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COVID-19 has led to seismic changes in neurological practice in a matter of weeks. The Association of British Neurologists has supported neurology specialists and patients during this rapid reorganisation and its attendant challenges. We have written guidance on structured service transformation, considering the need to sustain long term care while responding to acute developments; we have recognised that staff experience differs and that this, as well as individual risk factors should be considered when redeployment occurs. Appreciating that there may be understandable anxiety when facing a working routine outside normal practice, we have signposted ethical and psychological support for individuals. We have also focused on our patients: we have facilitated a national alert system to register all neurological COVID cases, coordinating research efforts on this new disease; finally we have defined how to identify the most vulnerable patients under our care. When this initial wave of the pandemic subsides, we will have planned for return to the new ‘norm’, ready to embrace innovation where appropriate, aiming to minimise fall-out in our chronic disease population, and potentially having enhanced and modernised our services.

Specialized palliative care teams improve outcomes for the steadily growing population of people living with serious illness. However, few studies have examined whether the specialty palliative care workforce can meet the growing demand for its services. We used 2018 clinician survey data to model risk factors associated with palliative care clinicians leaving the field early, and we then projected physician numbers from 2019 to 2059 under four scenarios. Our modeling revealed an impending \"workforce valley,\" with declining physician numbers that will not recover to the current level until 2045, absent policy change. However, sustained growth in the number of fellowship positions over ten years could reverse the worsening workforce shortage. There is an immediate need for policies that support high-value, team-based palliative care through expansion in all segments of the specialty palliative care workforce, combined with payment reform to encourage the deployment of sustainable teams.

The lack of health workers in remote and rural areas is a worldwide concern. Many countries have proposed and implemented interventions to address this issue, but very little is known about the effectiveness of such interventions and their sustainability in the long run. This paper provides an analysis of the effectiveness of interventions to attract and retain health workers in remote and rural areas from an impact evaluation perspective. It reports on a literature review of studies that have conducted evaluations of such interventions. It presents a synthesis of the indicators and methods used to measure the effects of rural retention interventions against several policy dimensions such as: attractiveness of rural or remote areas, deployment/recruitment, retention, and health workforce and health systems performance. It also discusses the quality of the current evidence on evaluation studies and emphasizes the need for more thorough evaluations to support policy-makers in developing, implementing and evaluating effective interventions to increase availability of health workers in underserved areas and ultimately contribute to reaching the United Nations' Millennium Development Goals.

Background The concept of health equity by design encompasses a multifaceted approach that integrates actions aimed at eliminating biased, unjust, and correctable differences among groups of people as a fundamental element in the design of algorithms. As algorithmic tools are increasingly integrated into clinical practice at multiple levels, nurses are uniquely positioned to address challenges posed by the historical marginalization of minority groups and its intersections with the use of “big data” in healthcare settings; however, a coherent framework is needed to ensure that nurses receive appropriate training in these domains and are equipped to act effectively. Purpose We introduce the Bias Elimination for Fair AI in Healthcare (BE FAIR) framework, a comprehensive strategic approach that incorporates principles of health equity by design, for nurses to employ when seeking to mitigate bias and prevent discriminatory practices arising from the use of clinical algorithms in healthcare. By using examples from a “real‐world” AI governance framework, we aim to initiate a wider discourse on equipping nurses with the skills needed to champion the BE FAIR initiative. Methods Drawing on principles recently articulated by the Office of the National Coordinator for Health Information Technology, we conducted a critical examination of the concept of health equity by design. We also reviewed recent literature describing the risks of artificial intelligence (AI) technologies in healthcare as well as their potential for advancing health equity. Building on this context, we describe the BE FAIR framework, which has the potential to enable nurses to take a leadership role within health systems by implementing a governance structure to oversee the fairness and quality of clinical algorithms. We then examine leading frameworks for promoting health equity to inform the operationalization of BE FAIR within a local AI governance framework. Results The application of the BE FAIR framework within the context of a working governance system for clinical AI technologies demonstrates how nurses can leverage their expertise to support the development and deployment of clinical algorithms, mitigating risks such as bias and promoting ethical, high‐quality care powered by big data and AI technologies. Conclusion and Relevance As health systems learn how well‐intentioned clinical algorithms can potentially perpetuate health disparities, we have an opportunity and an obligation to do better. New efforts empowering nurses to advocate for BE FAIR, involving them in AI governance, data collection methods, and the evaluation of tools intended to reduce bias, mark important steps in achieving equitable healthcare for all.

Aim. To develop a scale for measuring nurse’s perceived work environment during the public health emergencies (PHEs) and assess its reliability and validity. Background. Although there is extensive research on instruments for measuring nursing work environments in regular healthcare settings, there is a lack of specific scales tailored to address the unique work conditions experienced by nurses during PHEs. Design. This study employed a cross-sectional design for psychometric evaluation and adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Methods. A self-report scale, the Chinese Nursing Work Environment Scale for Public Health Emergencies (C-NWE-PHE), was developed, integrating situational characteristics. Data on demographics, adapted scale scores, and subjective evaluations of nursing management performance were collected from 1156 nurses through online surveys conducted between January 2023 and March 2023. Confirmatory factor analysis, Pearson correlations, and Cronbach’s alpha analyses were conducted to evaluate the psychometric properties of the scale. Results. The adapted C-NWE-PHE scale comprised 28 items organized into five subscales: Workforce and Deployment Support, Leadership and Emergency Management, Autonomy and Empowerment, Teamwork and Collaboration, and Logistics and Humanistic Care. Structural equation modelling showed satisfactory factor loadings for each subscale and a good model fit, confirming construct validity. The content validity and reliability of the total scale were confirmed. Conclusion. This study provides empirical evidence for understanding and assessing the nursing work environment during PHEs with a psychometrically sound scale. Implications for Nursing Management. The C-NWE-PHE scale, along with its five identified constructs, provides a nuanced comprehension of working conditions amid PHEs. Implementing this scale could foster specific enhancements, support nurse retention efforts, and enhance the effectiveness of responses during challenging emergency situations.

The current study examines teacher deployment strategies in Cambodian preschools and identifies challenges related to the supply and deployment of teaching staff in early childhood education by assessing the adequacy, efficiency, and quality of teacher deployment. This study employs multiple approaches in data collection, including desk review of existing policies and literature, analysis of school-level administrative data, and in-depth interviews at the national, sub-national, and school levels. The findings from the study highlight the severe teacher shortage, uneven distribution of qualified teachers and disparities in teacher quality in Cambodian early childhood education. Newly graduated and well-trained preschool teachers are disproportionately deployed in urban areas, while preschool teachers in rural schools are not adequately trained to be preschool teachers. Existing efforts to expand preschool access are insufficient without simultaneously addressing the urgent need for properly trained preschool teachers. Based on these findings, the study offers policy recommendations, including scaling up pre-service training, strengthening teacher workforce planning through improved data systems, and implementing targeted incentives to ensure a more equitable and sustainable ECE teacher workforce.

Issue Mass gatherings challenge healthcare systems, requiring structured preparedness to prevent hospital congestion. The 2024 Alpini National Gathering, held in Vicenza, Italy (May 10-12, 2024), drew 400,000 attendees, tripling the city's population. Without a coordinated strategy, emergency services could have been overwhelmed. ULSS 8 Berica, the local health authority, implemented a healthcare plan, ensuring seamless coordination between pre-hospital and hospital services, with San Bortolo Hospital as the main referral center. Description A structured healthcare strategy was activated to optimize patient management and hospital resources. Key components: 1. Four Advanced Medical Posts (PMA) to treat minor cases on-site, reducing ED visits; 2. A Temporary Field Hospital to stabilize moderate cases and limit hospital transfers; 3. Hospital capacity optimization, reinforcing staff and triage protocols; 4. Real-time coordination with SUEM 118 for efficient ambulance dispatch and referrals. Results - San Bortolo Hospital recorded 714 ED visits, a 7-11% decrease from the previous week. 94 hospitalizations remained stable despite the population surge. - The Field Hospital treated 106 patients, with only 7 requiring hospitalization, reducing hospital burden. Four PMAs handled 52 minor cases, filtering non-critical patients from the ED. - SUEM 118 handled 3074 emergency calls, 787 event-related, with 226 SAP on-site interventions, optimizing resources. - The triage system led to a 20% reduction in hospital admissions, based on pre-event trends, demonstrating the effectiveness of decentralized care. Lessons - Pre-hospital triage reduced hospital congestion while maintaining care quality. - Shuttle services and designated routes ensured timely workforce deployment. - This scalable model strengthens public health preparedness for future mass gatherings. Key messages • A coordinated mass gathering healthcare strategy prevented hospital overload and optimized emergency response. • Integrating pre-hospital and hospital services enhanced system resilience and ensured continuity of care during large-scale events.

OP 6: Health Policy 2, B308 (FCSH), September 3, 2025, 15:45 - 16:45 Aims The 2023 earthquake in northwest Syria worsened the vulnerabilities of a health system already weakened by conflict, displacement, and resource shortages. The crisis affected local populations and Syrian refugees in Türkiye, as health workers and humanitarian organizations faced legal restrictions, border closures, and fragmented aid distribution. This study examines the health workforce response in Syria, focusing on cross-border service provision, coordination mechanisms, and workforce adaptations to inform future emergency preparedness. Methods Fourteen key informant interviews were conducted with academics, local NGOs, and international organizations in southeast Türkiye involved in the earthquake response in Syria. A thematic analysis explored workforce availability, coordination structures, emergency deployment, cross-border patient referrals, and logistical barriers. Results The earthquake response in northwest Syria was hindered by a lack of preparedness, political constraints, and restricted cross-border access. Widespread damage to health facilities and shortages of physicians further strained the system. While health workers were relocated from less-affected areas, resource limitations and bureaucratic delays slowed reinforcements. In Türkiye, legal barriers prevented Syrian health workers from traveling or returning to Syria, while border closures delayed critical patient referrals. Bureaucratic hurdles obstructed the rapid deployment of international medical teams, increasing strain on the local workforce. Despite these challenges, cross-border coordination gradually improved with health clusters and humanitarian organizations redirecting resources, deploying mobile clinics in IDP camps, and integrating emergency services into refugee health programs. Lessons from past crises, including COVID-19, supported task shifting, emergency recruitment, and expanded mental health support for health workers. Conclusions The earthquake response exposed critical policy gaps in workforce preparedness and cross-border collaboration. Future efforts must pre-position medical supplies, fast-track licensing for displaced health workers, and improve cross-border coordination and referrals. Strengthening local workforce resilience through training, financial support, and policy reforms will be essential to mitigating future health crises for IDPs and Syrian refugees.

To determine the challenges met by, and needs of, the epidemiology emergency response workforce, with the aim of informing the development of a larger survey, by conducting key informant interviews of public health experts. We defined our study population as public health experts with experience of epidemiology deployment. Using purposive sampling techniques, we applied random number sampling to shortlists of potential interviewees provided by key organizations to obtain 10 study participants; we identified three additional interviewees through snowballing. The same interviewer conducted all key informant interviews during May-August 2019. We thematically analysed de-identified transcripts using a qualitative data analysis computer software package. Despite our interviewees having a wide range of organizational and field experience, common themes emerged. Interviewees reported a lack of clarity in the definition of an emergency response epidemiologist; the need for a broader range of skills; and inadequate leadership and mentoring in the field. Interviewees identified the lack of interpersonal skills (e.g. communication) and a lack of career progression options as limitations to the effectiveness of emergency response. The epidemiology emergency response workforce is currently not achieving collective competence. The lack of a clear definition of the role must be addressed, and leadership is required to develop teams in which complementary skills are harmonized and those less experienced can be mentored. Epidemiology bodies must consider individual professional accreditation to ensure that the required skills are being achieved, as well as enabling continual professional development.

Introduction Cameroon is classified by the World Health Organization (WHO) as having a critical shortage of health personnel. This is further complicated by the geographic distributional inequalities of the national health workforce. This shortfall impedes Cameroons’ progress of improving the human resources for health (HRH) to meet up with the Millennium Development Goals (MDGs) by 2015. However, it is unknown whether the health workforce of Cameroon is distributed equally across geographic regions. Additionally, indicators other than population levels have not been used to measure health care needs. This study aimed to assess the adequacy, evenness of distribution and challenges faced by the health workforce across the different regions of Cameroon. Methods National health personnel availability and distribution were assessed by use of end-of-year census data for 2011 obtained from the MoPH data base. The inequalities and distribution of the workforce were estimated using Gini coefficient and Lorenz curve and linear regression was used to determine the relation between health personnel density and selected health outcomes. Alternative indicators to determine health care needs were illustrated using concentration curves. Results Significant geographic inequalities in the availability of health workforce exist in Cameroon. Some regions have a higher number of physicians (per person) than others leading to poor health outcomes across the regions. 70 % of regions have a density of health personnel-to-population per 1,000 that is less than 1.5, implying acute shortage of health personnel. Poor working and living conditions, coupled with limited opportunities for career progress accounted for some documented 232 physicians and 205 nurses that migrated from the public sector. Significant distributional inequality was noticed when under-five infant mortality and malaria prevalence rate were used as indicators to measure health care needs. Conclusion Our results show an absolute shortage of public health personnel in Cameroon that is further complicated by the geographic distributional inequalities across the regions of the nation. Cameroon aims to achieve universal health coverage by 2035; to realize this objective, policies targeting training, recruitment, retention and effective deployment of motivated and supported health workforce as well as the development and improvement of health infrastructures remain the major challenge.