Health workforce response to Covid‐19: What pandemic preparedness planning and action at the federal and state levels in Germany? : Germany's health workforce responses to Covid‐19
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Abstract
Introduction
The Covid‐19 pandemic has required countries to prepare their health workforce for
a rapid increase of patients. This research aims to analyse the planning and health
workforce policies in Germany, a country with a largely decentralised workforce governance
mechanism.
Methods
Systematic search between 18 and 31 May 2020 at federal and 16 states on health workforce
action and planning (websites of ministries of health, public health authorities),
including pandemic preparedness plans and policies. The search followed World Health
Organisation (WHO) Europe's health workforce guidance on Covid‐19. Content analysis
was performed, informed by the themes of WHO.
Results
The pandemic preparedness plans consisted of no or limited information on how to expand
and prepare the health workforce during pandemics. The 16 states varied considerably
regarding implementing strategies to expand health workforce capacities. Only one
state adopted a policy on task‐shifting despite a federal law on task‐shifting during
pandemics.
Conclusions
Planning on the health workforce, its capacity and skill‐mix during pandemics was
limited in the pandemic response plans. Actions during the peak of the pandemic varied
considerably across states, were implemented ad hoc and with limited planning. Future
action should focus on integrated planning and evaluation of workforce policies.
In December, 2019, a local outbreak of pneumonia of initially unknown cause was detected in Wuhan (Hubei, China), and was quickly determined to be caused by a novel coronavirus, 1 namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak has since spread to every province of mainland China as well as 27 other countries and regions, with more than 70 000 confirmed cases as of Feb 17, 2020. 2 In response to this ongoing public health emergency, we developed an online interactive dashboard, hosted by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, Baltimore, MD, USA, to visualise and track reported cases of coronavirus disease 2019 (COVID-19) in real time. The dashboard, first shared publicly on Jan 22, illustrates the location and number of confirmed COVID-19 cases, deaths, and recoveries for all affected countries. It was developed to provide researchers, public health authorities, and the general public with a user-friendly tool to track the outbreak as it unfolds. All data collected and displayed are made freely available, initially through Google Sheets and now through a GitHub repository, along with the feature layers of the dashboard, which are now included in the Esri Living Atlas. The dashboard reports cases at the province level in China; at the city level in the USA, Australia, and Canada; and at the country level otherwise. During Jan 22–31, all data collection and processing were done manually, and updates were typically done twice a day, morning and night (US Eastern Time). As the outbreak evolved, the manual reporting process became unsustainable; therefore, on Feb 1, we adopted a semi-automated living data stream strategy. Our primary data source is DXY, an online platform run by members of the Chinese medical community, which aggregates local media and government reports to provide cumulative totals of COVID-19 cases in near real time at the province level in China and at the country level otherwise. Every 15 min, the cumulative case counts are updated from DXY for all provinces in China and for other affected countries and regions. For countries and regions outside mainland China (including Hong Kong, Macau, and Taiwan), we found DXY cumulative case counts to frequently lag behind other sources; we therefore manually update these case numbers throughout the day when new cases are identified. To identify new cases, we monitor various Twitter feeds, online news services, and direct communication sent through the dashboard. Before manually updating the dashboard, we confirm the case numbers with regional and local health departments, including the respective centres for disease control and prevention (CDC) of China, Taiwan, and Europe, the Hong Kong Department of Health, the Macau Government, and WHO, as well as city-level and state-level health authorities. For city-level case reports in the USA, Australia, and Canada, which we began reporting on Feb 1, we rely on the US CDC, the government of Canada, the Australian Government Department of Health, and various state or territory health authorities. All manual updates (for countries and regions outside mainland China) are coordinated by a team at Johns Hopkins University. The case data reported on the dashboard aligns with the daily Chinese CDC 3 and WHO situation reports 2 for within and outside of mainland China, respectively (figure ). Furthermore, the dashboard is particularly effective at capturing the timing of the first reported case of COVID-19 in new countries or regions (appendix). With the exception of Australia, Hong Kong, and Italy, the CSSE at Johns Hopkins University has reported newly infected countries ahead of WHO, with Hong Kong and Italy reported within hours of the corresponding WHO situation report. Figure Comparison of COVID-19 case reporting from different sources Daily cumulative case numbers (starting Jan 22, 2020) reported by the Johns Hopkins University Center for Systems Science and Engineering (CSSE), WHO situation reports, and the Chinese Center for Disease Control and Prevention (Chinese CDC) for within (A) and outside (B) mainland China. Given the popularity and impact of the dashboard to date, we plan to continue hosting and managing the tool throughout the entirety of the COVID-19 outbreak and to build out its capabilities to establish a standing tool to monitor and report on future outbreaks. We believe our efforts are crucial to help inform modelling efforts and control measures during the earliest stages of the outbreak.
This analysis of the German health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In the German health care system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population are covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% are covered by substitutive private health insurance. Characteristics of the system are free choice of providers and unrestricted access to all care levels. A key feature of the health care delivery system in Germany is the clear institutional separation between public health services, ambulatory care and hospital (inpatient) care. This has increasingly been perceived as a barrier to change and so provisions for integrated care are being introduced with the aim of improving cooperation between ambulatory physicians and hospitals. Germany invests a substantial amount of its resources on health care: 11.4% of gross domestic product in 2012, which is one of the highest levels in the European Union. In international terms, the German health care system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing. However, the German health care system still needs improvement in some areas, such as the quality of care. In addition, the division into statutory and private health insurance remains one of the largest challenges for the German health care system, as it leads to inequalities.
Journal ID (iso-abbrev): Int J Health Plann Manage
Journal ID (doi): 10.1002/(ISSN)1099-1751
Journal ID (publisher-id): HPM
Title:
The International Journal of Health Planning and Management
Publisher:
John Wiley and Sons Inc.
(Hoboken
)
ISSN
(Print):
0749-6753
ISSN
(Electronic):
1099-1751
Publication date
(Electronic):
18
March
2021
Publication date
(Print):
May
2021
Volume: 36
Issue: Suppl 1
,
Global health and health workforce development: Education, management and policy during
the COVID‐19 crisis and beyond
(
doiID:
10.1002/hpm.v36.S1
)
Pages: 71-91
Affiliations
[1]Department of Health Care Management
Technische Universität Berlin
Berlin
Germany
[2]Medical DepartmentDivision of Gastroenterology and Hepatology
Charité – Universitätsmedizin Berlin
Berlin
Germany
[3]Max Delbrück Center for Molecular Medicine
Berlin Institute for Medical Systems Biology
Berlin
Germany
Author notes
[*][*
]Correspondence
Julia Köppen, Technische Universität Berlin, Department of Health Care Management,
Straße des 17. Juni 135, 10623 Berlin, Germany.
This is an open access article under the terms of the
http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided
the original work is properly cited.
History
Date
revision received
: 18
February
2021
Date
received
: 10
January
2021
Date
accepted
: 22
February
2021
Page count
Figures: 0,
Tables: 3,
Pages: 21,
Words: 8836
Funding
Funded by: Open Access funding enabled and organized by Projekt DEAL. WOA Institution: TECHNISCHE
UNIVERSITAET BERLIN
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