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Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review. Health Policy 2022; 126:1195-1205. [PMID: 36257867 PMCID: PMC9556803 DOI: 10.1016/j.healthpol.2022.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.
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Horney JA, Carbone EG, Lynch M, Wang ZJ, Jones T, Rose DA. How Health Department Contextual Factors Affect Public Health Preparedness (PHP) and Perceptions of the 15 PHP Capabilities. Am J Public Health 2017; 107:S153-S160. [PMID: 28892447 DOI: 10.2105/ajph.2017.303955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess how health department contextual factors influence perceptions of the 15 Public Health Preparedness Capabilities, developed by the Centers for Disease Control and Prevention (CDC) to provide guidance on organizing preparedness activities. METHODS We conducted an online survey and focus group between September 2015 and May 2016 with directors of preparedness programs in state, metropolitan, and territorial jurisdictions funded by CDC's Public Health Emergency Preparedness (PHEP) cooperative agreement. The survey collected demographic information and data on contextual factors including leadership, partnerships, organizational structure, resources and structural capacity, and data and evaluation. RESULTS Seventy-seven percent (48 of 62) of PHEP directors completed the survey and 8 participated in the focus group. Respondents were experienced directors (mean = 10.6 years), and 58% led 7 or more emergency responses. Leadership, partnerships, and access to fiscal and human resources were associated with perception and use of the capabilities. CONCLUSIONS Despite some deficiencies, PHEP awardees believe the capabilities provide useful guidance and a flexible framework for organizing their work. Contextual factors affect perceptions of the capabilities and possibly the effectiveness of their use. Public Health Implications. The capabilities can be used to address challenges in preparedness, including identifying evidence-based practices, developing performance measures, and improving responses.
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Affiliation(s)
- Jennifer A Horney
- Jennifer A. Horney is with the School of Public Health, Texas A&M University, College Station. Eric G. Carbone is with the Office of Applied Research, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Molly Lynch is with the Center for Communication Science, RTI International, Durham, NC. Z. Joan Wang is with Avar Consulting, Rockville, MD. Terrance Jones is with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta. Dale A. Rose is with the Division of Emergency, Operations Office of Public Health Preparedness and Response, CDC, Atlanta
| | - Eric G Carbone
- Jennifer A. Horney is with the School of Public Health, Texas A&M University, College Station. Eric G. Carbone is with the Office of Applied Research, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Molly Lynch is with the Center for Communication Science, RTI International, Durham, NC. Z. Joan Wang is with Avar Consulting, Rockville, MD. Terrance Jones is with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta. Dale A. Rose is with the Division of Emergency, Operations Office of Public Health Preparedness and Response, CDC, Atlanta
| | - Molly Lynch
- Jennifer A. Horney is with the School of Public Health, Texas A&M University, College Station. Eric G. Carbone is with the Office of Applied Research, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Molly Lynch is with the Center for Communication Science, RTI International, Durham, NC. Z. Joan Wang is with Avar Consulting, Rockville, MD. Terrance Jones is with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta. Dale A. Rose is with the Division of Emergency, Operations Office of Public Health Preparedness and Response, CDC, Atlanta
| | - Z Joan Wang
- Jennifer A. Horney is with the School of Public Health, Texas A&M University, College Station. Eric G. Carbone is with the Office of Applied Research, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Molly Lynch is with the Center for Communication Science, RTI International, Durham, NC. Z. Joan Wang is with Avar Consulting, Rockville, MD. Terrance Jones is with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta. Dale A. Rose is with the Division of Emergency, Operations Office of Public Health Preparedness and Response, CDC, Atlanta
| | - Terrance Jones
- Jennifer A. Horney is with the School of Public Health, Texas A&M University, College Station. Eric G. Carbone is with the Office of Applied Research, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Molly Lynch is with the Center for Communication Science, RTI International, Durham, NC. Z. Joan Wang is with Avar Consulting, Rockville, MD. Terrance Jones is with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta. Dale A. Rose is with the Division of Emergency, Operations Office of Public Health Preparedness and Response, CDC, Atlanta
| | - Dale A Rose
- Jennifer A. Horney is with the School of Public Health, Texas A&M University, College Station. Eric G. Carbone is with the Office of Applied Research, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Molly Lynch is with the Center for Communication Science, RTI International, Durham, NC. Z. Joan Wang is with Avar Consulting, Rockville, MD. Terrance Jones is with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta. Dale A. Rose is with the Division of Emergency, Operations Office of Public Health Preparedness and Response, CDC, Atlanta
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Akl EA, El-Jardali F, Bou Karroum L, El-Eid J, Brax H, Akik C, Osman M, Hassan G, Itani M, Farha A, Pottie K, Oliver S. Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review. PLoS One 2015; 10:e0137159. [PMID: 26332670 PMCID: PMC4558048 DOI: 10.1371/journal.pone.0137159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/13/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field.
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Affiliation(s)
- Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Fadi El-Jardali
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Research, Advocacy and Public Policy-making Program, Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Jamale El-Eid
- VP of Medical Affairs, American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint Joseph, Beirut, Lebanon
| | - Chaza Akik
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mona Osman
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghayda Hassan
- Department of Psychology, University of Québec, Montreal, Québec, Canada
| | - Mira Itani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Aida Farha
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Kevin Pottie
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandy Oliver
- Department of Childhood, Families and Health, Social Science Research Unit, Institute of Education, University of London, London, United Kingdom
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Khan Y, Fazli G, Henry B, de Villa E, Tsamis C, Grant M, Schwartz B. The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation. BMC Public Health 2015; 15:432. [PMID: 25925775 PMCID: PMC4415223 DOI: 10.1186/s12889-015-1750-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigate the body of research excluding the anecdotal reports and better understand primary and analytical research for PHEP, a scoping review was conducted with two objectives: first, to develop a thematic map focused on primary research; and second, to use this map to inform and guide an understanding of knowledge gaps relevant to research and practice in PHEP. METHODS A scoping review was conducted based on established methodology. Multiple databases of indexed and grey literature were searched based on concepts of public health, emergency, emergency management/preparedness and evaluation/evidence. Inclusion and exclusion criteria were applied iteratively. Primary research studies that were evidence-based or evaluative in nature were included in the final group of selected studies. Thematic analysis was conducted for this group. Stakeholder consultation was undertaken for the purpose of validating themes and identifying knowledge gaps. To accomplish this, a purposive sample of researchers and practicing professionals in PHEP or closely related fields was asked to complete an online survey and participate in an in-person meeting. Final themes and knowledge gaps were synthesized after stakeholder consultation. RESULTS Database searching yielded 3015 citations and article selection resulted in a final group of 58 articles. A list of ten themes from this group of articles was disseminated to stakeholders with the survey questions. Survey findings resulted in four cross-cutting themes and twelve stand-alone themes. Several key knowledge gaps were identified in the following themes: attitudes and beliefs; collaboration and system integration; communication; quality improvement and performance standards; and resilience. Resilience emerged as both a gap and a cross-cutting theme. Additional cross-cutting themes included equity, gender considerations, and high risk or at-risk populations. CONCLUSIONS In this scoping review of the literature enhanced by stakeholder consultation, key themes and knowledge gaps in the PHEP evidence base were identified which can be used to inform future practice-oriented research in PHEP.
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Affiliation(s)
- Yasmin Khan
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Division of Emergency Medicine, Department of Medicine, University of Toronto, 2075 Bayview Ave, C753, Toronto, ON, M4N 3M5, Canada.
| | - Ghazal Fazli
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Bonnie Henry
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Eileen de Villa
- Peel Public Health, 7120 Hurontario Street, P.O Box 667 - RPO Streetsville, Mississauga, ON, L5M 2C2, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Charoula Tsamis
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
| | - Moira Grant
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
| | - Brian Schwartz
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
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