Prioritization of public health financing, organization, and workforce transformation: a Delphi study in Canada

Background The increased scrutiny on public health brought upon by the ongoing COVID-19 pandemic provides a strong impetus for a renewal of public health systems. This paper seeks to understand priorities of public health decision-makers for reforms to public health financing, organization, interven...

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Bibliographic Details
Published in:BMC public health Vol. 23; no. 1; pp. 544 - 9
Main Authors: Dedewanou, F. Antoine, Allin, Sara, Guyon, Ak’ingabe, Pawa, Jasmine, Ammi, Mehdi
Format: Journal Article
Language:English
Published: London BioMed Central 22.03.2023
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Biostatistics
Budgets
Canada
Coronaviruses
COVID-19
COVID-19 - epidemiology
Decision making
Delphi
Delphi method
Delphi Technique
Environmental Health
Epidemiology
Evaluation
Financing
Health services
Healthcare Financing
Humans
Information management
Infrastructure
Management systems
Medicine
Medicine & Public Health
Pandemics
Priorities
Priority setting
Public Health
Public health administration
Public health systems
Ratings
Reforms
Retention
Thematic analysis
Vaccine
Workforce
Working groups
Canada
COVID-19
Canada
Public health systems
Priority setting
Delphi
Thematic analysis
ISSN:1471-2458, 1471-2458
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Summary:Background The increased scrutiny on public health brought upon by the ongoing COVID-19 pandemic provides a strong impetus for a renewal of public health systems. This paper seeks to understand priorities of public health decision-makers for reforms to public health financing, organization, interventions, and workforce. Methods We used an online 3-round real-time Delphi method of reaching consensus on priorities for public health systems reform. Participants were recruited among individuals holding senior roles in Canadian public health institutions, ministries of health and regional health authorities. In Round 1, participants were asked to rate 9 propositions related to public health financing, organization, workforce, and interventions. Participants were also asked to contribute up to three further ideas in relation to these topics in open-ended format. In Rounds 2 and 3, participants re-appraised their ratings in the view of the group’s ratings in the previous round. Results Eighty-six public health senior decision-makers from various public health organizations across Canada were invited to participate. Of these, 25/86 completed Round 1 (29% response rate), 19/25 completed Round 2 (76% retention rate) and 18/19 completed Round 3 (95% retention rate). Consensus (defined as more than 70% of importance rating) was achieved for 6 out of 9 propositions at the end of the third round. In only one case, the consensus was that the proposition was not important. Proposition rated consensually important relate to targeted public health budget, time frame for spending this budget, and the specialization of public health structures. Both interventions related and not related to the COVID-19 pandemic were judged important. Open-ended comments further highlighted priorities for renewal in public health governance and public health information management systems. Conclusion Consensus emerged rapidly among Canadian public health decision-makers on prioritizing public health budget and time frame for spending. Ensuring that public health services beyond COVID-19 and communicable disease are maintained and enhanced is also of central importance. Future research shall explore potential trade-offs between these priorities.
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ISSN:1471-2458
1471-2458
DOI:10.1186/s12889-023-15373-9