Strengthening Public Health Systems During an Emerging Respiratory Disease Pandemic: A Realist Review

The recent outbreak of respiratory diseases such as COVID-19 has highlighted the need to strengthen public health systems to respond effectively to such crises. While previous research has identified various public health interventions for pandemics, there remains a significant gap in understanding which interventions can strengthen public health systems during emerging respiratory pandemics and under what conditions. To address this gap, we conducted a realist review to examine public health interventions during emerging respiratory disease pandemics, focusing on context, mechanisms, and outcomes. We conducted a literature search across PubMed, Scopus, ProQuest, and Web of Science for studies published since 2003. Finally, we analyzed and assessed the quality of 601 articles and analyzed 32 of them. This study emphasizes the importance of understanding the situational, structural, cultural, and environmental contexts that influence public health interventions within the six building blocks of public health systems. We have also identified the mechanisms of these interventions at the individual, organizational, and national levels for successful outcomes, such as improved access to health services, health equity, and effectiveness. This information is important for policymakers and practitioners who can use it to develop evidence-based strategies to strengthen public health systems during emerging respiratory disease pandemics. Our review introduced a new conceptual model to explore the interaction between context, interventions, mechanisms, and outcomes to strengthen public health systems. However, further research is needed to determine the effect of specific contextual factors on public health system interventions during respiratory disease pandemics.