ABSTRACT
Background The COVID-19 pandemic has exposed Public Health system weaknesses due to chronic underinvestment in Public Health. In this context, Essential Public Health Functions (EPHFs) have been revitalized as an integrated, cost effective and sustainable approach to operationalising Public Health. The World Health Organization's recent position paper on building health systems resilience towards universal health coverage and health security recommended investing in EPHFs as a key mean for countries’ health systems recovery and transformation during COVID-19 and beyond. There is a need for conceptual and operational clarity of EPHFs to support countries to build back better, fairer and more resilient health systems. Methods A rapid review of peer-reviewed and grey literature regarding the EPHFs was conducted to identify different actors’ understandings of EPHFs and key lessons of applying the EPHFs at the global, regional and national levels, in order to identify the added value and key enablers to operationalising EPHFs. A crosswalk analysis of different authoritative lists of EPHFs was conducted to develop a common list of EPHFs as a reference for countries in response to Public Health challenges. Results A consolidated list of 12 EPHFs derived from the crosswalk analysis of different authoritative lists is presented, underpinning the consideration of health systems components and pressing health challenges. Six key enablers are identified from evidence and experience. These enablers are fundamental for countries to build holistic and strong Public Health capacities. Conclusions The EPHFs provide a clear and integrated framing to operationalise Public Health in countries that can be adapted to country contexts to build resilience. Health authorities and other Public Health stakeholders must seize the opportunity brought by COVID-19 recovery to continue advocating for and strengthening Public Health as a priority in health systems’ reconstruction and reform.
ABSTRACT
Background COVID-19 has caused unprecedented disruptions to health, social and economic systems in countries worldwide including Ireland. Weaknesses in Public Health capacities have undermined health system resilience compounding the effects of the pandemic. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost-effective approach to operationalising public health and a means to build health systems resilience. As Ireland looks to recovery, the Department of Health engaged the World Health Organization (WHO) to undertake a mapping of the current state of delivery of EPHFs to identify opportunities for improvement and support wider health system strengthening towards resilience. Methods A strategic review of the delivery of EPHFs in Ireland was conducted with respect to policy, infrastructure, service provision and coordination and integration. Findings were reported in the context of international lessons identified through experience with COVID-19 and major health system challenges within the Irish context. Results There are significant capacities present within the Irish context to support the delivery of the EPHFs though they are limited in strategic cohesion, coordination and implementation. These include a high level of Public Health expertise, an agile and resourceful workforce, a strongly engaged community and significant evidence generation and synthesis capacities. Gaps recognised included ICT infrastructure and capacity, workforce resourcing and support, pandemic planning and public health governance, visibility, legislation, strategy and resourcing. COVID-19 has led to the development and strengthening of mechanisms to leverage a whole-of-government and -society approach to health that should be sustained to tackle ongoing and future stressors. Conclusions The use of the EPHFs within the Irish setting provides a comprehensive approach to strengthening capacities for public health and enhanced population health and wellbeing.
ABSTRACT
Health system strengthening towards universal health coverage and health security are key objectives promoted by health policy actors. However, bringing together these agendas has presented challenges. Health investments are often reactive and siloed e.g. emergency and humanitarian response programmes. There has been disinvestment in public health and primary health care (PHC), and limited linkages with allied sectors (e.g. environmental and animal health). There is a need to better understand policies that promote integration and enable effective response to threats such as COVID-19 in tandem with maintaining routine health system functions (e.g. PHC and essential individual and population health services). We conducted document analysis of national health sector, security and public health policies and plans and drew on perspectives of key stakeholders to investigate integration using a health systems resilience framework. We examined the extent and manner in which policies are integrated to enable national and subnational systems to prepare for, prevent and adapt to shocks while maintaining routine and essential functions. While we identified a recognition of the need for better integration to promote health security within health systems strengthening efforts and vice versa including strengthening governance, accountability and capacity for stewardship within national and local health and allied authorities, evidence of such an approach was limited. National laws to support IHR (2005) implementation were often outdated and insufficient to produce the policy environment for multi-sectoral working. In 2020, only 47% of national COVID-19 plans from 106 countries considered the maintenance of non-COVID-19 essential health services - a key component of health systems resilience. Policies which strengthen PHC services and preventative interventions can be cost-effective and efficient whilst bridging pandemic response and other essential functions of the health system. Key messages COVID-19 is an opportunity to promote and sustain greater integration and inter- and multisectoral engagement. Everyone can play a role to foster an integrated approach focussing on preventative, cost-effective health services to ensure health systems resilience.