Public health competences through the lens of the COVID-19 pandemic: what matters for health workforce preparedness for global health emergencies

New WHO Priorities in the European Region and Health Workforce Competencies: A Rapid Assessment of Capacities and Gaps in Public Health Competencies Frameworks

The 74th WHO Europe Regional Committee introduced a set of health priorities comprising core areas of public health and expanded tasks to respond to multiple crises and emergent needs of populations and health systems. No systematic procedure of competencies development and routine review has been established to align changing health policy priorities and workforce. We argue for a transformative approach to competencies development from theoretical constructs to actionable pathways. A rapid qualitative assessment of three of the most relevant public health workforce competencies frameworks in the WHO European region was undertaken using selected priorities and the public health workforce as cases. The results highlight that existing competencies frameworks provide some helpful guidance, but gaps exist in specific and generic competencies and leadership. Further research and policy are needed, calling European and national policymakers to action to invest in public health competencies development to respond to evolving priorities.

A review of national public health strategies in selected countries

National public health strategies play an essential role in defining a country's vision, policy direction and approaches for ensuring the health of its population. Gaining an understanding of the public health issues which countries prioritize, and how these health issues are improved upon, may provide insights into effective methods of national public health strategy development and delivery. National public health strategies were identified for ten countries and a descriptive analysis of strategy contents and development was undertaken. All of the identified national public health strategies included an overall aim of improving health and wellbeing, and all strategy scopes extended beyond the health domain. Themes or priorities frequently identified included promoting healthy living or behaviors, the strengthening of public health, and equity or equality. Approaches to strategy implementation were considered to be prescriptive or interpretive, with prescriptive approaches including detailed implementation plans with specific actions and key performance indicators, and interpretive approaches including high-level strategic actions along with principles to support their implementation. National public health strategy development was informed by both evidence and engagement with stakeholders, including the public, experts, and representatives from governmental and non-governmental organizations at local, regional and national levels. Overall, while the information gained in this analysis assists in the development of a national public health strategy, variation observed across the included strategies indicates that consideration should be given to factors which vary from country to country. These factors include the national health profile, the political context, underpinning and associated policies, and the availability of resources.

Competency-based and problem-based learning methodologies: the WHO and ISS European Public Health Leadership Course

The WHO European Programme of Work, 2020-2025 'United Action for Better Health in Europe', backed up by the Regional Director's vision, recognizes the need to invest in public health leadership towards addressing the multifaceted public health challenges in the WHO European Region. The WHO Regional Office for Europe in collaboration with the Italian National Institute of Health (Istituto Superiore di Sanità-ISS) developed the first European Public Health Leadership Course to support Member States in building their capacity. The course was delivered in blended modality over a period of 3 weeks (7-25 November 2022). It was structured according to the Competency-Based Education model and Problem-Based Learning methodology. Data analyses were conducted on the cohort of the course's 'Completers'. The formative assessment was conducted by a pre-post training questionnaire, while the summative assessment included three evaluation tools, in which participants were required to get a minimum overall mean score of 75/100 to pass the course. Thirty-eight participants passed all the summative tests out of 39 enrolled. The analysis of the multiple-choice questions showed an increase in knowledge. Survey results showed a high level of satisfaction. The course offered a mix of both theoretical and practical approaches, allowing participants to gain in-depth knowledge and develop skills that can be applied in their daily work. The successful completion of the course is expected to promote the development of the public health workforce in the eastern and southern parts of the WHO European Region.

Implications for developing global health education in China: evidence from an undergraduate teamwork with role-play

BACKGROUND

Since 2012, China has had one degreed undergraduate programme in global health for domestic students. The International Health Project Management course is a core component of this programme's curriculum, bridging theoretical knowledge to practice in global health engagement. This study aims to evaluate whether introducing a teamwork and role-play module would meet the learning objectives, including improving students' perception of global health, enhancing their understanding of the management processes for global health projects, and eventually developing competencies for effective global health involvement.

METHODS

The teamwork role-play module was used in a scenario assuming that all students played a specific role in project management in the 'Health System Enhancement for Pandemic Preparedness in Southeast and South Asian Countries' programme. This programme called for proposals to implement a project in at least one country in Southeast or South Asia. We conducted a content analysis using two types of materials from the students: (1) concept note and proposal presentations and (2) students' responses to the open-question feedback survey with four questions.

RESULTS

Students addressed the colonial origins of global health and its evolving definition, emphasising the need for a broader interdisciplinary approach. They perceived China's role in global health as evolving from a recipient to a donor, collaborator or participator, with a focus on enhancing soft power. However, their inadequate background knowledge of global health issues hindered their ability to undertake the tasks in depth. Students provided positive feedback on the teamwork with the role-play module, highlighting improved efficiency, broader and deeper learning through communication, increased participation, etc. Challenges such as poor leadership in teamwork, communication breakdowns and unequal workload distribution were identified.

CONCLUSIONS

Students showed a comprehensive understanding of managing a global health project through their teamwork tasks. Introducing teaching assistants to support teamwork, providing more hands-on opportunities, and integrating a broader range of disciplines into the curriculum will be crucial for the continued development of effective global health education programmes.

Psychological safety in enhancing the competence of nurse educators among early career nursing faculty in Japan: A cross-sectional study

Background

Given the diverse roles and responsibilities expected of academic nurse educators, it is essential that they acquire relevant nursing educator competencies. Early career nursing faculty often struggle to engage in their tasks. Therefore, systematic support is crucial in developing the necessary capacities for early career nursing faculty. In organizational sociology, the positive interaction between organizational and individual resources enhances the competence of nurse educators. Psychological safety enhances organizational members' ability to cope with challenges and perform effectively. It may also foster a high sense of coherence, linked to improved job performance and competence in nursing faculty. Both psychological safety and coherence promote work engagement, further boosting nurse educator competence.

Aim

This study explored the relationships between psychological safety, sense of coherence, work engagement, and competence of nurse educators among assistant professors and assistants in nursing education.

Design

A cross-sectional survey design was used. Data were collected from 164 early career nursing faculty using an anonymous self-administered web-based questionnaire. The study measured the psychological safety, sense of coherence, work engagement, and competence of academic nurse educators. The mediating effects of a sense of coherence and work engagement on the relationship between psychological safety and competency were assessed using the PROCESS macro model. Bootstrapping with 5,000 re-samples was used to determine the significance of the mediating effects.

Setting

The study was conducted from October 1 to December 31, 2022, at nursing universities in Japan.

Results

Positive correlations were identified among psychological safety, sense of coherence, work engagement, and the competence of nurse educator. The sense of coherence and work engagement indirectly mediated the relationship between psychological safety and the competence of nurse educator. A serial multiple mediation model demonstrated that psychological safety indirectly influenced the competence of nurse educator through a sense of coherence and work engagement.

Conclusions

Supportive organizational environments foster a sense of coherence, enabling effective resource utilization and the competence of nurse educator development. While structured intervention programs such as faculty development are vital, establishing supportive systems that nurture adaptable qualities and use various resources is also essential. A positive work environment can create a cycle of increasing competency through positive attitudes toward work.

The Urgent Need for Disaster Education as a Core Competency in Accredited Schools and Colleges of Public Health by the Council on Education for Public Health

Public Health is essential to disaster preparedness, mitigation, response, and recovery. This has never been more evident than during the COVID-19 pandemic when public health was the disaster response lead. However, students are graduating from accredited schools and colleges of public health with limited or no education in disaster management. This is a crisis unto itself, and it is incumbent upon The Council on Education for Public Health (CEPH) to take immediate action. Public health preparedness should be recognized as a core element in public health curricula, and practical experiences, such as drills and simulations, are necessary to equip students with the confidence and competencies needed in high-stress situations. The need for such preparedness education extends beyond the COVID-19 pandemic. It is a crucial step for creating a resilient and competent public health workforce capable of safeguarding community health in the face of complex and emerging challenges.

The effectiveness of competency-based global health education programs for medical students

PURPOSE

This study aimed to develop a competency-based global health education (GHE) program for medical students and analyze its effectiveness.

METHODS

The study had a pretest-posttest control group design. The program was developed based on the eight global health competency domains for medical students and implemented for 18 hours over 6 weeks beginning in September 2023. The intervention and control groups comprised 34 students and 41 students, respectively. The analytical methods used were t-test, chi-square test, and analysis of covariance.

RESULTS

Experience with global health activities and pretest scores were controlled as covariates to exclude the effects of participants' general characteristics and pretest scores. The intervention group had outscored the control group on interest in a global health career and the necessity of GHE and also showed significantly higher posttest scores on global competence, global citizenship, and global health competence. Students were generally satisfied with the GHE program.

CONCLUSION

A global health competency-based GHE program effectively increases medical students' interest in global health careers, their understanding of the need for GHE, and their global competence, global citizenship, and global health competence. This study is expected to promote GHE program development and research.

A systematic mapping of public health master's and structured doctoral programs in Germany

BACKGROUND

Well-trained public health professionals are key to addressing both global and local public health challenges of the twenty-first century. Though availability of programs has increased, the population health science (PHS) and public health (PH) higher education landscape in Germany remains scattered. To date, no comprehensive overview of programs exists.

OBJECTIVES

This study aimed to map PHS and PH master's and structured doctoral programs in Germany, including selected program characteristics, curricula and target competencies.

METHODS

We conducted a systematic mapping of PHS and PH programs in Germany following a prospectively registered protocol ( https://doi.org/10.17605/OSF.IO/KTCBA ). Relevant master's and doctoral programs were identified by two study authors independently searching a comprehensive higher education database, which was, for doctoral programs, supplemented with a google search. For PHS programs, general characteristics were mapped and for the subset of PH programs, in-depth characteristics were extracted.

RESULTS

Overall, 75 master's and 18 structured doctoral PHS programs were included. Of these, 23 master's and 8 doctoral programs focused specifically on PH. The majority of PHS master's programs awarded a Master of Science degree (55 out of 75 programs). The PH master's program curricula offered various courses, allowing for different specializations. Courses on topics like public health, epidemiology, health systems (research) and research methods were common for the majority of the master's programs, while courses on physical activity, behavioral science, nutrition, and mental health were offered less frequently. Structured PH doctoral programs were mainly offered by medical faculties (6 out of 8 programs) and awarded a doctorate of philosophy (Ph.D.) (6 out of 8 programs). PH doctoral programs were very heterogeneous regarding curricula, entry, and publication requirements. There was a broad geographical distribution of programs across Germany, with educational clusters in Munich, Berlin, Bielefeld and Düsseldorf.

CONCLUSION

Germany offers a diverse landscape of PHS and PH master's programs, but only few structured doctoral programs. The variety of mandatory courses and competencies in these programs reflect Germany's higher education system's answer to the evolving demands of the PH sector. This review may aid in advancing PH education both in Germany and globally.

Trust Building in Public Health Approaches: The Importance of a "People-Centered" Concept in Crisis Response

Purpose

To argue for trust-building as a key solution for responding to public health crises in the face of political ambiguity in international health governance.

Patients and Methods

This perspective piece reviews fundamental concepts and discusses future directions using secondary data from open-access sources.

Results

The promise of learning from Covid-19 and previous public health crises, along with the growing recognition of a 'Health For All Policies' approach, clash with siloed preparations, management, and recovery plans for future emergency crises. Trust is proposed as a possible solution to overcome these limitations. It acts as a binding force that unites individuals within the community, fostering a sense of belonging and participation. Trust-building is viewed as a "People-Centered" approach in Crisis Response, aimed at creating active and resilient communities to foster preparation and readiness, respond to emergent risks, facilitate recovery, and mitigate risks. A remaining question is how to measure and identify the dimensions and determinants of trust in specific circumstances. Some ideas are systematized to highlight the pathway to build trust in public health approaches, including transparency, education, robust and equitable health systems, strengthened social capital, stakeholders' engagement, and health workforce training.

Conclusion

Trust in public health approaches can be fostered through consistent delivery of quality care, a clear, shared vision, and values underpinned by ethical standards. It requires a commitment to stakeholder well-being, including staff, and the integration of reliability, integrity, and transparency into policies, strategies, and practices. Exemplary leadership, openness in resource utilization, addressing waste or corruption, and effective communication of these principles are essential.

Ethical preparedness in genomic medicine: how NHS clinical scientists navigate ethical issues

Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking.

Public health leadership in the COVID-19 era: how does it fit? A scoping review

The COVID-19 pandemic has put a lot of pressure on all the world's health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.

What makes health systems resilient? An analytical framework drawing on European learnings from the COVID-19 pandemic based on a multitiered approach

Introduction

The COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience in the context of pandemics. In addition to serving as a tool to analyse the preparedness and resilience of health systems, the framework is intended to provide guidance to decision-makers in health policy.

Methods

The analytical framework was developed based on a multitiered approach. A comprehensive review of the existing literature was conducted to identify relevant frameworks on health system resilience (published between 1 January 2000 and 30 November 2021) and determinants of resilience that emerged during the COVID-19 pandemic. Input was then gathered in several rounds of consultations with designated field experts and stakeholders, drawing on their experiences from the pandemic. Finally, the framework was empirically validated in several case studies.

Results

The framework distinguishes between prerequisites of resilience, pertaining to precautions to be taken in 'normal' times, and response strategies in the face of shocks. Both sections are further divided into six building blocks that were adapted from the WHO health system framework: governance and leadership, information and research, financing, physical resources, human resources, and service delivery. An overarching component on contextual factors-subdivided into situational, structural, cultural and international factors-represents an important addition to the existing spectrum of resilience frameworks.

Conclusions

Foundations for a resilient health system must be laid in 'normal' times and in all areas of the health system. In the face of a shock, adequate response strategies need to be developed. An essential learning from the COVID-19 pandemic has been that contextual factors of societies and subgroups play a major role in the ability of health systems to overcome a shock, as they impact the implementation and effectiveness of crisis management policies.

Public Health Nurses' Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study

OBJECTIVE

To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors-(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was "nurse-led" (directed by a nurse)-and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics.

RESULTS

In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill "identifying/applying evidence-based approaches to address public health issues." However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non-nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including "collaborating across the public health system" and "influencing policies external to the organization that affect community health." There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs.

CONCLUSIONS

Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.

Leadership: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response

The protracted nature of the COVID-19 pandemic demanded extraordinary efforts and innovation from public health agencies and their leaders. This is the first of 3 research briefs that highlight valuable experiences and opportunities that can be thought of as "bright spots" of the public health workforce's pandemic response. Using Public Health Workforce Interests and Needs Survey 2021 data, we qualitatively examined responses to an open-ended question about pandemic workforce experiences. Leadership was emphasized as a critical component of employees' experiences during the response, and 7 "leadership" subthemes were identified among 157 responses. Findings illustrate the importance of leaders prioritizing safe and supportive environments for employees. Respondents also highlighted the importance of leaders fostering teamwork alongside employees and advocating for and demonstrating appreciation for employees. In addition, effective leadership communication was reported to be motivational and alleviate uncertainty during crisis situations. Focusing on these leadership skills and competencies may aid the workforce during future emergency response events.

How can countries respond to the health and care workforce crisis? Insights from international evidence

Future global health security requires a health and care workforce (HCWF) that can respond effectively to health crises as well as to changing health needs with ageing populations, a rise in chronic conditions and growing inequality. COVID-19 has drawn attention to an impending HCWF crisis with a large projected shortfall in numbers against need. Addressing this requires countries to move beyond a focus on numbers of doctors, nurses and midwives to consider what kinds of healthcare workers can deliver the services needed; are more likely to stay in country, in rural and remote areas, and in health sector jobs; and what support they need to deliver high-quality services. In this paper, which draws on a Policy Brief prepared for the World Health Organization (WHO) Fifth Global Forum on Human Resources for Health, we review the global evidence on best practices in organising, training, deploying, and managing the HCWF to highlight areas for strategic investments. These include (1). Increasing HCWF diversity to improve the skill-mix and provide culturally competent care; (2). Introducing multidisciplinary teams in primary care; (3). Transforming health professional education with greater interprofessional education; (4). Re-thinking employment and deployment systems to address HCWF shortages; (5). Improving HCWF retention by supporting healthcare workers and addressing migration through destination country policies that limit draining resources from countries with greatest need. These approaches are departures from current norms and hold substantial potential for building a sustainable and responsive HCWF.

Profile, performance, and perception of pharmacist preparedness for the COVID-19 pandemic

INTRODUCTION

The lack of human resources for disease prevention and control is evident in times of health crisis, such as the COVID-19 pandemic. In public health emergencies, the capacity for adequate assistance and guaranteed access to pharmacological treatment are fundamental and contribute to impact reduction. We aimed to analyze the profile, performance, and characteristics related to the self-perception of preparedness among pharmacists who responded to the COVID-19 pandemic in Brazil.

METHOD

A cross-sectional study was conducted in two stages: content validation of a questionnaire and its application to a representative sample of pharmacists in Rio de Janeiro. The snowball technique was used to recruit participants. A logistic regression model was adjusted to determine the effects of the factors on the probability of a pharmacist feeling prepared to act during the pandemic.

RESULTS

Six experts approved and validated the questionnaire, and 376 pharmacists were included in the study, 60.6 % of whom were in places specially designated by health authorities to diagnose and treat COVID-19. Professionals participated in various activities related to pandemic demands, including medication management and population guidance. Postgraduate degrees increased the odds of participants feeling prepared to act during the pandemic. Furthermore, pharmacists who worked in reference facilities were more likely to feel ready than those who worked in other places. Professionals who knew treatment guidelines were almost three times more likely to feel prepared than the ones without the knowledge of treatment guidelines. Training or guidance on how to act during the pandemic increased pharmacists' odds of feeling prepared by 2.58 times.

CONCLUSION

Pharmacists actuated from diagnosis to treatment and participated in the health activities required during the pandemic. Factors contributing to the self-perception of preparedness were identified. Such factors can be targets for interventions to promote the preparedness of the workforce for future health emergencies.

Practical strategies to achieve resilient health systems: results from a scoping review

BACKGROUND

This paper presents the results of a systematic review to identify practical strategies to create the institutions, skills, values, and norms that will improve health systems resilience.

METHODS

A PRISMA 2020 compliant systematic review identified peer-reviewed and gray literature on practical strategies to make health systems more resilient. Investigators screened 970 papers to identify 65 English language papers published since 2015.

RESULTS

Practical strategies focus efforts on system changes to improve a health system's resilience components of collective knowing, collective thinking, and collaborative doing. The most helpful studies identified potential lead organizations to serve as the stewards of resilience improvement, and these were commonly in national and local departments of public health. Papers on practical strategies suggested possible measurement tools to benchmark resilience components in efforts to focus on performance improvement and ways to sustain their use. Essential Public Health Function (EPHF) measurement and improvement tools are well-aligned to the resilience agenda. The field of health systems resilience lacks empirical trials linking resilience improvement interventions to outcomes.

CONCLUSIONS

The rigorous assessment of practical strategies to improve resilience based on cycles of measurement should be a high priority.

Beyond the surface: unraveling global health curriculum insights through interviews of learners and educators using the CIPP model

PURPOSE

Our study aimed to delve beyond a surface-level understanding and explore the various dimensions of the global health curriculum from the perspective of both learners and educators using the Context, Input, Process, and Product (CIPP) model.

METHODS

From 2020 to 2021, interviews were conducted with a total of 10 individuals, including five students who had taken at least one elective course and at least one elective research course, three teaching assistants (TA), and two faculty members who had taken more than four global health courses in multiple phases in the global health curriculum. Semi-structured interview questions based on the CIPP model were used and qualitative data were analyzed through content analysis.

RESULTS

The study identified 12 sub-themes. Students held idealized views of global health careers and sought to bridge the gap through global health classes. They desired early exposure to global health courses, emphasizing both pre-medical and clinical phases. Challenges in adjusting course difficulty and recruiting faculty were identified, along with a preference for interactive teaching methods and offline discussions. The curriculum promoted reflection on medicine's essence, expanded career perspectives, and emphasized competencies like altruism, communication skills, and crisis management in the evolving global health landscape.

CONCLUSION

This study showed that a comprehensive approach is possible from the perspective of learners and educators by identifying strengths, weaknesses, and the value of the curriculum's goals, plans, implementations, and results through the CIPP model. For optimal curriculum design, a sequential approach from basic to advanced courses is essential, promoting hands-on global health experiences for students.

Professionalization of the public health workforce: scoping review and call to action

BACKGROUND

The 'WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce in the European Region' provides recommendations for strategic and systematic workforce planning around professionalization levers including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct as well as taxonomy and enumeration. It was based on a literature review till 2016. This scoping review aims to explore how the professionalization was documented in the literature between 2016 and 2022.

METHODS

Following the Joanna Briggs Institute guidelines, we searched Medline via PubMed, Web of Science, ERIC via EBSCO and Google Scholar and included studies on professionalization levers. Four critical appraisal tools were used to assess qualitative, quantitative, mixed methods studies and grey literature. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) was used for reporting.

RESULTS

Eleven articles included in this review spanned 61 countries, targeting undergraduate, master's, doctoral degrees and continuing professional development. Most of these documents were reviews. About half provided a definition of the public health workforce; more than half covered the taxonomy and included information about competences, but the use of frameworks was sporadic and inconsistent. Formal organization and the necessity of a code of conduct for the public health workforce were acknowledged in only two studies.

CONCLUSIONS

In spite of some efforts to professionalize the public health workforce, this process is fragmented and not fully recognized and supported. There is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the public health workforce worldwide.

Healthcare System Digital Transformation across Four European Countries: A Multiple-Case Study

Digitization has become involved in every aspect of life, including the healthcare sector with its healthcare professionals (HCPs), citizens (patients and their families), and services. This complex process is supported by policies: however, to date, no policy analysis on healthcare digitalization has been conducted in European countries to identify the main goals of digital transformation and its practical implementation. This research aimed to describe and compare the digital health policies across four European countries; namely, their priorities, their implementation in practice, and the digital competencies expected by HCPs. A multiple-case study was performed. Participants were the members of the Digital EducationaL programme invoLVing hEalth profEssionals (DELIVER), a project funded by the European Union under the Erasmus+ programme, involving three countries (Denmark, Italy, and Slovenia) and one autonomous region (Catalonia-Spain). Data were collected using two approaches: (a) a written interview with open-ended questions involving the members of the DELIVER project as key informants; and (b) a policy-document analysis. Interviews were analysed using the textual narrative synthesis and the word cloud policy analysis was conducted according to the Ready, Extract, Analyse and Distil approach. Results showed that all countries had established recent policies at the national level to address the development of digital health and specific governmental bodies were addressing the implementation of the digital transformation with specific ramifications at the regional and local levels. The words "health" and "care" characterized the policy documents of Denmark and Italy (309 and 56 times, 114 and 24 times, respectively), while "development" and "digital" (497 and 478 times, respectively) were common in the Slovenia document. The most used words in the Catalonia policy document were "data" and "system" (570 and 523 times, respectively). The HCP competencies expected are not clearly delineated among countries, and there is no formal plan for their development at the undergraduate, postgraduate, and continuing educational levels. Mutual understanding and exchange of good practices between countries may facilitate the digitalization processes; moreover, concrete actions in the context of HCP migration across Europe for employment purposes, as well as in the context of citizens' migration for healthcare-seeking purposes are needed to consider the differences emerged across the countries.

Association of continuity of carer and women's experiences of maternity care during the COVID-19 pandemic: A cross-sectional survey

BACKGROUND

Recent research highlights the impact of the COVID-19 pandemic on maternity services, although none to date have analysed the association between continuity of carer and how women felt about the changes to pregnancy care and birth plans.

AIM

To describe pregnant women's self-reported changes to their planned pregnancy care and associations between continuity of carer and how women feel about changes to their planned care.

METHODS

A cross-sectional online survey of pregnant women aged over 18 years in their final trimester of pregnancy in Australia.

FINDINGS

1668 women completed the survey. Most women reported at least one change to pregnancy care and birthing plans. Women receiving full continuity of carer were more likely to rate the changes to care as neutral/positive (p<.001) when compared with women who received partial or no continuity.

DISCUSSION

Pregnant women experienced many changes to their planned pregnancy and birth care during the COVID-19 pandemic. Women who received full continuity of carer experienced fewer changes to care and were more likely to feel neutral/positive about the changes than women who did not receive full continuity of carer.

The Relationship between Burnout and Wellbeing Using Social Support, Organizational Justice, and Lifelong Learning in Healthcare Specialists from Romania

Background and objectives: The goal of this study was to evaluate the levels of organizational justice, social support, wellbeing, and lifelong learning associated with the level of burnout experienced by medical and non-medical staff from public and private medical units. Materials and Methods: A cross-sectional study was conducted on a sample of 497 healthcare professionals: 367 medical personnel (M_age = 43.75 ± 0.50), including 216 nurses, 97 physicians, and 54 respondents with other medical specialities such as biologists, psychologists, physical therapists, pharmacists, etc., and 130 non-medical staff respondents (M_age = 45.63 ± 0.80), including administrative personnel. The Maslach Burnout Inventory, the ECO System, the Multidimensional Scale of Perceived Social Support, the WHO Wellbeing Index, and the revised Jefferson Scale of Physician's Lifelong Learning were used. Results: Burnout was measured in terms of emotional exhaustion, depersonalization, and personal accomplishment. Medical personnel registered higher values of personal accomplishment (38.66 ± 0.39 vs. 35.87 ± 0.69), while non-medical personnel registered higher values of depersonalization (6.59 ± 0.52 vs. 4.43 ± 0.26) and emotional exhaustion (27.33 ± 1.24 vs. 19.67 ± 0.71). In terms of organizational justice, higher scores were observed for medical staff, while non-medical staff recorded lower values (24.28 ± 0.24 vs. 22.14 ± 0.38). For wellbeing, higher scores were also registered for medical staff (11.95 ± 0.21 vs. 10.33 ± 0.37). Conclusions: For lifelong learning and social support, no statistically significant differences were found. In the case of the proposed parallel moderated mediation model, the moderated mediation effects of organizational justice, lifelong learning, and burnout on the relationship between social support and wellbeing were valid for every dimension of burnout (emotional exhaustion, depersonalization, and personal accomplishment), but lifelong learning was not found to be a viable mediating variable, even if high levels of social support correspond to high levels of lifelong learning and wellbeing.

A management perspective on resilience in healthcare: a framework and avenues for future research

Recent major health shocks, such as the 2014-16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.To fill this gap, this systematic literature review aims to provide a clear state of the art of the literature dealing with resilience in healthcare. Specifically, from the analysis of the theoretical articles and reviews, the key dimensions of resilience are identified, and a novel classification framework is proposed. The classification framework is then used to systematize extant empirical contributions. Two main dimensions of resilience are identified: the approach to resilience (reactive vs. proactive) and the type of crisis to deal with (acute shocks vs. chronic stressors). Four main streams of research are thus identified: (i) proactive approaches to acute shocks; (ii) proactive approaches to chronic stressors; (iii) reactive approaches to acute shocks; and (iv) reactive approaches to chronic stressors. These are scrutinised considering three additional dimensions: the level of analysis, the resources to nurture resilience, and the country context. The classification framework and the associated mapping contribute to systematising the fragmented literature on resilience in healthcare, providing a clear picture of the state of the art in this field and drawing a research agenda that opens interesting paths for future research.

Comparing impacts of the COVID-19 pandemic on training of public health Specialty Registrars starting before or after its onset

Objectives

To capture and compare the differences in experiences of public health Specialty Registrars who commenced training prior to the COVID-19 pandemic (pre-pandemic Registrars) and those who commenced training during the pandemic (post-pandemic Registrars).

Study design

This is a mixed methods study comprising a cross-sectional survey and participatory action research.

Methods

A questionnaire of 10 open and 5 closed questions exploring participants experience of training during the pandemic was sent to East Midlands Specialty Registrars. Thematic analysis and double coding were undertaken, coded based on pre- or post-pandemic Registrar status. Participatory action research was then undertaken in 2 rounds with 2 groups, based on pre/post-pandemic status to consolidate themes.

Results

The survey was completed by 17 Registrars (8 pre-pandemic, and 9 post-pandemic) and 19 Registrars took part in participatory action research. The findings showed pre-pandemic Registrars noted the importance of negative impacts on their mental health whilst post-pandemic Registrars were more positive and felt well supported in their training.

Conclusions

There is a stark difference in the impact of the pandemic for Registrars who started training before compared to during the pandemic. The training programme was not resilient to the impact of the pandemic. Robustness could be increased by encouraging early leadership experience and providing wellbeing support, particularly for post pandemic Registrars now and in future.

Revolutionizing the Public Health Workforce—A Policy Brief in Retrospect of the World Congress on Public Health Rome 2020

Background: The COVID-19 pandemic dramatically illustrates the consequences of inadequate prioritization of the Public Health Workforce (PHW). This Policy Brief introduces a Call for Action following the plenary session entitled “Revolutionising the Public Health Workforce (PHW) as Agents of Change” as part of the 2020 World Congress on Public Health.

Policy Options and Recommendations: In order to revolutionize the PHW, five long-term key approaches are proposed: 1. Transforming public health competencies through transdisciplinary education and inter-professional training; 2. Revolutionizing educational systems by shifting the public health paradigm; 3. Linking public health education and work opportunities; 4. Overcoming the paradoxical shortage and overproduction of graduates and 5. Developing adaptable, multisectoral agents of change.

Conclusion: Public health education of the future requires a paradigm shift towards a holistic understanding of public health, characterized by transdisciplinary education, inter-professional training and a closer integration of academia, health services, and communities.

Rapid evidence review: Policy actions for the integration of public health and health care in the United States

Objective

To identify policy actions that may improve the interface of public health and health care in the United States.

Methods

A rapid review of publicly-available documents informing the integration of public health and health care, and case examples reporting objective measures of success, with abstraction of policy actions, related considerations, and outcomes.

Results

Across 109 documents, there were a number of recurrent themes related to policy actions and considerations to facilitate integration during peace time and during public health emergencies. The themes could be grouped into the need for adequate and dedicated funding; mandates and shared governance for integration; joint leadership that has the authority/ability to mobilize shared assets; adequately staffed and skilled workforces in both sectors with mutual awareness of shared functions; shared health information systems with modernized data and IT capabilities for both data collection and dissemination of information; engagement with multiple stakeholders in the community to be maximally inclusive; and robust communication strategies and training across partners and with the public.

Conclusion

While the evidence does not support a hierarchy of policies on strengthening the interface of public health and health care, recurrent policy themes can inform where to focus efforts.

Core competencies in applied infectious disease epidemiology: a framework for countries in Europe

In 2009, the European Centre for Disease Prevention and Control (ECDC) developed a competency framework to support European Union countries and the European Commission in ensuring a competent public health workforce for Europe. The coronavirus disease (COVID-19) pandemic emphasised the importance of harmonised public health strategies and competencies across international boundaries, specifically for infectious diseases. This perspective presents the process to update the competency framework for applied infectious disease epidemiology, highlighting ECDC's efforts to support countries with using the framework. ECDC commissioned the Association of Schools of Public Health in the European Region (ASPHER) to update the framework through publication and dissemination of a technical report and a self-assessment tool linked to training resources. A mixed methods approach to gather input from experts in relevant specialities included qualitative interviews with 42 experts, workshops with ECDC Technical Advisory Group and an online survey of 212 public health professionals across Europe and beyond. Modifications resulted in 157 core competencies in 23 domains, each mapping to one of six subject areas of importance in applied infectious disease epidemiology. The framework serves as a basis to update the curriculum of the ECDC Fellowship programme with two alternative paths: intervention epidemiology or public health microbiology.

An integrative review of the continuing professional development needs for nurse educators

OBJECTIVES

The study aimed at describing the field of research in continuing professional development for nurse educators and the continuous education and development needs of nurse educators by asking: What research has been done in the field of continuing professional development of nurse educators? What are the continuing education and development needs and requirements reported for and by nurse educators?

DESIGN

An integrative review of peer-reviewed academic literature following a systematic search design.

DATA SOURCES

Qualitative, quantitative, and mixed methods publications in CINAHL, Cochrane Library, Web of Science, Embase, ERIC, and PubMed.

REVIEW METHODS

Search results were screened for full text and assessed for quality using the Mixed Methods Assessment Tool. Full texts were then thematic analysed using an inductive and reflective process.

RESULTS

The number of published academic articles about the continuing professional development for nurse educators is small (n = 13). The themes produced from the articles identify heterogenous development needs for nurse educators, clustered around four themes: (1) professional competencies (2) management and resources, (3) communication and collaboration, and (4) agency. The findings of this review show that nurse educators have multiple roles which have specific and multiple personal and institutional needs.

CONCLUSIONS

The results of this review show that the continuing professional development needs are heterogenous between nurse educators, yet share commonalities across departmental teams as a whole, and across different countries. This raises the issue of how these needs can or should be, focused on the sustainable development of nurse educators.

Pandemics and Other Health Crises: A Special Report from a European Parliament Workshop

Once an emergency has passed, general attention typically returns to dealing with day-to-day system management, and the opportunity to learn from the crisis and improve is missed. Lessons from the coronavirus disease 2019 (COVID-19) crisis must be learned, and the necessary changes made at all levels, both in terms of improving collaboration and strengthening health systems. This special report provides the conclusion of a workshop held in the European Parliament (EP) in Brussels, Belgium. The event explored the modalities of response and preparation to the COVID-19 pandemic, and to health crises in general. The workshop considered actions at different levels: international organizations (global level), European Union (EU) Member States ([MS] national level), and health services (local level). It provided an opportunity to look back at several initiatives taken during the pandemic, and to draw inspiration from them.

What Factors Influence the Interest in Working in the Public Health Service in Germany? Part I of the OeGD-Studisurvey

As in many European countries, the Public Health Service (PHS) in Germany has had considerable difficulties in attracting well-qualified personnel for decades. Despite ongoing political and societal debate, limited empirical research on possible causes and explanations is available. To identify areas of action, we explored reasons for the (lack of) interest in working in the PHS by conducting two cross-sectional surveys among 3019 medical students (MS), public health students, and students from other PHS-relevant fields (PH&ONM) in Germany right before (wave 1, 2019/2020) and during the COVID-19 pandemic (wave 2, 2021). While interest in working in the PHS among MS was low, it was considerably higher among PH&ONM. The prevalent underestimation of the importance of public health and low levels of knowledge about the PHS were identified as potential barriers. Although core activities of the PHS were often considered attractive, they were repeatedly not attributed to the PHS. A negative perception of the PHS (e.g., it being too bureaucratic) was prevalent among students with and without PHS interest, indicating that both a negative image and potentially structural deficits need to be overcome to increase attractiveness. Based on the findings, we propose approaches on how to sustainably attract and retain qualified personnel.

Experiences Shared by the (Future) Public Health Workforce during the COVD-19 Pandemic in Germany: Results of a Survey on Workload, Work Content, and Related Challenges among Students and Young Professionals

Although previous studies have focused on the adverse effects of the COVID-19 pandemic on various professional groups (particularly in the health and nursing care sector), this study aims to close a research gap by assessing perspectives of students and young professionals in epidemiology and public health in Germany in terms of shifts in workload, work content, and related challenges caused by the pandemic. We conducted a cross-sectional survey between mid-February and mid-March 2022. Quantitative data were analyzed via standardized mean differences. Qualitative data based on answers to open-ended questions were analyzed via a qualitative content analysis. Overall, 172 individuals participated in this survey. Results indicate that students felt burdened the most by lack of exchange with other students and lecturers. Study participants employed in public health experienced changes in their employment because they had changes in their work content- and administration, which was accompanied by a high burden due to the workload. Multiple demands that can have an impact on both acquired skills and mental health during the professional qualification phase were mentioned by the participants. Therefore, more in-depth analyses are needed to investigate the impact the pandemic will have on the (future) public health workforce in the long run.

Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study

The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.

Multi-, Inter-, and Transdisciplinarity within the Public Health Workforce: A Scoping Review to Assess Definitions and Applications of Concepts

In light of the current public health challenges, calls for more inter- and transdisciplinarity in the public health workforce are increasing, particularly to respond to complex and intersecting health challenges, such as those presented by the climate crisis, emerging infectious diseases, or military conflict. Although widely used, it is unclear how the concepts of multi-, inter-, and transdisciplinarity are applied with respect to the public health workforce. We conducted a scoping review and qualitative content analysis to provide an overview of how the concepts of multi-, inter-, and transdisciplinarity are defined and applied in the academic literature about the public health workforce. Of the 1957 records identified, 324 articles were included in the review. Of those, 193, 176, and 53 mentioned the concepts of multi-, inter-, and transdisciplinarity, respectively. Overall, 44 articles provided a definition. Whilst definitions of multidisciplinarity were scarce, definitions of inter- and transdisciplinarity were more common and richer, highlighting the aim of the collaboration and the blurring and dissolution of disciplinary boundaries. A better understanding of the application of multi-, inter-, and transdisciplinarity is an important step to implementing these concepts in practice, including in institutional structures, academic curricula, and approaches in tackling public health challenges.

Key Influencing Factors and Optimization Strategy of Epidemic Resilience in Urban Communities-A Case Study of Nanjing, China

COVID-19 has posed a significantly severe impact on both people’s lives and the global economic development. Increasing the community epidemic resilience will considerably improve the national public health emergency response capacity from bottom to top. This study identifies the influencing factors of community epidemic resilience through systematic literature review under the 4R framework, then obtains the relationships of influencing factors through Interpretive structural model, and finally assesses the performance of epidemic resilience using PROMETHEE II method through empirical cases in Nanjing, China. The results show that: (1) Eight factors influencing the epidemic resilience of community are identified, and the economic level plays the root role; (2) Community epidemic resilience can be improved from robustness, rapidity, redundancy and resourcefulness aspects; (3) Through the empirical analysis, the epidemic resilience ranking of community can be displayed (Community D > T > S > F); (4) Additionally, the performance and sensitivity analysis of influencing factors in each community can be demonstrated. (5) Finally, four implications are proposed, namely, allocating public resources rationally, significantly increasing the economic level, ensuring the accuracy of information delivery and conducting disaster learning.

Symptoms of Burnout Syndrome among Physicians during the Outbreak of COVID-19 Pandemic—A Systematic Literature Review

Background: Studies in the recent decades show that the medical profession has a high risk to develop burnout due to constant exposure to mental and physical suffering or death. The pandemic period induced additional stress for healthcare professionals due to the likelihood of a high rate of infection, long working shifts, using protective equipment, staying away from family, implementing new medical procedures. The present study is focusing on assessing the prevalence of burnout among physicians working in the healthcare system during the COVID-19 pandemic, and discovering the main factors associated with burnout syndrome among the population of physicians. Material and methods: A systematic review was conducted by searching PubMed, Wiley, and Google Scholar in November 2021. A total of 35 studies were eligible for the evaluation. Results: The samples ranged from 39 to 3071 physicians, and the overall burnout ranged from 14.7% to 90.4%. Sociodemographic characteristics associated with a high prevalence of burnout were the female gender, less experienced, not having children, and single marital status, associated with high levels of anxiety, depression, and stress in the female gender. The highest level of burnout among all the studies was 90.4% on a sample of physicians from the Republic of Korea, 80.2% among psychiatrists in Saudi Arabia, followed by a study in Ireland with a 77% level of burnout among senior and specialist physicians, and 74.7% prevalence of burnout for emergency physicians in USA. Conclusions: During the pandemic, the factors that contribute to burnout are the lack of personal protective equipment and the violence of issues related to organizational health; the high prevalence of burnout symptoms is associated with anxiety, depression, and stress.

Relevant HRH leadership during public health emergencies

BACKGROUND

Inadequate leadership capacity compounds the world's workforce lack of preparedness for outbreaks of all sizes, as illustrated by the COVID-19 pandemic. Traditional human resources for health (HRH) leadership has focused on determining the health workforce requirements, often failing to fully consider the unpredictability associated with issues such as public health emergencies (PHE).

MAIN ARGUMENTS

The current COVID-19 pandemic demonstrates that policy-making and relevant leadership have to be effective under conditions of ethical uncertainty and with inconclusive evidence. The forces at work in health labor markets (HLM) entail leadership that bridges across sectors and all levels of the health systems. Developing and applying leadership competencies must then be understood from a systemic as well as an individual perspective. To address the challenges described and to achieve universal health coverage (UHC) by 2030, countries need to develop effective HRH leaderships relevant to the complexity of HLM in the most diverse contexts, including acute surge events during PHE. In complex and rapidly changing contexts, such as PHE, leadership needs to be attentive, nimble, adaptive, action oriented, transformative, accountable and provided throughout the system, i.e., authentic, distributed and participatory. This type of leadership is particularly important, as it can contribute to complex organizational changes as required in surge events associated with PHE, even in in the absence of formal management plans, roles, and structures. To deal with the uncertainty it needs agile tools that may allow prompt human resources impact assessments.

CONCLUSIONS

The complexity of PHE requires transformative, authentic, distributed and participatory leadership of HRH. The unpredictable aspects of the dynamics of the HLM during PHE require the need to rethink, adapt and operationalize appropriate tools, such as HRH impact assessment tools, to redirect workforce operations rapidly and with precision.

The Environment Encouraging COVID-19 Response at Public Health Centers and Future Challenges in Japan

The coronavirus disease 2019 (COVID-19) pandemic has triggered the implementation of public health measures globally. The health department of local governments has played a critical role in confronting COVID-19. In Japan, public health centers (PHCs) are focal points for COVID-19 response. Understanding the response to COVID-19 in local areas is critical to ensure adequate preparation for future emergencies. Therefore, the purpose of this study is to clarify how the COVID-19 operations by PHCs in Japan were managed and facilitated at the beginning of the infection spread, and their future challenges. We designed a case study that included two PHCs with a population of approximately 400,000 in Japan. Semi-structured focus group interviews with public health nurses from these two PHCs were conducted in September and October 2020. The data were analyzed using chronological time-series analysis. The switch to crisis response was encouraged by the business continuity plan. Their operations for the prevention of COVID-19 in the community were facilitated by the existing network. Further, strengthening the knowledge and skill regarding infectious disease control and management skills during infectious disease-related health emergencies were recommended. It is important to ensure that the environment facilitates emergency response and that people-and-community-centered health promotion activities are conducted, during an emergency situation, with more innovative action and leadership.

Doctor of Public Health-Crisis Management and COVID-19 Prevention and Control: A Case Study in China

In the fields of public health policy and public health care, advanced educational programs are an important strategy in dealing with public health crises. The COVID-19 pandemic has exposed the global need for skilled public health leaders and managers to address complex public health challenges, which requires the strengthening of public health education at the highest levels. This paper is a qualitative case study of a special educational program for doctors of public health in China. The program's educational objectives are in line with epidemic prevention and control. With the goal of developing the world's leading national public health management system, the Chinese government established an advanced academic program for public health crisis management. The program offers doctoral students a multidisciplinary degree based upon the theoretical knowledge of crisis management, supported by advanced training in the foundational concepts, theories, and practices of public health, and the study of basic medicine which provides the theoretical support for developing essential clinical skills. Program graduates develop the theoretical, practical, and leadership-related capabilities required for the management of national emergencies. The program introduced in this paper meets current epidemic prevention and control needs and should be considered by public health policy makers, leaders, and scholars in the discussion of advanced public health policy and health care education in China, including the development of an internationally recognized Doctor of Public Health program.

Emerging Technology: Preparing Tomorrow's MCH Workforce to Innovate for Equity

Purpose

This commentary proposes a new direction to train the MCH workforce by leveraging today’s rapidly changing innovation and technology to address persistent health inequities.

Description

We outline the creation of an MCH technology and innovation training pipeline developed by harnessing creative funding opportunities, diversifying training modalities, and expanding partnerships beyond traditional academic-practice partners, that be replicated and adapted by other academic programs.

Assessment

Technology and innovation will continue to be a growing intersection between health and equity, and we must create a robust pipeline of MCH leaders prepared to collaborate with entrepreneurial and innovation leaders.

Conclusion

Technology offers an important opportunity to improve MCH outcomes and reduce disparities, but only if we train the MCH workforce to seize these opportunities.

Identification of the role of oral health educators in elementary schools during COVID-19 pandemic: a competency framework

OBJECTIVE

Oral health educators should have the required knowledge, skills and attitude in order to meet the increased needs of the Ministry of Education in Syria as well as to perform their duties in promoting oral health in children appropriately during the COVID-19 pandemic. Therefore, this study was undertaken to identify core competencies required for oral health educators in elementary schools during the COVID-19 pandemic. Qualitative exploratory study was undertaken. A focus group which consisted of 5 Medical Education postgraduates and 3 oral health educators' training team members were invited to formulate a preliminary list of basic competencies. Delphi technique was also adopted through inviting 12 experts in oral health education to evaluate and formulate a final list of elementary schools' oral health educators' competencies during the COVID-19 pandemic.

RESULTS

A competency framework was developed. Fifty-five competencies were identified including 35 in cognitive domain, 12 skills and 8 attitude competencies. A list of essential competencies has been identified. These competencies should be addressed in training programs targeting oral health educators, which can consequently produce competent educators who can successfully promote and provide health care to all schoolchildren during the COVID-19 pandemic.

Global health education for the post-pandemic years: parity, people, planet, priorities, and practices

Global health degree programs are now offered by institutions of higher education in most world regions. Based on our review of the curricula for many of these programs, we identified five domains that are central to current global health education. "Parity" emphasizes health equity as the ultimate goal of global health. "People" comprises the social, economic, cultural, and political contributors to health and access to medical care for individuals and communities. "Planet" encompasses various aspects of globalization and environmental health that affect population health. "Priorities" and "practices" include the values, data, and tools used to design, implement, and evaluate partnerships, policies, programs, and other global health interventions in countries of all income levels. The pandemic is likely to increase student demand for global health education from the undergraduate through the graduate and professional levels. Our "5 Ps model of global health education" provides a comprehensive framework for the core student learning objectives for global health today. Knowledge of each of these domains is essential for preparing students for meaningful experiential learning and skilled professional practice in global health.

Do ‘Mais Médicos’ à pandemia de Covid-19: duplo negacionismo na atuação da corporação médica brasileira

RESUMO O ensaio analisa a dinâmica de atuação corporativa da medicina brasileira na pandemia de Covid-19, de março de 2020 a julho de 2021, a partir de documentos e material institucional das entidades médicas nacionais, de organizações estudantis e de coletivos de médicos de expressão nacional, além de matérias jornalísticas e publicações da literatura científica sobre o tema. O período é marcado pela politização da agenda corporativa e pelo alinhamento com os discursos negacionistas do governo de Jair Bolsonaro. Argumenta-se que esse processo é resultado de uma politização anterior: o embate contra o Programa Mais Médicos no período de 2013, ano de seu lançamento, a 2019, quando foi encerrado pelo governo. Os dois momentos históricos revelam um duplo negacionismo da corporação médica – acentuando fragilidades, contradições e dilemas da encruzilhada da profissão – que exigirá diálogos internos e com a sociedade, para novos consensos da identidade corporativa e do projeto profissional da medicina. A compreensão dos entrelaçamentos, disputas e sentidos das dinâmicas e rumos da atuação corporativa da medicina permitem identificar problemas estruturais de raízes políticas que impedem maiores avanços na consolidação do Sistema Único de Saúde.

From ‘More Doctors’ to the COVID-19 pandemic: dual denialism in the Brazilian medical corporation’s performance

ABSTRACT This essay analyzes the dynamics of Brazilian medical practice’s corporate action in the COVID-19 pandemic, from March 2020 to July 2021, from documents and institutional material of national medical entities, student organizations, groups of nationally reputed physicians, and journalistic articles and scientific literature publications on the subject. This period is marked by the politicization of the corporate agenda and the alignment with the denialist discourses of Jair Bolsonaro’s administration. It is argued that this process stems from a previous politicization: the clash against the More Doctors Program from 2013, the year of its launch, to 2019, when the Government deactivated it. The two historical moments reveal the dual denialism of the medical corporation, emphasizing weaknesses, contradictions, and dilemmas of the profession’s crossroads, which will require internal and social dialogues for a new consensus on corporate identity and the professional project of Medicine. Understanding the intertwining, disputes, and meanings of the dynamics and directions of the corporate action of Medicine allows identifying structural problems of political roots that prevent further advances in the consolidation of the Unified Health System.

What does Bill Gates' call mean? A policy transfer analysis on creating an early warning system to prevent the next pandemic

OBJECTIVES

The purpose of this study is to discuss the need for an early warning system in order to prevent a new epidemic that may occur in the future and, if necessary, which system will be and how this warning system will be designed.

METHODS

A qualitative analysis through the World Health Organization (WHO) documents, an interview with a key expert, and a policy transfer analysis was conducted.

RESULTS

An early warning system is needed for new outbreaks that may occur in the future. We have seen that the Early Warning Alert and Response system (EWARs), which is implemented by WHO as a policy transfer in Syria, is successful in this area and the system can be easily adapted and established. The implementation of the system in Syria and the successful performance of the early warning system can be systematically transferred to other regions of the world with the policy transfer approach as a public health policy and the implementation phases in the study. The successful transfer of EWARs from WHO to Syria provides a good sample for the integration of a system developed by international and/or non-governmental organizations into an administration system of a state under pandemic and crises conditions.

Health workforce protection and preparedness during the COVID-19 pandemic: a tool for the rapid assessment of EU health systems

This article is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. The study aims to strengthen health workforce preparedness, protection and ultimately resilience during a pandemic. We argue for a health system approach and introduce a tool for rapid comparative assessment based on integrated multi-level governance. We draw on secondary sources and expert information, including material from Denmark, Germany, Portugal and Romania. The results reveal similar developments across countries: action has been taken to improve physical protection, digitalization and prioritization of healthcare worker vaccination, whereas social and mental health support programmes were weak or missing. Developments were more diverse in relation to occupational and organizational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strongest in Demark and weak in Portugal and Romania. Major governance gaps exist in relation to education and health integration, surveillance, social and mental health support programmes, gendered issues of health workforce capacity and integration of migrant healthcare workers (HCW). There is a need to step up efforts and make health systems more accountable to the needs of HCW during global public health emergencies.

Solidarity across borders: A pragmatic need for global COVID-19 vaccine equity

The COVID‐19 pandemic is one of the most disruptive social, political and economic crises of the modern era. In today's interconnected world, the pandemic shows how quickly infectious disease outbreaks can spread across continents. Since the initial outbreak, the introduction of several vaccines has brought hope to a virus‐weary world. In spite of the remarkable results of approved vaccines, many lower‐middle countries are yet to receive a single vaccine shot. This manuscript highlights the fact that global health inequities have intensified during the pandemic. While many wealthy nations have ramped up vaccination efforts and cautiously opened their borders, many in the developed world are still waiting to be inoculated. With the rise of several resistant variants, this work argues that public health policy experts demand a greater need for global solidarity in vaccine access. This is not only important ethically, but it is also a pragmatic response.