scholarly journals What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer B. Nuzzo ◽  
Diane Meyer ◽  
Michael Snyder ◽  
Sanjana J. Ravi ◽  
Ana Lapascu ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Scoping Review ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

scholarly journals A checklist to improve health system resilience to infectious disease outbreaks and natural hazards

2020 ◽  
Vol 5 (8) ◽  
pp. e002429 ◽  
Author(s):  
Diane Meyer ◽  
David Bishai ◽  
Sanjana J Ravi ◽  
Harunor Rashid ◽  
Shehrin Shaila Mahmood ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Disease Outbreaks ◽  
Health Systems Strengthening ◽  
Effective Response ◽  
Health Security ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Recent infectious disease outbreaks, including the ongoing global COVID-19 pandemic and Ebola in the Democratic Republic of the Congo, have demonstrated the critical importance of resilient health systems in safeguarding global health security. Importantly, the human, economic and political tolls of these crises are being amplified by health systems’ inabilities to respond quickly and effectively. Improving resilience within health systems can build on pre-existing strengths to enhance the readiness of health system actors to respond to crises, while also maintaining core functions. Using data gathered from a scoping literature review, interviews with key informants and from stakeholders who attended a workshop held in Dhaka, Bangladesh, we developed a Health System Resilience Checklist (‘the checklist’). The aim of the checklist is to measure the specific capacities, capabilities and processes that health systems need in order to ensure resilience in the face of both infectious disease outbreaks and natural hazards. The checklist is intended to be adapted and used in a broad set of countries as a component of ongoing processes to ensure that health actors, institutions and populations can mount an effective response to infectious disease outbreaks and natural hazards while also maintaining core healthcare services. The checklist is an important first step in improving health system resilience to these threats, but additional research and resources will be necessary to further refine and prioritise the checklist items and to pilot the checklist with the frontline health facilities that would be using it. This will help ensure its feasibility and durability for the long-term within the health systems strengthening and health security fields.

scholarly journals Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

2019 ◽  
Vol 9 (1) ◽  
pp. 6-16 ◽  
Author(s):  
My Fridell ◽  
Sanna Edwin ◽  
Johan von Schreeb ◽  
Dell D. Saulnier
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
World Health ◽  
Systems Research ◽  
Quality Health ◽  
System Resilience ◽  
Health Organization ◽  
Key Terms

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

Use and effectiveness of mHealth technologies in tracking the spread of infectious disease outbreaks and their implications for the COVID-19 pandemic: a systematic review protocol (Preprint)

2020 ◽  
Author(s):  
Madison Milne-Ives ◽  
Simon Rowland ◽  
Alison McGregor ◽  
J Edward Fitzgerald ◽  
Edward Meinert
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Systematic Review ◽  
Public Health Practice ◽  
Disease Outbreaks ◽  
Digital Technologies ◽  
World Health ◽  
Health Practice ◽  
Public Health Response ◽  
Infectious Disease Outbreaks

BACKGROUND The World Health Organisation (WHO) defines mHealth as medical and public health practice supported by mobile devices. A number of mHealth devices, primarily apps designed to support contact tracing, have been utilised as part of the public health response to the Covid-19 pandemic. The value of mHealth devices in augmenting public health practice is however yet to be defined. OBJECTIVE The study aims to address three research questions: (1) What digital technologies are being used to track the symptoms and spread of infectious disease outbreaks and what strategies do they use to do so? (2) How effective and cost-effective are digital technologies at tracking the spread of infectious disease outbreaks and what are their strengths and limitations? (3) What are the user perspectives on the usability and effectiveness of these technologies? METHODS The PICOS template and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) will be followed for this systematic review. The review will be composed of a literature search, article selection, data extraction, quality appraisal, data analysis, and a discussion of the implications of the data for the current COVID-19 pandemic. RESULTS N/A CONCLUSIONS This systematic review will summarise the available evidence for use of mHealth devices for tracking the spread of infectious disease outbreaks. These results are potentially valuable for informing public health policy during infectious disease outbreaks such as the current Covid-19 pandemic.

scholarly journals A New Model for Predicting Infectious Disease Outbreaks

2020 ◽  
Vol 8 (10) ◽  
Author(s):  
Peter Demitry ◽  
Darren McKnight ◽  
Erin Dale ◽  
Elizabeth Bartlett
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Infectious Diseases ◽  
Early Warning ◽  
Preventive Intervention ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
Health Authorities ◽  
The World

This project integrated tools and hybrid methodologies historically used for early warning, intelligence, counter space, public health, informatics, and medical surveillance applications. A multidiscipline team assembled and explored non-medical prediction and analytical techniques that successfully predict critical events for low probability but high-regret national and global scenarios. The team then created novel approaches needed to fill nuanced and unique gaps for the infectious disease prediction challenge. The team adopted and applied those proven procedures to determine which would be efficacious in foretelling infectious disease outbreaks around the world. One outcome of that effort was a successful two-year development and validation project designated ‘RAID’ (Risk Awareness Framework for Infectious Diseases), which focused on malaria prediction. The project’s objective was to maximize the warning (prediction) window of impending malaria epidemic outbreaks with sufficient time to allow meaningful preventive intervention before widespread human infection. It is generally recognized the more protracted the prediction window extends before an event, the more time available for health authorities to muster and deploy resources, which lessen morbidity, mortality, and harmful economic effects. Also, the value of early warning for an imminent epidemic must have mitigation options, or the warning window would have no beneficial impact on health outcomes. Finally, early notice is preferable over surprise epidemics, as unexpected waves of patients seeking acute care can easily overwhelm most local medical systems, as history repeatedly teaches. This cliché keeps repeating, with recurring Ebola epidemics and the recent COVID-19 pandemic as prominent exemplars. Predictive lead times need to be adequate for an intervention to be relevant. RAID’s focus on malaria prediction met these criteria from a relevant clinical and humanitarian perspective. Subsequent papers will address successful external generalization of these methods in predicting other similar infectious diseases. The model presented in this manuscript supports the conclusion that an additional two weeks advance notice could be available to public health authorities utilizing these techniques. This foreknowledge would allow the deployment of limited health resources into areas where they would do the most good and just in time. The geographical specificity was examined down to 5 km x 5 km grid squares overlaid anywhere in the world. Most of the model’s input data were derived from remote sensing satellite sources that could combine with historical WHO (World Health Organization) or nation-reported existential pathogen loads to improve model accuracy; however, such data harmonization is not required. If ground sensors were integrated into the modeling, the confidence of the risk of infection would logically improve. The model provides a successful global risk assessment via commercially available remote space sensors, even without ground sensing. RAID provides a necessary and useful preliminary means to predictive situational awareness. This improved predictive awareness is sufficiently granular to identify last chance windows for public health interventions globally. This need will become even more pronounced as infectious diseases evolve biologically and migrate geographically at ever-increasing rates.

scholarly journals Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018

2019 ◽  
Vol 147 ◽  
Author(s):  
F. Mboussou ◽  
P. Ndumbi ◽  
R. Ngom ◽  
Z. Kassamali ◽  
O. Ogundiran ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Disease Onset ◽  
Disease Outbreaks ◽  
Case Fatality ◽  
World Health ◽  
African Region ◽  
Regional Office ◽  
Member States ◽  
Infectious Disease Outbreaks ◽  
The World

Abstract The WHO African region is characterised by the largest infectious disease burden in the world. We conducted a retrospective descriptive analysis using records of all infectious disease outbreaks formally reported to the WHO in 2018 by Member States of the African region. We analysed the spatio-temporal distribution, the notification delay as well as the morbidity and mortality associated with these outbreaks. In 2018, 96 new disease outbreaks were reported across 36 of the 47 Member States. The most commonly reported disease outbreak was cholera which accounted for 20.8% (n = 20) of all events, followed by measles (n = 11, 11.5%) and Yellow fever (n = 7, 7.3%). About a quarter of the outbreaks (n = 23) were reported following signals detected through media monitoring conducted at the WHO regional office for Africa. The median delay between the disease onset and WHO notification was 16 days (range: 0–184). A total of 107 167 people were directly affected including 1221 deaths (mean case fatality ratio (CFR): 1.14% (95% confidence interval (CI) 1.07%–1.20%)). The highest CFR was observed for diseases targeted for eradication or elimination: 3.45% (95% CI 0.89%–10.45%). The African region remains prone to outbreaks of infectious diseases. It is therefore critical that Member States improve their capacities to rapidly detect, report and respond to public health events.

scholarly journals An evaluation of emergency guidelines issued by the World Health Organization in response to four infectious disease outbreaks

PLoS ONE ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. e0198125 ◽  
Author(s):  
Susan L. Norris ◽  
Veronica Ivey Sawin ◽  
Mauricio Ferri ◽  
Laura Raques Sastre ◽  
Teegwendé V. Porgo
Keyword(s):  
Infectious Disease ◽  
World Health Organization ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
The World ◽  
Health Organization

scholarly journals Ethics of instantaneous contact tracing using mobile phone apps in the control of the COVID-19 pandemic

2020 ◽  
Vol 46 (7) ◽  
pp. 427-431 ◽  
Author(s):  
Michael J Parker ◽  
Christophe Fraser ◽  
Lucie Abeler-Dörner ◽  
David Bonsall
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Mobile Phone ◽  
Public Health Practice ◽  
Disease Outbreaks ◽  
Contact Tracing ◽  
Mobile Phone Data ◽  
Public Health Response ◽  
Infectious Disease Outbreaks ◽  
Ethical Implications

In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deployed or are developing mobile phone apps capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions. In our paper, we outline some ethical considerations that need to be addressed in any deployment of this kind of approach as part of a multidimensional public health response. We also, briefly, explore the implications for its use in future infectious disease outbreaks.

scholarly journals Rigorous surveillance is necessary for high confidence in end-of-outbreak declarations for Ebola and other infectious diseases

2019 ◽  
Vol 374 (1776) ◽  
pp. 20180431 ◽  
Author(s):  
Robin N. Thompson ◽  
Oliver W. Morgan ◽  
Katri Jalava
Keyword(s):  
Infectious Disease ◽  
Disease Outbreaks ◽  
Decision Makers ◽  
World Health ◽  
Theme Issue ◽  
Public Health Decision ◽  
Infectious Disease Outbreaks ◽  
Travel Restrictions ◽  
Health Decision ◽  
Health Organization

The World Health Organization considers an Ebola outbreak to have ended once 42 days have passed since the last possible exposure to a confirmed case. Benefits of a quick end-of-outbreak declaration, such as reductions in trade/travel restrictions, must be balanced against the chance of flare-ups from undetected residual cases. We show how epidemiological modelling can be used to estimate the surveillance level required for decision-makers to be confident that an outbreak is over. Results from a simple model characterizing an Ebola outbreak suggest that a surveillance sensitivity (i.e. case reporting percentage) of 79% is necessary for 95% confidence that an outbreak is over after 42 days without symptomatic cases. With weaker surveillance, unrecognized transmission may still occur: if the surveillance sensitivity is only 40%, then 62 days must be waited for 95% certainty. By quantifying the certainty in end-of-outbreak declarations, public health decision-makers can plan and communicate more effectively.This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’. This issue is linked with the earlier theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’.

scholarly journals Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jude Thaddeus Ssensamba ◽  
Moses Mukuru ◽  
Mary Nakafeero ◽  
Ronald Ssenyonga ◽  
Suzanne N. Kiwanuka
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Facility ◽  
Health Systems ◽  
Building Blocks ◽  
Health Facilities ◽  
Health Centers ◽  
World Health ◽  
Care Services ◽  
Southern Central

Abstract Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to offer geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross-section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of critical items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level, and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8–26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores concerning; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher-level HFs were statistically significantly friendlier than lower-level HFs (p = 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p = 0.025). Conclusion There is a low readiness for public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for older adults if the 2020 global healthy ageing goal is to be met.

scholarly journals Rational trust in resilient health systems

2019 ◽  
Vol 34 (7) ◽  
pp. 553-557 ◽  
Author(s):  
Sonja Kristine Kittelsen ◽  
Vincent Charles Keating
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
The Public ◽  
Public Health Emergencies ◽  
Health Authorities ◽  
Cast Doubt ◽  
Public Health Authorities ◽  
System Resilience ◽  
Relevant Component

AbstractThe 2014–15 Ebola epidemic in West Africa highlighted the significance of trust between the public and public health authorities in the mitigation of health crises. Since the end of the epidemic, there has been a focus amongst scholars and practitioners on building resilient health systems, which many see as an important precondition for successfully combatting future outbreaks. While trust has been acknowledged as a relevant component of health system resilience, we argue for a more sustained theoretical engagement with underlying models of trust in the literature. This article takes a first step in showing the importance of theoretical engagement by focusing on the appeal to rational models of trust in particular in the health system resilience literature, and how currently unconsidered assumptions in this model cast doubt on the effectiveness of strategies to generate trust, and therein resilience, during acute public health emergencies.

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