An Evaluation of Florida’s Zika Response Using the WHO Health Systems Framework: Can We Apply These Lessons to COVID-19?

Abstract

Objectives From 2016 to 2018 Florida documented 1471 cases of Zika virus, 299 of which were pregnant women (Florida Department of Health, https ://www.flori dahea lth.gov/disea ses-and-condi tions /mosqu ito-borne disea ses/surve illan ce.html, 2019a). Florida's response required unprecedented rapid and continuous cross-sector communication, adaptation, and coordination. Zika tested public health systems in new ways, particularly for maternal child health populations. The systems are now being challenged again, as the Coronavirus COVID-19 pandemic spreads throughout Florida. This qualitative journey mapping evaluation of Florida's response focused on care for pregnant women and families with infants exposed to Zika virus. Methods Fifteen focus groups and interviews were conducted with 33 public health and healthcare workers who managed outbreak response, case investigations, and patient care in south Florida. Data were thematically analyzed, and the results were framed by the World Health Organization's (WHO) Healthcare Systems Framework of six building blocks: health service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership and governance (World Health Organization, https ://www.who.int/healt hsyst ems/strat egy/every bodys _busin ess.pdf, 2007, https ://www.who.int/healt hinfo /syste ms/monit oring /en/, 2010). Results Results highlighted coordination of resources, essential services and treatment, data collection, communication among public health and healthcare systems, and dissemination of information. Community education, testing accuracy and turnaround time, financing, and continuity of health services were areas of need, and there was room for improvement in all indicator areas. Conclusions The WHO Framework encapsulated important infrastructure and process factors relevant to the Florida Zika response as well as future epidemics. In this context, similarities, differences, and implications for the Coronavirus COVID-19 pandemic response are discussed.

Addressing Gaps for Health Systems Strengthening: A Public Perspective on Health Systems’ Response towards COVID-19

“…This finding was comparable with studies done in many countries showing how the complex interactions interfered with the outcomes [9][10][11]44,45]. In a study looking at Zika's outbreak management, it was found strong collaboration among stakeholders and efficient surveillance systems generating database of Zika-positive pregnant women shared effectively among healthcare providers were the main drivers for successful service deliveries [9]. In a nutshell, health systems relied on smooth and efficient interactions between the fundamental elements to deliver quality services while facing a crisis [47].…”

“…While the numbers of tests conducted were increasing throughout the outbreak, earlier identification, engagement and collaboration with universities and private sectors were the areas reported requiring improvements for the country to better cope with the surge of cases. This finding was comparable with studies done in many countries showing how the complex interactions interfered with the outcomes [9][10][11]44,45]. In a study looking at Zika's outbreak management, it was found strong collaboration among stakeholders and efficient surveillance systems generating database of Zika-positive pregnant women shared effectively among healthcare providers were the main drivers for successful service deliveries [9].…”

“…Multiple frameworks are available to guide countries in undertaking HSS activities and evaluation of HSS related programs [7]. The World Health Organisation (WHO) Health Systems Building Blocks is commonly used to describe the core components of a responsive and efficient health system and is widely adopted in various studies identifying elements needed to improve the health systems [8][9][10][11]. While the building blocks form the foundation of the health sector, the relationships and interactions among the building blocks represent the constituent of a health system.…”

A realist evaluation of the implementation of a large‐scale school eye health programme in India: a qualitative study

“…It is a public health priority to develop sustainable models of healthcare by strengthening local health systems, especially with the introduction of the six building block framework of health systems by the World Health Organisation 53–55 . While these blocks are not suitable to capture the dynamics and interplay between complex system elements, 56 it provided directions to decide on the programme aspects for realist evaluation of the REACH programme 55,57 …”

Rising Through the Pandemic: A scoping review of quality improvement in public health during the COVID-19 pandemic

“…24 Furthermore, the author indicates that AARs are essential to improving public health emergency preparedness by contributing to the essential evidence-based feedback loop and sustained application within public health practice. A separate study from Marshall et al, 25 examining Florida's response to the 2016-2018 Zika Virus outbreak and assessed collaboration and adaptation across systems of care to provide recommendations for response to future outbreaks, including potential implications for COVID-19. While this study did not conduct an AAR, the WHO Health Systems Framework was used to systematically assess the PHEM response, and utilized journeymapping and stakeholder engagement techniques to collect data for their evaluation which highlighted several areas of improvement in these indicator areas.…”