Strengthening regional public health intelligence: insights and experiences from the Pacific Public Health Surveillance Network, 2023

Technical Summary: Strengthening Regional Public Health Intelligence in the Pacific

Problem Statement
Pacific Island countries and territories (PICTs) face distinct public health challenges, including geographically dispersed populations, limited transport links, chronic workforce shortages, and a high burden of infectious diseases (29.3% of disability-adjusted life-years). To address these issues, the Pacific Public Health Surveillance Network (PPHSN) was established in 1996 to strengthen regional surveillance through cooperation, data harmonization, training, and communication. While individual components of the network have undergone reviews, the PPHSN as a whole had not been formally evaluated. This gap necessitated a comprehensive assessment to determine if the network effectively strengthens surveillance and response capabilities across the region and to identify opportunities for improvement in alignment with International Health Regulations (IHR 2005).

Methodology
The study employed a mixed-methods evaluation approach, with this specific paper focusing on findings from an online, bilingual (English and French) cross-sectional survey conducted between October and November 2023.

• Participants: Respondents were recruited via convenience sampling through Pacific Community (SPC) contact lists, Technical Advisory Group (TAG) networks, and the PacNet electronic mailing list. The target population included managers and staff of surveillance/response programs, development agencies, and other implementers of PPHSN functions.
• Instrument: The survey covered five domains: respondent demographics, understanding of PPHSN's purpose, engagement with specific service arms, utilization of tools/guidance, and perceived strengths/challenges. It utilized close-ended questions with conditional free-text fields.
• Analysis: Of 186 responses, 149 (80%) were complete and included in the analysis. Summary statistics described respondent characteristics and survey responses. Narrative analysis was applied to free-text responses to identify themes. Additionally, the authors systematically mapped PPHSN activities against IHR (2005) core capacities to assess alignment with global standards.
• Governance: A Technical Advisory Group comprising public health experts from the Coordinating Body, SPC, WHO, and the US CDC guided the study design, tool review, and interpretation of findings.

Key Contributions and Service Arms Evaluated
The evaluation assessed the performance of six established service arms of the PPHSN (the seventh, Pacific Vector Network, was excluded as it launched in 2023):

1. PacNet: Outbreak alert and communication platform.
2. LabNet: Laboratory network coordination.
3. PICNet: Pacific Infection Prevention and Control Network.
4. EpiNet: Outbreak response teams.
5. PSSS: Pacific Syndromic Surveillance System.
6. SHIP–DDM: Strengthening Health Intervention in the Pacific–Data for Decision Making (training program).

Results

• Demographics: The 149 respondents were primarily public health officers (52%) working at the national level (51%) within government health departments (74%). The majority (68%) had over 10 years of public health experience.
• Perceived Purpose: The most common perception of PPHSN's purpose (28%) was as a "communication platform for surveillance and response," followed by strengthening outbreak detection (23%) and health systems (18%).
• Service Arm Performance:
  • PacNet: 92% of users found the weekly outbreak map moderately to extremely useful. 75% agreed it effectively facilitated communication.
  • PSSS: 93% viewed the system as effective for early warnings and emergency response. However, 70% reported frequent reporting delays, attributed to logistical issues such as missing tally sheets, inconsistent internet coverage, and lack of data credit.
  • LabNet: 93% perceived the network as effective in strengthening laboratory services, with 87% reporting increased capacity during the pandemic. However, turnaround times for reference lab results were slow (1–3 weeks for 60% of respondents), and Laboratory Information Management System (LIMS) usage was low (40%), with only 17% of LIMS users reporting data to PPHSN.
  • PICNet: 82% rated the network as effective in building IPC capacity, with 91% of users applying PPHSN IPC guidelines.
  • EpiNet: 91% of respondents reported having a response team, though only 63% formally identified as an EpiNet team. 72% felt well-prepared, but 28% noted a need for improved resources and skills.
  • SHIP–DDM: 97% of respondents rated the field epidemiology training as helpful, with 86% reporting participation in outbreak responses.
• Identified Challenges: Key systemic challenges included delays in data reporting, lack of routine monitoring, workforce retention issues, funding constraints, and limited interoperability between systems (e.g., LIMS integration).

Significance and Claims
The paper claims that this is the first systematic evaluation of the PPHSN. The findings indicate that the network has successfully supported and strengthened regional surveillance and response since its inception, contributing to IHR (2005) core capacities in surveillance, laboratory capacity, and preparedness.

The study emphasizes that while significant progress has been made in communication, diagnostic capacity, and training, sustainable health security requires addressing persistent gaps. The authors argue that future success depends on:

• Coordinated investments and multisectoral collaboration.
• Sustained capacity-building and workforce retention strategies.
• Improved interoperability and timely data reporting mechanisms.
• Alignment with emerging frameworks such as the WHO Pandemic Agreement and the One Health approach.

The paper concludes by proposing a set of specific, time-bound indicators (Table 4) and strategic recommendations (Table 3) to guide the PPHSN's next five-year strategic plan, aiming to transform the network into a cohesive, adaptive, and high-performing system capable of addressing evolving health security priorities in the Pacific.