Implementing COVID-19 surveillance through inter-organizational coordination: a qualitative study of three cities in Colombia

Abstract

Introducing comprehensive surveillance is recommended as an urgent public health measure to control and mitigate the spread of COVID-19 worldwide. However, its implementation has proven challenging as it requires inter-organizational coordination among multiple health care stakeholders. The purpose of this study was to examine the role of soft and hard mechanisms in the implementation of inter-organizational coordination strategies for COVID-19 surveillance within Colombia, drawing on evidence from the cities of Bogotá, Cali and Cartagena. The study used a case study approach to understand the perspectives of local and national authorities, insurance companies and health providers in the implementation of inter-organizational coordination strategies for COVID-19 surveillance. 81 semi-structured interviews were conducted between June and November 2020. The data was analysed by codes and categorized using New NVivo software. The study identified inter-organizational coordination strategies that were implemented to provide COVID-19 surveillance in the three cities. Both soft (e.g. trust and shared purpose) and hard mechanisms (e.g. formal agreements and regulations) acted as mediators for collaboration and helped to address existing structural barriers in the provision of health services. The findings suggest that soft and hard mechanisms contributed to promoting change among health care system stakeholders and improved inter-organizational coordination for disease surveillance. The findings contribute to evidence regarding practices to improve coordinated surveillance of disease, including the roles of new forms of financing and contracting between insurers and public and private health service providers, logistics regarding early diagnosis in infectious disease, and the provision of health services at the community level regardless of insurance affiliation. Our research provides evidence to improve disease surveillance frameworks in fragmented health systems contributing to public health planning and health system improvement.

Organization of primary health care and surveillance in response to COVID-19 in municipalities in the Northeast of Brazil

“…Thus, when planning new coordinated surveillance strategies, it is vital to un-derstand the influence of and interaction between interorganizational coordination mechanisms in specific contexts. Moreover, it is important to underline the fundamental importance of political and technical guidelines and adequate structural conditions for the reorganization of work processes across sectors in order to create permanent arrangements that promote enabling conditions and strengthen cross-sector collaboration 37 . The following question remains, however: How can we institutionalize this collaboration in the midst of a "health war" and lack of coordination at national level?…”

Organização da atenção e vigilância em saúde na atenção primária frente à COVID-19 em municípios do Nordeste brasileiro

“…Assim, para planejar novas estratégias de vigilância com base no trabalho coordenado, é fundamental entender a influência e a interação entre mecanismos de coordenação interorganizacional em contextos específicos. Por outro lado, cabe pontuar que diretrizes políticas e técnicas e condições estruturais são fundamentais para a reorganização do trabalho entre os setores, de modo a fomentar arranjos permanentes que promovam condições e incentivem a colaboração intersetorial 37 . Con-tudo, como institucionalizar essa colaboração em um cenário de "guerra sanitária" e permeado pela descoordenação nacional?…”

Trabajo colaborativo entre academia y autoridades de salud en tiempos de COVID-19: experiencia en Santander, Colombia

“…En Colombia, una investigación que analizó la colaboración para la vigilancia de COVID-19 en tres ciudades identificó que los llamados mecanismos "blandos" relacionados con la confianza y los propósitos compartidos al combinarse con mecanismos "duros" como las regulaciones y formalizaciones de las alianzas permitieron superar las barreras identificadas durante el proceso de la colaboración. 22 Reunir a un grupo de profesionales académicos del ámbito de la salud pública y la epidemiología, en el que la mayoría de ellos nunca habían trabajado juntos y que de forma voluntaria y gratuita se comprometieron con sus conocimientos y experiencias a enfrentar la pandemia fue crucial para apoyar a los entes gubernamentales que carecen de este personal en sus instituciones. Adicionalmente, la participación de profesionales del sector académico y del gubernamental de la salud que ya habían trabajado juntos en la organización de servicios y en la búsqueda de soluciones a problemas regionales, dio confianza para la conformación y desarrollo del trabajo colaborativo.…”