A scoping review of strategies to support public health recovery in the transition to a “new normal” in the age of COVID-19 | BMC Public Health

The database search retrieved 44,087 records. An additional 155 references were identified through supplemental search strategies (websites, citation searching, content experts). After duplicates were removed, 21,998 titles and abstracts were screened, and 580 records were reviewed in full (498 identified via databases/registers and 82 identified via other methods). Seventeen articles were included in the final review, 14 from databases and three from other methods (see Fig. 1 PRISMA).

Fig. 1
figure 1

Characteristics of studies

Included studies were published from 2005 and comprised a variety of designs: descriptive (n = 8); qualitative (n = 4); mixed-methods (n = 2); cross-sectional (n = 1); case report (n = 1); single-group pretest/post-test design (n = 1). Many of the included studies were from North America including the United States (n = 8) and Haiti (n = 2). Four studies originated from Africa including West Africa (n = 3) and Uganda (n = 1). Three studies were from Asia, with one study each originating from Burma, Thailand, and Yemen. Included studies addressed a variety of public health disasters, including natural disasters (n = 9), infectious disease epidemics (n = 5), armed conflict (n = 2) and hazardous material disasters (n = 1).

Studies discussed the provision of diverse services and activities during disaster recovery which addressed several public health areas including infectious diseases (n = 8), nutrition (n = 6), maternal and infant health (n = 5), general emergency preparedness and response (n = 5), parenting and child development (n = 3), immunizations (n = 3), sexual health (n = 2), chronic diseases (n = 2), substance use (n = 1), physical activity (n = 1), and environmental health and safety (n = 1). These services and activities were implemented by a variety of service providers, including local health departments (n = 8), state/provincial health authorities (n = 6), federal agencies (n = 5) non-governmental organizations (n = 13) and other organizations (n = 6). Most of the studies described services that were provided by multiple types of service providers (see Supplementary File 2 for detailed characteristics of included studies).

Strategies for re-integration of public health services/programs.

Across 17 included studies, five emergent themes were identified. Studies often discussed multiple strategies (see Table 1).

Table 1 Five emergent themes for pandemic recovery identified from 17 included studies

‘Collaborative partnerships and coordination’ was an emergent theme identified in 11 studies [31,32,33,34,35,36,37,38,39,40,41]. These studies described the integral role of partnerships between multi-sectoral and multi-level (local, state, international) players in post-disaster activities. Across some studies, formal partnership structures such as large scale coalitions [31, 33, 34, 40], local committees, regional hubs or networks [32, 33, 35, 36, 38, 40] involving public health organizations were instituted to mobilize and facilitate the coordination of physical or human resources for recovery purposes. Key stakeholders varied across recovery activities, although common players included public health organizations (local and state level), international bodies (e.g., World Health Organization, United Nations), government (state or federal) and non-government agencies, academic institutions, private sector businesses, and local community health and social service organizations. Collaborative activity among these partners involved coordinated approaches to community needs assessments, strategic recovery planning to map out partner activities, and agreements on the allocation of shared resources and implementation of services and programs to prevent duplication [31, 34, 37, 38, 41]. Collaborative partnerships and coordination among these studies addressed diverse and multiple needs in relation to infectious diseases (n = 5), maternal/infant health (n = 4), general emergency preparedness and response (n = 3), parenting (n = 2), nutrition (n = 3), immunizations (n = 2), and sexual health (n = 2).

‘Community assessment’ was identified as a theme in seven studies [33,34,35,36, 39, 40, 42]. Health-related needs and priorities were identified by directly engaging local community residents in assessments [34,35,36, 42] and relying on the expertise of local stakeholders [33, 40]. Formal, structured assessments to determine evolving health status and needs during recovery periods were conducted using national surveys [34], epidemiological methodologies such as the Community Assessments for Public Health Emergency Response (CASPER) [36, 42], and surveillance systems (Geographic Information System) [34] to support recovery planning, decision-making and to initiate responsive public health programming/services. Implementation and use of data from these regular, structured assessments allowed for monitoring the progression of recovery processes through tracking of diverse indicators related to demographics, post-disaster experiences, physical and behavioural health status, mental health, vaccination rates, or disease-specific indicators. Unstructured or informal community assessments were also conducted to collect local anecdotal community data [36]. Needs assessments also encompassed an analysis of the public and health care system to determine gaps in infrastructure, human and financial resources that would be needed to support recovery interventions [35, 39]. While studies stated that collected data were used to guide prioritization and decision-making around emergent needs, details on the explicit processes used to do so were not elaborated on.

‘Workforce allocation and capacity development’ emerged from seven studies [34, 35, 37,38,39,40,41]. These studies reported on the use of continuous training opportunities to maintain workforce competency, and strategies employed to increase human resource capacity in recovery activities. Five studies described the establishment of training programs that aimed to develop knowledge and skills in diverse areas of disaster preparedness and recovery [35], general epidemiological principles (e.g., surveillance, data collection/analysis) [34], specific communicable diseases (e.g., Ebola) [41], chronic disease prevention [37], or population-specific issues (i.e., childhood immunization, maternal/child care) [40]. Training programs targeted diverse workforce groups including local volunteers [41], community health workers (CHWs) [34, 37, 40], and local community leaders [35]. Strategies discussed to address workforce gaps included the establishment of tiered volunteer systems [35, 38], creation of temporary health centers or teams of staff to provide preventive health services during short-term recovery [38, 39], the use of professional students or new graduates (nursing or midwifery) [38, 40], and assuming roles outside of practice scope (e.g., midwives serving as vaccinators or general health educators) [40]. A critical point in sustaining workforce capacity emphasized by two studies involved the preservation of workforce psychological well-being [39, 41]. Geiger et al. [41] discussed strategies to address this including task shifting for fatigue prevention, contingency plans to cover absences due to illness and the implementation of psychosocial teams to support psychological well-being.

‘Community engagement’ emerged as a predominant theme in five studies [43,44,45,46,47]. Community-engaged strategies reflected a strength-based approach in which the social capital of impacted communities was utilized. The implementation of CHW programs was reported in four studies [43,44,45, 47]. Across these studies, CHWs were residents from impacted communities who had diverse professional backgrounds in social work, health care (e.g., nursing), education, in addition to youth and staff with non-profit community organization experience [43, 45]. CHWs conducted a myriad of health promotion, protection, and prevention activities in disaster/epidemic recovery periods including relationship building, home visits, referral generation and follow-up, needs assessment and screening, individual health counselling, linking to community resources and organizations, and leading community groups (e.g., exercise or nutrition sessions). CHW programs targeted specific populations (e.g., maternal/child health) [47], specific communicable diseases (e.g., tuberculosis prevention post-Ebola epidemic) [44, 45], or chronic disease prevention and management [43]. Comprehensive training to ensure CHW competency [43,44,45] and fair financial compensation were reported as important facilitators in CHW program implementation [47]. One additional study reported on the use of a community-based participatory service approach to address community health-related concerns in a post-disaster circumstance and help sustain longer-term recovery processes [46]. At the centre of this approach was the establishment of a community coalition of local volunteer leaders that championed and organized townhall meetings to identify priorities and needs, training workshops for community members on various public health topics, the establishment of a community health tracking registry, and the implementation of health screenings conducted by community volunteers [46].

‘Funding and resource enhancement’ was identified as a theme among four studies [35, 37, 38, 41]. These studies emphasized the critical nature of establishing long-term and flexible funding frameworks to sustain resources required for programs or services over the course of longer recovery periods instead of short-term funding mechanisms. Craddock et al. [35] discussed the importance of advanced planning to secure long-term recovery funding through diverse means including donations, proposals/grants, and formal funding allocations in annual healthcare and public health budgets. State of emergency declarations and the establishment of new governmental policies were reported as facilitating supplemental funding to hire additional public health personnel for surging recovery demands [38].

Trends also emerged when mapping specific strategies to disaster type (see Table 2). Community engagement was employed as a strategy across all four disaster types related to infectious diseases, natural disasters, armed conflict, and hazardous material. Across the natural disaster literature (n = 9) all five strategies were represented, with most studies discussing community assessment (n = 6) and collaborative partnerships (n = 7). Among the studies addressing infectious disease epidemics (n = 5), almost all strategies were discussed, except for community assessment. Infectious disease literature was consistently distributed across the strategies of community engagement (n = 2), collaborative partnerships (n = 3), workforce capacity (n = 3), and funding/resource enhancement (n = 3).

Table 2 Number of included studies according to recovery strategy and disaster type

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