A novel methodological approach to systematically analyse pandemic influenza response programs within health systems

Background: Pandemic influenza preparedness plans exist in most countries yet the health systems operational capacity to actually implement these is a challenge. Diverse approaches to evaluate pandemic influenza programmes like guidelines, checklists or table top exercises exist yet they do not see the broader health system context in which programs have to function. Here we present an evaluation framework which helps to systematically determine how health systems and pandemic programmes interact, whether, where and which weak points exist; and how and where pandemic response programmes can be improved effectively. Method: The applied evaluation framework draws upon two existing approaches, the Systemic Rapid Assessment Toolkit (SYSRA) and the Hazard Analysis of Critical Control Points (HACCP) modified to systematically assess pandemic preparedness programmes in context. The assessment process can be divided into four basic phases i) data collection, ii) data synthesis, iii) hazard analysis and iv) generating recommendations. Results: The SYSRA is a systematic approach to analyse the interplay between pandemic control programmes and the broader health systems context within which they operate i.e. the meso level. Program functionality is for e.g. influenced by the political, economical, social and legal background of the health system environment. The HACCP methodology extends this to the micro level (service delivery) and builds upon a systematic analysis of predefined successive process steps within a pandemic programme to identify and localise likely hazards and to develop control measures to address them. Discussion: The combination of a systematic data collection tool with an analytical evaluation method provides a simple and rapid means for developing a contextual understanding and for identifying frailties in programmes that need to be responded to. Data collection from different sources (interviews, documents and guidelines) and data triangulation aims to display programme and system functionality as accurately as possible yet as with all models it can only represent reality.