National Health Strategy Research Articles

Review on the Reflection of National Health Financing Policy and Strategy on Nigerians towards Achieving Universal Health Coverage by 2030

Labour pain management is crucial for a comfortable childbirth experience. A range of options, including epidural anesthesia, breathing techniques, massage and positional changes, are available for managing labour pain. Factors such as maternal preference, stage of labour and medical conditions are considered when choosing the right approach. Effective labour pain management benefits both the mother and baby. This systematic review is aimed to identify best practices and gaps in managing labour pain and to provide recommendations for a comprehensive and effective capacity building program. The review analyzed relevant literature and data sources to assess the current state of midwifery education and practice in labour pain management. The results of the review indicate a need for a comprehensive and multi-faceted capacity building program that includes hands-on training, mentorship, and ongoing professional development opportunities for midwives. The study concludes that a well-designed and well-implemented capacity building program on labour pain management can improve the quality of care for mothers and newborns and enhance the competencies of midwives in Ekiti State.

Using Responsive Feedback in Scaling a Gender Norms-Shifting Adolescent Sexual and Reproductive Health Intervention in the Democratic Republic of Congo.

Growing Up GREAT! (GUG) is a sexual and reproductive health (SRH) program for adolescents aged 10-14 years in Kinshasa, Democratic Republic of the Congo (DRC). The multilevel program takes an ecological approach to foster community examination of gender inequitable norms and to increase adolescents' SRH knowledge, skills, and gender-equitable attitudes. GUG design, piloting, and scale-up were informed by a theory of change and responsive feedback mechanisms (RFMs) during piloting and scale-up. The program engaged stakeholders via quarterly learning meetings to review monitoring data, evaluation results, and practice-based knowledge and to subsequently identify challenges and develop solutions. The program commissioned rapid research on specific intervention elements to improve implementation and documented scale-up learnings using the World Health Organization/ExpandNet framework. RFMs used in the pilot period allowed the program to address community concerns by intensifying orientation activities with parents and schools, shifting the calendar of activities to increase male engagement, and increasing facilitator training length to improve facilitation quality. Using RFMs during scale-up prompted further adaptations for program sustainability, including recommendations for task-shifting from NGO facilitators to community health workers. GUG used RFMs from pilot through scale-up to foster a learning culture among local partners, implementers at headquarters, and global research partners. Using responsive feedback (RF) enabled timely response to the evolving implementation context, resulting in strategic program adaptations that fostered increased community support of the project. Other successes due, at least in part, to this RF approach include incorporation of the program into DRC's national adolescent health strategy, and rapid response to the COVID-19 pandemic in educational strategies for program beneficiaries.

An analysis of the inclusion of ear and hearing care in national health policies, strategies and plans.

Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms 'human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)', 'tuberculosis' and 'malaria' were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.

A major conditions strategy cannot replace a national cancer plan—patient advocates voice their concerns

The UK Secretary of State for Health and Social Care, Stephen Barclay, has set out plans for an alternative approach to cancer service provision based on a major conditions strategy. 1 Barclay S Major conditions and diseases announcement. Jan 24, 2023. Hansard, Commons. https://hansard.parliament.uk/Commons/2023-01-24/debates/23012433000010/MajorConditionsAndDiseasesDate accessed: February 24, 2023 Google Scholar The six areas for inclusion in the strategy are cancer, cardiovascular disease, respiratory disease, dementia, mental health, and musculoskeletal disorders. All these areas are priorities for a national health strategy but is lumping them all together an effective route to success in treating them? As patients and patient advocates, we do not consider that this approach is wise, either for people with these diseases or for the National Health Service (NHS). A holistic approach to patient care can be helpful and there are many scenarios when “integrated, whole-person care”, as promised by this new strategy, 1 Barclay S Major conditions and diseases announcement. Jan 24, 2023. Hansard, Commons. https://hansard.parliament.uk/Commons/2023-01-24/debates/23012433000010/MajorConditionsAndDiseasesDate accessed: February 24, 2023 Google Scholar is appropriate and beneficial; however, understanding comorbidities is vital to treatment outcomes and experiences and a key part of clinical decision making for individual patients, and is very different to merging diseases in a national strategy that will dilute attention to specific areas.

Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

Access to healthcare technologies in the context of sanctions and unilateral restrictive measures.

The object of the study is public relations arising from the interaction of international intergovernmental organizations, government agencies, transnational corporations and non-state actors in the framework of ensuring human access to health technologies in the context of unilateral restrictive measures and sanctions. The subject of the study is international legal norms, documents of international organizations, as well as acts of domestic law that form guarantees of ensuring the human right to the highest attainable level of health and access to healthcare technologies. The purpose of the study is to conduct a comprehensive analysis of the practical significance of the application of international legal and domestic mechanisms aimed at minimizing the humanitarian consequences of sanctions and unilateral restrictive measures and expanding access to vital health technologies. The methodology of the study is based on the general scientific method of cognition, including the formal logical and situational method and private law methods, such as comparative, historical and formal legal methods. The article presents an analysis of the importance of health technologies in achieving international goals in the field of development and human health protection, as well as priorities in the implementation of national health strategies. The theoretical aspects of access to healthcare technologies in the context of unilateral restrictive measures are consistently considered as an important element of ensuring international guarantees of human rights protection. The authors present the differences in the normative content of the concepts of "sanctions" and "unilateral restrictive measures" in accordance with international law, as well as a legal assessment of the legitimacy of their application. The article systematizes the consequences of the application of unilateral restrictive measures on the availability of healthcare technologies in various regions of the world, as well as the practice of applying the norms of international and domestic law to overcome them.

Assessment of Patient Treatment and Rehabilitation Processes Using Electromyography Signals and Selected Industry 4.0 Solutions.

Funding treatment and rehabilitation processes for patients with musculoskeletal conditions is an important part of public health insurance in European Union countries. By 2030, these processes will be planned in national health strategies (sequential process activities will be identified, care packages will be defined, service standards will be described, roles in the implementation of activities will be distinguished). Today, in many countries of the world (including the EU countries), these processes tend not to be very effective and to be expensive for both patients and insurance companies. This article aims to raise awareness of the need for process re-engineering and describes possible tools for assessing patient treatment and rehabilitation processes (using electromyographic signals-EMG and selected Industry 4.0 solutions). This article presents the research methodology prepared for the purpose of process evaluation. The use of this methodology will confirm the hypothesis that the use of EMG signals and selected Industry 4.0 solutions will improve the effectiveness and efficiency of treatment and rehabilitation processes for patients with musculoskeletal injuries.

Implementation Challenges for Danish Hospitals in Digital Transformation

Background Increased digitalization of hospitals is a goal for national and regional health strategies. Since 2019, it has been an explicit goal to increase the use of virtual consultation with hospital patients. Two years after the start of the pandemic, virtual consultation for hospital patients has increased. At Odense University Hospital (OUH), we have seen a 30% and 337% increase in the annual number of telephone and video consultations with patients, respectively. However, the annual number of video consultations is still below 1% of the total number of outpatient visits. Objective This presentation describes challenges that may explain the slow implementation of telemedicine at OUH and how these challenges are handled in practice. Methods The description is based on 12 meetings with hospital managers and staff at OUH. Analysis of the content of the meetings has been condensed into the major themes specified in the results. Results Three main challenges have been found: (1) uncertainty regarding the quality of telemedicine interventions, (2) uncertainty regarding the technical and communicative skills needed to do video consultation, and (3) misunderstandings regarding the economic consequences of telemedicine. To address the uncertainty among our staff toward the clinical quality of telemedicine, a database including randomized trials of telemedicine interventions described in the PubMed database from 2010-2022 was produced. The database shows that more than 96% of interventions results in similar or improved clinical outcomes for selected patient groups. To ensure the skills needed by the hospital staff to do video consultation, we have offered courses in the technical and communicative aspects of video consultation to interested departments. Finally, some members of our staff believe that reducing the number of physical visits may reduce the hospital budget, which is contrary to the actual financial agreements with capitation payment. To address this misunderstanding, information about the true economic consequences of implementing telemedicine has been provided. Conclusions Successful implementation of telemedicine requires more than solid evidence; it also requires initiatives focusing on the challenges among the hospital staff. Conflicts of Interest None declared.

National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas.

National strategies for addressing chronic kidney disease (CKD) are crucial to improving kidney health. We sought to describe country-level variations in non-communicable disease (NCD) strategies and CKD-specific policies across different regions and income levels worldwide. The International Society of Nephrology Global Kidney Health Atlas (GKHA) was a multinational cross-sectional survey conducted between July and October 2018. Responses from key opinion leaders in each country regarding national NCD strategies, the presence and scope of CKD-specific policies, and government recognition of CKD as a health priority were described overall and according to region and income level. 160 countries participated in the GKHA survey, comprising 97.8% of the world's population. Seventy-four (47%) countries had an established national NCD strategy, and 53 (34%) countries reported the existence of CKD-specific policies, with substantial variation across regions and income levels. Where CKD-specific policies existed, non-dialysis CKD care was variably addressed. 79 (51%) countries identified government recognition of CKD as a health priority. Low- and low-middle income countries were less likely to have strategies and policies for addressing CKD and have governments which recognise it as a health priority. The existence of CKD-specific policies, and a national NCD strategy more broadly, varied substantially across different regions around the world but was overall suboptimal, with major discrepancies between the burden of CKD in many countries and governmental recognition of CKD as a health priority. Greater recognition of CKD within national health policy is critical to improving kidney healthcare globally.

Overview of the main incremental health care reforms introduced between 2014 and 2020 in Romania

Aim: On 2014 the Government of Romania has committed to improving health and health system through the implementation of the 2014–2020 National Health Strategy: Health for Prosperity. An official evaluation of the strategy implementation is not publicly available yet. This paper aims to provide an overview of the main incremental reforms taken during this period in Romania and to analyse the results from the perspective of the main Strategy goals. Methods: Information was collected from legislative documents, statistical and scientific publications. The main implemented or initiated incremental reforms, during the assessed period, were assigned to five main clusters: ”governance”, “resources for health”, “coverage and access”, “organization of health care”, “quality of care” and were analysed in accordance with the aim, the type, the implementation stage and the corresponding objectives of the Strategy. Results: The 2014–2020 National Health Strategy has definitely not reached all its objectives, but one sign of prosperity, is that based on 2019 per capita income (of $12,630) World Bank classified Romania, for the first time, as a high-income country. The health status of the population has increased in many aspects, yet Romanians’ health has still remained among the poorest in the European Union (EU). Conclusion: Incremental reforms might be successful, but the small steps should be taken in a holistic approach, and should be tailored to specific needs. Previous strengthening health systems resilience and plans for overcoming possible risks and obstacles might ensure successful implementation. Assessments of the reforms might draw lessons that help policymakers in shaping further health policies and designing of next strategies.

Salud en cárceles del Uruguay Reflexiones y propuestas de intervención en gestión y política sanitaria

The Prison Parliamentary Office of Uruguay is the one that, according to the law, supervises and advises the adult penitentiary system. At the end of April 2022, it presented its preliminary report for the year 2021 on the situation of the prison system in our country. Although the report covers multiple thematic areas, ranging from prison administration to the role of external organizations that affect the institute, the purpose of this article is to focus on the health aspects of the report, analyze them, present some reflections, and propose where a policy of prison health care and management should be directed in the country. The report shows a prison system that does not meet the minimum level established by international standards. So far, the Ministry of Health has not yet created a specific area that directs and regulates a prison health strategy in the country. Assistance is fragmented and weak, affecting prisoners, their families and the community. A unified policy led by an area defined in the Ministry of Health, based on primary care, with the participation of all actors involved in the prison system, promoting campaigns that include prisoners as active users, in added a protect and train staff, are some of the aspects that a national health strategy in prisons should consider to guarantee universal and quality access.

Reviewing the National Health Services Quality Policies and Strategies of the Iranian Health System: A Document Analysis.

High-quality health care is an important component of efforts to reach Universal Health Coverage (UHC). Given this pivotal fact, poor quality of care is a significant bottleneck in the endeavors of Iran to UHC. This study was part of a broader qualitative study and aimed to provide supplementary data about the documents related to the National Quality Policies and Strategies (NQPS) health services in the health system of Iran to determine the degree of alignment with the World Health Organization (WHO) approach for NQPS, and to track change and development over time. This document analysis was performed following the READ approach for systematic document analysis in health policy research. Furthermore, qualitative content analysis following parallel forms of the mixed analysis in which the textual material proceeded with different inductive and deductive content-analytical procedures simultaneously, applying the WHO practical approach for NQPS, was selected. The 15 included records that met the inclusion criteria were released in the post-Islamic Revolution period. The Ministry of Health was found as the most responsible authority for publishing the NQPS among the other authorities. Furthermore, 67% of NQPS was aligned with the goals and priorities of a broader national plan or policy. Contradictions, variations, and ambiguities were also found in the literature circumstances of the NQPS. There was no NQPS concentrated on the entire pathway of care in the Iranian health system, which developed according to the WHO approach for NQPS. Qualitative analysis of the current NQPSs based on the eight inter-dependent elements and critical supplements, the technical perspective of broad stakeholders, community engagement, and steady commitment of policymakers are our recommendations for future efforts towards having NQPS.

Accessibility to dental services by immigrant and refugee children residing in Turkey.

Turkey is hosting the world's largest immigrant population under temporary and international protection. Due to the social inequalities contributing to early childhood dental caries, the effectiveness of dental care service for immigrant children should be evaluated. To evaluate the accessibility of immigrant and refugee children residing in four different regions of Turkey to oral health products and dental treatment services. A questionnaire consisting of 21 questions was administered: The first six questions elicited demographic data, and the remaining 15 questions asked about oral health habits, access to oral hygiene materials, and dental treatment services. Participants included the parents of 430 children under the age of 18, who were registered with migrant associations in the regions where they lived (Istanbul, Samsun, Hatay, or Ankara). The majority of the participants were from Syria and Iraq. Of the participants, 42.1% reported that their children's oral hygiene habits had changed negatively after they migrated, 71.9% reported that they had not been to the dentist in the last year, and 82.8% reported that they had not been to the dentist for more than 12 months. Access to oral and dental hygiene products was not difficult for 68.4%. About 62.6%, however, reported that they had difficulty accessing dental treatment. The findings showed that this disadvantaged group had difficulty accessing dental treatment. Therefore, there is a need for national and international health strategies to ensure that immigrant and refugee children have effective access to dental treatment.

Utilization of long-acting contraceptive methods and associated factors among married women in Farta Woreda, Northwest Ethiopia: a community-based mixed method study

BackgroundAlthough long-acting contraceptive methods are highly effective, safe, and provide uninterrupted protection from unintended pregnancy compared to short-acting methods, evidences suggest that majority of women were relayed on short-acting contraceptive methods. Thus, this study aimed to determine the level of long-acting contraceptive methods utilization and associated factors among married women in Farta Woreda, Northwest Ethiopia, 2021.MethodsA community-based cross-sectional study supplemented with qualitative data was performed among 556 married women from March 1 to 31, 2021. A semi-structured interviewer-administered questionnaire and interview guides were used to collect the data. The data were entered into Epi data version 4.6 and analyzed by SPSS version 23 software. The association between variables was analyzed using bivariate and multivariable binary logistic regression. The level of statistically significant association was determined at a P-value < 0.05. After translation and transcription, manual thematic analysis was applied to the qualitative data.ResultsThe magnitude of long-acting contraceptive methods among married women in Farta Woreda was found to be 14.3% [95% CI 11.5–17.6]. Previous use of long-acting contraceptive methods (AOR = 5.83, 95% CI 3.03, 11.21), positive attitude towards long-acting contraceptives (AOR = 2.74, 95% CI 1.48, 5.07), having formal education for husbands’ (AOR = 3.05, 95% CI 1.5, 6.21), and poor wealth index (AOR = 3.39, 95% CI 1.33, 8.67) were positively associated with utilization of long-acting contraceptive methods. Moreover, fear of side effects, misconceptions, and partner opposition were the most commonly identified barriers by the qualitative data.ConclusionUtilization of long-acting contraceptives among married women in Farta Woreda was low as compared to the 2020/21 national reproductive health strategy plan to increase the long-acting reversible and permanent contraceptive methods use to 50%. Previous use of long-acting contraceptives, positive attitude towards long-acting contraceptives, husband education, and household wealth index was found to be significantly associated with long-acting contraceptive utilization. Hence, it is better to work more on changing women's attitudes and increasing husband education.

Physician’s Knowledge and Skill to Complete the Certificate of Cause of Death According to who Guidelines A Survey Among the Doctors of A Tertiary Care Hospital at Lahore\

Background: The medical document certifying the cause of death provides vital data to develop health policies. In spite of very comprehensive guidelines issued by the WHO for thecompletion of death certificates; very few certificate arefound errorfree which might be due to lack of knowledge and practice on the part of physicians issuing that certificate.Purpose of this study is to assess the knowledge and competencies of a doctor in completing a death certificate. Methods: This study was cross-sectional. The population of this study was physicians of a tertiary care hospital of Lahore. A structured questionnaire along with a case scenario was given to 137 physicians having variable working experiences, performing in different clinical departments of a tertiary care hospital of Lahore.The participants were asked to complete the component of cause of death of the certificateonly. The percentage of omissions done by the doctors during the completion of said section was analyzed using the chi square test to establish the association between participant’s characteristics and their relevant responses. Results: Among 137participants working in different clinical departments of a Tertiary Care Hospital at Lahore, 89% were having less than 5 years’ experience and 11% having more than 5 years’ experience. 53% were qualified from public sector, 24% from private sector and 23% from foreign institutes. 77% doctors identified immediate cause of death incorrectly, 83 % did not identify and interpret underlying cause of death correctly; 90 % did notidentify contributory cause of death correctly. In46 % cases mechanism/mode of death was confused with the cause of death. Practical Implication: The correct completion of death certificates would provide an accurate and genuine mortality index essential for framing a national health policy. Conclusion: Physician’s knowledge and skill of completing the death certificates is very deficient and alarming which necessitate periodical and regular training of the physicians on completing the death certificates as per guidelines of the WHO to get an appropriate and valid health statistics effective for future public national health policies and strategies. Keywords (MeSH): Death certificate completion, Medical certification of cause of death, Physician’s knowledge, skill to complete death certificate, Mortality index

Factors Associated with Mortality with Tuberculosis Diagnosis in Indigenous Populations in Peru 2015-2019.

To identify factors associated with mortality in indigenous populations diagnosed with tuberculosis in Peru, 2015-2019. We conducted a nested case-control study in a retrospective cohort using the registry of indigenous peoples of the National Health Strategy for TB Prevention and Control of the Ministry of Health of Peru. A descriptive analysis was performed, and then bivariate and multivariate logistic regression was used to evaluate associations between the variables and the outcome (alive-deceased). The results are shown as OR with their respective 95% confidence intervals. The mortality rate of the total indigenous population of Peru was 1.75 deaths per 100,000 indigenous people diagnosed with TB. The community of Kukama Kukamiria-Yagua reported 505 (28.48%) individuals, followed by the Shipibo-Konibo community with 385. The final logistic model showed that indigenous males (OR = 1.93; 95% CI: 1.001-3.7) with a history of HIV prior to TB (OR = 16.7; 95% CI: 4.7-58.7), and indigenous people in old age (OR = 2.95; 95% CI: 1.5-5.7) were factors associated with a greater chance of dying from TB. It is important to reorient health services among indigenous populations, especially those related to improving a timely diagnosis and early treatment of TB/HIV co-infection, to ensure comprehensive care for this population considering that they are vulnerable groups.

Work-related injuries in Qatar for 1 year: an initial report from the work-related injury unified registry for Qatar.

The Ministry of Public Health National Health Strategy 2018-2022 has recognized the need for accurate, updated, and representative data that truly reflects the occupational health and safety status in Qatar. In 2015, the Hamad Trauma Center received a research grant to create a unified registry for work-related injuries in Qatar [WURQ], whose processes and research findings have been reported earlier. This paper shall describe the findings from the initial 1-year collection of data on work-related injuries [WRIs] and deaths in Qatar for the year 2020 through the WURQ database. The WURQ database was queried for all WRIs from January 1 to December 31, 2020. These data were classified by date of injury, age, sex, nationality, mechanism of injury, severity of injury, location of medical consultation, and clinical outcome. Out of a total worker population of 2,174,828 [2.29 occupational fatalities per 100,000 workers, there were 50 deaths caused by WRIs]. The majority of WRI deaths were in the prehospital setting [60%] with the majority of fatal injuries occurring at the worksite [64%] and 22% due to falls. Five hundred six workers sustained severe WRIs [23.26 severe occupational injuries per 100,000 workers], and 37,601 workers sustained mild to moderate WRIs [1,728.91 mild to moderate occupational injuries per 100,000 workers]. The severe WRIs were most commonly due to falls [226 out of 506] from height [45%] and falling heavy objects [80 out of 506] [16%]. Road traffic injuries [RTI] make up one-fourth [133 out of 506] of all severe WRIs. WURQ has described WRIs in Qatar using a purpose-built and nationally linked occupational injury registry. Occupational injury and injury fatality statistics, for Qatar in 2020, are lower than or comparable with those from other high-income countries. This data can be used to inform worksite inspections, investigations, worker safety education, environmental improvements, and injury prevention programs to make Qatar safer for all its workers.

Optimizing spinal cord injury care in Canada: Development of a framework for strategy and action.

National health strategies are integral in defining the vision and strategic direction for ensuring the health of a population or for a specific health area. To facilitate a national coordinated approach in spinal cord injury (SCI) research and care in Canada, Praxis Spinal Cord Institute, with support from national experts and funding from the Government of Canada, developed a national strategy to advance SCI care, health, and wellness based on previous SCI strategic documents. This paper describes the development process of the SCI Care for Canada: A Framework for Strategy and Action. Specifically, it covers the process of building on historical and existing work of SCI in Canada through a thorough review of literature to inform community consultations and co-creation design. Furthermore, this paper describes planning for communication, dissemination, and evaluation. The SCI Care Strategic Framework promotes an updated common understanding of the goals and vision of the SCI community, as well as strengths and priorities within the SCI system regarding care, health, and wellness. Additionally, it supports the coordination and scaling up of SCI advancements to make a sustainable impact nationwide focusing on the needs of people living with SCI.

Helping Women Suffering from Drug Addiction: Needs, Barriers, and Challenges.

Statistical data on the use of various psychoactive substances indicate a narrowing of previous differences in substance use between men and women. Data from studies conducted among women suffering from drug addiction are increasingly published, with the authors highlighting the specific needs of this group and the difficulties that women with addiction problems encounter. The current study aimed to identify the barriers and needs of this audience, both when seeking help and during treatment. The method used in the study was secondary content analysis. To identify publications describing the barriers and needs of women suffering from drug addiction, we searched the PubMed database to find publications that met the adopted research objective. We set the data search period to the last ten years to examine the timeliness of the issue under study. The search yielded 199 research reports. Twenty-three articles describing 21 studies were included in the final analysis. The selected publications dealt with the difficulties and challenges faced by women with addiction problems. Barriers to accessing treatment for this group, the needs, and the challenges of helping women suffering from addiction were identified. Results showed that the barriers are mainly stigma but also deficits in the therapeutic offerings for this group. The primary need was identified as the introduction of appropriate drug policies, and the challenges, unfortunately, are the still-reported gender inequalities. To improve the situation of women, regular attention to these issues and the need to include them in national health strategies is essential.

Together for better health in Germany. Towards a public health strategy

Abstract In Germany, the responsibility for public health is divided both between federal levels and between sectors, and there is no national or general strategy for public health. However, a strategy is essential for achieving the overarching goal of ensuring the best possible health for all people, including preventing and addressing significant health challenges such as pandemics and climate change. In 2016, Zukunftsforum Public Health (Future Forum Public Health) was established with the primary goal to enhance coherence and collaboration between public health stakeholders from academia, policy and practice. According to the principle of health in all policies, it also aims to promote collaboration across federal levels and political sectors. Within the platform provided by Future Forum, the public health community agreed that a strategy was necessary for strengthening and uniting the disparate field of German public health even though no official mandate for developing a strategy existed. Thus, Future Forum launched a grassroots process to identify key elements for a strong and resilient public health system, based on the essential public health operations (EPHOs), as defined by WHO Europe. For each of the ten EPHOs, the key issues paper “Towards a Public Health Strategy - Together for Better Health in Germany” presents a description of the current situation and challenges, an introduction to the key players, a definition of the aims and objectives, and concrete proposals on how to achieve these. Through its participative nature, the process of developing the key issues itself was an important factor for strengthening the public health community. This process highlights that even where national public health strategies and structures are missing, grassroots public health movements can be effective in strengthening the public health community as well as producing a visible set of recommendations for a resilient public health system. Key messages • Based on WHO’s essential public health operations, Future Forum Public Health developed a key issues paper with guidelines for a resilient public health system. • The participative process leading to the key issues paper was itself an important factor for networking and strengthening Germany’s public health community.