Essential Public Health Functions in Ireland: Perspectives to strengthen capacities and stewardship

Abstract Background COVID-19 has caused unprecedented disruptions to health, social and economic systems in countries worldwide including Ireland. Weaknesses in Public Health capacities have undermined health system resilience compounding the effects of the pandemic. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost-effective approach to operationalising public health and a means to build health systems resilience. As Ireland looks to recovery, the Department of Health engaged the World Health Organization (WHO) to undertake a mapping of the current state of delivery of EPHFs to identify opportunities for improvement and support wider health system strengthening towards resilience. Methods A strategic review of the delivery of EPHFs in Ireland was conducted with respect to policy, infrastructure, service provision and coordination and integration. Findings were reported in the context of international lessons identified through experience with COVID-19 and major health system challenges within the Irish context. Results There are significant capacities present within the Irish context to support the delivery of the EPHFs though they are limited in strategic cohesion, coordination and implementation. These include a high level of Public Health expertise, an agile and resourceful workforce, a strongly engaged community and significant evidence generation and synthesis capacities. Gaps recognised included ICT infrastructure and capacity, workforce resourcing and support, pandemic planning and public health governance, visibility, legislation, strategy and resourcing. COVID-19 has led to the development and strengthening of mechanisms to leverage a whole-of-government and -society approach to health that should be sustained to tackle ongoing and future stressors. Conclusions The use of the EPHFs within the Irish setting provides a comprehensive approach to strengthening capacities for public health and enhanced population health and wellbeing.


Background:
COVID-19 has caused unprecedented disruptions to health, social and economic systems in countries worldwide including Ireland. Weaknesses in Public Health capacities have undermined health system resilience compounding the effects of the pandemic. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost-effective approach to operationalising public health and a means to build health systems resilience. As Ireland looks to recovery, the Department of Health engaged the World Health Organization (WHO) to undertake a mapping of the current state of delivery of EPHFs to identify opportunities for improvement and support wider health system strengthening towards resilience.

Methods:
A strategic review of the delivery of EPHFs in Ireland was conducted with respect to policy, infrastructure, service provision and coordination and integration. Findings were reported in the context of international lessons identified through experience with COVID-19 and major health system challenges within the Irish context.

Results:
There are significant capacities present within the Irish context to support the delivery of the EPHFs though they are limited in strategic cohesion, coordination and implementation. These include a high level of Public Health expertise, an agile and resourceful workforce, a strongly engaged community and significant evidence generation and synthesis capacities. Gaps recognised included ICT infrastructure and capacity, workforce resourcing and support, pandemic planning and public health governance, visibility, legislation, strategy and resourcing. COVID-19 has led to the development and strengthening of mechanisms to leverage a whole-of-government and -society approach to health that should be sustained to tackle ongoing and future stressors.

Conclusions:
The use of the EPHFs within the Irish setting provides a comprehensive approach to strengthening capacities for public health and enhanced population health and wellbeing.

Background:
The COVID-19 pandemic has placed healthcare systems worldwide under unprecedented pressure, with the Irish Public Health system no different. To strengthen delivery of Essential Public Health Functions (EPHFs) and increase future pandemic preparedness, Public Health leaders are now focused on identifying learnings from the pandemic. Within Ireland, given their experience, organisations situated within the Public Health system may be in a unique position to provide valuable information around the delivery of EPHFs, both prior to and in light of the COVID-19 pandemic, and how this can be improved in the future.

Methods:
An online survey was distributed by the Department of Health, from 2 March 2022 to 25 March 2022, amongst organisations situated within the Public Health domain in Ireland. The survey consisted of six open-ended questions around the delivery of EPHFs prior to and in light of the pandemic, success stories that could provide scalable solutions to EPHF delivery and current health system barriers, key areas in the public health system that require strengthening, and barriers to achieving these actions. Thematic analysis to identify key themes was conducted on survey responses.

Results:
Twenty-eight organisational responses were received. Themes around the workforce were apparent throughout, with staff training, staff diversity and staff morale, identified as areas for strengthening EPHF delivery. Themes around ICT, data collection and research were frequently identified with a lack of adequate ICT identified as a key lesson from the pandemic, while the Public Health ICT strategy was identified as key to strengthening future EPHF delivery.

Conclusions:
In general, themes around the workforce; leadership, management and governance and ICT, data collection and research were reoccurring across organisational responses and therefore may be key areas for consideration when strengthening delivery of the EPHFs in Ireland.