Public Health Services during the COVID-19 pandemic in 3 European countries: PT, EN and DE

Abstract Background Monitoring and responding to health hazards and emergencies is an Essential Public Health Operation delivered by public health services (PHS) (2). In the European Region, there is a wide range of organizational and financial models for PHS delivery to the populations, but the best approach is still largely unknown (3). This work aims to analyze PHS organization and financing and compare their health results during the COVID-19 pandemic in 3 countries: Portugal, England and Germany. Methods We searched The European Observatory on Health Systems and Policies database; GoogleScholar® for the terms “organization” and “financing” associated with PHS and Europe; OurWorldInData® for COVID-19 data. Results PHS Organization: PT has national, regional and local units with a top-down decision-making hierarchy, though information flows both ways. EN has the national health system and Public Health England (that supports autonomous local elected health authorities), with independence and little overlapping between them. DE has Federal, State, County and Municipal health actors with self-government and administrative autonomy to a certain degree. Spending on ‘preventing care' as a share of total health expenditure: PT (1,7%), DR (3,2%) and EN (5,1%). COVID-19 cases: DE showed best results while PT and EN were similar. Conclusions WHO states the most effective and efficient method of delivering PHS is through an integrated approach, rather than through vertical programmes (2), but PT vertical organization with information flowing both ways and a network of horizontal supporting PH institutions may favor needed coordinated responses during a pandemic. In geographically larger countries, exerting autonomous decisions at different levels may improve preventive measures' efficacy. This analysis adds to the previous literature that suggests the most efficient PHS are adapted to local contexts. Key messages The best PHS organization is still unknown, though adaptation to regional and local contexts seems key for better results. Greater spending on “preventive care” does not necessarily guarantee better results, suggesting PHS organization may have a more important role.