Enhancing Insights into Australia's Gonococcal Surveillance Programme through Stochastic Modelling.

Continued surveillance of antimicrobial resistance is critical as a feedback mechanism for the generation of concerted public health action. A characteristic of importance in evaluating disease surveillance systems is representativeness. Scenario tree modelling offers an approach to quantify system representativeness. This paper utilises the modelling approach to assess the Australian Gonococcal Surveillance Programme's representativeness as a case study. The model was built by identifying the sequence of events necessary for surveillance output generation through expert consultation and literature review. A scenario tree model was developed encompassing 16 dichotomous branches representing individual system sub-components. Key classifications included biological sex, clinical symptom status, and location of healthcare service access. The expected sensitivities for gonococcal detection and antibiotic status ascertainment were 0.624 (95% CI; 0.524, 0.736) and 0.144 (95% CI; 0.106, 0.189), respectively. Detection capacity of the system was observed to be high overall. The stochastic modelling approach has highlighted the need to consider differential risk factors such as sex, health-seeking behaviours, and clinical behaviour in sample generation. Actionable points generated by this study include modification of clinician behaviour and supplementary systems to achieve a greater contextual understanding of the surveillance data generation process.

Incidence management system of the healthcare institutions for disaster management in Sri Lanka.

BACKGROUND: Incident management systems and disaster planning processes facilitate maximal use of available resources. Evaluation of the Incident Command System (ICS) is one of the top five key areas of research priority in the field of surge. The study was aimed at assessing the disaster preparedness and ICS of the public healthcare institutions for the disaster management in a disaster-prone district of Sri Lanka. METHODS: A descriptive cross-sectional study was conducted among all public sector healthcare institutions (n = 74), including curative-healthcare institutions (n = 46) which have inward-care facilities for patient care and preventive healthcare institutions (n = 28) in Kurunegala district, Sri Lanka from May-September 2019 using a validated interviewer administered questionnaire which was based on 'CO-S-TR Model' for ICS assessment including 'Clear need for increased capacity (≤25%), Basic level (26 - 50%), Moderate level (51 - 75%) and High level (>75%)'. RESULTS: Focal points for disaster management were nominated by the majority of the curative sector (n = 33; 76.7%) and preventive sector (n = 19; 73.1%) healthcare institutions. A written disaster preparedness and response plans were available in 72% (n= 31) curative sector and 76% (n= 19) preventive sector institutions. The higher proportion of the curative sector institutions had moderate level capacity in the area of providing treatment, and basic level capacities were in the areas of 'staff mobilization, coordination of activities, supplying of special needs, triage of cases and transportation'. There is a clear need for improvement in the areas of communication commanding, management of controlling the incidence and tracking of the cases in the curative sector. The majority of the preventive sector institutions had moderate level capacity in commanding, control, coordination and tracking of cases. The basic level capacity in the areas of staff mobilization, stuff management and triage of cases. There is a clear need for improvement in the areas of communication in preventive sector. Of the public sector healthcare institutions, the higher proportion of the preventive sector (n = 20; 76.9%) and curative sector (n = 29; 67.4%) had basic level overall surge capacity of ICS for disaster management. CONCLUSION: Coordination, communication, commanding, management of controlling the incidence and tracking of cases following outbreaks need to be improved and capacity development programmes could implement to develop the preparedness for future disasters.

Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol.

INTRODUCTION: Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic. METHODS: The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar ETHICS AND DISSEMINATION: Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review's findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics. PROSPERO REGISTRATION NUMBER: CRD42022352612; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022352612.

Disparities in the implementation of the Health Extension Program in Ethiopia: Doing more and better towards universal health coverage.

Introduction: Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in the implementation of the HEP is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia. Methods: We used data from the 2019 National HEP assessment which was conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data were collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), and 7043 women from 7122 Households. This study focused on selected input, service delivery, and coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions. Results: We found wide inter-regional disparities in HEP implementation. Developing regional states (DRS) had significantly lower availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40), and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There were also significant disparities in HEP implementation among DRS in the proportion of households visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services was relatively high. Conclusion: There were significant inter-regional disparities in the implementation HEP in Ethiopia. The level of disparity among DRS was also remarkable. To achieve Universal Health Coverage, it is important that these disparities are addressed systematically and strategically. We recommend a tailored approach in HEP implementation in DRS.