Health Workforce Development in Health EDRM: Scoping Review, Case Studies and Expert Consultations

The COVID-19 Pandemic has amplified the fact that health emergencies require responsive and resilient health systems to address both the increased health needs of a population whilst maintaining routine healthcare services [1]. Human resource management is one of the 10 core components in the Health Emergency and Disaster Risk Management (Health EDRM) framework for stronger disaster risk management [2]. Frontline healthcare workers, managers and policy makers work together to protect life and health during health emergencies. Developing an effective workforce for Health EDRM based on an all-hazard and whole-of-society approach is key for the successful implementation of programmes during health emergencies [3]. Various programmes and initiatives have been implemented worldwide to increase disaster risk management capacity and operational readiness by focusing on availability, ability and accessibility of workforces for Health EDRM at local, national and global level [3].

However, significant evidence gaps exist in this field, including how to increase surge capacity, the common competencies, deployment and coordination mechanisms, and program evaluation [4] in recognition of the different needs across countries.

1. Multilingual scoping reviews (English, Chinese and Japanese) using PRISMA (2018) [4], 
2. Twelve case studies from low, middle, and high-income countries where health or environmental disasters occurred after 1995,
3. Delphi and expert consultation to gain consensus about key strategies and actions in two phases: statement design (Phase 1) and a modified Delphi process (Phase 2).

1. Scoping Review

For the scoping review, 103 papers met the inclusion criteria. Key findings include major barriers for volunteer deployment, such as lack of legal protection, risk protection from injury and death, training, and guidance on regulation of foreign medical teams. The lack of recognised competency matrix for developing training activities across different hazards and for different health personnel was also identified. Better health system coordination was facilitated by standards for hospital disaster preparedness.

2. Case Studies

Twelve case studies were completed. A collection and analysis of existing Health EDRM workforce development initiatives illustrated holistic picture of real-life situations and good practices. Common factors across the case studies that facilitated successful emergency responses include: stable and sufficient financial resources, clear coordination structures within health professional bodies, established training programmes for target groups, established workforce structure and health systems, and established disaster response plans and strategies at national level.

3. Expert Consensus

A total of 51 preliminary statements were developed from the scoping review and the case study analyses. The review of the preliminary statements resulted in 46 statements for the Delphi process.

A modified Delphi method was employed to seek consensus among 31 global Health EDRM expert panelists. After three rounds of the consensus surveys, 44 out of the 52 (84.6%) statements from the LMIC group and 34 out of the 53 (64.2%) statements from the HIC group attained consensus. The full list of statements that attained consensus for the LMIC and the HIC groups is available  here.

The main consensus findings include the importance of conducting health workforce capacity and gap assessments of the national labour market, developing national-level health workforce databases, collaborating with academic and research institutions to establish national and international health workforce observatories, and allocating sufficient financial resources for the development of robust health workforce systems.

Established human resource and management systems is an essential element for increasing disaster risk management capacities and operational readiness to perform Health EDRM functions. A risk management approach to Health EDRM recognises that Health EDRM workforce include diverse composition of human resources before, during, and after health emergencies to reduce the risk and impact of emergencies and disasters.

This research project identified key factors for effective management and mobilisation of all available human resources with different skill sets, experiences, and knowledge at national level, including continuous capacity and gap assessments, established training programmes for target groups, comprehensive disaster response plans and strategies, stable financial resources, and established workforce structure and health systems.

Each country’s strategies to develop and implement Health EDRM workforce depend on the national context. However, in order to ensure an adequate human resource capacity during health emergencies at the local, national and global levels, recognition and engagement of all the health workforce based on all-hazard and whole-of-society approach is paramount.

Experience in Kansai and Japan in strengthening local workforce capacity and operational readiness contributed to the development of strategic actions in this research project. The study results led by the literature review and other case studies from this project also inform policies and programmes in the Kansai Region. Hence it is important to promote more cross learning opportunities among regions and countries to reduce and prevent avoidable human suffering.

[1] World Health Organization. (‎2020)‎. Health workforce policy and management in the context of the COVID-19 pandemic response: interim guidance, 3 December 2020. World Health Organization.  https://apps.who.int/iris/handle/10665/337333. License: CC BY-NC-SA 3.0 IGO

[2] World Health Organization. (‎2019)‎. Health emergency and disaster risk management framework. World Health Organization.  https://apps.who.int/iris/handle/10665/326106. License: CC BY-NC-SA 3.0 IGO

[3] Hung KKC, Mashino S, Chan EYY, MacDermot MK, Balsari S, Ciottone GR, Della Corte F, Dell’Aringa MF, Egawa S, Evio BD, Hart A, Hu H, Ishii T, Ragazzoni L, Sasaki H, Walline JH, Wong CS, Bhattarai HK, Dalal S, Kayano R, Abrahams J, Graham CA. (2021). Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations. International Journal of Environmental Research and Public Health. 18(7):3382. https://doi.org/10.3390/ijerph18073382

[4] Kayano, R.; Chan, E.Y.; Murray, V.; Abrahams, J.; Barber, S.L. WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (TPRN): Report of the Kobe Expert Meeting. Int. J. Environ. Res. Public Health 2019, 16, 1232.

[5] Tricco, AC, Lillie, E, Zarin, W, O'Brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley, T, Weeks, L, Hempel, S et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018,169(7):467-473. doi:10.7326/M18-0850.  https://www.acpjournals.org/doi/10.7326/M18-0850

Journal articles

Research Proposal Paper

1. Hung KKC, Mashino S, Chan EYY, MacDermot MK, Balsari S, Ciottone GR, Della Corte F, Dell’Aringa MF, Egawa S, Evio BD, Hart A, Hu H, Ishii T, Ragazzoni L, Sasaki H, Walline JH, Wong CS, Bhattarai HK, Dalal S, Kayano R, Abrahams J, Graham CA. Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations. International Journal of Environmental Research and Public Health. 2021; 18(7):3382.  https://doi.org/10.3390/ijerph18073382 

Delphi Study

1. Hung K, MacDermot M, Chan E, Mashino S, Balsari S, Ciottone G, Della Corte F, Dell’Aringa MF, Egawa S, Evio BD, Hart A, Ishii T, Ragazzoni L, Sasaki H, Walline JH, Wong CS, Dalal S, Kayano R, Abrahams J, Huda Q, Graham AC. (2022). Health Emergency and Disaster Risk Management Workforce Development Strategies: Delphi Consensus Study. Prehospital and Disaster Medicine, 1-14. doi:10.1017/S1049023X22001467

Published Case Studies

1. Hart A, Rodríguez Á, Carvajal J, & Ciottone, G. 2021. Earthquake response in Chile: A case study in health emergency and disaster risk management. American Journal of Disaster Medicine. 2021. 16(4), 313-318. doi: https://doi.org/10.5055/ajdm.2021.0413
2. Bhattarai HK, Hung KKC, MacDermot MK, Hubloue I, Barone-Adesi F, Ragazzoni L, Della Corte F, Acharya R, Graham CA. Role of Community Health Volunteers Since the 2015 Nepal Earthquakes: A Qualitative Study. Disaster Med Public Health Prep. 2022 Mar 15:1-7. doi: 10.1017/dmp.2022.47. Epub ahead of print. PMID: 35287784.
3. Wong A, Hung KKC, Mabhala M, Tenney JW, Graham CA. Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa. International Journal of Environmental Research and Public Health. 2021; 18(15):8132.  https://doi.org/10.3390/ijerph18158132
4. Hung KKC, MacDermot MK, Chan EYY, Liu S, Huang Z, Wong CS, Walline JH, Graham CA. CCOUC Ethnic Minority Health Project: A Case Study for Health EDRM Initiatives to Improve Disaster Preparedness in a Rural Chinese Population. International Journal of Environmental Research and Public Health. 2021; 18(10):5322.  https://doi.org/10.3390/ijerph18105322
5. Kawa N, Abisaab J, Abiad F, Badr K, El-Kak F, Alameddine M, Balsari S. The toll of cascading crises on Lebanon's health workforce. The Lancet. Open Access. Published November 17, 2021.DOI:  https://doi.org/10.1016/S2214-109X(21)00493-9
6. Dalal S, Singh P. Chapter 16: Mainstreaming safety within hospitals and institutionalizing emergency preparedness in healthcare sector. In Gupta AK, Barwal A, Madan A, Sood A, Bindal MK. (eds.) (2021) Health Adaptation and Resilience to Climate Change and Related Disasters: A Compendium of Case Studies. National Institute of Disaster Management. New Delhi, pp 332.

Literature review reports

1. A Scoping Review on Health Workforce Development Strategies in Health Emergency and Disaster Risk Management (Health EDRM) in the English language literature.
2. Scoping Review on Health Workforce Training Strategy in Health-Emergency Disaster Risk Management (Health EDRM) in Chinese Literature.
3. A report: Japanese literature review.

1. Virtual Symposium: New Frontiers in Emergency and Disaster Care: Advancing Emergency Care in Greater China (24/25 April 2021). Organised by Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong. 

1. 8 December 2021.  Health EDRM Workforce Development Recommendations: Results from Knowledge Hub Survey. Presented by Prof Kevin KC Hung and Prof Sonoe Mashino. Organised by Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong.
2. 17 November 2021.  Health EDRM Workforce Development Recommendations: Results from Delphi Study. Presented by Prof Kevin KC Hung. Organised by Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong. 
3. 12 May 2021.  CCOUC Ethnic Minority Health Project: A Case Study for Health EDRM Initiatives to Improve Disaster Preparedness in a Rural Chinese Population. Presented by Prof Kevin KC Hung. Organised by Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong.