4.A. Workshop: Lessons from the response to COVID-19 to inform strengthening of Essential Public Health Functions

Abstract   Internationally, the COVID-19 pandemic has increased disease burden and mortality, impacted mental health and wellbeing and delayed diagnosis and treatment of non-COVID care. It has been argued that, had sufficient funding of Public Health, including pandemic preparedness, been in place historically, many shortcomings of the pandemic response could have been mitigated. Thus, strengthening Public Health systems is on the agenda of governments internationally. Areas of specific interest are, emergency preparedness, international cooperation and solidarity, promoting vaccination uptake, health equity and community engagement, health literacy and misinformation (particularly online), planning for future workforce requirements and harnessing digitalization in health to address communicable and non-communicable disease threats. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost effective and operational approach to strengthening Public Health and are recognized by the WHO as key to building health system resilience. In a recent report, the WHO has proposed an approach to operationalizing the EPHFs, identifying key enablers that can be applied within specific country contexts. This workshop will describe the national and international research undertaken by the Irish Health Information and Quality Authority (HIQA) and the WHO at the request of the Department of Health to inform reform of the delivery model of Public Health in Ireland. HIQA and WHO will present the evidence base in terms of the value of EPHFs for health system strengthening, the findings of research to describe changes in Public Health structures and lessons learned in Ireland and across 12 countries during the COVID-19 pandemic, a description of the current state of delivery of the EPHFs within Ireland, and the results of a consultation survey distributed by the Department of Health in Ireland, investigating the experiences of organisations involved in the delivery of Public Health in light of the pandemic. The presenters will allow ample time for audience engagement and discussion with the expert panel to enable shared learning and to discuss the applicability of these findings to the reform and strengthening of the delivery of the EPHFs. The workshop objectives are to: • Describe the current evidence base in terms of the value of EPHFs for health system strengthening and the key enablers to support their application at country level. • Describe the recent changes and lessons learned regarding the delivery of the EPHFs during the COVID-19 pandemic in 12 countries. • Describe the delivery of the EPHFs in the Irish system in light of experience with COVID-19 and with awareness of current and future health system stressors. • Describe Public Health organisations’ experiences of delivering the EPHFs in Ireland in light of the pandemic. • Provide insights into how the delivery of the EPHFs could be reformed and strengthened for the future. Key messages • Lessons from the Public Health response to COVID-19, internationally and in Ireland will be discussed. • The workshop will provide a space to share ideas on reform and strengthening EPHF delivery.

COVID-19 pandemic on the care and management of cancer patients allows exploring potential and unsuspected issues that may affect society, health care systems, and patients. Those groups should not be considered individually but as an ecosystem continuously interacting, where a decision may affect everyone. This type of information may be of high relevance to policy-and decision-makers in their public health interventions.

Background:
The role of policymaking is to create the future that we want. In its communication on Better Regulation, the European Commission recognises the need for strategic foresight to play a key role in helping to 'future-proof' EU policymaking. The aim is to ensure that decisions are grounded in a longer-term perspective. In times of rapid change, EU policymaking needs to have impact assessments, fitness checks and major regulatory evaluations informed by foresight. Strategic foresight is also a powerful way to engage with stakeholders and not only capture their perspectives, but also generate collective intelligence in the areas of policy interest. Lessons from EU policy making: This fits within a broader effort at the Commission to be at the forefront of excellence in policymaking in Europe and worldwide. This is why the EU Policymaking Hub was launched 2020. It offers a platform for policymakers to learn, collaborate and share knowledge in EU policymaking, introducing new capacity building offers. It aims at strengthening the Commission's policymaking capacity through anticipating, developing, implementing, monitoring, and evaluating policies in an evidence-informed, transparent, and collaborative way with stakeholders, citizens and experts. Providing the policymaking community with a framework for long-term competence development will strengthen the profession, make it fit for the future, contribute to colleagues' motivation and help the Commission to achieve its goals.

Conclusions:
Being futures literate covers a range of skills from anticipation to the ability to run in-depth foresight processes. It spans a range of abilities from having an anticipatory mindset to scanning for change, understanding change and being able to influence change. Since its inception, this competence framework is at the base of an effort to train European civil servants in foresight and to increase foresight literacy for application in policymaking.
including pandemic preparedness, been in place historically, many shortcomings of the pandemic response could have been mitigated. Thus, strengthening Public Health systems is on the agenda of governments internationally. Areas of specific interest are, emergency preparedness, international cooperation and solidarity, promoting vaccination uptake, health equity and community engagement, health literacy and misinformation (particularly online), planning for future workforce requirements and harnessing digitalization in health to address communicable and non-communicable disease threats. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost effective and operational approach to strengthening Public Health and are recognized by the WHO as key to building health system resilience. In a recent report, the WHO has proposed an approach to operationalizing the EPHFs, identifying key enablers that can be applied within specific country contexts. This workshop will describe the national and international research undertaken by the Irish Health Information and Quality Authority (HIQA) and the WHO at the request of the Department of Health to inform reform of the delivery model of Public Health in Ireland. HIQA and WHO will present the evidence base in terms of the value of EPHFs for health system strengthening, the findings of research to describe changes in Public Health structures and lessons learned in Ireland and across 12 countries during the COVID-19 pandemic, a description of the current state of delivery of the EPHFs within Ireland, and the results of a consultation survey distributed by the Department of Health in Ireland, investigating the experiences of organisations involved in the delivery of Public Health in light of the pandemic. The presenters will allow ample time for audience engagement and discussion with the expert panel to enable shared learning and to discuss the applicability of these findings to the reform and strengthening of the delivery of the EPHFs. The workshop objectives are to: Describe the current evidence base in terms of the value of EPHFs for health system strengthening and the key enablers to support their application at country level. Describe the recent changes and lessons learned regarding the delivery of the EPHFs during the COVID-19 pandemic in 12 countries. Describe the delivery of the EPHFs in the Irish system in light of experience with COVID-19 and with awareness of current and future health system stressors. Describe Public Health organisations' experiences of delivering the EPHFs in Ireland in light of the pandemic. Provide insights into how the delivery of the EPHFs could be reformed and strengthened for the future. Key messages: Lessons from the Public Health response to COVID-19, internationally and in Ireland will be discussed. The workshop will provide a space to share ideas on reform and strengthening EPHF delivery.

Background:
The impact of the COVID-19 pandemic has prompted governments internationally to consider reform and strengthening of their Public Health systems. To support this work in Ireland, we undertook a review Public Health systems internationally (research question [RQ] 1), and identified lessons learned from the COVID-19 pandemic (RQ2).

Methods:
Data relating to Public Health systems (RQ1), and lessons learned (RQ2) for a select group of 12 countries were identified from organisations' websites, an electronic database and grey literature search and representatives from key national-level organisations. Data for RQ1 were extracted, mapped to the 12 Essential Public Health functions (EPHFs) at national, regional and local levels, and verified by participating representatives. For RQ2, thematic analysis of semi-structured interviews with participating representatives was undertaken and.

Results:
Typically, across all included countries, there is national strategic oversight of all EPHFs and, for certain functions, there is regional and local level implementation. Lessons learned from the COVID-19 pandemic broadly related to the themes of legislation and decision making; data collection, surveillance, evidence synthesis and collaboration; public