form small sub groups of 6-8 participants with different backgrounds (2 mins); c. Introduce with key words on paper their respective complex community health issues and sub group jointly selects one issue for which most information and experience is present (6 mins); d. First round in duos within sub group: participants work through the guidance steps to an initial idea for the collaborative action approach consisting of a community platform, engagement mechanisms, and mediating civil society organizations, drawn out on paper (10 mins); e. Second round in duos within the sub group: duos review another duos initial design idea and conduct an intuitive SWOT analysis of feasibility, acceptability, and practicability (8 mins); f. Third round in sub group: compare the three proposals in SWOT perspective, select the most salient one, and improve with strong elements from other proposals (8 mins); g. Summarize in key words the final proposal and enter into Mentimeter. 5. Plenary wrap up using Mentimeter: select the winning proposal, and evaluate the exercise (5 mins). Key messages • Collaborative action is enhanced considerably through (a) the use of community platforms, (b) concrete engagement mechanisms and (c) mediating civil society organizations. • The Guidance Tool offers concrete steps for designing a reflexive and adaptive structure and process for community collaborative action and self-governance. Speakers/Panelists Marleen Bekker Wageningen University & Research, Wageningen, Netherlands Dheepa Rajan WHO, Brussels, Belgium Goncalo Figueiredo Augusto National Health Council, Lisbon, Portugal

9.X.1. Protecting the mental health of healthcare workers: evidence, policy and implementation challenges

Abstract Background There is growing evidence that highlights increasing stress levels and declining mental health among the global healthcare workforce, exacerbated by challenges within workplace environments, labour market and policy frameworks. These conditions place additional strain on an already vulnerable healthcare workforce and consequently threaten the stability of health systems as a whole, given the escalating challenges in retaining, recruiting and reactivating healthcare workers. Although the problems are evident, awareness is increasing and international organisations such as the WHO have advanced policy recommendations, comprehensive and context-specific interventions effectively addressing these problems at varying levels are missing. Objectives This innovative workshop offers a platform for bridging the gap between research evidence and policy interventions, stimulating policy learning and knowledge exchange across countries. The session provides an overview of existing knowledge and engages representatives of academia as well as national policymaking, and international organisations to critically discuss challenges as well as good practice experiences with a focus on implementation and problem-solving. The following major questions will be explored: What evidence is available regarding the mental health and wellbeing needs of the healthcare workforce? How are different countries responding to these needs and supporting healthcare workers more effectively? What are some best practice cases focusing on improving mental health support for healthcare workers across various groups, considering diverse needs, gender-inclusiveness, and minority groups? Finally, how can evidence-based policymaking be improved, and how can the implementation of these policies be advanced in a more effective manner? Thesession will encourage critical debate and identify major policy recommendations, focusing on governance and implementation strategies. In the second half of the session, the panel will engage the audience in an interactive discussion to explore novel solutions that prioritise the wellbeing of healthcare workers and effectively address the healthcare workforce crisis in a more person-centred and ‘humanised’ manner. The workshop supports cross-country learning and networking opportunities. Key messages • Mental health and wellbeing of the healthcare workforce is crucial for health system resilience and needs stronger advocacy for coordinated multi-level governance action. • Establish a health system and governance approach together with comprehensive monitoring and qualitative comparative workforce studies to identify transformational policies in contextual settings.