The costs of improving health emergency preparedness: A systematic review and analysis of multi-country studies

Epidemic preparedness and response capacity against infectious disease outbreaks in 186 countries, 2018-2022

OBJECTIVES

Disruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022.

METHODS

We utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems' IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index's capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann-Kendall nonparametric trend test.

RESULTS

SPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains.

CONCLUSIONS

There was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases.

The Resilience Hub approach for addressing mental health of health and social care workers during the COVID-19 pandemic: a mixed-methods evaluation

Background

Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic.

Aim

To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic.

Design

Mixed-methods evaluation.

Setting

Four Resilience Hubs.

Methods

Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs.

Results

Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive.

Limitations

Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection.

Conclusions

Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data.

Study registration

This study is registered as researchregistry6303.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.

Disaster Preparedness in Home Care: Moving Beyond Checklists

Disasters have become increasingly common, with hurricanes off the southern, eastern, and western coasts, fires in the northwest, earthquakes, mass shootings, and continuing cases of COVID-19 looming over healthcare systems. Home care agencies have a history of meeting patients' needs during disasters and are strategically positioned to support communities during public emergencies and disasters. However, the "who" and the "how" of engaging the disaster cycle of mitigation, preparedness, response, and recovery is not always understood by clinicians and leadership. A gap in the literature cries out for better preparedness strategies for home care leadership and staff that go beyond the broad guidance of regulatory and accreditation organizations. This article aims to examine current literature and offer direction to home care leaders and staff as they seek to understand the "who" and the "how" in preparing for disasters in an increasingly unstable world.

Investing in preparedness for rapid detection and control of epidemics: analysis of health system reforms and their effect on 2021 Ebola virus disease epidemic response in Guinea

The 2014-2016 West Africa Ebola Virus Disease (EVD) Epidemic devastated Guinea's health system and constituted a public health emergency of international concern. Following the crisis, Guinea invested in the establishment of basic health system reforms and crucial legal instruments for strengthening national health security in line with the WHO's recommendations for ensuring better preparedness for (and, therefore, a response to) health emergencies. The investments included the scaling up of Integrated Disease Surveillance and Response; Joint External Evaluation of International Health Regulation capacities; National Action Plan for Health Security; Simulation Exercises; One Health platforms; creation of decentralised structures such as regional and prefectural Emergency Operation Centres; Risk assessment and hazard identification; Expanding human resources capacity; Early Warning Alert System and community preparedness. These investments were tested in the subsequent 2021 EVD outbreak and other epidemics. In this case, there was a timely declaration and response to the 2021 EVD epidemic, a lower-case burden and mortality rate, a shorter duration of the epidemic and a significant reduction in the cost of the response. Similarly, there was timely detection, response and containment of other epidemics including Lassa fever and Marburg virus disease. Findings suggest the utility of the preparedness activities for the early detection and efficient containment of outbreaks, which, therefore, underlines the need for all countries at risk of infectious disease epidemics to invest in similar reforms. Doing so promises to be not only cost-effective but also lifesaving.

Water supply emergency preparedness and response in health care facilities: A systematic review on international evidence

Introduction

Enabling health care facilities to deal with impairments or outages of water supply and sewage systems is essential and particularly important in the face of growing risk levels due to climate change and natural hazards. Yet, comprehensive assessments of the existing preparedness and response measures, both in theory and practice, are lacking. The objective of this review is to assess water supply and wastewater management in health care facilities in emergency settings and low-resource contexts. It thereby is a first step toward knowledge transfer across different world regions and/or contexts.

Method

A systematic review was performed to identify published articles on the subject using online MEDLINE and Web of Science. The initial searches yielded a total of 1,845 records. Two independent reviewers screened identified records using selection criteria. A total of 39 relevant studies were identified. Descriptive analyses were used to summarize evidence of included studies.

Results

Overall, water supply was far more discussed than wastewater management. Studies on emergency preparedness identified back-up water storage tank, additional pipelines, and underground wells as key sources to supply health care facilities with water during an emergency. In emergency response, bottled of water, followed by in-situ back-up water storage tanks previously installed as part of disaster preparedness measures, and tanker trucks to complete were most used. Questions on how to improve existing technologies, their uptake, but also the supplementation by alternative measures remain unanswered. Only few guidelines and tools on emergency preparedness were identified, while multiple studies formulated theoretical recommendations to guide preparedness. Recovery planning was rarely discussed, despite many studies mentioning the importance of the reconstruction and restoration phases. Literature focus on recovery is mostly on technical aspects, while organizational ones are largely absent. Despite their key role for preparedness and response, citizens and patients' perspectives are hugely underrepresented. This fits into the bigger picture as communication, awareness raising and actor cooperation in general is addressed comparatively little.

Discussion

Combining organizational and technical aspects, and intersecting theory and practice will be necessary to address existing gaps. Improving both, preparedness and response, is key to maintaining public health and providing primary care.

Relevance of the world health organization in a multipolar world in solving global health challenges

There have been many criticisms about the World Health Organization (WHO) in the last decade. In a multipolar world, there are rivalries between nations and geopolitical regions. However, health issues remain outside the murky world of politics due to their far-reaching consequences on human society. The power conferred on the WHO is very significant in protecting the health and well-being of the global population. As a neutral organization, the WHO is supposed to uphold people's rights to health, especially in controlling diseases of international importance. The paper highlighted the significant roles of the WHO in leadership issues, research and development, solving disputes among countries, providing resources for low-performing regions, regulating international health laws, responding to a humanitarian crisis, and communicating during the crisis. Further, evidence from global literature critically analyzed the enforcement role of WHO on international health regulations (IHRs).

Viewing the global health system as a complex adaptive system - implications for research and practice

The global health system (GHS) is ill-equipped to deal with the increasing number of transnational challenges. The GHS needs reform to enhance global resilience to future risks to health. In this article we argue that the starting point for any reform must be conceptualizing and studying the GHS as a complex adaptive system (CAS) with a large and escalating number of interconnected global health actors that learn and adapt their behaviours in response to each other and changes in their environment. The GHS can be viewed as a multi-scalar, nested health system comprising all national health systems together with the global health architecture, in which behaviours are influenced by cross-scale interactions. However, current methods cannot adequately capture the dynamism or complexity of the GHS or quantify the effects of challenges or potential reform options. We provide an overview of a selection of systems thinking and complexity science methods available to researchers and highlight the numerous policy insights their application could yield.   We also discuss the challenges for researchers of applying these methods and for policy makers of digesting and acting upon them. We encourage application of a CAS approach to GHS research and policy making to help bolster resilience to future risks that transcend national boundaries and system scales.