World Health Organization Regional Office for Europe, Copenhagen, Denmark
World Health Organization Regional Office for Europe, Copenhagen, Denmark.
BMJ Open. 2023 Mar 3;13(3):e066279. doi: 10.1136/bmjopen-2022-066279.
Our study described how the WHO intra-action review (IAR) methodology was operationalised and customised in three Western Balkan countries and territories and the Republic of Moldova and analysed the common key findings to inform analyses of the lessons learnt from the pandemic response.
We extracted data from the respective IAR reports and performed a qualitative thematic content analysis to identify common (between countries and territories) and cross-cutting (across the response pillars) themes on best practices, challenges and priority actions. The analysis involved three stages, namely: extraction of data, initial identification of emerging themes and review and definition of the themes.
IARs were conducted in the Republic of Moldova, Montenegro, Kosovo and the Republic of North Macedonia between December 2020 and November 2021. The IARs were conducted at different time points relative to the respective pandemic trajectories (14-day incidence rate ranging from 23 to 495 per 100 000).
Case management was reviewed in all the IARs, while the infection prevention and control, surveillance and country-level coordination pillars were reviewed in three countries. The thematic content analysis identified four common and cross-cutting best practices, seven challenges and six priority recommendations. Recommendations included investing in sustainable human resources and technical capacities developed during the pandemic, providing continuous capacity-building and training (with regular simulation exercises), updating legislation, improving communication between healthcare providers at all levels of healthcare and enhancing digitalisation of health information systems.
The IARs provided an opportunity for continuous collective reflection and learning with multisectoral engagement. They also offered an opportunity to review public health emergency preparedness and response functions in general, thereby contributing to generic health systems strengthening and resilience beyond COVID-19. However, success in strengthening the response and preparedness requires leadership and resource allocation, prioritisation and commitment by the countries and territories themselves.
本研究描述了世卫组织内部行动审查（IAR）方法在三个西巴尔干国家和地区以及摩尔多瓦共和国的实施和定制情况，并分析了共同的主要发现，以为从大流行病应对中吸取的经验教训的分析提供信息。
我们从各自的 IAR 报告中提取数据，并进行了定性主题内容分析，以确定关于最佳实践、挑战和优先行动的共同（国家和地区之间）和跨领域（应对支柱之间）主题。分析涉及三个阶段，即：数据提取、新兴主题的初步识别以及主题的审查和定义。
IAR 于 2020 年 12 月至 2021 年 11 月在摩尔多瓦共和国、黑山、科索沃和北马其顿共和国进行。IAR 是在各自大流行轨迹的不同时间点进行的（14 天发病率从每 10 万人 23 例到 495 例不等）。
所有 IAR 都审查了病例管理，而感染预防和控制、监测以及国家一级协调支柱则在三个国家进行了审查。主题内容分析确定了四项共同和跨领域的最佳实践、七项挑战和六项优先建议。建议包括投资于在大流行期间开发的可持续人力资源和技术能力、提供持续的能力建设和培训（包括定期模拟演习）、更新立法、改善各级医疗保健提供者之间的沟通以及加强卫生信息系统的数字化。
IAR 提供了一个持续集体反思和学习的机会，涉及多部门参与。它们还提供了一个审查公共卫生应急准备和应对功能的机会，从而有助于加强一般卫生系统，提高应对大流行病之外的复原力。然而，加强应对和准备工作的成功需要各国和地区自身的领导力和资源分配、优先排序和承诺。
