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To help explain the diversity of COVID-19 outcomes by country, research teams worldwide are studying national government response efforts. However, these attempts have not focused on a critical national authority that exists in half of the countries in the world: national public health institutes (NPHIs). NPHIs serve as an institutional home for public health systems and expertise and play a leading role in epidemic responses. To characterize the role of NPHIs in the COVID-19 response, we conducted a descriptive literature review that explored the research documented during March 2020-May 2021. We conducted a name-based search of 61 NPHIs in the literature, representing over half of the world's NPHIs. We identified 33 peer-reviewed and 300 gray articles for inclusion. We describe the most common NPHI-led COVID-19 activities that are documented and identify gaps in the literature. Our findings underscore the value of NPHIs for epidemic control and establish a foundation for primary research.

Background Global policymakers have proposed strengthening midwifery regulation to improve access to and quality of care provided by midwives, thereby enhancing maternal healthcare delivery and outcomes. However, quantifying ‘midwifery regulatory environments’ as a construct across countries has been difficult, limiting our ability to evaluate relationships between regulatory environments and key outcomes and hindering actionable steps toward improvement. The Global Midwives’ Associations map survey includes data across five domains of regulation (overarching regulatory policy and legislation; education and qualification; licensure; registration/re-licensure; and scope and conduct of practice). We aimed to use these data to develop a composite index that represents the midwifery regulatory environment in the countries that participated in the survey. Methods To develop our composite Midwifery Regulatory Environment (MRE) Index, we analyzed data from 115 countries in the Global Midwives’ Associations map survey. We identified five different possible scoring characterizations for thirteen regulatory items. Four characterizations used continuous or categorical cumulative scoring and one used multiple individual components scoring. We compared these characterizations using Clarke’s test and descriptive model fit metrics to identify the best fit and performance for three outcomes: maternal mortality ratio, low birthweight prevalence, and stillbirth rate. Results The Aggregated Domain Scoring method, which assigns one point for each of the five essential regulatory domains with activity (possible score range: 0–5), was the best fit and performing characterization for maternal mortality ratio and stillbirth outcomes. The Any-or-None Scoring method, which assigns one point per survey item with regulatory activity (possible score range: 0–13), best fit low birthweight prevalence. Conclusions Our study demonstrates that developing composite characterizations of complex constructs, as exemplified by MRE Index development, can enhance the usability of existing global health datasets. Additionally, it highlights how employing model fit prediction provides a transparent, replicable, and accessible approach for identifying the optimal characterization of the construct based on a specific outcome. Specifically, we found that different characterizations for the MRE Index are preferred for different maternal health outcomes. The MRE Index we have developed stands as a valuable tool for future research exploring relationships between midwifery regulation and maternal health outcomes.

COVID-19 has highlighted the importance of essential public health functions (EPHFs) and the coordination between them. The US Centers for Disease Control and Prevention defines EPHFs as ‘the public health activities that all communities should undertake’. According to multiple functional frameworks published in literature, the functions typically include workforce development, surveillance, public health research, laboratory services, health promotion, outbreak response and emergency management. National Public Health Institutes (NPHIs) are often the lead government agency responsible for execution of these functions.This paper describes how NPHIs or other health authorities can improve public health impact by enhancing the coordination of public health functions and public health actors through functional and organisational linkages. We define public health linkages as practical, replicable activities that facilitate collaboration between public health functions or organisations to improve public health. In this paper, we propose a novel typology to categorise important public health linkages and describe enablers of linkages identified through our research.Based on our research, investments in health systems should move beyond vertical approaches to developing public health capacity and place greater emphasis on strengthening the interactions between public health functions and institutions. Development of linkages and their enablers require a purposeful, proactive focus that establishes and strengthens linkages over time and cannot be developed during an outbreak or other public health emergency.

Background The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy. Methods MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes. Results Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2–23.5%) and 22.3% (95% confidence interval 13.2–31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV. Conclusions Similar to other Project ECHO evaluation results in the United States of America, Namibia’s Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.

Background The clinical burden of Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other post-infectious fatiguing illnesses (PIFI) is increasing. There is a critical need to advance understanding of the effectiveness and sustainability of innovative approaches to clinical care of patients having these conditions. Methods We aim to assess the effectiveness of a Long COVID and Fatiguing Illness Recovery Program (LC&FIRP) in a two-arm, single-blind, pragmatic, quality improvement, professional cluster, randomized controlled trial in which 20 consenting clinicians across primary care clinics in a Federally Qualified Health Center system in San Diego, CA, will be randomized at a ratio of 1:1 to either participate in (1) weekly multi-disciplinary team-based case consultation and peer-to-peer sharing of emerging best practices (i.e., teleECHO (Extension for Community Healthcare Outcomes)) with monthly interactive webinars and quarterly short courses or (2) monthly interactive webinars and quarterly short courses alone (a control group); 856 patients will be assigned to participating clinicians (42 patients per clinician). Patient outcomes will be evaluated according to the study arm of their respective clinicians. Quantitative and qualitative outcomes will be measured at 3- and 6-months post-baseline for clinicians and every 3-months post assignment to a participating clinician for patients. The primary patient outcome is change in physical function measured using the Patient-Reported Outcomes Measurement Information System (PROMIS)-29. Analyses of differences in outcomes at both the patient and clinician levels will include a linear mixed model to compare change in outcomes from baseline to each post-baseline assessment between the randomized study arms. A concurrent prospective cohort study will compare the LC&FIRP patient population to the population enrolled in a university health system. Longitudinal data analysis approaches will allow us to examine differences in outcomes between cohorts. Discussion We hypothesize that weekly teleECHO sessions with monthly interactive webinars and quarterly short courses will significantly improve clinician- and patient-level outcomes compared to the control group. This study will provide much needed evidence on the effectiveness of a technology-enabled multi-disciplinary team-based care model for the management of Long COVID, ME/CFS, and other PIFI within a federally qualified health center. Trial registration ClinicalTrials.gov, NCT05167227 . Registered on December 22, 2021.

Background Although attainment of the health-related Millennium Development Goals relies on countries having adequate numbers of human resources for health (HRH) and their appropriate distribution, global understanding of the systems used to generate information for monitoring HRH stock and flows, known as human resources information systems (HRIS), is minimal. While HRIS are increasingly recognized as integral to health system performance assessment, baseline information regarding their scope and capability around the world has been limited. We conducted a review of the available literature on HRIS implementation processes in order to draw this baseline. Methods Our systematic search initially retrieved 11 923 articles in four languages published in peer-reviewed and grey literature. Following the selection of those articles which detailed HRIS implementation processes, reviews of their contents were conducted using two-person teams, each assigned to a national system. A data abstraction tool was developed and used to facilitate objective assessment. Results Ninety-five articles with relevant HRIS information were reviewed, mostly from the grey literature, which comprised 84 % of all documents. The articles represented 63 national HRIS and two regionally integrated systems. Whereas a high percentage of countries reported the capability to generate workforce supply and deployment data, few systems were documented as being used for HRH planning and decision-making. Of the systems examined, only 23 % explicitly stated they collect data on workforce attrition. The majority of countries experiencing crisis levels of HRH shortages (56 %) did not report data on health worker qualifications or professional credentialing as part of their HRIS. Conclusion Although HRIS are critical for evidence-based human resource policy and practice, there is a dearth of information about these systems, including their current capabilities. The absence of standardized HRIS profiles (including documented processes for data collection, management, and use) limits understanding of the availability and quality of information that can be used to support effective and efficient HRH strategies and investments at the national, regional, and global levels.

Armed conflicts threaten the resilience of health systems and the continuity of medical education. The war in Ukraine has impacted the health infrastructure and depleted the workforce, highlighting the need for trauma care training to strengthen healthcare professionals' capacity to provide care. Sustaining training remotely may offer a practical way to overcome limitations of in-person courses. In response, the Harvard Humanitarian Initiative (HHI), in collaboration with Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico, piloted a virtual case-based community of practice (VCoP) to strengthen the delivery of trauma care in Ukraine and bridge initial in-person training. Ten VCoP sessions were implemented between October and December. Participation was offered to all Ukrainian trauma care trainers who participated in prior in-person training. The assessment survey was sent to all VCoP session participants and evaluated program feasibility, reach, engagement, and perceived impact. Highly engaged participants were invited to an additional virtual interview to provide additional feedback. Implementation and outcomes were measured with a mixed-methods formative evaluation. Analysis included attendance data, post-session and end-of-series surveys, and semi-structured interviews. Forty-four Ukrainian trauma trainers who participated in earlier in-person education participated in at least one session, representing 10 oblasts (administrative regions) in Ukraine. Post-session survey response rate averaged 74%. 94% of participants indicated applying knowledge from the sessions in their practice or teaching and 89% reported changes in their practice and innovation in their teaching methods. 94% of participants reported that the program helped them increase professional connectedness. All participants expressed interest in participating in future VCoP sessions with 77% expressing interest in leading future sessions. The Ukraine Trauma Care VCoP demonstrated that virtual education can be feasible and effective in bridging initial training and capacity strengthening of healthcare providers in conflict settings, providing sustainability. Future efforts should evaluate the ability of this model to adapt and scale in similar contexts.

Over the last decade, there have been growing calls for national and local governments to adapt to a changing climate to protect human health. Due to the shift in U.S. federal climate policy under the Trump Administration, leadership for this climate and health adaptation rests increasingly among state, local and tribal health authorities. These authorities need effective strategies for planning climate and health adaptation in funding-constrained environments. This study proposes an adapted model for planning climate and health adaptation among state and local health departments, based on a review of existing efforts in the U.S., with a particular focus on the U.S. CDC’s Building Resilience Against Climate Effects (BRACE) model employed in the CDC-funded Climate Ready States and Cities Initiative (CRSCI). Study methods comprised: a literature review of existing adaptation efforts in the U.S.; analysis of 11 CDC interviews with CRSCI grantees; and 11 online, videoconference focus group discussions with 46 city and county health officials. The study characterizes the key inputs and processes involved in BRACE implementation by 9 states and 2 cities, revealing key challenges and enabling factors that influenced successful climate and health adaptation planning. The study also summarizes the input of health authorities on operational requirements to expand climate and health adaptation at state and local levels, and their recommendations for an adapted BRACE model. Lastly, the study proposes an adapted BRACE model for state and local health departments facing resource constraints, and recommendations for how CDC and the broader health community can advance climate and health adaptation nationwide.

Introduction Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. The purpose of this case presentation is to document for the first time Mozambique’s novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. Case presentation Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a “health extension” which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique’s health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals’ physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following: HRIS information was used to examine the deployment of nurses trained in antiretroviral therapy (ART) vis-à-vis the health facilities where ART is being provided. Such results help the MOH align specialized skill sets with service provision. Twenty-five percent of the MOH health workforce had passed the 2-year probation period but had not been updated in the MOH information systems. For future monitoring of employee status, the MOH established a system of alerts in semi-monthly reports. As of August 2014, 1046 health workers were receiving their full salary but no longer working at the facilities. The MOH is now analyzing this situation to improve the retirement process and coordination with Social Security. Conclusion The Mozambican system is an important example of an HRIS built on a local platform with local staff. Notable models of strategic data use demonstrate that the system is empowering the MOH to improve health services delivery, health workforce allocation, and management. Combined with committed country leadership and ownership of the program, this suggests strong chances of sustainability and real impact on public health equity and quality.