Capacity Of Public Health System Research Articles

Assessing and implementing a test, trace, isolate and face mask-wearing programme to reduce SARS-CoV-2 transmission in Queretaro, Mexico: a mathematical modelling approach

Abstract Non-pharmacological interventions stood as the only severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) morbidity and mortality mitigation tools before vaccines were made available. Some, such as strict “stay-at-home” strategies, posed significant adherence, compliance and sustainability challenges because of social, economic, and psychological factors. Following relaxation of strict social distancing measures, Test, trace and isolate (TTI) strategies sought to mitigate viral spread via self-isolation and quarantine through early detection of infectious people. Mathematical modelling can contribute insight into emergency responses by examining possible scenarios and their impact on morbidity, mortality and public health system capacity. This paper describes the use of mathematical modelling to assess the impact of a test, trace, isolate and face mask-wearing programme to reduce SARS-CoV-2 transmission in Queretaro. This model was developed by Oxford University and implemented during the COVID-19 emergency to inform the Health Security Committee in Queretaro. Describing the implementation of mathematical modelling in the field may be valuable to strengthen preparedness and response plans for other potential future pandemics.

Implementation of a paraprofessional role across the public health sector in Manitoba: Impacts on system capacity.

Manitoba experiences sexually transmitted and blood-borne infection (STBBI) incidence rates above the national average and fundamental public health sector responses face human resource constraints. Manitoba implemented a paraprofessional role, the Communicable Disease Technician (CD Tech), to complete low-complexity STBBI investigations and support STBBI testing, care engagement initiatives, provider reporting, harm reduction supply distribution, and community engagement. Secondary roles included tuberculosis directly observed treatment (DOT) and virtual DOT, and flu and COVID immunization support. Twenty CD Tech positions were allocated to regional public health teams along with additional Public Health Nurse (PHN) positions to support the role. Mixed methods were used to evaluate the impact on public health system capacity. Follow-up of chlamydia and gonorrhea case investigations increased from 35% to 98%. Volume of contacts followed by public health increased for chlamydia (114%), gonorrhea (33%), and HIV (68%). Health care provider reporting for cases of STBBI and treatment more than doubled (116%). No significant differences in case investigation data quality were found between CD Techs and PHNs. Qualitative interviews by public health staff (n = 24) found CD Techs highly flexible and competent team members who can fill gaps and expand capacity in direct client service, outreach, administration, data entry, or community/partner engagement. Mentorship, ongoing supervision, role clarity, training, and clear practice standards are required to optimize the role. There is potential to expand this innovation and build surge capacity in other areas of public health practice, and other public health jurisdictions.

The influence of crisis on policy formulation: the case of alcohol regulation in South Africa during COVID-19 (2020-21).

This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.

An analysis of COVID-19 vaccination campaign in Ukraine.

The Coronavirus disease (COVID-19) pandemic is still an important problem of concern in Ukraine. The rapid deployment of the vaccination program is a key event for the formation of herd immunity and helps to prevent negative outcomes, overloading the public health system. The object of the retrospective-archival study was a depersonalized database of open panels on the management of the COVID-19 situation from the Ministry of Health of Ukraine. The total number of COVID-19 cases in Ukraine as of 25 December 2022 amounted to 5 314 388 individuals (12.83% of the population), and COVID-19-related deaths reached 110 029 individuals (0.26% of the population). The overall number of COVID-19 vaccinated persons in Ukraine as of 16 January 2022, with one dose was 36 198 per 100 000 persons (36% of the population), and with two doses, it was 34 703 per 100 000 persons (35% of the population). It was shown a decrease in the number of COVID-19 vaccinated persons among men and persons over the age of 70. In the dynamics of COVID-19 vaccination with one and two doses, an increase in the number of persons vaccinated with Pfizer/BioNTech and CoronaVac was noted. Despite the significant increase in the morbidity and mortality rates of COVID-19, the coverage of vaccination among the population remained insufficient in Ukraine. The effective COVID-19 vaccination strategy should include appropriate management and ensuring the public health system capacity, implementation of information technologies to address logistics issues, and clear communication strategies to maintain public trust.

Current status of public health system in Guangdong-Hong Kong-Macao Greater Bay Area and improvement suggestion

Guangdong-Hong Kong-Macao Greater Bay Area (GBA) has three public health systems under different systems, which plays an important role in the construction of the public health system in China. Further strengthening the construction of the public health system in the GBA will play an important reference role in the optimization and upgrade of China's public health system in the future. Based on the key consulting project of "research on the strategy of the modern public health system and capacity building in China" by Chinese Academy of Engineering, this paper deeply analyzes the current status and existing problems of public health system construction in GBA and suggests to improve and innovate the mechanisms of collaborative prevention and control of public health risks, resource coordination and joint research and result sharing, information sharing and exchange, personnel training and team building in order to comprehensively improve the capacity of public health system in GBA, and promote the construction of Healthy China.

The historic failure of the EU and nationalism in the Covid 19 pandemic

Analysis of per capita death rate figures from officially recorded deaths and credible estimates of excess deaths until late 2021 shows that almost all countries in the European Union (EU) performed poorly during the first two years of the Covid 19 pandemic. This historic failure is linked to previous processes of disintegration, including the impact of prolonged austerity policies on the capacity of public health systems. Forms of nationalism that have obstructed European cooperation during the pandemic are examined, together with low levels of public satisfaction with the EU’s response in core countries. A deeper cause of the EU’s pandemic failure was its inability to achieve significant institutional renewal. One consequence of this failure has been to reveal the EU’s weak normative power and declining global influence, shown by its inability to supply Covid vaccines to associated countries, and by its reluctance to lead a prompt, effective global vaccination effort.

Training the MCH workforce: the Time for Change is now

IntroductionMaternal and child health (MCH) services are critical for vulnerable populations. Workforce shortages, poor retention, and gaps in necessary trainings impede the capacity of public health systems to address needs. This manuscript characterizes the current MCH workforce, MCH program applicants and graduates, and describe findings within a national context to devise elements of a recruitment and retention strategy.MethodsData were obtained for public health program applicants, first-destination employment outcomes, and worker perceptions and demographics. Data were stratified according to the MCH and total public health workforce and by local, state, and national totals. Data were characterized by degree type, discipline, demographics, and employment outcomes.ResultsMCH staff constitute 11% of the state and local governmental public health workforce. MCH staff are approximately as diverse, have higher educational attainment, and are more likely to hold nursing degrees than the rest of the public health workforce. Yet, just 14% of MCH staff hold any type of public health degree. The MCH pipeline from academia appears modestly sized, with approximately 5% of applicants between 2017 and 2021 applying to a MCH master’s degree.DiscussionThe MCH workforce has a lower proportion of formal training or degrees in public health, though trends seem to indicate improvements. However, it is critical that a multi-faceted recruitment and retention strategy be coordinated by a broad range of stakeholders. These efforts will serve to improve the capability and capacity of the public health system to address critical needs of increasingly diverse MCH populations.SignificanceIn order to modernize and reimagine the academic-public health pipeline, it is critical to better understand how many applicants and graduates exist within Maternal and Child Health programs across the US, and their characteristics. This manuscript connects that information with the most recently available public health workforce information on demographics, workplace perceptions, and intent to leave among staff at state and local health departments. Data presented in this paper allow the most comprehensive characterization of the MCH academia->practice pipeline to-date, identifies a fundamental disconnect in those career pathways, and offers options to repair that break.

Development and applications of digital public health

Rapidly upgraded digital technology has impacted all walks of life, and public health field is also undergoing a digital transformation. The COVID-19 pandemic has accelerated the wide use of digital technology in the prevention and control of infectious diseases, greatly enhancing the capacity of public health system in emergency response and routine disease prevention and control. This article summarizes the definition of digital public health, applications of digital technology in the prevention and control of infectious diseases and chronic non-communicable diseases, as well as in public health surveillance, discusses the challenges in the development of digital public health and introduces the eight principles for digital transformation of public health proposed by the Pan American Health Organization.

Identifying Value-Added Population Health Capabilities to Strengthen Public Health Infrastructure.

While the novel coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in public health delivery systems. Information about the relative value in the implementation of recommended population health capabilities can help communities prioritize their use of limited time and resources and identify the most effective pathways for building a stronger public health system. We used a longitudinal cohort design with data from the National Longitudinal Survey of Public Health Systems to examine longitudinal and geographic trends in the delivery of population health capabilities and their impact on system strength across communities in the United States. We used linear probability models to ascertain whether the delivery of certain capabilities added value to public health system strength. Those communities with the strongest classification of public health system structure in both urban and rural areas implemented the largest set of population health capabilities. Results from the linear probability model indicate that a set of population health capabilities are associated with increased public health system strength. Key activities include allocating resources based on a community health plan, surveying the community for behavioral risk factors, analyzing the data on preventive services use, and engaging community stakeholders in health improvement planning (p < 0.01). The results of this study suggest that public health systems can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities may help communities increase their public health system's capacity and improve health outcomes.

Epidemic Exposure Tracking With Wearables: A Machine Learning Approach to Contact Tracing

The recent pandemic revealed weaknesses in several areas, including the limited capacity of public health systems for efficient case tracking and reporting. In the post-pandemic era, it is essential to be ready and provide not only preventive measures, but also effective digital strategies and solutions to protect our population from future outbreaks. This work presents a contact tracing solution based on wearable devices to track epidemic exposure. Our proximity-based privacy-preserving contact tracing (P3CT) integrates: 1) the Bluetooth Low Energy (BLE) technology for reliable proximity sensing, 2) a machine-learning approach to classify the exposure risk of a user, and 3) an ambient signature protocol for preserving the user’s identity. Proximity sensing exploits the signals emitted from a smartwatch to estimate users’ interaction, in terms of distance and duration. Supervised learning is then used to train four classification models to identify the exposure risk of a user with respect to a patient diagnosed with an infectious disease. Finally, our proposed P3CT protocol uses ambient signatures to anonymize the infected patient’s identity. Extensive experiments demonstrate the feasibility of our proposed solution for real-world contact tracing problems. The large-scale dataset consisting of the signal information collected from the smartwatch is available online. According to experimental results, wearable devices along with machine learning models are a promising approach for epidemic exposure notification and tracking.

Local Public Health System Capacity and Its Relationship to COVID‐19 Mortality Patterns across the U.S

Research ObjectiveAs of January 5, 2020, the United States confirmed over 20 million cases of COVID‐19 resulting in at least 353,730 deaths. The public health response to COVID‐19 in the U.S. is trailing many countries and the bulk of the response burden is left to state and local public health systems. Studies comparing public health systems across the U.S. reveal gaps in the capacity and capabilities of public health systems at the state and local level. These gaps can lead to further disparities in public health access, policy enactment, emergency preparedness and preventable outcomes. Our study explores the potential associations between local public health system capacity and COVID‐19 death rates.Study DesignPublic health system capacity was assessed using a public health system composite measure developed from the National Longitudinal Survey of Public Health Systems (NALSYS). This measure combines information about the extent to which a set of 20 guideline‐recommended public health activities are implemented in the community (i.e., conducting needs assessments for the community's health status, investigating adverse health events, etc.) and information about the network of community organizations that contribute to implementing these activities. Combining this information into a composite measure resulted in three distinct classifications of local public health system capacity: Comprehensive, Conventional and Limited. Comprehensive systems deliver the most public health activities and have the largest network of community partners, while limited systems deliver the fewest public health activities and have the smallest network of community partners. Two‐part generalized linear models (GLM) were used to estimate the relationship between this system composite measure and COVID‐19 death rates while controlling for a range of population and community characteristics associated with COVID‐19 risks, distinguishing counties with and without at least one COVID‐19 death. Falsification tests and several model‐specification checks where performed to further verify the association between the system composite measure and COVID‐19 death rates.Population StudiedThe 2018 wave of the NALSYS includes a stratified national sample of 725 local governmental public health agencies.Principal FindingsUsing mortality data between April and July 2020, counties served by comprehensive public health systems had 11.9 fewer COVID‐19 deaths per 100,000 residents than counties with conventional systems (z‐statistic = 3.13; p‐value = 0.002), and 9.94 fewer COVID‐19 deaths per 100,000 residents than counties with limited systems (z‐statistic = 3.69; p‐value <0.001) after controlling for other model covariates. These results remained consistent and significant when mortality data were included from later in the pandemic through January 2021.ConclusionsCommunities with stronger local public health systems, as measured by scope of activity and network density, experienced significantly fewer deaths attributable to COVID‐19.Implications for Policy or PracticeEfforts to contain the adverse health consequences associated with COVID‐19 and future public health threats should include initiatives to strengthen local public health system capacity, such as through increased funding, training and network coordination.Primary Funding SourceThe Robert Wood Johnson Foundation.

Who Counts Where? COVID-19 Surveillance in Federal Countries.

While the World Health Organization (WHO) has established guidance on COVID-19 surveillance, little is known about implementation of these guidelines in federations, which fragment authority across multiple levels of government. This study examines how subnational governments in federal democracies collect and report data on COVID-19 cases and mortality associated with COVID-19. We collected data from subnational government websites in 15 federal democracies to construct indices of COVID-19 data quality. Using bivariate and multivariate regression, we analyzed the relationship between these indices and indicators of state capacity, the decentralization of resources and authority, and the quality of democratic institutions. We supplement these quantitative analyses with qualitative case studies of subnational COVID-19 data in Brazil, Spain, and the United States. Subnational governments in federations vary in their collection of data on COVID-19 mortality, testing, hospitalization, and demographics. There are statistically significant associations (p < 0.05) between subnational data quality and key indicators of public health system capacity, fiscal decentralization, and the quality of democratic institutions. Case studies illustrate the importance of both governmental and civil-society institutions that foster accountability. The quality of subnational COVID-19 surveillance data in federations depends in part on public health system capacity, fiscal decentralization, and the quality of democracy.

Health System Barriers and Facilitators to Delivering Additional Vaccines through the National Immunisation Programme in China: A Qualitative Study of Provider and Service-User Perspectives.

In China, there are two categories of vaccines available from the Chinese Center for Disease Control and associated public health agencies. Extended Program of Immunization (EPI) vaccines are government-funded and non-EPI vaccines are voluntary and paid for out-of-pocket. The government plans to transition some non-EPI vaccines to EPI in the coming years, which may burden public health system capacity, particularly in terms of budget, workforce, supply chains, and information systems. Our study explored vaccinator and caregiver perspectives on introducing non-EPI vaccines into routine immunization and perceived facilitators and barriers affecting this transition. We conducted a qualitative study from a realist perspective, analysing semi-structured interviews with 26 vaccination providers and 160 caregivers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. Data were analysed thematically, using deductive and inductive coding. Most participants were positive about adding vaccines to the national schedule. Candidate EPI vaccines most frequently recommended by participants were varicella, mumps vaccine, and hand–foot–mouth disease. Providers generally considered existing workspaces, cold-chain equipment, and funding sufficient, but described frontline staffing and vaccine information systems as requiring improvement. This is the first qualitative study to explore interest, barriers, and facilitators related to adding vaccines to China’s national schedule from provider and caregiver perspectives. Findings can inform government efforts to introduce additional vaccines, by including efforts to retain and recruit vaccine programme staff and implement whole-process data management and health information systems that allow unified nationwide data collection and sharing.

A control theory approach to optimal pandemic mitigation.

In the framework of homogeneous susceptible-infected-recovered (SIR) models, we use a control theory approach to identify optimal pandemic mitigation strategies. We derive rather general conditions for reaching herd immunity while minimizing the costs incurred by the introduction of societal control measures (such as closing schools, social distancing, lockdowns, etc.), under the constraint that the infected fraction of the population does never exceed a certain maximum corresponding to public health system capacity. Optimality is derived and verified by variational and numerical methods for a number of model cost functions. The effects of immune response decay after recovery are taken into account and discussed in terms of the feasibility of strategies based on herd immunity.

An Investigation of a Confirmed Imported Case of COVID-19 Infected Abroad - Qingpu District, Shanghai Municipality, China, November 15, 2020.

Summary What is already known about this topic? A passenger who was from the United States was taken to the hotel for the required isolation on November 13, 2020. During the quarantine she was diagnosed as the COVID-19 patient on November 15, 2020. Controlling the importation of COVID-19 remains a major challenge. What is added by this report? In this study, an epidemiological investigation was conducted for a confirmed case of COVID-19, including the treatment records in the hospital and 14-day travel trajectory before the onset of disease. What are the implications for public health practice? This study described an epidemiological investigation and management process on an imported case of COVID-19 and analyzed the test results, aiming to provide useful warnings to strengthen the capacity of public health system in response to the importation.

Thoughts on Adaptive Leadership in a Challenging Time.

Thoughts on Adaptive Leadership in a Challenging Time.

Healing the schism between public health and medicine, promoting the integration of prevention and treatment

It has been nearly 30 years since the publication of "Healing the Schism: Epidemiology, Medicine, and the Public's Health" by Professor Kerr L. White. Although scholars have been calling for strengthening the integration of public health and clinical medicine in Chinese medical education and eliminating barriers between public health professionals and clinicians, these effects are not obvious. The epidemic situation of COVID-19 has become an open course for Chinese citizens on the treatment, prevention and control of infectious diseases. Consequently, the public has higher expectations on the modernization of public health governance, and the social atmosphere of bridging the gap between public health and clinical medical education has been establishing. In the future, when combating with novel infectious diseases and public health emergencies, the response capacity of public health system and treatment capacity of clinical system in China will be significantly improved, and the situation of insufficient integration of medical treatment and prevention is bound to be reversed.

Thoughts on Connections Between COVID-19 Pandemic And Climate Crisis

Thoughts on Connections Between COVID-19 Pandemic And Climate Crisis

Needed: new authority to build public health system capacity for climate change health threats.

Strong public health system capacity is essential to protection against climate change health threats. Taken as a whole, the United States (U.S.) public health system lacks the requisite capacity. Unlike some other countries, the U.S. federal government and most state and local governments give low priority to strengthening public health capacity even though states and localities have begun investing billions of dollars in strategies to protect physical infrastructure from climate change-related severe weather events. I recommend enactment of new legislative authority specifically to develop public health capacity more rapidly and completely. Doing so can give new impetus to construction of, ultimately, a national public health system able to protect all those who reside in the U.S. from climate change health threats and to serve as a model for building such system capacity globally.

Capacity-need gap in hospital resources for varying mitigation and containment strategies in India in the face of COVID-19 pandemic.

BackgroundDue to uncertainties encompassing the transmission dynamics of COVID-19, mathematical models informing the trajectory of disease are being proposed throughout the world. Current pandemic is also characterized by surge in hospitalizations which has overwhelmed even the most resilient health systems. Therefore, it is imperative to assess health system preparedness in tandem with need projections for comprehensive outlook.ObjectiveWe attempted this study to forecast the need for hospital resources for one year period and correspondingly assessed capacity and tipping points of Indian health system to absorb surges in need due to COVID-19.MethodsWe employed age-structured deterministic SEIR model and modified it to allow for testing and isolation capacity to forecast the need under varying scenarios. Projections for documented cases were made for varying degree of containment and mitigation strategies. Correspondingly, data on health resources was collated from various government records. Further, we computed daily turnover of each of these resources which was then adjusted for proportion of cases requiring mild, severe and critical care to arrive at maximum number of COVID-19 cases manageable by health care system of India.FindingsOur results revealed pervasive deficits in the capacity of public health system to absorb surge in need during peak of epidemic. Also, model suggests that continuing strict lockdown measures in India after mid-May 2020 would have been ineffective in suppressing total infections significantly. Augmenting testing to 1,500,000 tests per day during projected peak (mid-September) under social-distancing measures and current test to positive rate of 9.7% would lead to more documented cases (60, 000, 000 to 90, 000, 000) culminating to surge in demand for hospital resources. A minimum allocation of 13x, 70x and 37x times more beds for mild cases, ICU beds and mechanical ventilators respectively would be required to commensurate with need under that scenario. However, if testing capacity is limited to 9,000,000 tests per day (current situation as of 19th August 2020) under continued social-distancing measures, documented cases would plummet significantly, still requiring 5x, 31x and 16x times the current allocated resources (beds for mild cases, ICU beds and mechanical ventilators respectively) to meet unmet need for COVID-19 treatment in India.