Public health capacities are a combination of available infrastructures, resources and people’s competencies to achieve desired public health goals. Public health capacities are determined by the organisational, human, financial and other resources that enable actions to be taken by responsible authorities to improve health and reduce health inequalities.

While public health capacities relate more to the inputs of the health system, public health performance relates more to the outputs of the health system, as visualised in the figure below.

Figure 1. A visualisation of how performance assessments are applied in (public) health systems
PH Performance assessment

In the following section we will describe how a public health capacity assessment has been conducted in recent years in a European context.

Public Health Capacity Assessment in Europe

In the period 2010 – 2012, there was a consortium of renowned researchers and institutions which conducted a comprehensive public health capacity assessment (HSCA) for the European region. This project was led by the Department of International Health of Maastricht University, and funded by the European Commission.

The objectives of this public health capacity assessment were threefold:
1. To develop and implement public health policies and interventions based on a detailed review of the capacities of each EU Member State.
2. To identify gaps, needs and common issues.
3. To come up with suggestions for action where EU involvement could provide assistance and added value for strengthening public health capacities

At the time this study was conducted, there were a lot of transitions and paradigm shifts in the European public health arena, with new goals, approaches and actors becoming prominent. In the aftermath of the economic crisis of 2008, the sustainability of many public health systems in Europe was jeopardised. However, there were still substantial financial resources available to strengthen health systems (e.g. with the Structural- and Cohesion Funds), but in order to tap into these funds effectively it was first necessary to gain an overview of which components of health systems needed improvement and strengthening. Against this background, the aforementioned project was initiated.

The steps for conducting the public health capacity assessment were roughly the following:
1. A literature review to identify dimensions for public health capacity.
2. Developing a public health capacity assessment tool
3. Mapping the public health capacities in each individual Member State.
4. Creating an overview of public health capacities in the EU.
5. SWOT-analysis for public health in the EU (Strengths, Weaknesses, Opportunities, Threats).
6. Recommendations for action.

The following flowchart illustrates more accurately the different steps of the described public health capacity assessment procedure. The various aforementioned steps are illustrated with red numbers.

Figure 2.The different steps of the public health capacity assessment procedure
Different steps in PHCA procedure

In the following section we will describe the outcomes of step 1 and 2 of the assessment procedure, namely which dimensions were found to be representative of the capacities of public health systems.

The 7 dimensions that capture the capacity of a public health system

The project team identified 7 public health capacity dimensions, with most of these dimensions consisting of several components.

The 7 identified capacity dimensions of a public health system were:
1. Financial resources

2. Knowledge development
3. Partnerships
4. Workforce
5. Leadership and governance
6. Organizational structures
7. Context

The following figure illustrates the 7 different capacity dimensions and also lists the various components per dimension. The dimension ‘context’ is more of an overarching dimension which affects the other dimensions in various ways.

Figure 3. The 7 public health capacity dimensions and their components
PHC dimensions and components

Using the framework depicted above, the project team created many indicators that represented and adequately captured the various dimensions and components. This eventually enabled the project team to assess the actual capacities of the EU’s public health systems.

Outcomes: Public health capacities in the EU

The current article is intended to introduce the concept of public health capacities and to provide a quick overview of how public health capacity assessments can be applied in international (European) contexts. For those who are interested in learning more about public health capacities in the European Union, we encourage you to read the complete report on public health capacity in the EU

Special acknowledgement: Christoph Aluttis, Maastricht University