Health Emergency and Disaster Risk Management During the COVID-19 Pandemic: A Case Study from Italy

Abstract Background The COVID-19 pandemic has profoundly impacted societies, influencing countries’ Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the pandemic focusing on challenges, response strategies, lessons learned and implications for H-EDRM, with an emphasis on health workforce, health services delivery and logistics. Methods This was a retrospective observational study using qualitative methodology. Data was collected via semi-structured interviews and analyzed according to the H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian pandemic response. Stakeholders from five sectors (policymaking, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, Veneto) were interviewed, reaching 15 interviewees in total. Results With regard to human resources, the main themes concerned the shortage of personnel, inadequate training, poor occupational health, and lack of multidisciplinarity. Regarding health services delivery, interviewees reported weakness of public health, hospital, and primary care systems. With regard to logistics, the following themes emerged: inadequate infrastructures, shortage of supplies, issues with transportation systems, and weak communication channels. Lessons learned stressed the importance of considering pragmatic disaster preparedness and the need for cultural and structural reforms. Conclusions Implications that emerged from this study can inform advancements in disaster management in Italy. Acknowledgments: This study was conducted in collaboration with the Department of Public Health and Health Policy, Hiroshima University, Japan and funded by the World Health Organization Kobe Centre for Health Development (WKC-HEDRM-K21001). *ALC and EP are both first authors Key messages • Findings show that great interconnection of sectors is key in overcoming challenges and for future disaster preparedness. • Lessons learned contribute to translating the H-EDRM precepts into practice.


Introduction:
The COVID-19 crisis has disrupted health systems all over the world. In a survey by the WHO, 93% of the countries reported disruption in their mental health services. This research assessed the extent to which mental health was included in the national response to the COVID-19 pandemic in African countries. It also explored barriers and enablers to mental health integration into the COVID-19 response. Lessons learned from COVID-19 can help improve the response to future public health emergencies.

Methods:
A web-based survey was sent to mental health focal points in 55 African countries. The survey assessed the perceived degree of implementation of the Inter-Agency Standing Committee (IASC) ''14 Globally Recommended Activities'' for mental health response to COVID-19. This was followed by in-depth interviews to explore barriers and enablers to mental health integration into the COVID-19 response.

Results:
Responses were received from 28 countries. Lack of political will, poor funding, limited human resources, and weak preexisting mental health systems were the key challenges in addressing mental health needs during COVID-19. Participants highlighted the need to capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the longer term. They have also stressed the importance of sustaining and strengthening the new partnerships and service delivery models that emerged during the COVID-19 pandemic.

Conclusions:
The number of recommended mental health activities implemented during the COVID-19 pandemic varied considerably across African countries. Several factors limit mental health integration into emergency response. However, there are signs of optimism, as mental health gained some attention during COVID-19, which can be built on to integrate mental health into emergency response and strengthen health systems in the long term. Key messages: Capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the long term. Sustain and strengthen the new partnerships and service delivery models that emerged during the COVID-19 pandemic.

Background:
The COVID-19 pandemic has profoundly impacted societies, influencing countries' Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the pandemic focusing on challenges, response strategies, lessons learned and implications for H-EDRM, with an emphasis on health workforce, health services delivery and logistics.

Methods:
This was a retrospective observational study using qualitative methodology. Data was collected via semi-structured interviews and analyzed according to the H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian pandemic response. Stakeholders from five sectors (policymaking, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, Veneto) were interviewed, reaching 15 interviewees in total.

Results:
With regard to human resources, the main themes concerned the shortage of personnel, inadequate training, poor occupational health, and lack of multidisciplinarity. Regarding health services delivery, interviewees reported weakness of public health, hospital, and primary care systems. With regard to logistics, the following themes emerged: inadequate infrastructures, shortage of supplies, issues with transportation systems, and weak communication channels. Lessons learned stressed the importance of considering pragmatic disaster preparedness and the need for cultural and structural reforms.

Conclusions:
Implications that emerged from this study can inform advancements in disaster management in Italy.