Centralization and integration of public health systems: Perspectives of public health leaders on factors facilitating and impeding COVID-19 responses in three Canadian provinces

Smith, Robert; Jarvis, Tamika; Sandhu, Harman Singh; Pinto, Andrew D.; O’Neill, Meghan; Ruggiero, Erica Di; Pawa, Jasmine; Rosella, Laura; Allin, Sara

doi:10.1016/j.healthpol.2022.11.011

Cited by 15 publications

(21 citation statements)

References 38 publications

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“…However, the emphasis many KIs placed on the positive potential opportunities may reflect an interest in advocating for changes they hope to preserve. In light of these limitations, generalizing beyond the study period, KI sample, and 3 provinces is cautioned and we recognize that our findings may not reflect changes seen in Indigenous-led PH organizations that may face mandate ambiguity with provincial and federal PH actors 21. Finally, we did not collect sociodemographic information.…”

Section: Discussionmentioning

confidence: 84%

“…We conducted a descriptive multiple case study of the COVID-19 response in 3 Canadian provinces (Alberta, Ontario, and Québec). We analyzed descriptive reports of provincial PH systems (forthcoming)18,19 to design a qualitative study to better understand the impacts of recent PH reforms, capacity to respond to COVID-19, and impacts of COVID-19 on PH systems. Because of the richness and breadth of the data collected, this article focuses on a subset of the study while findings related to PH system reforms20 and COVID-19 response21 are forthcoming elsewhere.…”

Section: Methodsmentioning

confidence: 99%

“…The provinces of Alberta, Ontario, and Québec were chosen as case studies due to their variation in PH systems, large populations, and high burden of COVID-19 28,29. In terms of PH organization, Alberta is relatively more centralized with 5 regional PH units operating within a hierarchical province-wide authority (Alberta Health Services), Québec's PH system is organized into 18 PH regions that are integrated with health care and social services, and finally, Ontario is relatively decentralized with 34 PH units with comparatively little integration with health care or social services 21…”

Section: Methodsmentioning

confidence: 99%

“…In some cases, multisectoral (or "liaison") tables or working groups were set up to coordinate the COVID-19 response. In other cases, memoranda of understanding or other agreements between parties were established: "we've got CBOs [community-based organizations] who are immunizing their patient population or their client population under the delegation of a Medical Officer of Health and it's a formal arrangement" (AB- 19).…”

Section: Intensified Collaboration Within and Beyond The Health Systemmentioning

confidence: 99%

“…In light of these limitations, generalizing beyond the study period, KI sample, and 3 provinces is cautioned and we recognize that our findings may not reflect changes seen in Indigenous-led PH organizations that may face mandate ambiguity with provincial and federal PH actors. 21 Finally, we did not collect sociodemographic information. Diverse representation of identities and experiences was an implicit goal; however, a more systematic capturing of these data could have helped ensure this goal and deepen the relevance and trustworthiness of our findings.…”

Section: Limitationsmentioning

confidence: 99%

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Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study

Sandhu

Smith

Jarvis

et al. 2022

Journal of Public Health Management and Practice

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Context:The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice. Objective: To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned. Design: A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis.Setting: This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems. Participants: Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58). Results: We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted. Conclusions:The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.

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Section: Discussionmentioning

confidence: 84%