Public Health Functions Research Articles

Perceptions of Primary Care Providers on Public Health Services in Primary Care in Oman: A Qualitative Study.

Background The integration of public health functions in primary care is not well-defined in the literature. This paper examines the perceptions of healthcare workers on public health services in primary care, as well as the challenges and views on strengthening the integration of public health functions in a primary care setting in Oman. Methodology This qualitative study (employing a face-to-face interview) was conducted in a primary healthcare setting in Muscat from January 1, 2022, to May 31, 2022. This study is based on interpretative phenomenological analysis using purposeful sampling. Participants were interviewed to answer the study questions. The targeted participants included directors and other official personnel, physicians, nurses, pharmacists, nutritionists, health educators, and lab technicians. Verbal consent was obtained from the participants before the interview, and all responses were anonymously audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results A total of 10 primary care providers were interviewed once for 30 minutes over a two-week period. All participants were females apart from one male participant. The study included three physicians, five nurses, one pharmacist, and one nutritionist. All participants had over 10 years of experience as primary care providers at the time of the interview. The main themes were a lack of awareness of public health services in a primary care setting, challenges to practicing public health in a primary care setting, and recommendations to strengthen the integration of public health services in primary care. In general, there were inconsistent views on public health services in a primary care setting, and the interactions between the functions were not clear. Participants reported an absence of clear guidelines, training, and competencies for public health in a primary care setting. Building public health capacities and reforming the health system were highly recommended to integrate public health into primary health care. Conclusions Understanding how public health and primary care interact is crucial to improve population health. Building competencies and supportive health systems are required for the effective integration of public health in primary care settings.

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.

Promise and peril: how health system reforms impacted public health in three Canadian provinces

ObjectivesSeveral Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations.MethodsA multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes.ResultsThree major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising “value for money” and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce.ConclusionOur study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms.

Mapping obesity and diabetes' representation on Twitter: the case of Italy.

One of the main functions of public health is to monitor population health to identify health problems and priorities. Social media is increasingly being used to promote it. This study aims to investigate the field of diabetes and obesity and related tweets in the context of health and disease. The database extracted using academic APIs (Application Programming Interfaces) allowed the study to be run with content analysis and sentiment analysis techniques. These two analysis techniques are some of the tools of choice for the intended objectives. Content analysis facilitated the representation of a concept and a connection between two or more concepts, such as diabetes and obesity, on a purely text-based social platform such as Twitter. Sentiment analysis therefore allowed us to explore the emotional aspect related to the collected data related to the representation of such concepts. The results show a variety of representations connected to the two concepts and their correlations. From them it was possible to produce some clusters of elementary contexts and structure narrative and representational dimensions of the investigated concepts. The use of sentiment analysis and content analysis and cluster output to represent complex contexts such as diabetes and obesity for a social media community could increase knowledge of how virtual platforms impact fragile categories, facilitating concrete spillovers into public health strategies.

Modeling temporal and spatial variations of biogeochemical processes in a large subtropical lake: Assessing alternative solutions to algal blooms in Lake Okeechobee, Florida

Study region:Algal blooms (ABs), often exacerbated by excess nutrients from anthropogenic activities, can pose serious risks to public health, fisheries, and ecosystem structure and functions. Lake Okeechobee is located in southcentral Florida (USA), and with a surface area of 1730 km2, it is the largest subtropical lake in the United States. This lake is shallow, nutrient-rich, and subject to frequent and intense blooms of cyanobacteria, some of which are toxic. Study focus:In this study, a three-dimensional (3D) model was developed, coupling long-term monitoring data with complex physical, chemical, and ecological processes at fine spatial (15–1000 m horizontal mesh size) and temporal (1 h) resolution. We used this model to understand the influence of environmental factors and nutrient management on ABs dynamics in Lake Okeechobee. New Hydrological Insights for the Region:The model showed that ABs mostly developed in shallow nearshore regions near canal outlets, and then spread over the lake as a result of prevailing winds and currents. Hypothetical scenario modeling showed that reducing both nitrogen and phosphorus inputs by 50%–75% would be more effective at reducing ABs in the lake than targeting a single nutrient. The model could be used as a tool to assess the effectiveness of different nutrient management strategies in Lake Okeechobee and its watershed, while the framework could be adopted to other large water bodies facing similar issues.

No time for complacency on COVID-19 in Europe

No time for complacency on COVID-19 in Europe

A synthesis of concepts of resilience to inform operationalization of health systems resilience in recovery from disruptive public health events including COVID-19.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict' Health systems resilience has become a ubiquitous concept as countries respond to and recover from crises such as the COVID-19 pandemic, war and conflict, natural disasters, and economic stressors inter alia. However, the operational scope and definition of health systems resilience to inform health systems recovery and the building back better agenda have not been elaborated in the literature and discourse to date. When widely used terms and their operational definitions appear nebulous or are not consistently used, it can perpetuate misalignment between stakeholders and investments. This can hinder progress in integrated approaches such as strengthening primary health care (PHC) and the essential public health functions (EPHFs) in health and allied sectors as well as hinder progress toward key global objectives such as recovering and sustaining progress toward universal health coverage (UHC), health security, healthier populations, and the Sustainable Development Goals (SDGs). This paper represents a conceptual synthesis based on 45 documents drawn from peer-reviewed papers and gray literature sources and supplemented by unpublished data drawn from the extensive operational experience of the co-authors in the application of health systems resilience at country level. The results present a synthesis of global understanding of the concept of resilience in the context of health systems. We report on different aspects of health systems resilience and conclude by proposing a clear operational definition of health systems resilience that can be readily applied by different stakeholders to inform current global recovery and beyond.

The subjective perception of the happiness of older adult residents in Colombia.

Happiness is understood as the perception of subjective well-being, it can be a quality, a result, or a state characterized by well-being or satisfaction that every person wants to achieve. In older adults, this satisfaction is a sum of lifelong achievements and triumphs; However, some factors influence this ideal. Analyze demographic, family, social, personal, and health factors associated with the subjective perception of happiness in older adults, using data from a study conducted in five cities in Colombia, in order to make a theoretical contribution in the search for improvement of their physical, mental and social health. A quantitative, cross-sectional, analytical study was carried out, using primary source information, obtained with 2,506 surveys from voluntary participants aged 60 and over, who had no cognitive impairment, and who reside in urban areas but not in long-term centers. The variable happiness (classified as high or moderate/low) was used for: (1) A univariate explorative characterization of older adult, (2) a bivariate estimation of the relationships with the factors studied, and (3) a multivariate construction of profiles through multiple correspondences. 67.2% reported high happiness levels, with differences by city: Bucaramanga (81.6%), Pereira (74.7%), Santa Marta (67.4), Medellín (64%), and Pereira (48.7%). Happiness was explained by the absence of risk of depression and little hopelessness, strengthened psychological well-being, a perception of high quality of life, and living in a functional family. This study provided an overview of possible factors that can be enhanced and strengthened with public policies (structural determinant), community empowerment, family strengthening (intermediate determinant), and educational programs (proximal determinant). These aspects are included in the essential functions of public health, in favor of mental and social health in older adults.

Creating a Health Emergency and Disaster Risk Management (EDRM) Learning Community

Introduction:Disaster research is primarily posthoc analysis, locally focused or within response organizations, overlooking the wellness and safety of first and second responders or the broad multi- and interdisciplinary activities necessary to foster and sustain recovery. A broad framework to span locality, institutional, and professional boundaries supports the development of a true learning community–a health EDRM sector that supports society in recognizing lessons, refining findings, and free and fluid global sharing.Method:Several organizations joined to create a robust disaster health learning community: CREDO, GloHSA, ICDM, and ECDM, a multi-national, multi-disciplinary collaborative network of patients, universities, societies, regulators, publishing, healthcare, and technology partners designed to foster expert level education and training with shared educational design concepts, milestones, and core curricula that embrace the strength of a standardized base upon which to link unique pillars of excellence of separate functions, institutions, nations, and regions.Results:The Emergency Disaster Global Health Sciences (EDGHS) model developed by University of Texas Southwestern Medical Center is interactive, open, and responsive. EDGHS addresses critical gaps in applied research by convening leaders across the healthcare and public health continuum to map the way forward, designing and implementing high-quality, evidence-based practical and policy research.This defines essential public health functions for national contexts, including a focus on emergency preparedness and response, strengthening competency-based education on essential public health functions, and mapping and measurement of occupations delivering EDRM functions, offering an exportable model of global relevance.Conclusion:Putting disaster prevention into recovery processes is a strategic opportunity to improve the well-being of future generations. The survivability and well-being needs of present and future generations are contingent on knowledge-based, lived experiences of recoverable disaster loss and damage, and the capacity to thrive sustainably. This presentation serves as an invitation to join the growing momentum of creating a learning health EDRM community.

Strenthening public health functions in azerbaijan through community oriented primary care training

Strenthening public health functions in azerbaijan through community oriented primary care training

The role of the university in recovering from COVID-19 and preparing for future crises-perspectives and experiences from Sunway University, Malaysia.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Universities, as engines of knowledge creation and dissemination and as incubators of disciplined yet original thinking, have a key role to play in tackling the most complex challenges that societies and our planet face, from infectious diseases to the climate emergency. This commentary presents the perspectives from Sunway University, a young private university in Malaysia that made a strong commitment to the sustainable development goals (SDGs) prior to the pandemic, and its experiences in promoting research, innovation, and learning as part of COVID-19 recovery and in preparation for future crises such as the climate emergency. Some of the university's initiatives include embracing the planetary health approach, reviving essential public health functions, exploring pandemic resilience, addressing 'infodemics' and promoting science diplomacy. The example of Sunway University provides some insights on the opportunities and challenges that academic institutions face as they seek to reorient the paradigm of education, research, and service away from disciplinary siloes and towards a more integrated, preventive, accessible and translational approach.

Health Sciences students’ experience of COVID-19 case management and contact tracing in Cape Town, South Africa

BackgroundCOVID-19 has challenged health and higher education systems globally. Managing the epidemic in Cape Town, South Africa (SA), required partnerships with universities and setting up of de novo systems for mass case and contact tracing (C&CT). Health sciences, predominantly medical students, as well as social work and psychology students formed the core of this telephone-based work over the 18 months when SARS-CoV-2 caused severe disease.MethodsThis qualitative study aimed to elicit students’ motivations for becoming involved in C&CT, their experiences, and recommendations for C&CT and curricula. After Cape Town’s first COVID-19 wave, six on-line focus groups comprising 23 students were conducted, and a further four were conducted with 13 students after the second wave. As the researchers were predominantly educators previously involved in undergraduate health sciences education, the study’s purpose was to reflect on students’ experiences to make educational and health system recommendations.ResultsStudents were largely motivated to mitigate the impact of the epidemic on society and support people affected by COVID-19, as well as hone their professional skills. While these motivations were realised, students also needed to learn new skills – to autonomously work remotely, using novel communication strategies to engage those affected and use virtual groups to connect with colleagues. They managed responsibilities within the healthcare systems that did not always work smoothly, distressed cases who were financially insecure, difficult employers, and language barriers. They were prepared through training, and supported by virtual, yet effective teamwork and debriefing opportunities. Although the work was sometimes physically and emotionally exhausting, students found the work personally meaningful. They embraced public health’s role to protect population and individuals’ health.ConclusionNew teaching and learning practices adopted due to Covid-19 lockdowns enabled this digital C&CT project. It facilitated students to become confident, work autonomously and navigate challenges they will encounter as young professionals. The programme demonstrated that novel opportunities for rich student learning, such as in telehealth, can be embedded into public health and clinical functions of health services in contexts such as in SA, deepening partnerships between the health services and universities, to mutual benefit.

Developing technical support and strategic dialogue at the country level to achieve Primary Health Care-based health systems beyond the COVID-19 era.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Pursuing the objectives of the Declaration of Alma-Ata for Primary Health Care (PHC), the World Health Organization (WHO) and global health partners are supporting national authorities to improve governance to build resilient and integrated health systems, including recovery from public health stressors, through the long-term deployment of WHO country senior health policy advisers under the Universal Health Coverage Partnership (UHC Partnership). For over a decade, the UHC Partnership has progressively reinforced, via a flexible and bottom-up approach, the WHO's strategic and technical leadership on Universal Health Coverage, with more than 130 health policy advisers deployed in WHO Country and Regional Offices. This workforce has been described as a crucial asset by WHO Regional and Country Offices in the integration of health systems to enhance their resilience, enabling the WHO offices to strengthen their support of PHC and Universal Health Coverage to Ministries of Health and other national authorities as well as global health partners. Health policy advisers aim to build the technical capacities of national authorities, in order to lead health policy cycles and generate political commitment, evidence, and dialogue for policy-making processes, while creating synergies and harmonization between stakeholders. The policy dialogue at the country level has been instrumental in ensuring a whole-of-society and whole-of-government approach, beyond the health sector, through community engagement and multisectoral actions. Relying on the lessons learned during the 2014-2016 Ebola outbreak in West Africa and in fragile, conflict-affected, and vulnerable settings, health policy advisers played a key role during the COVID-19 pandemic to support countries in health systems response and early recovery. They brought together technical resources to contribute to the COVID-19 response and to ensure the continuity of essential health services, through a PHC approach in health emergencies. This policy and practice review, including from the following country experiences: Colombia, Islamic Republic of Iran, Lao PDR, South Sudan, Timor-Leste, and Ukraine, provides operational and inner perspectives on strategic and technical leadership provided by WHO to assist Member States in strengthening PHC and essential public health functions for resilient health systems. It aims to demonstrate and advise lessons and good practices for other countries in strengthening their health systems.

Syndemic health crises-The growing role of National Public Health Institutes in shaping a coordinated response.

Countries across the world are experiencing syndemic health crises where infectious pathogens including COVID-19 interact with epidemics of communicable and non-communicable diseases. Combined with war, environmental instability and the effects of soaring inflation, a public health crisis has emerged requiring an integrated response. Increasingly, national public health institutes (NPHIs) are at the forefront of leading this, as demonstrated at the 2022 Annual Meeting of the International Association of National Public Health Institutes (IANPHI). These effects are particularly evident where conflict is exacerbating health crises in Ukraine and Somalia. In Ukraine, medical and public health workers have been killed and infrastructure destroyed, which require major efforts to rebuild to international standards. In Somalia, these crises are magnified by the effects of climate change, leading to greater food insecurity, heat-related deaths and famine. National public health institutes are crucial in these contexts and many others to support integrated political responses where health challenges span local, national and international levels and involve multiple stakeholders. This can be seen in strengthening of Integrated Disease Surveillance and work towards the Sustainable Development Goals. National public health institutes also provide integration through the international system, working jointly to build national capacities to deliver essential public health functions. In this context, the 2022 IANPHI Annual meeting agreed the Stockholm Statement, highlighting the role that NPHIs play in tackling the causes and effects of interconnected global and local challenges to public health. This represents an important step in addressing complex health crises and syndemics which require whole-of-society responses, with NPHIs uniquely placed to work across sectors and provide system leadership in response.

Mapping public health training in Latin America: perspectives for training institutionsMapeamento da formação em saúde pública na América Latina: perspectivas para as instituições formadoras

Map the public health training courses and programs offered in Latin America, and identify regional training strategies and competencies developed in health workers. An internet search was conducted to identify public health training courses and programs offered by Latin American institutions. The following data were collected: name, country, and province/state of the training institution; course name; type of institution; educational level; modality; accreditation; year first offered; periodicity; and contact information. The programs and curricula on offer were analyzed by training level using descriptive content analysis, and the main competencies developed were identified. The mapping identified 2 296 public health training opportunities in all Latin American subregions, distributed across 29 of the Region's 33 countries; these were fairly heterogeneous, both conceptually and programmatically, with uneven geographical distribution within and between countries. In the analysis of curricula and programmatic contents, a need for greater linkage with essential public health functions was detected. It is necessary to adapt the competencies and skills developed by the courses and programs to the demands of users of the regional health services, programs, and systems in order to achieve programs aimed at tackling the socio-environmental determinants of health and the production and reproduction of inequalities.

Toward Public Health Resilience in the Eastern Mediterranean Region: Findings From the Seventh Eastern Mediterranean Public Health Network Regional Conference.

The resilience of public health in the Eastern Mediterranean Region (EMR) varies from country to country, mostly based on the governmental and financial situation of the countries. With the theme of Towards Public Health Resilience in the EMR: Breaking Barriers, the seventh Eastern Mediterranean Public Health Network regional conference, held from November 14 to 18, 2021, was dedicated to exploring ways for achieving public health resilience. A total of 101 oral presentations and 13 poster presentations were presented on various public health topics. The conference included 6 keynote sessions, 10 roundtable sessions, and 5 preconference workshops. The preconference workshops were conducted on border health; the mobilization of Field Epidemiology Training Program (FETP) residents and graduates and rapid responders in EMR countries; continuous professional development for the public health workforce; brucellosis surveillance using the "One Health" approach; and strategies to integrate and use noncommunicable diseases data sources. The roundtable sessions included discussions on the following topics: the role of FETPs in responding to COVID-19, institutionalization of rapid response to public health emergencies, health systems resilience, integration of early warning and response with event-based and indicator-based surveillance, sustaining international health regulations, strengthening the "One Health" approach, the anticipated future of public health in the post COVID-19 era, supporting public health research capacity in a diverse region, and COVID-19 vaccines and routine immunization synergies and drawbacks. The keynote speaker sessions covered topics on essential public health functions and the universal health coverage challenge in the EMR, lessons from the US COVID-19 public health response, learning from COVID-19, reshaping public health after the pandemic era, COVID-19 resilient primary health care, and the cohesion of society during and after a pandemic. The conference sessions provided highly promising opportunities to explore ways to achieve such goals in the EMR and shed light on the latest scientific findings, important lessons learned, and discussions on the ways in which current barriers can be broken down through coordination and collaboration.

Global public health policies: gathering public health associations’ perspectives

ABSTRACT Background Advocacy is one of the core functions of public health and is a key tool for achieving Sustainable Development Goals. Public health associations play a key role in advocating for the development and implementation of strategies to prevent diseases and promote health and well-being. Objective This study aims to map out the focus of public health advocacy carried out by selected national public health associations over 4 years, between 2018 and 2021, in order to identify gaps and strengths and support associations and professionals in their advocacy efforts. Methods Twelve national public health associations participated in the study. Official policy documents produced between 2018 and 2021 were collected and analysed. The title and summary of the policy documents were examined line by line and coded into the main subject categories and themes. A qualitative thematic analysis was conducted. Policies were assessed from global and regional perspectives. Results A total of 220 policy documents were analysed. Overall, the largest number of policy documents came from high-income countries and dealt with environmental health and communicable diseases, including COVID-19, with, however, important differences among regions. In the African region, public health advocacy focused mainly on strengthening health systems; Europe and South America were mostly concerned with communicable diseases and pandemic management; and North America and the Western Pacific regions focused primarily on climate change. Limited attention was paid to international health and health as a human right in all regions. Conclusion Our study showed that, especially in high-income countries, public health associations actively engage in advocacy; however, more effort needs to be devoted to implementing a more international and intersectoral approach at the global level, anchored in health as a human right and aligned with the Sustainable Development Goals.

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19

BackgroundIn 2016, the Government of the southern Indian state of Kerala launched the Aardram mission, a set of reforms in the state’s health sector with the support of Local Self Governments (LSG). Primary Health Centres (PHCs) were slated for transformation into Family Health Centres (FHCs), with extended hours of operation as well as improved quality and range of services. With the COVID-19 pandemic emerging soon after their introduction, we studied the outcomes of the transformation from PHC to FHC and how they related to primary healthcare service delivery during COVID-19.MethodsA qualitative study was conducted using In-depth interviews with 80 health system actors (male n = 32, female n = 48) aged between 30–63 years in eight primary care facilities of four districts in Kerala from July to October 2021. Participants included LSG members, medical and public health staff, as well as community leaders. Questions about the need for primary healthcare reforms, their implementation, challenges, achievements, and the impact of COVID-19 on service delivery were asked. Written informed consent was obtained and interview transcripts – transliterated into English—were thematically analysed by a team of four researchers using ATLAS.ti 9 software.ResultsLSG members and health staff felt that the PHC was an institution that guarantees preventive, promotive, and curative care to the poorest section of society and can help in reducing the high cost of care. Post-transformation to FHCs, improved timings, additional human resources, new services, fully functioning laboratories, and well stocked pharmacies were observed and linked to improved service utilization and reduced cost of care. Challenges of geographical access remained, along with concerns about the lack of attention to public health functions, and sustainability in low-revenue LSGs. COVID-19 pandemic restrictions disrupted promotive services, awareness sessions and outreach activities; newly introduced services were stopped, and outpatient numbers were reduced drastically. Essential health delivery and COVID-19 management increased the workload of health workers and LSG members, as the emphasis was placed on managing the COVID-19 pandemic and delivering essential health services.ConclusionMost of the health system actors expressed their belief in and commitment to primary health care reforms and noted positive impacts on the clinical side with remaining challenges of access, outreach, and sustainability. COVID-19 reduced service coverage and utilisation, but motivated greater efforts on the part of both health workers and community representatives. Primary health care is a shared priority now, with a need for greater focus on systems strengthening, collaboration, and primary prevention.

Assessment of laboratory capacity in conflict-affected low-resource settings using two World Health Organization laboratory assessment tools.

Laboratory diagnostic services are essential to drive evidence-based treatment decisions, manage outbreaks, and provide population-level data. Many low- and middle-income countries (LMICs) lack sufficient diagnostic capacity, often further exacerbated in conflict-affected areas. This project assessed laboratory services in conflict-affected LMICs to understand gaps and opportunities for improving laboratory capacity. The World Health Organization Laboratory Assessment Tool Facility Questionnaire (WHO Laboratory Tool) and Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklist were used to assess five laboratories in Eastern Democratic Republic of the Congo (DRC) and five in Gaza, Palestine. Total scores and percentage outcomes by indicator were calculated. Average WHO Laboratory Tool score across all facilities was 41% (range 32-50%) in DRC and 78% (range 72-84%) in Gaza. Lowest scoring indicators in DRC were Biorisk management (13%, range 8-21%), Documentation (14%, range 6-21%), and in Gaza, were Facilities (59%, range 46-75%) and Documentation (60%, range 44-76%). Highest scoring indicators in DRC were Facilities (70%, range 45-83%) and Data and Information Management (61%, range 38-80%), and in Gaza were Data Information and Management (96%) and Public Health Function (91%, range 88-94%). In DRC, no laboratory achieved a SLIPTA star rating. In Gaza, two laboratories had a 3-star SLIPTA rating, one had a 2-star rating and two had a 1-star rating. Laboratory systems in conflict-affected LMICs have significant gaps. Implementating improvement strategies in such settings may be especially challenging.