Participatory Monitoring and Evaluation of the COVID-19 Response in a Local Public Health System

Local Health Department Values and Organizational Authorities Guiding Cross-Sector Work During COVID-19

OBJECTIVE

The COVID-19 pandemic highlighted the role that local health departments (LHDs) have in cross sector can address alone, including the work of value alignment and the strategic use of organizational authorities. The practices by which LHDs used their authorities to conduct cross-sector work during the pandemic need exploration.

METHOD

We conducted semi-structured interviews with 19 public health leaders from metropolitan LHDs across the United States. Our interview guide assessed the values that LHD leadership prioritized in their cross-sector work as well as the range of organizational authorities they leveraged to influence external decision-making in other sectors.

RESULTS

We found that LHDs approached cross-sector work by leaning on diverse values and authorities, each with unique implications for their work. The LHDs emphasized their approach to value alignment on a sector-by-sector basis, strategically using diverse organizational authorities-economic, political, moral, scientific, and logistical. While each authority and value we assessed was present across all interviewees, how each shaped action varied. Internally, LHDs emphasized certain authorities more than others to the degree that they more closely aligned with prioritized core values.

CONCLUSION

Our findings highlight the ongoing need for LHD leadership to improve their ability to effectively communicate public health values and the unique authorities by which health-supporting work can be facilitated, including how this message must be adapted, depending on the specific sectors with which the LHD needs to partner and the governance arrangement in which the LHD is situated.

What Chicago community organizations needed to implement COVID-19 interventions: lessons learned in 2021

Introduction

As the COVID-19 pandemic placed a spotlight on the health inequities in the United States, this study aimed to determine the local programmatic needs of community organizations (CO) delivering COVID-19 interventions across Chicago.

Methods

In the summer of 2021, the Chicagoland CEAL Program interviewed 34 COs that were providing education, testing, and/or vaccinations in communities experiencing poor COVID-19 outcomes. The interviews were analyzed thematically and organized around logistical challenges and funding/resource needs.

Results

The COs routinely offered testing (50%) or vaccinations (74%), with most (56%) employing some programmatic evaluation. Programs utilizing trusted-messenger systems were deemed most effective, but resource-intensive. CO specific needs clustered around sustaining effective outreach strategies, better CO coordination, wanting comprehensive trainings, improving program evaluation, and promoting services and programs.

Conclusion

The COs reached populations with low-vaccine confidence using trusted messengers to overcome mistrust. However, replenishment of the resources needed to sustain such strategies should be prioritized. Leveraging the Chicagoland CEAL Program to help negotiate community organizations' interorganizational coordination, create training programs, and provide evaluation expertise are deliverable supports that may bolster COVID-19 prevention.

Policy implications

Achieving health justice requires that all institutions of power participate in meaningful community engagement, help build community capacity, and infuse health equity throughout all aspects of the research and program evaluation processes.

Equity Lens Protocol: Reflecting on Harms From the COVID-19 Response and Mitigation Strategies Implemented in a Local Public Health System

This report describes an Equity Lens Protocol and its use to guide partners' systematic reflection on harms and mitigation strategies of the COVID-19 response in a local public health system. This process evaluation tool is based on the Guidance document for assuring an equitable response to COVID-19 prepared by the Pan American Health Organization. We used a participatory approach to engage public health partners in systematically reflecting on harms, mitigation strategies, and lessons learned and implications for practice. Outputs from using this tool included identified: (a) specific harms (e.g., loss of income and challenges to learning) related to particular COVID-19 response measures (e.g., home confinement and school closure) and (b) mitigation strategies implemented to reduce harms. In response to the protocol's guiding questions, partners also identified lessons learned and practice recommendations for strengthening equity work in public health responses (e.g., an equitable response requires an investment in people, structures, and relationships before a crisis). This report-and accompanying protocol-illustrates use of a practical method for systematic reflection on public health responses through an equity lens.

Behavioral Interventions Contributing to Reducing Poverty and Inequities

Behavioral science has a long history of engaging in efforts to understand and address socially important issues. Poverty and inequities in health and development are among the most important and complex social issues facing the world today. With its Sustainable Development Goals (SDGs), the United Nations (2015) has focused attention and guidance on addressing key global challenges, including to "end poverty" (SDG 1), "ensure good health and well-being for all" (SDG3), and "reduce inequality within and among countries" (SDG 10). In this paper, we provide a framework and illustrative examples of contributions of behavioral science to these issues. We feature illustrative behavioral interventions at the individual, relationship, community, and societal levels. We highlight the diversity of issues, intervention methods, and settings reflected in applications of behavioral science. By joining methods from behavioral science, public health, and other disciplines-and the experiential knowledge of those most affected by inequities-behavioral methods can make significant contributions to collaborative efforts to assure health and well-being for all.

Participatory Monitoring and Evaluation of the COVID-19 Response in the Africa Region

As the COVID-19 pandemic swept throughout the world, it created a demand for information to help understand the public health response and its effects. Limited capacity to see and interpret data-"sensemaking" with measures of progress-affects the use of data for quality improvement. The World Health Organization Regional Office for Africa (WHO AFRO) supported partners from the Member States in using a participatory monitoring and evaluation system to document and systematically reflect on the COVID-19 response at the country level. The WHO AFRO's COVID-19 Response Monitoring and Evaluation (M&E) team captured and communicated response activities based on available reports from 35 of the 47 member countries. By reviewing reports and communications, the M&E team documented nearly 8,000 COVID-19 response activities during the study period (January 2020 through July 2021). A "sensemaking" protocol was used to support country partners in identifying factors associated with increases or decreases in both new cases and response activities. This report describes this participatory M&E approach and process of shared sensemaking. We illustrate with a country-level case study of the COVID-19 response in the Africa Region.

A Reflection on Community Research and Action as an Evolving Practice

Community research and action is an evolving field of practice with multiple influences. Its varied ways of knowing and doing reflect recombined elements from different disciplines, including behavioral science, community psychology, public health, and community development. This article offers a personal reflection based on my evolving practice over nearly 50 years. The focus is on three types of influence: (a) engaging with different communities, fields, and networks (e.g., discovering shared values, diverse methods); (b) building methods and capabilities for the work (e.g., methods for participatory research, tools for capacity building); and (c) partnering for collaborative research and action, locally and globally. This story highlights the nature of the field's evolution as an increasing variation in methods. Our evolving practice of community research and action-individually and collectively-emerges from the recombination of ideas and methods discovered through engagement in a wide variety of contexts.