Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization

Abstract

The COVID-19 pandemic, climate change-related events, protracted conflicts, economic stressors and other health challenges, call for strong public health orientation and leadership in health system strengthening and policies. Applying the essential public health functions (EPHFs) represents a holistic operational approach to public health, which is considered to be an integrated, sustainable, and cost-effective means for supporting universal health coverage, health security and improved population health and wellbeing. As a core component of the Primary Health Care (PHC) Operational Framework, EPHFs also support the continuum of health services from health promotion and protection, disease prevention to treatment, rehabilitation, and palliative services. Comprehensive delivery of EPHFs through PHC-oriented health systems with multisectoral participation is therefore vital to meet population health needs, tackle public health threats and build resilience. In this perspective, we present a renewed EPHF list consisting of twelve functions as a reference to foster country-level operationalisation, based on available authoritative lists and global practices. EPHFs are presented as a conceptual bridge between prevailing siloed efforts in health systems and allied sectors. We also highlight key enablers to support effective implementation of EPHFs, including high-level political commitment, clear national structures for institutional stewardship on EPHFs, multisectoral accountability and systematic assessment. As countries seek to transform health systems in the context of recovery from COVID-19 and other public health emergencies, the renewed EPHF list and enablers can inform public health reform, PHC strengthening, and more integrated recovery efforts to build resilient health systems capable of managing complex health challenges for all people.

Reviewing essential public health functions in the Eastern Mediterranean Region post COVID-19 pandemic: a foundation for system resilience

“…Our revised 2023 EMR EPHF framework (figure 2) includes nine functions, with the most recent addition being a ‘Public Health Services’ function as a core function (see box 3). Public health services are actions with a primary focus on improving population-level health outcomes, while reducing risks and promoting health at the individual level 3 5. Examples include vaccination programmes, screening programmes, health information and technology assessment, infection prevention and control and workplace inspections.…”

“…Examples include vaccination programmes, screening programmes, health information and technology assessment, infection prevention and control and workplace inspections. Public health services can be distributed across all EPHFs, such as through preventative, promotive and protective health services, and this is the approach taken for the global reference list 11. However, in the EMR context, the addition of a specific function was considered to increase the visibility of public health services within the framework and mitigate the risk of these essential services being missed.…”

Essential public health functions: the key to resilient health systems

“…To this end, there has been renewed attention and focus on essential public health functions (EPHFs), with the WHO proposing a unified list of 12 fundamental activities in 2021 (box 1). 10…”

“…The first list of EPHFs was published in 1998 and adapted by regions, organisations and countries to support the benchmarking of their public health capacities. The EPHFs contain the set of minimum requirements for the orientation of health systems and have been proposed as an approach to enhancing systems resilience 10. The EPHFs provide a bridge between health and allied sectors and set out responsibilities to improve and protect health, to reinforce the role of primary care and for the provision of public health services such as surveillance, community engagement and contact tracing—functions which help build resilience of front-line health services 11…”

“…As part of this collaboration, at a meeting held in Paris, 10– 12 May 2023, WHO’s Health Systems Resilience and EPHF Team13 consulted experts from IANPHI’s members from Bangladesh, Brazil, Canada, China, Japan, France, Germany, Norway, Pakistan, Sweden, UK and USA on how to operationalise the EPHFs. We, the participants of the Paris meeting, critically reviewed WHO technical guidance on the EPHFs including the unified list of 12 EPHFs (box 1) and an expanded list of subfunctions, public health services and enabling system inputs intended to support operationalisation 10. The roles of the EPHFs as a tool for defining the scope of NPHIs as well as the role of NPHIs in supporting their implementation were considered.…”