RESUMEN
Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH.
RESUMEN
OBJECTIVES: Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations. METHODS: A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes. RESULTS: Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising "value for money" and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce. CONCLUSION: Our study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms.
RéSUMé: OBJECTIFS: Plusieurs provinces et territoires canadiens ont réformé leur système de santé en centralisant le pouvoir, les ressources et les responsabilités. Notre étude a exploré les facteurs sous-jacents et les impacts perçus des réformes de centralisation sur les systèmes et les opérations essentielles de santé publique. MéTHODES: Nous avons mené une étude de cas multiples pour examiner la situation de trois provinces canadiennes qui ont subi ou qui sont en train de réaliser une réforme du système de santé. Des entrevues semi-structurées ont été menées auprès de 58 participants de la santé publique aux niveaux stratégique et opérationnel, en Alberta, en Ontario et au Québec. De façon itérative, nous avons thématiquement analysé les données recueillies. RéSULTATS: Trois thèmes principaux ont été formulés pour décrire le contexte et les impacts des réformes de centralisation du système de santé sur la santé publique : 1) la promesse d'une « optimisation des ressources ¼ et la consolidation de l'autorité, 2) l'impact sur la collaboration intersectorielle et communautaire, et 3) la privatisation des opérations de santé publique et la précarisation de la main-d'Åuvre. La centralisation a mis en lumière des préoccupations quant à la priorité accordée aux services de santé. Certaines fonctions essentielles de la santé publique fonctionneraient de manière plus efficace, avec moins de dédoublement des services et des améliorations de la cohérence et de la qualité des programmes, notamment en Alberta. Les réformes auraient aussi détourné des fonds et des ressources humaines des fonctions essentielles de base et auraient réduit les effectifs de la santé publique. CONCLUSION: Notre étude a mis en exergue les priorités des parties prenantes et une compréhension limitée des systèmes de santé publique qui ont influencé la manière dont les réformes ont été mises en Åuvre. Nos résultats soutiennent les appels à une gouvernance plus modernisée et inclusive, à un financement stable de la santé publique et à un investissement dans le personnel de santé publique, pouvant ainsi contribuer à alimenter les futures réformes.
Asunto(s)
Reforma de la Atención de Salud , Salud Pública , Humanos , Ontario , Quebec , AlbertaRESUMEN
The extent to which power, resources, and responsibilities for public health are centralized or decentralized within a jurisdiction and how public health functions are integrated or coordinated with health care services may shape pandemic responses. However, little is known about the impacts of centralization and integration on public health system responses to the COVID-19 pandemic. We examine how public health leaders perceive centralization and integration facilitated and impeded effective COVID-19 responses in three Canadian provinces. We conducted a comparative case study involving semi-structured interviews with 58 public health system leaders in three Canadian provinces with varying degrees of centralization and integration. Greater public health system centralization and integration was seen by public health leaders to facilitate more rapidly initiated and well-coordinated provincial COVID-19 responses. Decentralization may have enabled locally tailored responses in the context of limited provincial leadership. Opacity in provincial decision-making processes, jurisdictional ambiguity impacting Indigenous communities, and ineffectual public health investments were impediments across jurisdictions and thus appear to be less impacted by centralization and integration. Our study generates novel insights about potential structural facilitators and impediments of effective COVID-19 pandemic responses during the second year of the pandemic. Findings highlight key areas for future research to inform system design that support leaders to manage large-scale public health emergencies.