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ObjectivesThis study elucidates the status of public health governance, defines the concept and synthesises the evidence to guide stakeholders in enhancing governance for the delivery of essential public health functions (EPHFs).DesignA scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.Data sourcesA systematic search of peer-reviewed literature was performed using PubMed and Embase for English-language publications from 2000 to April 2025, supplemented by a grey literature search.Eligibility criteriaWe included literature addressing public health governance and institutional arrangements. We excluded documents focusing solely on disease-specific and clinical governance, and governance at supranational level.Extraction and synthesisData from 177 included documents were extracted and analysed to identify definitions, components, actors, enablers and principles relevant to public health governance. Findings were complemented by WHO’s experiences to develop an operational definition and framework.ResultsFindings revealed the absence of a standardised definition of public health governance and highlighted the diversity of actors within and across health and allied sectors. Findings identified strategy and policy development, oversight, partnership, legal authority, resource stewardship, and monitoring and evaluation as key components of public health governance; legislation, financing, institutional structures and political will as key enablers; and integration, comprehensiveness with equity and shared responsibility as key principles. Four institutional models were identified: autonomous public health bodies, semi-autonomous bodies under health ministries, public health departments within ministries and interministerial platforms without a designated institute.ConclusionDespite differences in institutional structures, successful delivery of the EPHFs depends on clearly defined roles and effective coordination across sectors. Government-led reviews and reforms are needed urgently to strengthen public health governance through institutional clarity, sustained investment and cross-sectoral collaboration for building resilient, trusted and equitable systems.

Background The COVID-19 pandemic exposed weaknesses in health systems globally, highlighting chronic underinvestment, fragmentation, and a lack of preparedness with catastrophic impact on public health, economies and societies. Lessons learned reconfirmed the necessity to build health systems resilience, integrating efforts to achieve Universal Health Coverage (UHC) and health security in tandem. Results This study identified 63 global and regional policies, collaborations, and investments (collectively termed “initiatives”) that came out post-COVID-19 and reviewed them in reference to their focus on integration of UHC and health security through the lens of WHO’s seven policy recommendations for building resilient health systems. The findings indicate that while efforts to align UHC and health security are evident at global and regional levels, they vary in depth and coherence. 81% of initiatives align with at least four of the seven WHO policy recommendations. While there is emphasis for health security preparedness, focus on primary care and health promotion is less pronounced. Policy initiatives show stronger alignment with WHO policy recommendations compared to Collaborations or Investments, indicating synergies between policies, while apparently a gap between policy and practice. Multilateral groups, including UN agencies, and government-affiliated organizations show greater alignment with the WHO policy recommendations too, while there is less alignment with those from non-governmental and other entities. Conclusions This review shows that while post COVID-19 policies increasingly articulate visions for integrated health systems strengthening, existing collaborations and investments have not demonstrated comparable commitment to the implementation of these visions. This underscores a prevailing disconnect among global health actors and the mostly reactive and short-term nature of external investments and partnerships. In low-income and fragile health system contexts, this misalignment risks the inefficient use of global support and may perpetuate foundational weaknesses in health systems. Moreover, this is particularly problematic given worsening fiscal constraints from reductions in overseas development assistance and country-level economic contractions. By (re)orienting global health policies, collaborations, and investments toward more unified approaches to achieving UHC and health security, the international community can more effectively support countries in building health systems capable of withstanding future crises, maintaining essential health services and safeguarding gains in health equity.

Summary The sustained instability in Afghanistan, along with ongoing disease outbreaks and the impact of the COVID-19 pandemic, has significantly affected the country. During the COVID-19 pandemic, the country’s detection and response capacities faced challenges. Case identification was done in all health facilities from primary to tertiary levels but neglected cases at the community level, resulting in undetected and uncontrolled transmission from communities. This emphasizes a missed opportunity for early detection that Event-Based Surveillance (EBS) could have facilitated. Therefore, Afghanistan planned to strengthen the EBS component of the national public health surveillance system to enhance the capacity for the rapid detection and response to infectious disease outbreaks, including COVID-19 and other emerging diseases. This effort was undertaken to promptly mitigate the impact of such outbreaks. We conducted a landscape assessment of Afghanistan’s public health surveillance system to identify the best way to enhance EBS, and then we crafted an implementation work plan. The work plan included the following steps: establishing an EBS multisectoral coordination and working group, identifying EBS information sources, prioritizing public health events of importance, defining signals, establishing reporting mechanisms, and developing standard operating procedures and training guides. EBS is currently being piloted in seven provinces in Afghanistan. The lessons learned from the pilot phase will support its overall expansion throughout the country.