Evaluating health systems’ preparedness for emerging infectious diseases: A novel conceptual and analytic framework

doi:10.1016/j.healthpol.2010.06.004

Health Policy

Volume 98, Issues 2–3, December 2010, Pages 91-97

https://doi.org/10.1016/j.healthpol.2010.06.004 Get rights and content

Abstract

In this article we present a novel conceptual framework for systematically assessing the national health system capacity to respond to pandemic influenza. This framework helps to determine how health systems and pandemic programmes interact, whether, where and which weak points exist, and how and where pandemic response health programmes can be improved effectively. This new conceptual framework draws upon two existing approaches for assessment and evaluation, the Systemic Rapid Assessment Toolkit (SYSRA) and the Hazard Analysis of Critical Control Points (HACCP). SYSRA is a systematic approach to analyse the interplay between communicable disease programmes and the broader health systems context within which they operate and the HACCP methodology builds upon a systematic analysis of process steps within a programme in order to identify likely hazards and to develop control measures to address them. The analytical framework that we have developed from the novel conceptualisation is simple, can be applied rapidly, and should, we believe, be low cost to implement. Thus, this provides a means for developing a contextual understanding of the broader health system in which a pandemic infectious disease programme operates, and for identifying frailties in programmes that need to be responded to.

Section snippets

Background

The emergence of influenza A H1N1 in Mexico, and its rapid global spread showed dramatically how a novel virus transmissible between humans, can attain pandemic status. Until recently, pandemic preparedness strengthening had focused principally on three public health functions, surveillance, containment and mitigation. With the advent of the H1N1 (2009) influenza pandemic, in retrospect the containment of future influenza A pandemics seems like an unrealistic challenge. Yet global public health

Evaluating pandemic influenza preparedness: a novel conceptual framework

This new conceptual framework draws upon the linkage of two existing approaches to evaluation, the Systemic Rapid Assessment Toolkit (SYSRA) and the Hazard Analysis of Critical Control Points (HACCP) method. The former addresses the mesolevel health system and programmatic elements of pandemic control, whilst HACCP extends this to the microlevel through service delivery analysis to identify critical weaknesses that likely need to be remedied.

Why and how can the new framework strengthen pandemic planning?

In the quest to evaluate the capacity of health systems to respond to pandemics both the SYSRA and the HACCP methods can be conjoined such that their strengths can add value. The SYSRA explores the health system level and programmatic elements of pandemic control. It is designed to assess the impact of the broader health system and programme on disease control and identify obstacles which affect pandemic programme control performance at the mesolevel. The HACCP, however, explores in finer

Combining SYSRA and HACCP

Within the new conceptual framework, a systematic data collection tool is combined with an analytical evaluation method. Practically, this framework can be subdivided into four basic phases: Within Phase I (data collection), documents are reviewed and stakeholder interviews conducted to gather and triangulate information about the health system and programme functionality and performance in terms of stewardship and organisational arrangements, financing, resource generation and allocation,

Limitations to the framework's applicability

The data gathered within the analytical framework has to answer how and for whom these programmes work and what influences their success. Therefore, it has to model system and programme components as accurately as possible, which is challenging since the evaluation is applied on an often theoretical pandemic response programme which has seldom been practically applied. As with all models, they represent an artificial construct. The aim is to gain as true a representation of the system as

Conclusion

The novel conceptual framework we present combines two accepted robust approaches to evaluation that offers potentially useful insights through their pragmatic application. Evaluation remains an important component in the development of robust programmes for controlling pandemics. This evaluation needs to be cognisant of the wider context within which programmes sit, acknowledge microlevel programme components, and analyse critically likely weaknesses in the implementation of interventions. The

Acknowledgements

Funding: This work was conducted as part of “AsiaFluCap: Heath system analysis to support capacity development in response to the threat of pandemic influenza in Asia”, a European Commission project funded within the Seventh Framework Programme (FP7/2007-2013), grant agreement number: Health-F3-2008-201823.

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The 2013–2016 Ebola outbreak in West Africa highlighted both the successes and limitations of social science contributions to emergency response operations. An important limitation was the rapid and effective communication of study findings. A systematic review was carried out to explore how rapid qualitative methods have been used during global heath emergencies to understand which methods are commonly used, how they are applied, and the difficulties faced by social science researchers in the field. We also asses their value and benefit for health emergencies. The review findings are used to propose recommendations for qualitative research in this context. Peer-reviewed articles and grey literature were identified through six online databases. An initial search was carried out in July 2016 and updated in February 2017. The PRISMA checklist was used to guide the reporting of methods and findings. The articles were assessed for quality using the MMAT and AACODS checklist. From an initial search yielding 1444 articles, 22 articles met the criteria for inclusion. Thirteen of the articles were qualitative studies and nine used a mixed-methods design. The purpose of the rapid studies included: the identification of causes of the outbreak, and assessment of infrastructure, control strategies, health needs and health facility use. The studies varied in duration (from 4 days to 1 month). The main limitations identified by the authors were: the low quality of the collected data, small sample sizes, and little time for cross-checking facts with other data sources to reduce bias. Rapid qualitative methods were seen as beneficial in highlighting context-specific issues that need to be addressed locally, population-level behaviors influencing health service use, and organizational challenges in response planning and implementation. Recommendations for carrying out rapid qualitative research in this context included the early designation of community leaders as a point of contact, early and continuous sharing of findings, and development of recommendations with local policy makers and practitioners.
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ReviewEvaluating health systems’ preparedness for emerging infectious diseases: A novel conceptual and analytic framework

Abstract

Section snippets

Background

Evaluating pandemic influenza preparedness: a novel conceptual framework

Why and how can the new framework strengthen pandemic planning?

Combining SYSRA and HACCP

Limitations to the framework's applicability

Conclusion

Acknowledgements

Health Policy

Lancet

Health Policy

The Journal of Hospital Infection

Health Policy

Journal of Food Protection

WHO global influenza preparedness plan. WHO/CDS/CSR/GIP/2005.5

WHO checklist for influenza pandemic preparedness planning. WHO/CDS/CSR/GIP/2005.4

Assessment tool for influenza preparedness in European countries—with a main focus on pandemic preparedness

Action, not talk: a simulation of risk communication during the first hours of a pandemic

Health Promotion Practice

Common ground: a pandemic influenza simulation exercise for the European Union, 23–24 November 2005

Euro Surveillance

A framework and toolkit for capturing the communicable disease programmes within health systems: tuberculosis control as an illustrative example

European Journal of Public Health

A framework for assessing the performance of health systems

Bulletin of the World Health Organization

Review
Evaluating health systems’ preparedness for emerging infectious diseases: A novel conceptual and analytic framework