Background 

Building and strengthening National Public Health Institutes (NPHIs) is a key part of long-term, sustainable solutions for building public health capacity and achieving global health security. High-impact investments are needed to increase the impact of NPHIs, promote their integration into national systems, and ensure eventual self-reliance. While global actors have invested in developing systems to strengthen global health security, less attention has been paid to analyzing and strengthening the support systems within NPHIs. The Johns Hopkins Bloomberg School of Public Health (BSPH) team (Grant Number: NU2HGH000014) has been working in coordination with the NPHI Program team at the U.S. Centers for Disease Control and Prevention (CDC) to strengthen NPHIs’ organizational systems, management, and strategies. 

Framework

The project aims to support NPHIs through engagement in a series of Organizational Strengthening Modules, based on the unique needs of NPHIs.  The modular framework (figure 1) allows the US CDC NPHI Program team and NPHIs to prioritize modules that are most needed to support development. Each module takes approximately 3-6 months to complete, and is administered as highly focused, collaborative, problem-solving sprints in each of the framework domains. As module tools and resources are developed and tested, they are modified to ensure that they are responsive to NPHIs and the US CDC NPHI Program Team and are to be housed on a Resource Library.  

Reaching Impact, Saturation and Epidemic Control (RISE) assists countries to respond to the HIV, COVID-19, and Mpox health emergencies, providing technical assistance, service delivery, research, and cross-cutting health systems support to address critical pandemic response priorities. RISE has partnered with ministries of health, nongovernmental organizations, and other local stakeholders in more than 20 countries globally to advance HIV and COVID-19 response efforts. With funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), RISE works across the HIV prevention, care, and treatment cascade to assist efforts by countries to reach the UNAIDS 95-95-95 goals. To address the COVID-19 pandemic and emerging global health security threats, RISE provides short-term, emergency response support to countries along with collaboration on longer-term health systems strengthening to achieve pandemic response preparedness across the World Health Organization’s Joint External Evaluation framework’s technical areas. As of May 2023, RISE is able to accept Global Health Security funds and engage in GHS activities.

As of November, 2023, the Pan American Health Organization/World Health Organization (PAHO/WHO) has designated the Department of Emergency Medicine, Johns Hopkins University, a WHO Collaborating Center for Emergency, Critical, and Operative Care. Our Collaborating Center is structured around a workplan developed under the guidance of the WHO Clinical Services and Systems Unit to assist in its core strategic goals, and will be guided by three key objectives: 1) To support WHO’s activities on prevention and reduction of disease, disability, and premature death from emergency conditions in the region and globally; 2) Assist in research to support advocacy and scale-up of Emergency, Critical and Operative care dissemination; 3) Assist in the implementation of WHO Emergency, Critical and Operative Care initiatives - clinical care process tools, data collection, training, and impact assessment strategies.

Infections cause a large number of deaths globally every year. Patients in low-resource settings are affected at much higher rates than other parts of the world. Management of acute infectious illnesses involves the entire medical system. It is important to understand the whole medical system and how patients interact with it to identify how and where care can be improved. 

As part of her Fogarty Fellowship, Dr. Lukacs is leading a mixed method study in Kumasi, Ghana to map the pathway to care for patients with acute infectious illnesses (AII). The aims of the study are to 1) Define the pathway of care for patients with AII in Kumasi, Ghana, and determine their 30-day mortality, and 2)  Develop a list of priority interventions to improve clinical outcomes for patients with AII. Her research engages both patients and a range of healthcare providers to get a holistic perspective on medical system operations, how patients engage with the system, and what type of care they receive at various facilities.

Emergency and critical care capacity are underdeveloped throughout the African continent. Limited critical care resources include infrastructure, medications, equipment, trained personnel and coordinated systems of care make it challenging to deliver safe and effective emergency and critical care services. However, these services are essential to save lives, strengthen communities and combat poverty, and they can be highly cost effective.

Dr. Laytin works with emergency and critical care specialists in Addis Ababa, Ethiopia to study emergency and critical care service delivery in order to identify priority targets for quality improvement efforts. They then use those findings to inform data-driven, context-appropriate quality improvement strategies to make the most of the limited resources that are available, advocate for further capacity-building, and educate the country’s next generation of leaders in emergency medicine and critical care.