Edelman, Alexandra, Allen, Tammy, Devine, Susan, Horwood, Paul F., McBryde, Emma s., Mudd, Julie, Warner, Jeffrey, and Topp, Stephanie M. (2024) "Hospitals respond to demand. Public health needs to respond to risk": health system lessons from a case study of northern Queensland’s COVID-19 surveillance and response. BMC Health Services Research, 24. 104.

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Abstract

Background The vast region of northern Queensland (NQ) in Australia experiences poorer health outcomes and a disproportionate burden of communicable diseases compared with urban populations in Australia. This study examined the governance of COVID-19 surveillance and response in NQ to identify strengths and opportunities for improvement.

Methods The manuscript presents an analysis of one case-unit within a broader case study project examining systems for surveillance and response for COVID-19 in NQ. Data were collected between October 2020–December 2021 comprising 47 interviews with clinical and public health staff, document review, and observation in organisational settings. Thematic analysis produced five key themes.

Results Study findings highlight key strengths of the COVID-19 response, including rapid implementation of response measures, and the relative autonomy of NQ’s Public Health Units to lead logistical decision-making. However, findings also highlight limitations and fragility of the public health system more generally, including unclear accountabilities, constraints on local community engagement, and workforce and other resourcing shortfalls. These were framed by state-wide regulatory and organisational incentives that prioritise clinical health care rather than disease prevention, health protection, and health promotion. Although NQ mobilised an effective COVID-19 response, findings suggest that NQ public health systems are marked by fragility, calling into question the region’s preparedness for future pandemic events and other public health crises.

Conclusions Study findings highlight an urgent need to improve governance, resourcing, and political priority of public health in NQ to address unmet needs and ongoing threats.

Item ID:	82990
Item Type:	Article (Research - C1)
ISSN:	1472-6963
Copyright Information:	© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Date Deposited:	19 Jun 2024 23:03
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 60% 42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified @ 40%
SEO Codes:	20 HEALTH > 2003 Provision of health and support services > 200303 Health surveillance @ 40% 20 HEALTH > 2002 Evaluation of health and support services > 200206 Health system performance (incl. effectiveness of programs) @ 60%
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