System Preparedness Research Articles

Factors influencing healthcare workers' and health system preparedness for the COVID-19 pandemic: A qualitative study in Ghana.

Adequate preparedness of health systems, particularly healthcare workers (HCWs), to respond to COVID-19 is critical for the effective control of the virus, especially in low- and middle-income countries where health systems are overburdened. We examined Ghanaian HCWs' perceived preparedness to respond to the pandemic and the factors that shaped their preparedness and that of the health system. Semi-structured in-depth interviews were conducted with n = 26 HCWs responsible for the clinical management of COVID-19 patients and three administrators responsible for developing and implementing COVID-19 policies at the facility level. Interviews were conducted over the phone in English, transcribed, and analyzed using a thematic analysis approach. Generally, HCWs felt inadequately prepared to contain the spread of COVID-19 due to resource shortages and inadequate training. HCWs, similarly, perceived the health system to be unprepared due to insufficient clinical infrastructure and logistical challenges. The few who felt prepared identified readiness in managing high consequence infectious disease cases and pre-existing protocols as enablers of HCW preparedness. The health system and HCWs were unprepared to manage the COVID-19 pandemic due to inadequate training, logistical challenges, and weak clinical infrastructure. Interventions are urgently needed to improve the health system's preparedness for future pandemics.

Review of SNP assays for disaster victim identification: Cost, time, and performance information for decision-makers.

In mass disaster events, forensic DNA laboratories may be called upon to quickly pivot their operations toward identifying bodies and reuniting remains with family members. Ideally, laboratories have considered this possibility in advance and have a plan in place. Compared with traditional short tandem repeat (STR) typing, single nucleotide polymorphisms (SNPs) may be better suited to these disaster victim identification (DVI) scenarios due to their small genomic target size, resulting in an improved success rate in degraded DNA samples. As the landscape of technology has shifted toward DNA sequencing, many forensic laboratories now have benchtop instruments available for massively parallel sequencing (MPS), facilitating this operational pivot from routine forensic STR casework to DVI SNP typing. Herein, we present the commercially available SNP sequencing assays amenable to DVI, we use data simulations to explore the potential for kinship prediction from SNP panels of varying sizes, and we give an example DVI scenario as context for presenting the matrix of considerations: kinship predictive potential, cost, and throughput of current SNP assay options. This information is intended to assist laboratories in choosing a SNP system for disaster preparedness.

Employee and Management Preparedness in Facing Fire Disasters at Public Fuel Filling Stations in Pinrang District

Objective: The purpose of this study was to determine the preparedness of employees and management in dealing with fires at Public Fuel Filling Stations in Pinrang District. Theoretical Framework: In this topic, the main concepts and theories that underpin the research are presented. Disaster experiences influence a person's preparedness according to the theory of Havwina (2016) and Sadeka (2020), Experience in the past will have an influence on behavior in the future, so that it becomes a learning. Method: The method used is mixed methods, which is a research step by combining two pre-existing forms of research, namely qualitative research and quantitative research. This study involved 121 respondents using purposive sampling techniques, of which 112 respondents filled out the employee preparedness questionnaire and 9 respondents as informants to assess management preparedness. Variables were measured using a questionnaire and indept interview. Results and Discussion: The results showed that there was a significant relationship between disaster experience and emergency response plan, early warning system, resource mobilization and employee preparedness. The results also showed that there was no significant relationship between disaster experience and knowledge. In addition, disaster experience also affects management preparedness. The findings of this study support that disaster experience affects employee and management preparedness.. Research Implications: The practical and theoretical implications of this research are discussed, providing insight into how the results may be applied or influence practice in the field of occupational safety and health. These implications may include public fuel station workers who have highly fire-prone workplaces. Originality/Value: This research can contribute to improving occupational health and safety which can have an impact on preparedness of employees and management. The results of this study can help employees and management by educating them about the elements that can cause a decrease in performance elements that can improve preparedness in the face of fire hazards that may occur in the future.

Community perspective and healthcare assessment in malaria endemic states of India: a cross-sectional study protocol

IntroductionIndia’s contribution to the malaria burden was highest in South-East Asia Region in 2021, accounting for 79% of the estimated malaria cases and 83% of malaria-related deaths. Intensified Malaria Control...

Strengthening Healthcare Supply Chains: A Comprehensive Strategy for Resilience in the Face of Natural Disasters

Effective and uninterrupted management of the healthcare supply chain and healthcare system preparedness for natural disasters (e.g., pandemics, earthquakes, forest fires, etc.) is essential to ensure that victims receive critical healthcare services and products with minimal disruption, even in the event of damage to transport and logistics infrastructure as a result of significant disasters. The article examines this issue using the example of Vital Health Systems, a prominent hospital system with multiple facilities across a wide region. The qualitative data for the study was collected through interviews and focus groups with key stakeholders in Vital Health Systems, including supply chain managers, procurement specialists, frontline staff, etc. The quantitative data for the study were based on reports, internal documentation and archival documents, industry reports, market research, government databases. Analysis of the supply chain resilience of Vital Health Systems to natural disasters was carried out using the PESTLE framework, based on which a comprehensive risk reduction strategy was proposed. This strategy, while rooted in theory, is highly practical and feasible, with measures to optimise stocks, creation of alternative transport routes and logistics networks, and use of technological solutions. Organisational and managerial proposals for minimising supply chain disruptions for Vital Health Systems in the event of natural disasters are based on the theory of transformational leadership, Denison’s organisational culture, Levitt’s diamond model, and McKinsey’s theory of strategic horizons. The role of healthcare professionals, supply chain managers, procurement specialists, and researchers in healthcare management and disaster preparedness is crucial in implementing these strategies.

Determinants of willingness and level of COVID-19 vaccination uptake among intra-city transporters in Benin Metropolis, Nigeria

The COVID-19 pandemic was a litmus test for the epidemic preparedness and response mechanism of health systems. Road Transporters constitute a large at-risk group for spread and morbidity related to the disease. This study assessed determinants of willingness and level of COVID-19 vaccination uptake among intra-city road transporters in the Benin City Metropolis of Edo State Nigeria. An analytic cross-sectional design was utilized for this study using 389 structured questionnaires distributed among intra-city drivers selected via a multi-stage sampling technique across bus parks in Benin City metropolis. The mean age of respondents studied was 38.7 ± 9.3 years. Less than one-tenth 30 (7.7%) of respondents had taken the COVID-19 vaccine. Willingness to take COVID-19 vaccine was a significant determinant of uptake of COVID-19 vaccine (OR = 8.082; 95% Cl = 2.208 – 29.584; p = 0.002). There is need to initiate appropriate health promotional interventions to address vaccine hesitancy for improve vaccination uptake.

Epidemiology of respiratory syncytial virus in Central Queensland, Australia.

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in infants. Little is known about the epidemiology, burden, and seasonality of RSV in subtropical regions of Australia like Central Queensland. This information is important to plan prevention strategies, including therapeutics, future vaccines, and health system preparedness. We collected data on laboratory-confirmed RSV cases and admissions in Central Queensland for the period 1 July 2021 to 31 December 2022. From July 2021, RSV was listed as a nationally notifiable condition on laboratory-confirmed diagnosis. During the study period, 1,142 laboratory-confirmed cases of RSV (50.0% female sex) were reported, with 169 cases (14.8%) requiring hospital admission, 12 of which (7.1%) required intensive care unit/high dependency unit admissions; two deaths occurred. Of cases requiring hospital admission, RSV was listed as the primary diagnosis in 113/169 cases (66.9%); 63/169 admitted cases (37.3%) had a major comorbidity. Of all cases, 55.4% were in children < 5 years of age (20.9% hospitalised); 35.7% in children < 2 years of age (24.3% hospitalised), and 19.1% in children < 12 months of age (27.5% hospitalised). Children under five years of age made up 78.1% of admissions, a rate of 9.0 admissions per 1,000 children over the 18-month study period, with an average age of 15.8 months (standard deviation, SD: 13.1 months) in this cohort. Indigenous children aged < 5 years were over-represented in cases (rate ratio, RR: 1.6; 95% confidence interval [95% CI]: 1.3-1.9) and admissions (RR: 1.6; 95% CI: 1.0-2.4). Antibiotics were prescribed to 48.5% of admitted cases under two years of age, despite documented bacterial infection in only 26.3% of these cases; antibiotic prescription was significantly higher in those who received a chest X-ray (p < 0.001). Of all cases, 33.5% occurred in July 2022 alone, with greater than 75.0% of cases occurring during June-August 2022. RSV showed year-round activity with a distinctive winter peak in 2022; however, this season was likely affected by coronavirus disease 2019 (COVID-19) restrictions and behaviours. Ongoing surveillance is required to better understand the epidemiology and seasonality of RSV in Central Queensland.

SCOPE AND NATURE OF CHANGES IN THE CRISIS MANAGEMENT SYSTEM IN THE CIRCUMSTANCES OF CLIMATE CHANGE ON THE EXAMPLE OF THE POMERANIAN VOIVODESHIP

With the increasing impacts of climate change, especially in the context of rising temperatures,frequency and severity of extreme events, research into the preparedness of emergencymanagement systems is becoming a priority for governments and the international community.The purpose of the research was to identify the current state of the emergency managementsystem in the context of climate change and to assess its preparedness to operate under threatsgenerated by those changes, and to formulate proposals for improvement. The conducted researchwas based on an analysis of strategic documents, legal acts and an assessment of climate changeadaptation plans. An analysis of the preparedness of civil protection system structures for actionunder conditions of climate change at the local, regional and national levels was also carried out.The results of the research showed that the emergency management system of the PomeranianVoivodeship is insufficiently prepared for effective action under existing climate change risks.The discussion of the research results clearly indicates the need for systemic measures, coveringlegislative, organizational, educational and economic areas. Further research should focus ondeveloping tools for assessing the preparedness of civil protection system structures for actionunder conditions of climate change, and on developing more comprehensive adaptation plansat a local level. In addition, it is important to continue research on improving the warning andalert system, as well as increasing public awareness of climate risks. This research is a step towardeffectively preparing the emergency management system for operations under a changing climate,thus providing a more secure environment for local communities.

Innovation, affordability, access: Alzheimer disease drugs and the Inflation Reduction Act.

This analysis examines the implications of new Alzheimer disease drugs in the era of the Inflation Reduction Act (IRA). It focuses on balancing innovation in Alzheimer disease treatment with affordability and access, assessing the impact on Medicare's budget, patient cost, and health care system readiness. A comprehensive review was conducted, synthesizing information from recent FDA drug approvals, drug pricing models, Medicare coverage policies, and the updated regulations under the IRA. This analysis reflects on the broader clinical and economic consequences of introducing new Alzheimer disease treatments. The study employs a qualitative review of existing literature, policy documents, and economic data. It explores the implications of Alzheimer disease drugs on health care policy, analyzing the economic and clinical impacts within the current health care landscape in the US. The study highlights the economic challenges posed by the high costs of new Alzheimer disease drugs, contrasting with their moderate clinical benefits and potential risks. It discusses the limitations of the IRA in regulating drug prices and the resulting implications for Medicare's budget. Additionally, it examines disparities in health care access and system preparedness for these newtreatments. The study findings underscore the need for a comprehensive approach to ensure fair pricing and equitable access to Alzheimer disease treatments. It suggests the application of frameworks such as the ISPOR Value Flower, focusing on diversity, equity, and comprehensive economic evaluations, to navigate the evolving landscape of Alzheimer disease treatment in the context of the IRA.

Analysis of Fire Emergency Response Readiness at Oil and Gas Company

Introduction: Fire is one of the dangers that is often found in the oil and gas industry. A fire preparedness system is needed by companies to avoid dangers and risks that have the potential to cause damage, injury or death. Objective: This research aims to see the readiness of Fire Emergency Response system. The results of this research can be used as a basis for developing policies and programs Fire Emergency Response work. Method: This research uses the FERRAT Form as the basis for the research. The instrument used in this research is the FERRAT Form. Field observations were carried out to see directly the field conditions and the form filling process. Result: The results of this research show that the company's readiness in implementing the Fire Emergency Response system as a whole has reached an average of &lt;90% with an overall value of 40.33%. Conclusion: It is hoped that with this research, companies can carry out independent evaluations and immediately initiate improvements related to risk-based system design, adequacy levels according to potential fire risks and ensuring emergency response equipment is always in a ready-to-operate and alert condition

Envisioning how to advance the MASH field.

Since 1980, the cumulative effort of scientists and health-care stakeholders has advanced the prerequisites to address metabolic dysfunction-associated steatotic liver disease (MASLD), a prevalent chronic non-communicable liver disease. This effort has ledto, among others, the approval of the first drug specific for metabolic dysfunction-associated steatohepatitis (MASH; formerly known as nonalcoholic steatohepatitis). Despite substantial progress, MASLD is still a leading cause of advanced chronic liver disease, including primary liver cancer. This Perspective contextualizes the nomenclature change from nonalcoholic fatty liver disease to MASLD and proposes important considerations to accelerate further progress in the field, optimize patient-centric multidisciplinary care pathways, advance pharmacological, behavioural and diagnostic research, and address health disparities. Key regulatory and other steps necessary to optimize the approval and access to upcoming additional pharmacological therapeutic agents for MASH are also outlined. We conclude by calling for increased education and awareness, enhanced health system preparedness, and concerted action by policy-makers to further the public health and policy agenda to achieve at least parity with other non-communicable diseases and to aid in growing the community of practice to reduce the human and economic burden and end the public health threat of MASLD and MASH by 2030.

Automatic speech recognition for Indonesian medical dictation in cloud environment

&lt;span lang="EN-US"&gt;This paper introduces SPWPM, an automatic speech recognition (ASR) system designed specifically for Indonesian medical dictation. The main objective of SPWPM is to assist medical professionals in producing medical reports and diagnosing patients. Deployed within a cloud computing service architecture, SPWPM strives to achieve a minimum speech recognition accuracy of 95%. The ASR model of SPWPM is developed using Kaldi and PyChain technologies—creating a comprehensive training dataset involving collaboration with PT Dua-Empat-Tujuh and Harapan Kita Hospital. Several optimization techniques were applied, including language modeling with smoothing, lexicon generation using the Grapheme-to-Phoneme Converter, and data augmentation. The readiness of this technology to assist hospital users was assessed through two evaluations: the SPWPM architecture test and the SPWPM speech recognition test. The results demonstrate the system's preparedness in accurately transcribing medical dictation, showcasing its potential to enhance medical reporting for healthcare professionals in hospital environments.&lt;/span&gt;

Covid-19: Lessons from the pandemic in sub-Saharan Africa relevant to the WHO IA2030 vaccination agenda

While the global need to promote vaccination against viral illnesses is recognized, there are fundamental reasons for the failure of many programs. The World Health Organization has emphasized that the causes of low vaccine use must be understood and addressed in order to increase people’s demand for immunization services, and such understanding is central to promoting vaccine acceptance, as called for in the current WHO IA2030 initiative. Immunization programs remain fundamental to both pandemic preparedness and robust health systems. But, to achieve the goals of IA2030 requires improved targeting and reach to protect against viral illness and other global pathogens, hence the need for creative and innovative community engagement to increase vaccine uptake, and the relevance of learning from past pandemics. In sub-Saharan Africa, important lessons were learned during the Covid-19 pandemic; many of these are now broadly applicable to enhance current programs to promote vaccine acceptance such as the WHO IA2030 initiative. Strategies that helped increase vaccine uptake in Africa included six approaches to health promotion called for by the 2017 Lancet Commission on the future of health in sub-Saharan Africa. (Adoption of a community empowerment approach; Use of inclusive, people-centered strategies; Provision of innovative education; Creation of novel and improved tools; Training personnel to be mindful of, and responsive to, local needs; and Endorsement of non-traditional avenues to engage and inform). This commentary describes the principles underlying these six approaches, and summarizes ways in which their use contributed to programs working to increase vaccine uptake in sub-Saharan Africa that are applicable in a global context.

Perceptions of policymakers and ethicists on ethical considerations in the conduct of research during disease outbreaks in Nigeria

Background There is a dearth of literature on the perspectives of stakeholders from countries in Africa on the institution of a research culture as part of a holistic system of pandemic preparedness and response. This study aimed to explore the perspectives of policymakers, representatives from Research Ethics Committees (RECs), and international bioethics experts on the ethics of conducting research during infectious disease outbreaks in Nigeria. Methods We conducted structured interviews with six policymakers actively engaged in disease outbreak response. The interview themes included systems and structures for research, local researcher competency, regulatory oversight, study types, ethical review approaches, and integrating research into outbreak response. We further engaged 12 participants including REC members from Nigeria and Liberia, international bioethics experts, and study co-investigators in a structured discussion to appraise and expand on themes identified during the interviews at a 2-day meeting in December 2018. We also held two virtual consultations afterwards. The findings from these processes were synthesized to develop a comprehensive report. Results Participants stressed the significance of conducting research during disease outbreaks to understand causal factors, evaluate public health measures, and inform future prevention and treatment strategies, and identified the need for clear ethical guidelines for RECs during outbreaks. Participants proposed a sliding scale for prioritizing categorized studies, emphasizing immediate solutions over future-focused research. Discussants proposed a "systems approach" to ethics review, emphasizing interdependence, governance structures, communication infrastructure, effective communication with policymakers, and a funding structure. Conclusion Conducting ethical research during disease outbreaks requires a comprehensive, context-dependent approach, involving stakeholders, and ensuring robust ethical oversight through proficient RECs. The proposed "System Approach" offers a model for sustainable and effective ethics review during outbreaks, fostering locally relevant and socially valuable research while prioritizing the well-being of research participants and communities.

Evaluation of urban flood susceptibility through integrated Bivariate statistics and Geospatial technology.

Flood disasters are frequent natural disasters that occur annually during the monsoon season and significantly impact urban areas. This area is characterized by impermeable concrete surfaces, which increase runoff and are particularly susceptible to flooding. Therefore, this study aims to adopt Bi-variate statistical methods such as frequency ratio (FR) and weight of evidence (WOE) to map flood susceptibility in an urbanized watershed. The study area encompasses an urbanized watershed surrounding the Chennai Metropolitan area in southern India. The essential parameters considered for flood susceptibility zonation include geomorphology, soil, land use/land cover (LU/LC), rainfall, drainage, slope, aspect, Topographic Wetness Index (TWI), and Normalized Difference Vegetation Index (NDVI). The flood susceptibility map was derived using 70% of randomly selected flood areas from the flood inventory database, and the other 30% was used for validation using the area under curve (AUC) method. The AUC method produced a frequency ratio of 0.806 and a weight of evidence value of 0.865 contributing to the zonation of the three classes. The study further investigates the impact of urbanization on flood susceptibility and is further classified into high, moderate, and low flood risk zones. With the abrupt change in climatic scenarios, there is an increase in the risk of flash floods. The results of this study can be used by policymakers and planners in developing a preparedness system to mitigate economic, human, and property losses due to floods in any urbanized watershed.

INADEQUATE CARE OF HYPERTENSION AND OTHER NON-COMMUNICABLE DISEASES DURING THE COVID-19 PANDEMIC IN SOUTH AFRICA

Objective: In the setting of an already overburdened healthcare system, South Africa has a high burden of hypertension and other non-communicable diseases (NCDs), and the country experienced a high COVID-19 caseload. The aim of this study was to examine the perceptions and experiences of 1) healthcare professionals (HPs) on the preparedness of health systems to provide NCD care and of NCD management during the COVID-19 pandemic, and 2) people living with NCDs (PLWNCDs) on the care they received for hypertension and other NCDs during the COVID-19 pandemic in South Africa. Design and method: Across the country, we recruited a convenience sample of 1) HPs who worked in healthcare management i.e., public health officials and healthcare workers who provided care and engaged with patients in any healthcare capacity, and 2) PLWNCDs with at least 1 NCD. Questionnaires included quantitative and open-ended follow-up questions. Quantitative analyses were conducted using SPSS. The qualitative open-ended questions were evaluated using content analysis with inductive reasoning. Results: There were 31 HPs and 79 PLWNCDs (59 with hypertension) included in this cross-sectional study. HPs perceived COVID-19 care to be adequate, while NCD care was poor during the pandemic. There were service disruptions including for emergency and specialised NCDs care. Strategies for the care of non-COVID-19 illnesses during the pandemic were absent. This would have serious long-term consequences for PLWNCDs and the healthcare system. Perceptions of inadequate hypertension and other NCD care were reiterated by PLWNCDs; 49% felt they received ’very little’ or no adequate care. 18% had a scheduled appointment cancelled. Additionally, many PLWNCDs (52%) felt anxious, lonely, or frightened during the pandemic and 15% felt their mental health had deteriorated. The utility of digital health in future was positively perceived by both HPs and PLWNCDs and may be able to improve health provision during crises. Conclusions: Policies are required 1) so that NCD care will not be overlooked during future crises and 2) to encourage PLWNCDs to timeously access healthcare services during such periods. Such strategies may incorporate digital health apps to improve care and target the mental healthcare needs of PLWNCDs.

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.

The impact of the COVID-19 pandemic on HIV treatment gap lengths and viremia among people living with HIV British Columbia, Canada, during the COVID-19 pandemic: Are we ready for the next pandemic?

The SARS-CoV-2 (COVID-19) pandemic has impacted the care of people living with HIV (PLWH). This study aims to characterize the impact of the pandemic on the length of HIV treatment gap lengths and viral loads among people living with HIV (PLWH) in British Columbia (BC), Canada, with a focus on Downtown Eastside (DTES), which is one of the most impoverished neighbourhoods in Canada. We analyzed data from the HIV/AIDS Drug Treatment Program from January 2019 to February 2022. The study had three phases: Pre-COVID, Early-COVID, and Late-COVID. We compared results for individuals residing in DTES, those not residing in DTES, and those with no fixed address. Treatment gap lengths and viral loads were analyzed using a zero-inflated negative binomial model and a two-part model, respectively, adjusting for demographic factors. Among the 8982 individuals, 93% were non-DTES residents, 6% were DTES residents, and 1% had no fixed address during each phase. DTES residents were more likely to be female, with Indigenous Ancestry, and have a history of injection drug use. Initially, the mean number of viral load measurements decreased for all PLWH during the Early-COVID, then remained constant. Treatment gap lengths increased for all three groups during Early-COVID. However, by Late-COVID, those with no fixed address approached pre-COVID levels, while the other two groups did not reach Early-COVID levels. Viral loads improved across each phase from Pre- to Early- to Late-COVID among people residing and not residing in DTES, while those with no fixed address experienced consistently worsening levels. Despite pandemic disruptions, both DTES and non-DTES areas enhanced HIV control, whereas individuals with no fixed address encountered challenges. This study offers insights into healthcare system preparedness for delivering HIV care during future pandemics, emphasizing community-driven interventions with a particular consideration of housing stability.

Swedish crisis preparedness planners' understanding and sense‐making of preparedness work in a public organisation: Implications for future development

AbstractThe sometimes rapid development of (new) threats and extraordinary events calls for a robust, flexible, and well‐equipped civil crisis preparedness system to respond and limit the damage of crisis events. To achieve this, Swedish municipalities and regions are required by law to regularly perform and report risk and vulnerability analysis ‘bottom up’ to governmental agencies. When performed in large and complex public organisations, crisis preparedness planning activities require negotiation, coordination, and cooperation among large numbers of people. Crisis preparedness planners facilitate and produce this proactive crisis preparedness work. However, research has revealed that preparedness planners face organisational and practical challenges when performing their work.This study aims at increasing the knowledge of crisis preparedness planners' understandings and sense‐making of their work in one Swedish region when fulfilling the requirements set by the Swedish national regulations. The objectives of this paper are to present findings on (1) how the preparedness planners understand and make sense of their crisis preparedness work; (2) which major enablers and barriers that affect their work; and, based on the results, (3) forward possibilities for improvement.Semi‐structured interviews were conducted with the 10 crisis preparedness planners. A narrative stepwise analysis approach was applied. The analysis results revealed challenges in the crisis preparedness work due to uncommitted managers, unclear goalsetting, and the planners' sometimes limited skills in crisis preparedness work. It also report on managers' autonomy and varying focus on crisis preparedness, planners' unclear individual work space, and many different and sometimes strong voices about the work performance and content. This raises the question whose interest that in practice sets the agenda for crisis preparedness planning in the organisation.The study demonstrates needs for increased organisational sense‐making on the concept of crisis preparedness and how it should be performed, and for conceptual and technical skills to perform the preparedness work. To increase sense‐making and strengthen generic subjectivity on crisis preparedness work, further discussions are needed about enablers and barriers in preparedness work and an increased joint focus on possible internal and external threats. There are also needs for increased manager‐coworker‐planner cooperation when developing the preparedness work, and strategic changes in the organisational development involving goalsetting for crisis preparedness ‘top‐down’ as well as ‘bottom‐up’.

Analysing health system capacity and preparedness for climate change

Analysing health system capacity and preparedness for climate change