Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations

Exploring Volunteer Pharmacists' Experiences in Responding to 2023 Türkiye Earthquakes: A Qualitative Phenomenological Study

OBJECTIVE

Pharmacists are vital in disaster response efforts, dispensing essential medications, managing pharmacy services, consulting, and educating survivors regarding their medications. Their contributions, however, are often underrepresented in scientific literature. This study aimed to explore the experiences of pharmacists who provided pharmacy services to meet the pharmaceutical needs of the survivors after 2 major earthquakes in Türkiye in 2023.

METHODS

This study adopted a phenomenological approach. Data were collected using semi-structured interviews. Purposive sampling was used to invite pharmacists who provided pharmacy services to survivors. Interview transcripts were analyzed following an inductive, reflexive thematic analysis.

RESULTS

In total, 15 pharmacists were interviewed. Four main overarching themes "response to the earthquake," "preparedness for the earthquake," "experiences during service delivery," and "mental and physical experiences" were developed.

CONCLUSIONS

From participants' experiences, it is essential to expand the clinical responsibilities of pharmacists and train them in providing wound care, administering immunization, and prescribing. Pharmacists should be integrated as essential members of disaster health teams. International health organizations, nongovernmental organizations, and governments are encouraged to work collaboratively and develop disaster management plans including pharmacists in early responders. This might help mitigate the deficiencies and overcome challenges in health-care systems to provide effective patient-centered care by health professionals and respond effectively to disasters.

Mapping study for health emergency and disaster risk management competencies and curricula: literature review and cross-sectional survey

BACKGROUND

With the increasing threat of hazardous events at local, national, and global levels, an effective workforce for health emergency and disaster risk management (Health EDRM) in local, national, and international communities is urgently needed. However, there are no universally accepted competencies and curricula for Health EDRM. This study aimed to identify Health EDRM competencies and curricula worldwide using literature reviews and a cross-sectional survey.

METHODS

Literature reviews in English and Japanese languages were performed. We searched MEDLINE, EMBASE, CINAHL (English), and the ICHUSHI (Japanese) databases for journal articles published between 1990 and 2020. Subsequently, a cross-sectional survey was sent to WHO Health EDRM Research Network members and other recommended experts in October 2021 to identify competency models and curricula not specified in the literature search.

RESULTS

Nineteen studies from the searches were found to be relevant to Health EDRM competencies and curricula. Most of the competency models and curricula were from the US. The domains included knowledge and skills, emergency response systems (including incident management principles), communications, critical thinking, ethical and legal aspects, and managerial and leadership skills. The cross-sectional survey received 65 responses with an estimated response rate of 25%. Twenty-one competency models and 20 curricula for managers and frontline personnel were analyzed; managers' decision-making and leadership skills were considered essential.

CONCLUSION

An increased focus on decision-making and leadership skills should be included in Health EDRM competencies and curricula to strengthen the health workforce.

Nurses' challenges for disaster response: a qualitative study

BACKGROUND

Healthcare providers, particularly nurses, play a critical role in mitigating the impact of disasters on victims and the healthcare system. However, nurses face unique challenges in disasters that may not experience in their daily practice, which can make it harder for them to deal with disasters efficiently. This study aimed to investigate the challenges faced by nurses for disaster response.

METHODS

A qualitative content analysis approach was used in this study. Purposeful sampling was used to select 24 nurses working in the emergency departments of hospitals in Kerman, southeastern Iran. Data were collected through semi-structured interviews and analyzed using MAXQDA10. The conventional content analysis method proposed by Graneheim and Lundman was used to analyze the data.

RESULTS

The analysis of the findings resulted in one major category, insufficient ability of nurses to respond to disasters, and five subcategories: diverse nursing conditions during disasters, inappropriate interactive platform during disasters, the presence of obstacles to teamwork, lack of platform for nurses to acquire adequate disaster risk management competence, and moral tension in complex disaster situations.

CONCLUSIONS

Determining the challenges that nurses face during disasters is essential for improving disaster response efforts, promoting disaster preparedness, ensuring appropriate care for patients, and reducing emotional fatigue among nurses. Finally, nursing leaders, healthcare policymakers and governments should use these findings to better support the nursing workforce in disasters.

Mental Health Status, Risk and Protective Factors for Healthcare Staff Prior to the First Major COVID-19 Outbreak in Western Australia

Objectives: Western Australia's unique public health response delayed the first wave of community COVID-19 transmission for 2 years. We aimed to determine the status of post-traumatic stress (PTSS), depressive, and anxiety symptoms among healthcare staff in major tertiary hospitals, together with associated risk and protective factors prior to the first substantial outbreak of COVID-19. Methods: A cross-sectional study was conducted with 431 healthcare staff immediately prior to the Western Australian border re-opening in 2022. Staff were recruited via notices in email newsletters, at four tertiary hospitals and a public mental health clinic in metropolitan Perth. Validated and original questionnaires were administered via Qualtrics. Results: Moderate levels of PTSS (22.3%), depression (21.9%), and anxiety (25.9%) were reported. Pathway analyses indicated that sleep difficulties, workplace stressors, and infectious disease training were associated with higher PTSS, depression and anxiety symptoms, and younger age was associated with higher levels of depression and anxiety. Nursing roles were associated with higher PTSS. Social support and workplace support were associated with lower levels of depression and anxiety but were not associated with PTSS. Conclusion: The findings illustrate high levels of resilience, but indicate a need for structural supports within the health system to foster staff mental health prior to the onset of emergencies.

Knowledge, Attitude and Practices of Frontline Health Care Workers to Disaster Risk Management in Private General Hospitals in Addis Ababa, Ethiopia: Multicenter Cross-Sectional Study

Background

Disaster is an acute dysfunction of the existing environment that requires external assistance. Although disaster has had a significant impact in Ethiopia, little is known about KAP of frontline HCW on disaster management in private hospitals. Therefore, this study will be a background for future researches and disaster management plan in private health sectors. The study was conducted to assess the knowledge, attitudes, practices and their influencing factors among frontline healthcare workers on disaster risk management in private general hospitals in Addis Ababa.

Methods

The study design was multicenter cross-sectional survey that used structured closed- and open-ended questions. Multi-stage sampling technique was used. The sample size was 270 with a response rate of 98.9%. The study was conducted in frontline HCW of six private general hospitals from July 20-September 30, 2022. Epi-info version 7.0 and SPSS-25 were used for data clearing and statistical analysis. Level of KAP was calculated from the participants' scores of the questions. Associations were done by using bivariate and multivariate logistic regression.

Results

Of the participants, 64% had poor level of knowledge, and 89.10% had poor level of practice while 93.6% had positive attitude. Lack of previous training, inadequate level of practice, and health experience below one year were negatively associated with good level of knowledge. Poor level of knowledge was negatively associated with good practice.

Conclusion

Although the majority of the participants had positive attitude, the mean level of knowledge and practice were poor to properly handle disastrous events.

"Seems Like There Is No Stopping Point at All Whatsoever": A Mixed-Methods Analysis of Public Health Workforce Perception on COVID-19 Pandemic Management and Future Needs

OBJECTIVE

The COVID-19 pandemic, caused by a highly contagious novel virus called SARS-CoV-2, has led to significant global morbidity and mortality, with disproportionate burden among frontline workers. While the current empirical body of evidence highlights reported depression, burnout, moral injury, compassion fatigue, and post-traumatic stress among healthcare workers, similar assessment among the public health workforce is limited. Given work-related pressure of rapid pandemic management strategies, risk of exposure, potential fatigue, etc., understanding the caregiver burden of the public health workforce is critical. Methods: This study used a convergent parallel mixed-methods design. Participants were recruited using a mix of both convenience and snowball sampling. All data were collected virtually and kept anonymous. All statistical analyses were conducted using SPSS version 28, and all qualitative results were thematically analyzed using the grounded theory approach. Results: Among the study participants, nearly 65% reported that their personal lives were impacted due to providing COVID-19 related services. Furthermore, a majority (88%) reported poor sleep health, including low daytime wakefulness, while 24% reported serious psychological distress. Qualitative analysis demonstrated several emergent themes, with central themes indicative of the need for paradigm shift in capacity building for public health emergency preparedness that integrates caregiver support. Conclusions: Results highlight the importance of addressing the caregiver burden experienced by public health and related workforces during public health emergencies.

A Psychometric Validation of the Korean Version of Disaster Response Self-Efficacy Scale for Nursing Students

Nurses are very important healthcare providers in disaster situations, and from undergraduate nursing students to professional registered nurses, such practitioners should focus on strengthening their disaster-response-related self-efficacy and competency. The purpose of this study was to develop a Korean version of the Disaster Response Self-Efficacy Scale (DRSES-K) and evaluate its psychometric properties. The DRSES was translated into Korean and developed based on the translation and adaptation of instruments suggested by the World Health Organization. Data were collected from 30 October to 23 November 2020. A total of 209 undergraduate nursing students participated in this study. Psychometric properties were assessed using the programs SPSS/WIN 29.0, AMOS 26.0, and Winsteps 3.68.2, with which Rasch model analysis was carried out. The DRSES-K fit was sufficiently suitable for the unidimensional Rasch model with acceptable goodness of fit (χ2/df = 2.20 (p < 0.001), CFI = 0.92, IFI = 0.92, TLI = 0.91, AGFI = 0.82, and RMSEA = 0.07). The DRSES-K was significantly correlated with the measure of preparedness for disaster response, so concurrent validity was satisfied. The findings in this study suggested that the DRSES-K is a scale with verified validity and reliability. It is expected that the DRSES-K will be used for disaster nursing education to strengthen the competency of undergraduate nursing students.

Health Emergency and Disaster Risk Management Workforce Development Strategies: Delphi Consensus Study

INTRODUCTION

Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM).

STUDY OBJECTIVE

The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC).

METHODS

A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking.

RESULTS

In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were "Human Resources" (n = 15), "Planning and Coordination" (n = 7), and "Community Capacities for Health EDRM" (n = 6) in the LMIC group. "Policies, Strategies, and Legislation" (n = 7) and "Human Resources" (n = 7) were the components with the most recommendations for the HIC group.

CONCLUSION

The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.

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.

Coordination and Management of COVID-19 in Africa through Health Operations and Technical Expertise Pillar: A Case Study from WHO AFRO One Year into Response

Background: following the importation of the first Coronavirus disease 2019 (COVID-19) case into Africa on 14 February 2020 in Egypt, the World Health Organisation (WHO) regional office for Africa (AFRO) activated a three-level incident management support team (IMST), with technical pillars, to coordinate planning, implementing, supervision, and monitoring of the situation and progress of implementation as well as response to the pandemic in the region. At WHO AFRO, one of the pillars was the health operations and technical expertise (HOTE) pillar with five sub-pillars: case management, infection prevention and control, risk communication and community engagement, laboratory, and emergency medical team (EMT). This paper documents the learnings (both positive and negative for consideration of change) from the activities of the HOTE pillar and recommends future actions for improving its coordination for future emergencies, especially for multi-country outbreaks or pandemic emergency responses. Method: we conducted a document review of the HOTE pillar coordination meetings’ minutes, reports, policy and strategy documents of the activities, and outcomes and feedback on updates on the HOTE pillar given at regular intervals to the Regional IMST. In addition, key informant interviews were conducted with 14 members of the HOTE sub pillar. Key Learnings: the pandemic response revealed that shared decision making, collaborative coordination, and planning have been significant in the COVID-19 response in Africa. The HOTE pillar’s response structure contributed to attaining the IMST objectives in the African region and translated to timely support for the WHO AFRO and the member states. However, while the coordination mechanism appeared robust, some challenges included duplication of coordination efforts, communication, documentation, and information management. Recommendations: we recommend streamlining the flow of information to better understand the challenges that countries face. There is a need to define the role and responsibilities of sub-pillar team members and provide new team members with information briefs to guide them on where and how to access internal information and work under the pillar. A unified documentation system is important and could help to strengthen intra-pillar collaboration and communication. Various indicators should be developed to constantly monitor the HOTE team’s deliverables, performance and its members.

Design and Implementation of Adaptable Self-Protection Plans for Public Buildings: A Nursing Home Case in Spain

COVID-19 is reflecting the importance of self-protection plans in nursing homes, especially when it concerns persons of older age. Self-protection plans intend to prevent and control the risks of residential buildings. The goal of this research is to develop a design process for self-protection plans of public buildings, and specifically a nursing home. In this regard, it is key for the viability of the nursing home operations to be capable of adapting to any potential future event. Starting from some initial hypotheses that establish the need for adaptability, a self-protection plan model is developed for public buildings based on a new approach consisting of four elements and three steps. It was applied to an elderly residence which is currently under construction. The methodology followed has consisted of a process by stages, to design and implement a novel self-protection plan for public buildings. Subsequently, it has been applied to the specific case study, using the most common tools and applications available for later analysis of the result obtained with the starting hypotheses. The results show how the research allows an increase in the adaptability of self-protection plans for any publicly owned building, although there is an extensive and precise subsequent work of adaptation to specific cases considering the different legal frameworks which makes the work challenging. Finally, the research on adaptability and its application for elderly residences enabled the derivation of recommendations regarding self-protection plans in general and specifically in homes for the elderly.

Association Between Clinical Competencies and Mental Health Symptoms Among Frontline Medical Staff During the COVID-19 Outbreak: A Cross-Sectional Study

Background

In China, mental health of frontline medical staff might be influenced by clinicians' ability to handle the outbreak of coronavirus disease 2019 (COVID-19). Few studies to-date have addressed the association between clinicians' competencies and mental health in this context. This cross-sectional study was to examine the prevalence of mental health symptoms among frontline medical staff that fought against the COVID-19 outbreak, and explore the associations between their competencies, and separate and concurrent depressive and anxiety symptoms.

Methods

A total of 623 frontline medical staff was included in this study. Competencies, depressive symptoms, and anxiety symptoms were assessed using a self-reported short form of the Chinese clinical physicians' competency model, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 questionnaire, respectively. Logistic regression models were used to evaluate the associations between one SD increase in competency scores and the prevalence of mental health problems.

Results

The prevalence of depressive, anxiety, and comorbid depressive and anxiety symptoms was 40.93, 31.78, and 26.00%, respectively. Among the medical staff with higher total competency scores, the prevalence of depressive [odds ratios (ORs) = 0.67, 95% confidence intervals (CIs): 0.55-0.81], anxiety (OR = 0.68, 95% CI: 0.56-0.83), and comorbid anxiety and depressive symptoms (OR = 0.69, 95% CI: 0.55-0.83) was lower than among their lower-scoring counterparts. Subgroup analyses stratified by core competency scores revealed similar associations as the main analyses.

Conclusion

The present findings highlight the association between high core competency scores and lower prevalence of depressive, anxiety, and comorbid anxiety and depressive symptoms.

Role of Community Health Volunteers Since the 2015 Nepal Earthquakes: A Qualitative Study

OBJECTIVE

Nepal female community health volunteers (FCHVs) were the first available health personnel in communities during the 2015 Nepal earthquakes. This study explored the facilitating factors and barriers of the FCHVs during health emergencies.

METHODS

In-depth interviews with 24 FCHVs and 4 health managers from 2 districts in Nepal (Gorkha and Sindhupalchowk) were conducted using semi-structured interview guides. The qualitative data were analyzed using thematic analysis methods.

RESULTS

FCHVs were the first responders to provide services after the earthquakes and were well accepted by the local communities. Different models of supervision existed, and differences in the workload and remuneration offered to FCHVs were described. A wide range of disaster-related knowledge and skills were required by FCHVs, and lack of prior training was an issue for some respondents. Furthermore, lack of access to adequate medical supplies was a major barrier for FCHVs in the 2015 earthquakes. The 5 identified themes were discussed.

CONCLUSION

Providing regular disaster response training for FCHVs and strong leadership from the public sector with sustained investments will be essential for increasing the capacities of community health workforces to prepare for and reduce the impacts of future health emergencies in resource-poor settings.

Indonesia’s Climate-Related Disasters and Health Adaptation Policy in the Build-Up to COP26 and Beyond

In recent years, Indonesia has experienced rapid increases in severe climate-related disasters have dramatically impacted populations unevenly; the poor and the vulnerable populations are most affected, and adaptive measures are urgently needed to protect and mitigate the impact on their health. However, very little is known about the existing measures addressing climate-related disasters and health impacts among vulnerable groups. WHO established a Health Emergency and Disaster Risk Management framework to urge governments and relevant actors to systematically collect evidence to develop science-based feasible adaptive strategies for priority groups. This study used scoping review methods to identify the action areas of Health-EDRM in policy documents in Indonesia, its content, and any potential gaps that require further study. The results from the documents’ review were then reported and discussed at a national stakeholder consultation meeting. This study has identified several achievements, lessons learned, and challenges from strategies and policies for health adaptation in facing climate-related disasters in Indonesia. This study also proposed strategies and recommendations to support mobilizing and accelerating health adaptation actions towards climate-related disasters in Indonesia.

Insecure Employment Contracts during the COVID-19 Pandemic and the Need for Participation in Policy Making

Job security influences the ability of nurses to provide high-quality nursing care. The Iranian health system has always faced nursing shortages, and the COVID-19 pandemic has worsened this situation. Although nurses have been labelled 'heroes' across the globe, many of them have been hired using insecure employment contracts. This commentary aims to describe issues surrounding job contracts for Iranian nurses during the COVID-19 pandemic and discusses how the current situation can be improved. Iranian nurses are at the frontline of the fight against COVID-19 and need to receive better support in terms of job security and dignity. They should participate more in policymaking activities to improve their job condition and prevent the development and implementation of the short-term and insecure job contracts that lead to job insecurity.

European Educational Programmes in Health Emergency and Disaster Management: An Integrative Review

There is a need for trained health professionals who can swiftly respond to disasters occurring worldwide. Little is known about whether the currently available programmes in disaster management are in line with the recommendations of expert researchers. Our objective was to qualitatively review the characteristics of European educational programmes in health emergency and disaster management and to provide guidance to help improve their curricula. We carried out an integrative review to extract the main characteristics of the 2020/21 programmes available. We identified 34 programmes, the majority located in Spain, the UK or France. The primary qualification types awarded were master’s degrees, half of them lasting one year, and the most common teaching method was in person. Almost all of the programmes used a virtual university classroom, a third offered multidisciplinary disaster management content and teachers, and half of them employed situational simulations. The quality of European educational programmes in health emergency and disaster management has improved, especially in terms of using more practical and interactive teaching methodologies and in the inclusion of relevant topics such as communication, psychological approaches and evaluation of the interventions. However, generally, the educational programmes in disaster management have not yet incorporated the skills related to the intercultural and interprofessional awareness aspects.

Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa

Background: While the pharmacy workforce is the third largest professional healthcare group worldwide, the pharmacy workforce landscape remains unclear in post-conflict areas in sub-Saharan Africa. Method: Key informants were selected for semi-structured interviews due to their role in providing pharmacy services in the selected country: the Central African Republic (CAR), the Democratic Republic of Congo (DRC), Ethiopia, and South Sudan. Transcripts from the interviews were anonymized, coded, and analyzed. Results: Nine participants were recruited (CAR: 2; DRC: 2; Ethiopia: 2; South Sudan: 3), and all except two were pharmacists. Conflict-specific challenges in pharmacy service delivery were identified as the following: unpredictable health needs and/or mismatched pharmaceutical supply, transport difficulties due to insecure roads, and shortage of pharmacy workforce due to brain drain or interrupted schooling. Barriers to health workforce retention and growth were identified to be brain drain as a result of suboptimal living and working conditions or remuneration, the perception of an unsafe work environment, and a career pathway or commitment duration that does not fit the diaspora or expatriate staff. Conclusion: To tackle the barriers of pharmacy health workforce retention and growth, policy solutions will be required and efforts that can bring about long-term improvement should be prioritized. This is essential to achieve universal health coverage and the targets of the sustainable development goals for conflict affected areas, as well as to “leave no one behind”.

CCOUC Ethnic Minority Health Project: A Case Study for Health EDRM Initiatives to Improve Disaster Preparedness in a Rural Chinese Population

Disasters disproportionately impact poor and marginalised populations due to greater vulnerability induced by various risk determinants, such as compromised living conditions, language barriers, and limited resources for disaster risk management. Health Emergency and Disaster Risk Management (Health EDRM) emphasises a people- and community-centred approach for building stronger capacities in communities and countries since community members are often the first responders to health emergencies and should be central to effective risk management. A key action for promoting community disaster preparedness is the provision of Health EDRM education interventions. The Ethnic Minority Health Project (EHMP) has provided community-based Health EDRM education interventions in 16 ethnic minority-based villages in remote areas of China since 2009. It aims to enhance community disaster preparedness and resilience by improving health-risk literacy and self-help capacity at the individual and household levels. This case study outlines the first EHMP project in an ethnic minority-based community (Ma’an Qiao Village) in Sichuan Province, China. It highlights the key elements for planning and managing such a project and is a good demonstration of an effective Health EDRM workforce development project in rural communities. This report concludes with five recommendations for setting up a sustainable and effective Health EDRM education intervention in similar contexts.