Lessons learned from implementing a surge capacity support program for COVID-19 contact management in Ontario.

SETTING: In Ontario, local public health units (PHUs) are responsible for leading case investigations, contact tracing, and follow-up. The workforce capacity and operational requirements needed to maintain this public health strategy during the COVID-19 pandemic were unprecedented. INTERVENTION: Public Health Ontario's Contact Tracing Initiative (CTI) was established to provide a centralized workforce. This program was unique in leveraging existing human resources from federal and provincial government agencies and its targeted focus on initial and follow-up phone calls to high-risk close contacts of COVID-19 cases. By setting criteria for submissions to the program, standardizing scripts, and simplifying the data management process, the CTI was able to support a high volume of calls. OUTCOMES: During its 23 months of operation, the CTI was used by 33 of the 34 PHUs and supported over a million calls to high-risk close contacts. This initiative was able to meet its objectives while adapting to the changing dynamics of the pandemic and the implementation of a new COVID-19 provincial information system. Core strengths of the CTI were timeliness, volume, and efficient use of resources. The CTI was found to be useful for school exposures, providing support when public health measures were lifted, and in supporting PHU's reallocation of resources during the vaccine roll-out. IMPLICATIONS: When considering future use of this model, it is important to take note of the program strengths and limitations to ensure alignment with future needs for surge capacity support. Lessons learned from this initiative could provide practice-relevant knowledge for surge capacity planning.

RéSUMé: CONTEXTE: En Ontario, ce sont les bureaux de santé publique qui s'occupent des enquêtes de cas, de la recherche des contacts et des suivis. Pendant la pandémie de COVID-19, les besoins opérationnels et de capacité de la main-d'œuvre à combler pour conserver cette stratégie de santé publique ont atteint une ampleur jamais vue. INTERVENTION: L'Initiative de recherche des contacts dans le cadre de la lutte contre la COVID-19 de Santé publique Ontario a été mise sur pied dans l'objectif de centraliser l'effectif. Mobilisant des ressources humaines d'organisations fédérales et provinciales, ce programme a permis de faire les appels initiaux et de suivi aux contacts étroits de cas de COVID-19 exposés à un risque élevé. Grâce à des critères bien établis pour les soumissions au programme, à l'uniformisation des scripts et à la simplification du processus de gestion des données, un grand volume d'appels a pu être traité. RéSULTATS: Durant les 23 mois de l'Initiative, 33 des 34 bureaux de santé publique y ont eu recours. Ce sont ainsi plus d'un million d'appels à des contacts étroits qui ont pu être faits. L'Initiative a permis d'atteindre les objectifs en s'adaptant au contexte pandémique en constante évolution et de mettre en œuvre un nouveau système de gestion des renseignements provinciaux sur la COVID-19. Ses grandes forces sont la rapidité, le volume et l'efficacité de l'utilisation des ressources. Elle a été particulièrement utile dans les cas d'exposition en milieu scolaire, permettant d'offrir du soutien à la levée des mesures sanitaires et d'aider à la réaffectation des ressources des bureaux de santé publique pendant la campagne de vaccination. CONSéQUENCES: Si l'on envisage de réutiliser ce modèle, il importe de tenir compte des forces et des faiblesses du programme pour qu'il cadre avec les besoins futurs de soutien en matière de capacité de mobilisation. Les leçons tirées de cette initiative pourraient s'avérer pertinentes pour la planification de cette capacité.

Sustainable by design: a systematic review of factors for health promotion program sustainability.

BACKGROUND: Sustaining health promotion programs (HPP) is critical to maintain their intended health benefits, community capacity, and to optimize resources and investment. However, not all programs are sustained beyond their initial implementation period. This is partly due to uncertainty regarding sustainability: lack of a clear definition; infrequent use of a sustainability framework; and lack of understanding of the factors that influence sustainability. The aim of this systematic review is to identify barriers and facilitators that promote or inhibit the sustainability of HPP, particularly those that can be considered in program planning. METHODS: Two search strategies were used: 1) electronic database searching; and 2) grey literature searching. Inclusion criteria included papers published since 1998, in English, focusing on the sustainability of HPP that explicitly used a sustainability framework and specifically reported on facilitators and barriers to sustainability. Exclusion criteria included papers that addressed environmental, system or sector sustainability. Quality assessment was conducted on all included papers and a quality assessment tool was developed for grey literature. Data analysis included a thematic analysis, using an a priori framework to initially code barriers and facilitators, which were then grouped into factors for HPP sustainability. Factors were then analyzed for frequency, importance, and relevance, and categorized into one of three tiers. RESULTS: Sixteen papers were included in this review. Eleven definitions of sustainability and 13 sustainability frameworks were used. A total of 83 barriers and 191 facilitators were identified and categorized into 14 factors: nine from the a priori framework, and five additional ones based on the results of our analysis. Tier 1 factors were the most important for sustainability with organizational capacity scoring the highest; tier 3, the least important. CONCLUSION: This review provides clarity regarding existing definitions of sustainability and sustainability frameworks. It identifies fourteen factors that influence program sustainability, which practitioners can consider when planning, developing and implementing HPP. In addition, it is important for practitioners to clearly articulate program elements that should be sustained, define sustainability as it relates to the context of their program, select a sustainability framework to guide their work, and consider these factors for sustainability.