Sub-national public health intelligence responses to disease outbreaks: A mixed-methods systematic review

COVID-19 provided an impetus to improve infectious disease emergency preparedness. Provision of public health intelligence (PHI) during outbreaks by sub-national public health authorities (PHAs) supports decision making during these events. We synthesised studies describing such responses to elucidate transferable influencing factors.

This was a mixed methods systematic review.

Literature searches of eight databases (PubMed, Embase, Applied Social Sciences Indexes and Abstracts [ASSIA], Scopus, Health Management Information Consortium [HMIC], WHO Global Health Library, Health Systems Evidence, and PDQ Evidence) were undertaken in March 2022. We selected peer-reviewed, primary research in English, published in or after January 2019 relating to sub-national PHA PHI activities during a disease outbreak. Studies were quality assessed using appropriate tools and analysed by thematic analysis and pillar integration.

Forty studies from 24 countries, 31 COVID-19 related, were included. Six themes summarise factors influencing responses: 1) appropriate data infrastructure, 2) effective intelligence products, 3) multisector collaboration, 4) obtaining public support, 5) strong and supportive management and leadership and 6) the capacity and capability to respond. Synthesis of empirical studies increases the review's reliability, but evidence mainly relates to countries with very high levels of human development limiting its transferability to countries with lower levels.

Public health systems should ensure adequate data infrastructure and PHI staff capability and capacity, plan for strong but supportive leadership and effective intelligence production, encourage multisector intelligence collaborations and ongoing communication with the public at a sub-national level. PROSPERO International Prospective Register of Systematic Reviews Ref. CRD42022308042.