Resilient Health Systems Research Articles

Synergies and dis-synergies between universal health coverage and global health security: A case study of Cambodia.

After the coronavirus disease 2019 (COVID-19) pandemic, the global community's increased focus on pandemic preparedness has driven efforts such as the Pandemic Treaty proposed by the World Health Organization (WHO) and the Pandemic Fund managed by the World Bank. While these initiatives will enhance countries' capabilities in pandemic preparedness, synergies could be achieved by exploring the intersections between universal health coverage (UHC) and global health security (GHS). This is particularly relevant for developing countries like Cambodia. As it transitions to higher income status and reduces its reliance on external funding, the synergistic development of UHC and GHS will help Cambodia maximise health investment and align with its population health goals. We aimed to identify synergies and dis-synergies between UHC and GHS and recommend implementations that the government can consider moving forward. We conducted a rapid review of policy documents based on the World Health Organization (WHO) Health System Framework and undertook consultations with key stakeholders in Cambodia. Our findings show the synergies between the two agendas in Cambodia resulted from having a central coordinating authority through the Ministry of Health (MoH), an extensive primary care network, and intersecting human resources that drive both UHC and GHS. We also identified potential dis-synergies such as vertical programmes and funding sources, inadequate regulation and engagement of the private sector, and underutilisation of information and data. Recommendations include cross-consultations between departments within the MoH when developing policies in GHC or UHC, and training programmes to increase awareness of the synergies between UHC and GHS. Our findings reinforce those of previous case studies in Bangladesh, Ethiopia, and Ghana, offering recommendations for building resilient health systems by integrating UHC and GHS.

Nurse Managers' Experiences in Organisational Adaptation During Public Health Emergencies: A Qualitative Study.

To elucidate strategies for improving organisational adaptation during public health emergencies from the perspectives of nurse managers. This study utilised a qualitative approach, incorporating complex adaptive system theory within a phenomenological tradition. Semi-structured interviews were conducted from May 2022 to June 2022. Participants included core members of the Shanghai Public Health Emergency Teams-Nursing from 12 tertiary hospitals in Shanghai, all of whom had substantial experience as nurse leaders impacting health systems. Data obtained were coded and analysed using interpretative phenomenological analysis. Seventeen frontline nurse managers participated, leading to the emergence of three key themes related to complex organisational adaptation: seeking institutional support for environmental adaptation, building intrateam support for structural adaptation and activating individual support for behavioural adaptation. A conceptual framework of organisational adaptation was proposed, displaying the interconnections among these themes. The study provides valuable insights into managing nursing teams involved in public health emergency preparedness and response as an adaptive system. Identified managerial strategies offer guidance to ensure effective organisational assembly and optimal utilisation of the nursing workforce within the healthcare system. Recognising the crucial role of nurses in managerial positions, who leverage leadership, adaptability and decision-making skills to coordinate frontline teams, is vital for effective public health emergency response. Their involvement in administrative roles underscores the importance of nursing perspectives in strategic planning, organisational adaptation and enhancing health system resilience during crises. The organisational adaptation strategies effectively adopted by nurse managers provide a reference for international scholars seeking to enhance the function and performance of nursing staff in healthcare system during public health emergencies. Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. No Patient or Public Contributions.

The impact of COVID-19 on routine child immunisation in South Africa

BackgroundThe COVID-19 pandemic disrupted immunisation programs worldwide, reversing gains that had brought vaccine-preventable diseases largely under control. This study explored the impact of COVID-19 on the uptake of routine child immunisation services in South Africa.MethodsWe conducted qualitative research using in-depth interviews with 51 purposively selected parents/caregivers of children below the age of five who missed or delayed one or more scheduled immunisation doses in 2020–2022 and with 12 healthcare providers who provided public immunisation services during the pandemic.ResultsDuring the pandemic lockdowns, most caregivers perceived the risk of their child being infected with COVID-19 during a clinic visit as more salient than the risk of missing immunisation doses. Caregivers reported minimal exposure to routine immunisation communication, as well as shortages of routine vaccines for children at public health facilities, healthcare workers experienced anxiety and burnout. There was a post-pandemic shift to more active decision-making about immunisation, which had previously been an almost automatic behaviour, leading some caregivers to delay vaccinating their children. There was also evidence of a “bad vaccine” mental model among some caregivers regarding COVID vaccinations, which could lead to doubts about the safety of routine childhood vaccinations.DiscussionThe shift from default to active decision-making highlights a risk that routine immunisation will backslide in future pandemics. Governments should build resilient health systems at all levels and communicate clearly about the benefits and availability of RIs and the safety of vaccinations in general, alongside supply-side interventions.ConclusionRoutine immunisation is widely accepted in South Africa, driven by generational norms and provider recommendations. During the COVID-19 pandemic, many caregivers faced the dilemma of balancing COVID-19 exposure risk with the risk of their child developing a deadly VPD, leading to missed RI visits. This shift to active decision-making highlights a future pandemic risk. Governments should build resilient health systems and focus on understanding and engaging procrastinating and doubtful caregivers. Clear communication about RI benefits and vaccine safety is crucial, as misinformation can lead to distrust in new vaccines.

Vaccine equity implementation: exploring factors influencing COVID-19 vaccine delivery in the Philippines from an equity lens

BackgroundDuring the early phase of the COVID-19 vaccine rollout, low and middle-income countries (LMICs) were facing challenges in achieving equitable vaccine delivery. Few studies have contextualized global vaccine distributive injustice into national-specific contexts to understand its impact on vaccine delivery from an equity perspective. We aimed to investigate factors influencing equitable COVID-19 vaccine delivery in the Philippines and to provide recommendations to enhance equitable vaccine delivery in LMICs to prepare for future health emergencies.MethodsThe Health Equity Implementation Framework was employed to guide this qualitative study. We recruited participants using purposeful and snowballing sampling strategies. Semi-structured interviews were conducted with participants in person, online, or over the phone. A reflective thematic analysis approach was employed to analyze data.ResultsWe recruited 38 participants including seven high-level stakeholders from the public and private sectors, 14 health workers, and 17 community members in the province of Negros Occidental, Philippines. Equitable delivery of COVID-19 vaccines was influenced by an interplay of multiple factors operating in different domains. Contextually, the rapidly evolving nature of the COVID-19 virus, ongoing scientific advancements, and international negotiations directed national-level vaccine policies. Political commitment and support were recognized as crucial drivers for successful vaccine delivery, with a strong emphasis on health information framing and communication and adherence to human rights principles. The vulnerability of the health system significantly impacted the timely and effective distribution of vaccines. Furthermore, the geographical characteristics of the Philippines presented unique logistical challenges to vaccine delivery. At the recipient domain, individual perceptions of vaccines, shaped by their socioeconomic status, exposure to (mis)information, social influence, and entrenched religious beliefs, played a major role in their vaccine decisions and thus vaccine coverage regionally. Additionally, vaccine characteristics and operational challenges related to its distribution also impacted fair allocation.ConclusionsThe findings highlight the urgent need for LMICs to strengthen their health system resilience and sustainability and use multilevel strategies to build public trust to improve vaccine uptake and coverage. Moreover, each LMIC must be attentive to its unique contextual factors to develop tailored implementation strategies to promote equitable vaccine distribution.

Household satisfaction with health services and response strategies to malaria in mountain communities of Uganda.

Measuring satisfaction with health service delivery in fragile communities provides an opportunity to improve the resilience of health systems to threats including climate change. Additionally, understanding factors associated with the choice of response strategies to certain public health threats provides an opportunity to design context-specific interventions. We used polytomous latent class analyses to group participants' responses and an additive Bayesian modelling network to explore satisfaction with health service delivery as well as factors associated with response strategies of households to malaria. We did this with a focus on the rural parts of Uganda in Mount Elgon. We found that approaches to malaria control and management at household level include the use of traditional (54.5%), private (20.5%) and publicly available services (25%). Regarding satisfaction with health services, 66.6% of respondents were satisfied with health service components of information flow, drug/vaccine access and accessibility. Type of housing, livelihood sources, previous malaria experience and health services were strongly associated with responses to malaria occurrence at household level. The rest of the factors were weakly associated with malaria responses. The indigenous interventions utilised by households to manage and control malaria were largely dependent on their satisfaction with health service delivery components. Interventions thus ought to leverage local existing knowledge to optimise outcomes and ensure sustainable health.

Flexible ngo-donor coordination in aid interventions to strengthen resilience: the case of Lebanon’s primary healthcare system

IntroductionWith shifts in international aid, international donors have increasingly regarded non-governmental organisations (NGOs) as capable of providing alternative public service arrangements. As funding flows to NGOs, particularly in contexts where...

Strengthening Indonesia’s health system through community and technological engagements in public health interventions

The 7th International Symposium on Public Health (ISoPH 2023), was held on October 2-3, 2023, in Surabaya, Indonesia, which brought together a diverse array of public health professionals, researchers, and policymakers from around the globe. The purpose of the symposium was to facilitate the exchange of the latest information and ideas within the realm of public health. The symposium aspired to foster discussions and the exchange of insights regarding scientific issues in the field of public health globally and within the context of Indonesia. Organized by the Faculty of Public Health at Airlangga University in Indonesia, the symposium addressed the urgent need for robust, resilient health systems capable of navigating the complex challenges of the modern era, particularly in the context of the Society 5.0 paradigm.

Exploring sustainable health financing strategies in humanitarian settings: Challenges, innovations and efforts towards Achieving Universal Health Coverage

Sustainable health financing is critical in humanitarian settings to ensure that the most vulnerable populations have access to necessary healthcare services. In crises such as conflicts, natural disasters, or prolonged emergencies, healthcare systems are often destabilized, leading to significant challenges in providing adequate care. This review explores innovative financing mechanisms designed to support health services in these contexts, focusing on their potential to achieve Universal Health Coverage (UHC). Key challenges include limited funding, high out-of-pocket costs, and the uneven distribution of healthcare resources. In response, emerging models such as impact bonds, Islamic social finance, disaster risk insurance, and digital financial solutions offer new approaches to mobilizing resources and sustaining health interventions. These strategies are essential to bridging gaps in healthcare access, promoting equity, and strengthening the resilience of health systems. Policy recommendations highlight the importance of integrating emergency and routine health services, engaging communities, and enhancing coordination among stakeholders. Strengthening health financing mechanisms is vital for long-term improvements in health outcomes, especially in fragile settings. This research underscores the need for sustainable, inclusive policies that bolster health systems in the face of humanitarian crises.

Public Administration "Changing Paradigms of Public Administration in Facing the Global Health Crisis: Lessons from the Pandemic"

The COVID-19 pandemic has changed the paradigm of public administration in dealing with the global health crisis by emphasizing the importance of multilateralism and cross-border cooperation. The government now plays the role of a facilitator that integrates health and political policies to respond more effectively. The study identifies countries with swift and transparent leadership, such as Vietnam, that are better able to respond to the pandemic, while also exposing global inequalities in low-income countries that need international support. Public administration has a crucial role in designing effective policies, providing resources, and implementing measures such as social distancing, with transparent communication to build public trust. The digitization of public services and evidence-based collaboration between governments and scientists have become important pillars in responding to people's needs. This study uses a descriptive-qualitative approach with case studies and comparative analysis of policies in various countries. The results show that adaptation and innovation in public administration, including increasing digital literacy and community participation, are critical to building health system resilience to future crises. This research is expected to contribute to public administration theory and relevant policy recommendations to face similar challenges in the future.

11.L. Round table: Fiscal measures for building resilient European health systems

Abstract Currently, over 100 million European citizens are affected by obesity and non-communicable diseases. These health conditions impact individuals and society economically as well as socially. Therefore, an increasing number of Member States has introduced taxes on foods high in fat, sugar, or salt. However, divergent national fiscal health measures can lead to market distortion or fraudulent activities, revealing that, although the responsibility for implementing fiscal measures lies with national governments, health systems of different Member States are much interlinked. The increasing health risks for European citizens and its broader impact underline the importance of resilience in European health systems more than ever before, calling for early response and effective concrete actions from both EU institutions and national governments. Additionally, the topic of resilient health systems currently ranks high on the European agenda, with the Belgian Presidency promoting health system preparedness and early response and health care strengthening as one of their six priorities. The European Commission will also continue its work on this issue for the next five years. The EU has already taken steps in this matter, such as the launch of the European Health Union and the creation of HERA. However, in order to preserve a healthy society, the EU must further develop in this regard. Therefore, this round table discussion will focus on the question of how fiscal measures in Member States can contribute to resilient health systems. It aims to generate ideas on how Ministries of Health can contribute to resilient health systems via fiscal measures compatible with European Community law that promote health and prevent disease. Panellists from the WHO Regional Office for Europe, the Hungarian Ministry of Health and Ecorys, a research-based consultancy, will provide diverse perspectives on the topic. The added value of the round table is laying out possible ways of how both the EU and Member States can contribute to enhancing the resilience of European health systems. In the discussion, knowledge is derived from various research projects, such as Ecorys’ study for DG TAXUD on health taxes, their study for the Dutch Ministry of Finance on sugar taxes, and their literature study on sugar taxation and VAT reduction on fruits and vegetables. Furthermore, as an example of alternative funding mechanisms for resilient health systems, the Hungarian approach to health taxes will be reviewed, since a portion of the tax revenue from their public health tax is used to finance public health initiatives. From a policy perspective, the round table will aid in formulating recommendations for improving the resilience of EU health systems for the next five years. Key messages • Unhealthy foods and drinks consumption poses significant health risks, impacting economy and society, and requiring evidence-based fiscal measures as part of comprehensive measures. • The round table provides public health stakeholders the opportunity to generate recommendations for improving the resilience of EU health systems for the next five years. Speakers/Panelists Kremlin Wickramasinghe Division of Country Health Programs, WHO/Europe, Denmark Krisztina Biró Ministry of Interior, State Secretariat for Health, Budapest, Hungary Soila Karreinen Tampere University, Tampere, Finland Rana Orhan Pees Ecorys, Rotterdam, Netherlands Sara Cerdas Former Member of the European Parliament, Brussels, Belgium

How are the three environmental threats challenging health systems’ resilience?

Abstract Background Known avoidable environmental risks cause about one quarter of all deaths and disease burden worldwide, amounting to at least a steady 13 million deaths each year. Indeed, diseases caused by the environment weigh heavily on health systems. These not only harm directly human health increasing the burden of disease but also potentiate other threats, by acting as drivers (e.g. pandemics, antimicrobial resistance). In addition, the increased burden due to these environmental threats also put in risk the capacity of health systems to adapt to the new healthcare needs and to provide a proper answer to the diseases caused by other health determinants. Methods Based on a review of the literature, the presentation addresses the question of potential options in public health climate action at the interface of environmental sustainability and health systems sustainability and resilience. It identifies possible priority areas in order to guarantee environmental and healthcare sustainability. Results Approaches that focus on treatment of individual diseases rather than improvement of environmental determinants of health will be insufficient to tackle the triple environmental crises of climate change, biodiversity loss and pollution. Single-determinant approaches are unlikely to achieve expected improvements, given the complex interaction of environmental factors. Conclusions Approaches that are more integrated are required to address the root causes of disease and guarantee health systems sustainability, which are often defined by policies in key sectors other than health, such as the environment. Multi-sectoral actions are needed to prevent and mitigate the threats to human health from the ongoing and interconnected environmental crises of climate change, biodiversity loss and pollution, contributing to a Planetary Health perspective on health systems’ resilience.

8.C. Scientific session: Health system resilience: A Planetary Health perspective

Abstract Planetary Health is a collective and unifying approach to balance the interlinkages between human health, political, economic and social systems as well as the natural systems of our planet, the importance of which is growing in the context of climate change in European countries and beyond. Yet, there is a dearth of of research linking Planetary Health to health systems’ resilience, particularly from a public health lens. With the number of studies growing regarding impacts of climate change on health, the question remains how health systems need to be prepared, focusing for example on the emergence of infectious diseases as well as the triple crises of biodiversity loss, pollution and climate change. In addition, tools to assess climate-related risks developed at international level, such as the vulnerability, adaptation and capacity assessment developed by the World Health Organization (WHO) have rarely been piloted in European countries. In this workshop, firstly evidence is presented on the status quo of how climate change impacts health and emerging infections in Europe and at global level. Secondly, the workshop provides insights into how tools to assess vulnerability and resilience of health systems in the context of climate change may be used in the European context. Thirdly, resilience is assessed against evidence emerging from the triple environmental crises of biodiversity loss, pollution and climate change. Key messages • In a planetary health lens, using mixed methods to consider climate change vulnerability of different population groups and adaptation potentials are key to address current complex health challenges. • Synergistic solutions and joint working across climate and health offer opportunities for greater health system resilience and population health impact.

3.L. Round table: Outcomes from a public debate on the future health priorities of the European Union

Abstract Objective and background In the run up to the European elections, the European Observatory on Health Systems and Policies facilitated a public debate on the future health priorities of the European Union. The purpose of the debate was to provide insights to the European Commission on the views of stakeholders and the public health community with regards to the future of the European Health Union (EHU). The EHU was established as a comprehensive health systems and public health response to the COVID-19 pandemic, featuring enhanced budgets, expanded mandates for existing bodies, and the introduction of new entities like the Health Emergency Response Authority (HERA) alongside new strategies. Methods The methodology for this comprehensive debate included workshops and plenary sessions at various conferences like the 2023 EUPHA conference in Dublin, an interactive webinar series, and a detailed stakeholder survey featuring both closed and open-ended questions. Data was collected and analyzed using diverse qualitative and quantitative tools, including AI-driven analysis of survey responses. Preliminary outcomes Preliminary analysis shows that participants actively engaged in the debate, and mostly expressed support for the EHU’s achievements to date. There was a consensus on the significant value added by the EHU, with many advocating for stronger EU action on a range of discussion topics. Stakeholders and the public health community could also relate to the discussion framework designed to guide the public debate, which included nine topics: enhancing health security; addressing the determinants of health through Health in All Policies and Health for All Policies; supporting health system transformation; enhancing the labour market for health and care workers; achieving universal health coverage; implementing digital solutions and AI; improving the performance and resilience of health systems; addressing long-term challenges, such as population ageing or climate change; and strengthening the EU’s global voice and leadership. The importance placed on these topics varied among different groups. Young participants prioritized climate-related actions, the public health community emphasized addressing the determinants of health, and policymakers concentrated on issues related to health system resilience, universal coverage, and transformation. Digital solutions and AI were recognized as crucial, but they were typically considered integral and transversal to broader issues rather than standalone priorities. The debate also surfaced priorities not initially included in the discussion framework, such as health promotion, prevention, and equity within health systems, which were repeatedly highlighted. Key messages • The debate on the EU’s future health priorities demonstrates that stakeholders and the public health community acknowledge the value of the EHU and would like to see further action to build on it. • Stakeholders and the public health community have formulated concrete action to take the EHU further. Speakers/Panelists Giada Scarpetti TU Berlin, Berlin, Germany Caroline Costongs EuroHealthNet, Brussels, Belgium Isabel de La Mata DG SANTE, European Commission, Luxembourg, Luxembourg

2.E. Round table: Building climate resilient health systems in the EU

Abstract Climate change is one of the biggest challenges for modern society. The health effects of climate change lead to negative impacts on European health systems, and conversely, European health systems contribute significantly to climate change. To overcome challenges posed by the climate crisis, European cooperation is essential. The interdependencies between climate change and public health and its broader impact underline the importance of resilience in European health systems, calling for concrete actions from both EU institutions and national governments. Additionally, the topic of resilient health systems currently ranks high on the European agenda, with the Belgian Presidency promoting health care strengthening as one of its six priorities. The European Commission will also continue its work on this issue for the next five years. The EU has already taken steps in this matter, such as the launch of the European Health Union and the adoption of the EU4Health Programme. However, in order to better prepare for climate resilient health systems, the EU must further develop in this regard. To explore this pressing issue, the round table discussion will focus on how EU actions in climate adaptation can synergistically contribute to the resilience of health systems. Resilience, often associated with adaptation, embodies the capacity to anticipate, withstand, and recover from shocks and stresses related to climate change. By delving into this question, the workshop seeks to uncover ways in which EU and Member State climate initiatives can reinforce health system resilience, thereby fostering a more adaptive and responsive health workforce and infrastructure. Featuring 4 panellists from Erasmus University Rotterdam, the Austrian National Public Health Institute, the Dutch Green Healthcare Alliance and the European Environment Agency, the round table will bring together diverse perspectives on this issue. The added value of the round table is laying out possible ways of how both the EU and Member States can contribute to enhancing the resilience of European health systems. After establishing the necessity for action, the round table discussion will focus on generating ideas to address climate change. Specifically, this discussion will cover examples of national policies, such as from the Netherlands, Austria, and other Member States. Also discussed will be the importance of monitoring and surveillance, and conducting a health and vulnerability assessment. This ensures better understanding of the relevant current and future health impacts, which will inform resilience measures. This will be followed by a discussion with the audience to formulate recommendations for improving the resilience of EU health systems for the next five years. Key messages • Climate change challenges European health systems, emphasising the need for European cooperation in resilience efforts. • Synergising climate adaptation with health system strengthening enhances EU’s capacity for resilience. Speakers/Panelists Chiara Cadeddu Erasmus University Rotterdam, Rotterdam, Netherlands Aleksandra Kazmierczak European Environment Agency, Copenhagen, Denmark Andrea Schmidt Austrian Public Health Institute, Vienna, Austria Juliette Mattijsen Groene Zorg Alliantie, Rotterdam, Netherlands

Exploring methodologies and frameworks for best practice transfer at the primary care level

Abstract Background In Feb 2023, the EU’s Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched with the objective of effectively transferring and implementing six best practices (BPs) among Member States (MS). Transferability from one primary care (PC) setting to another can be challenging given organizational, legal, cultural, social, economic, and environmental factors, requiring robust a methodological framework to guide the transfer process. A scoping review was conducted to identify conceptual models and methodological frameworks for context-relevant and evidence-informed BP transfer in PC settings. Methods The study aimed to identify models or frameworks to guide BP transfer in PC settings, whilst maximizing transferability. The JBI methodology was used, and an extensive search was conducted in PubMed (time limit: Jan ‘13-May ‘23). All publications of original research, systematic reviews, and text and opinion papers in English were eligible for inclusion. Key exclusion criteria were set, i.e., intervention type, level of care and reporting quality. The search was supplemented by gray literature review. Results From a total of 369 publications, 9 met eligibility criteria, reporting on 10 conceptual and methodological models/framework largely varying. These included transfer models applicable to all BPs as well as elements specific to some BPs, i.e., addressing integration, patient-centered care, care coordination, and health promotion. Strengths and weaknesses were identified for all. Conclusions Transferability of health interventions is complex, requiring systematic consideration of setting and intervention characteristics to inform and support local adaptation, implementation, and decision-making. Key elements identified can support the CIRCE-JA BP transfer and are largely relevant for further BP transfer across PC settings in EU MS, incl. for local adaptation, stakeholder engagement and effective implementation monitoring. Key messages • Innovative BPs are successfully deployed in many EU MS. To best support transformation for strong EU primary care and resilient health systems, it is important to ensure evidence-informed BP transfer. • This review reports on the selection of appropriate frameworks and models, and key elements thereof, to allow successful transfer of CIRCE-JA BPs and other BP transfer across PC settings in Europe.

Evaluating health system resilience testing; what makes this practice successful?

Abstract Issue Health system resilience is an important and desirable attribute of health systems. We have evaluated the operationalization of our step-by-step guide for conducting a resilience test. Description of the problem Preparedness planning is often siloed and does not take the entire health system into account. The objective was to develop a new methodology for policy making that is adaptable to any health system context and shock scenario. Resilience testing uses a mixed-method approach to assess resilience by understanding health system strengths and weaknesses in relation to a hypothetical shock scenario. A programme logic model, semi-structured interviews and an online questionnaire were used to evaluate the methodology and to answer the following questions: Can resilience tests be used to identify strengths and weaknesses in different health system contexts? What are the determinants for successful resilience testing? Results Three resilience tests were conducted in Finland, Greece and the Asturias region of Spain. All resilience tests identified health system strengths and weaknesses. 97% of participants agreed that the test identified broader vulnerabilities. However, 76% thought that a different scenario would identify different strengths and vulnerabilities. 94% of participants agreed or strongly agreed that the test was a valuable exercise. The semi-structured interviews consistently found that successful resilience testing requires neutral facilitation and carefully selected test participants. Lessons Resilience test results have been used in 2 out of 3 cases to develop health policy. Resilience testing needs to be initiated and supported by the ministry of health to ensure results are considered in the policy making process. Key messages • Health system resilience tests can identify health system strengths, weaknesses, and steps towards remedial policy action to improve resilience in different European health system contexts. • Successful health system resilience testing requires carefully selected facilitators and test participants as well as support from the Ministry of Health.

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

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

Heatwaves, Hospitals, and Health System Resilience in England: A Qualitative Assessment (Summer 2019)

Abstract Background Frequent heatwaves challenge healthcare delivery in England, affecting patient safety and staff welfare. This study addresses the observational gap in how healthcare settings adapt to extreme weather. Methods We utilised a qualitative approach, conducting semi-structured interviews with fourteen NHS staff across England to explore experiences during the 2019 summer heatwave. Participants included clinical and non-clinical personnel, providing broad insights into operational challenges and adaptive strategies. Results The 2019 heatwave significantly disrupted service delivery, with variable staff awareness of the Heatwave Plan for England affecting responses. Key issues included managing infection control versus electric fan usage, impacting patient and staff comfort and safety. These conditions also led to an increase in hospital admissions. Conclusions The findings highlight the need for improved workforce training and strategic planning to enhance resilience to heat-related risks. Further research is essential to develop a comprehensive evidence base on the impacts and costs of heatwaves and to assess the effectiveness of adaptation strategies. This will support national health adaptation planning and emergency response. Key messages • Enhanced planning and training are crucial for health system resilience to heatwaves. • More research is needed to understand heatwave impacts and effective responses.

10.H. Round table: Transforming health systems in Europe to respond to the large-scale displacement from war in Ukraine

Abstract The Russian invasion of Ukraine in 2022 caused one of the largest population displacements in Europe since World War II. More than 6 million persons have sought international protection in other European countries, distributed in ways that take little account of the host countries’ population size, national income, or health system capacity. This workshop provides a platform to present and discuss findings of a health system impact assessment designed to anticipate the range of mid- to long-term impacts of this large-scale displacement on essential health system functions in refugee-receiving countries, identifying the challenges they face and opportunities to develop transformative policies and actions. This task is urgent given the risks of wider conflict in Europe. Objectives The workshop will 1) present the main findings from the health system impact assessment in seven refugee-receiving countries, 2) set out options for effective responses, considering policy and implementation perspectives, and 3) capitalise on the expertise of workshop participants to develop and refine policy options for structural reforms that not only help to sustain an effective response, but enhance the resilience of European health systems for the benefit of displaced populations and national residents alike. Format The workshop will comprise a panel with three speakers, followed by a roundtable discussion. Each panel member will make a short presentation (5 min) on different, but interrelated aspects of a transformative health system response to a protracted crisis scenario. These will highlight country and regional-level challenges arising during the Ukraine crisis, propose concrete policy options for transformation, and identify intersections between the health system response with other societal sectors and crises. The workshop objectives and rationales will be introduced by Kayvan Bozorgmehr, including a short pitch-presentation (3 min) highlighting the unequal distribution of displaced persons from Ukraine and the key-findings of the health system impact assessment. The panel will include follow-up presentations elaborating specific aspects in this context: 1. Healthcare models and needs for transformative response in a protracted crisis (Dr. Nino Berdzuli, WHO Special Envoy for Ukraine Emergency Response in refugee-receiving countries); 2. Supra-national health financing as transformative reform: pros and cons (Eilin Rast, Bielefeld University, Germany); 3. Regional Geopolitical Conflicts and Population Health in Caucasus, CIS and Ukraine (Prof. Akaki Zoidze, Ilia State University, Georgia). The subsequent roundtable discussion will be chaired by Martin McKee. It will focus on the proposed actions and considerations from a policy and implementation perspective, and workshop participants will be invited to contribute to a critical reflection regarding barriers and enablers, as well as required alliances and processes to translate the structural reforms into practice. Key messages • The ongoing conflict-related displacements from Ukraine have created a protracted crisis that will require structural transformations to enhance health system resilience. • Enhancing healthcare delivery, continuity of care, and effective health financing requires national and supra-national collaboration to sustain effective responses and prepare for future crises. Speakers/Panelists Nino Berdzuli Division of Country Health Programmes, WHO/Europe, Denmark Eilin Rast Bielefeld University, Bielefeld, Germany Akaki Zoidze Ilia State University, Tbilisi, Georgia

The EU-funded action to strengthen health information systems

Abstract The European Commission initiative to build a European Health Union recognizes the need to address in a coordinated fashion the effects of the pandemic in health and social sectors and to strengthen the resilience, accessibility and effectiveness of health systems through co-operation, best practice exchange, training schemes, technical support and improved data and knowledge management. To make the most of the potential of health data, the European Health Data Space (EHDS) is being established as one of the central building blocks of a strong European Health Union. The EHDS sets out rules, common standards, infrastructures and a governance framework for the use of electronic health data for healthcare, research, innovation and policy making. In line with these policy goals, the European Commission is funding the Action ‘Supporting Member States in the WHO European Region in strengthening health information systems and boosting health data governance’. This Action will be implemented by WHO Regional Office for Europe and aims to boost the use and reuse of health data, including by promoting, where possible, the principles and solutions developed and implemented for the EHDS. It will also contribute to the objectives of the EU Global Health Strategy to improve global health security and deliver better health for all in a changing world. In addition, the Action is designed to strengthen countries’ capacity across critical programmatic areas of health data and digital health such as data quality (including appropriate data management and analytics) and digital health literacy across the 53 Member States in the WHO European region. The main objectives of the Action are to establish a Health Information Network for strategic guidance; and develop and implement tools and capacities to strengthen health information systems, health data governance, data quality and interoperability in countries.