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. 2023 Jun 22;3(6):e0001386. doi: 10.1371/journal.pgph.0001386

Strengthening COVID-19 pandemic response coordination through public health emergency operations centres (PHEOC) in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020–2021

Womi-Eteng Oboma Eteng 1,*, Abrham Lilay 2, Senait Tekeste 2, Wessam Mankoula 1, Emily Collard 3, Chimwemwe Waya 1, Emily Rosenfeld 4, Chuck Menchion Wilton 4, Martin Muita 3, Liz McGinley 3, Yan Kawe 2, Ali Abdullah 5, Ariane Halm 6, Jian Li 7, Virgil L Lokossou 8, Youssouf Kanoute 7, Ibrahima Sonko 1, Merawi Aragaw 1, Ahmed Ogwell Ouma 1
Editor: Megan Coffee9
PMCID: PMC10286958  PMID: 37347769

Abstract

The coronavirus disease 2019 (COVID-19) pandemic disrupted health security program implementation and incremental gains achieved after the West African Ebola outbreak in 2016 across Africa. Following cancellation of in-person events, a multi-faceted intervention program was established in May 2020 by Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organisation, and partners to strengthen national COVID-19 response coordination through public health emergency operations centres (PHEOC) utilizing continuous learning, mentorship, and networking. We present the lessons learned and reflection points. A multi-partner program coordination group was established to facilitate interventions’ delivery including webinars and virtual community of practice (COP). We retrieved data from Africa CDC’s program repository, synthesised major findings and describe these per thematic area. The virtual COP recorded 1,968 members and approximately 300 engagements in its initial three months. Fifty-six webinar sessions were held, providing 97 cumulative learning hours to 12,715 unique participants. Zoom data showed a return rate of 85%; 67% of webinar attendees were from Africa, and about 26 interactions occurred between participants and facilitators per session. Of 4,084 (44%) participants responding to post-session surveys, over 95% rated the topics as being relevant to their work and contributing to improving their understanding of PHEOC operationalisation. In addition, 95% agreed that the simplicity of the training delivery encouraged a greater number of public health staff to participate and spread lessons from it to their own networks. This just-in-time, progressively adaptive multi-faceted learning and knowledge management approach in Africa, with a consequential global audience at the peak of the COVID-19 pandemic, served its intended audience, had a high number of participants from Africa and received greatly satisfactory feedback.

Introduction

On March 11, 2020, the World Health Organisation (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic [1]. Implementation of annual program plans of local and international health security stakeholders were abruptly interrupted, testing the recent increases in health security investments that African countries had received since the end of the West African Ebola outbreak in 2016. In-person events including training workshops and on-site support were cancelled to limit the spread of the then-fast-spreading COVID-19 pandemic. As the pandemic progressed, it severely tested existing multi-sectoral coordination structures and mechanisms for health emergency information and resource management by the public health emergency operations centres (PHEOCs) and similar institutional arrangements in countries across the African continent and globally. The pandemic further revealed the need for a whole-of-government approach, necessitating the active participation of an extensive array of stakeholders in the traditional health sector arrangements in the previous, and familiar public health responses.

A PHEOC is a physical location for the coordination of information and resources to support emergency management functions. The functionality of a PHEOC is predicated on four components–policies, plans, and procedures; information system and data standards; skilled human resources; as well as communication technology and physical infrastructure. The timely implementation of functional PHEOCs has been documented as a factor for improved response to emergencies [2,3] and equally important in meeting the minimum requirements of the International Health Regulations (IHR-2005) [4]. As best practice, response resources are arranged and managed using the Incident Management System (IMS), which is a standardised, scalable, and flexible emergency management structure with sets of procedures and protocols that provide a coordinated approach while avoiding duplication of effort for all types of health emergencies.

With the COVID-19 pandemic, programmatic plans and events aimed at strengthening PHEOC capabilities and events including in-person training were disrupted due to the travel and physical distancing measures implemented globally to limit the spread of the pandemic [5]. Virtual systems and communication became the alternative business norm for organising meetings and training delivery. This option became the leverage for delivering webinars accessible through smartphones, tablets, and computers from any part of the world. Several of the available technology platforms had audio and video capabilities [6]. Webinars allowed various interactive opportunities, such as discussion, instant messaging functions, conducting polls, surveys, and knowledge checks. In addition, an interactive and accessible online community of practice could be established alongside webinar training sessions, offering a space to share presentations, continued discussion, peer-to-peer cross-learning and mentoring. Training, learning, and satisfaction through online webinars could lead to excellent outcomes for a significantly large and geographically dispersed audience, compared to face-to-face events, as concluded in a meta-analysis conducted by Gegenfurtner et al. [7].

In the initial months of the COVID-19 pandemic, many Member States in the African continent and globally, where PHEOC capacity was still in development, communicated the need for operational guidance to partner organisations. In response, a multi-faceted intervention program was established in May 2020 by Africa Centres for Disease Control and Prevention, the World Health Organisation, and partners to strengthen COVID-19 response coordination through public health emergency operations centres (PHEOCs) using continuous learning, mentorship, and networking. The program focused on building and/or strengthening capacity in PHEOC management for a coordinated COVID-19 response and included the creation of an online Community of Practice (CoP) comprising mainly PHEOC professionals from the African continent. This intention was to achieve this through strengthening of attendees and users’ capacities and allow them to cascade the acquired competences. The platform was designed to address the immediate knowledge gaps, facilitate the exchange of experience, and serve as a springboard for launching a sustained post-COVID-19 experiential learning base. The primary target audience was personnel working in PHEOCs across the African continent. Besides, participants across the globe were actively engaged throughout the weekly webinars. A complementary Discord (an open-source social communications and online community platform capable of hosting a large virtual group, one-on-one messaging, live in-app audio and video meetings and ease of sharing various file formats) platform Community of Practice was established to provide continuous engagement and networking opportunities [8]. However, no review of the webinar series was conducted to determine whether it had met its objectives, and no lessons learned were drawn to improve future webinar delivery programs.

A review of the webinar series and the Community of Practice (CoP) was conducted to document the experience acquired and to identify recommendations that could potentially serve as a future reference for the establishment of virtual learning programs and CoP within the continent of Africa and in settings similar to Africa.

Methods

Program coordination

A core working group was established to lead the overall coordination with members identified from Africa Centres for Disease Control and Prevention (Africa CDC), World Health Organisation Regional Office for Africa (WHO AFRO), World Health Organisation Regional Office for the Eastern Mediterranean (WHO EMRO), WHO Headquarters, UK Health Security Agency (UKHSA), US Centers for Disease Control and Prevention (US CDC), Robert Koch Institute (RKI), European Centres for Disease Prevention and Control (ECDC), Resolve to Save Lives (RTSL) and the global Emergency Operations Centre Network (EOC-NET).

A secretariat was established at the Africa CDC headquarters to oversee program coordination, including scheduling, and coordinating meetings, producing technical briefs, and developing publicity materials (flyers and broadcast emails). The secretariat also provided an enquiry desk to address queries and respond to requests for information and assistance from country teams.

Webinar facilitation

The webinar series was initiated to respond to identified gaps in multiple aspects of PHEOC operationalisation communicated to WHO and Africa CDC by PHEOC focal points in the initial months of the COVID-19 pandemic. The working group developed a take-off curriculum and content for the webinars delivered through the Zoom communication platform, chosen for its global accessibility, ability to accommodate several hundreds of participants and capabilities such as screen sharing, interactive survey, polls, breakout room and simultaneous translation services. Webinars were generally delivered in English with simultaneous translation into Arabic and French. The webinars were also recorded and broadcast on the Africa CDC YouTube and Facebook channels to ensure maximum accessibility. Webinars were initially broadcast every week, changing to a biweekly basis in September 2021. Country experience was frequently included in the webinars alongside guest presenters from across the globe. Webinar presenters were typically senior public health specialists, PHEOC professionals, and program leads from across the continent and global public health institutions who were assigned topics based on their areas of expertise.

Special sessions also included live tours of PHEOC facilities, showcasing equipment, human resources, and workflows.

The approach to selecting webinar topics evolved and hence remained dynamic and adaptive. In the initial stages, the first few webinar topics were identified based on the results of an abridged baseline survey that was distributed to those in the PHEOC field across the continent and were known to the PHEOC partners working group. With continuous interactions with webinar participants, through direct feedback, survey findings, and consultations with key actors at country levels, the webinar topics were tailored toward the needs and interests of participants. As the webinars progressed, participants’ inquiries into previously treated topics prompted the re-organisation of one-off topics into multi-part series to provide a deep-dive learning experience into various thematic areas of a public health emergency management (PHEM) program—anticipating, preventing, preparing for, detecting, responding to, and recovering from the consequences of public health threats. An emerging best practice for coordinating PHEM programs includes the implementation of functional PHEOCs. Participants who attended at least 75% of the webinar sessions were emailed a link to a knowledge-check in the Flexiquiz platform; those who obtained an 80% pass rate in this knowledge-check were rewarded with an automated certificate of attendance.

Community of practice

Following an overwhelming interest in the webinar series and in an effort to maintain continuous engagement with experts, networking and response to out-of-topic, but equally important questions, a community of practice (CoP) was formed on Discord on 02 July 2020, one month after the initial webinar. Discord is an open-source social communication and online community platform which was evaluated by the working group to meet the needs of hosting a large virtual community, group, and one-on-one messaging, live in-app audio and video meetings and ease of sharing various file formats [8]. This platform allowed free global access to a PHEOC webinar channel, established by the working group. On this channel, each webinar presentation was uploaded, allowing access to those who could not join the live webinar. Additionally, members of the PHEOC webinar Discord community could share messages, questions, documents, and experiences through the community message board, moderated by members of the webinar working group. Subsequent to this Discord CoP, a PHEOC Network message group was set up on the WhatsApp messaging platform. This message group has been used to share PHEOC-relevant training information, country milestones in PHEM training and situational awareness of emergency responses across the African continent.

Data variables and analysis

Key indicators were chosen to assess webinar and CoP performance. Relevant registration and participation information were extracted and consolidated for analysis using a pre-defined data extraction tool. For webinars, these included attendance rates from Africa and around the world per webinar, the countries with the most attendees, the length of the webinar sessions, and the number of participants-to-facilitator discussions.

Participants’ responses to the post-webinar polls, which began during webinar 16 and were administered until webinar 52, were reviewed, with an additional question to clarify the attendee’s role in the PHEOC from webinar 30 to 52. The questions were:

  • Will you attend another webinar based on the delivery of this session?

  • Did the session improve your understanding of the topic?

  • Was the content easy to follow?

  • Was there enough time for questions and discussion?

  • Would you recommend the session to someone?

  • How relevant was the topic to your current role in the COVID-19 response?

  • Is your current role related to Public Health Emergency Operations Centre?

A thematic analysis (inductive, and semantic approaches) was used to group, analyse, and describe major findings. Further descriptive statistics (percentages, tables, charts, etc.) were used to summarize the quantitative data. MS Excel and R [9] were used to analyse the quantitative data and produce tables and figures.

Ethics statement

The data collected in the frame of this study did not involve any personally identifiable information and data was anonymised. Respondents invited to fill in the online survey feedback were informed about its purpose and objectives and were aware by providing their answers they consented to participate.

Results

Establishing the webinar series

Baseline survey

In May 2020 before the first webinar, an initial baseline survey was created using an online survey tool and shared with stakeholders from across the PHEOC networks. The responses to the survey were used to help develop and refine the topics and content of the webinars.

The summary of survey responses showed the working group what challenges Member States were facing and areas of good practice in PHEOCs responding to COVID-19 (Table 1).

Table 1. Summary response of baseline survey, May 2020.
Summary of the Challenges Areas of Good Practice

  • Resilience and maintaining the response long term–supplies, funding, and human resources.

  • Managing concurrent incidents and emergencies in addition to COVID-19

  • Staff welfare (fatigue) and reducing the exposure risk.

  • Cross Government involvement and unfamiliarity with public health response structures and PHEOC principles

  • Lack of funding, human resources, and supplies

  • Leadership untrained or unfamiliar with PHEOC principles

  • Command, control, and coordination

  • Cross-regional and other stakeholder collaboration

  • Basic communications systems and other infrastructure

  • Activation of PHEOC improved coordination and unity

  • Multi-level response allows for regional particularities and specifics to be considered and addressed.

  • Use of event bases surveillance and early warning systems benefited preparedness and global tracking of COVID.

  • Concurrent incident management

  • Multi-sector and partner involvement

  • COVID-19-specific government-level input

  • Served as a platform for cooperation cross-border and cross-boundary where previous political divisions exist
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Webinar planning and coordination

The webinar coordination group had the responsibility for developing and agreeing on the webinar topics, schedule, and content. Decisions were generally made by consensus, and where not possible such decisions were arrived at by a simple majority. Through direct feedback, survey findings, and consultations with key actors at the country level, the webinar topics were tailored towards the needs and interests of participants. The secretariat was then responsible for the official marketing of the webinars with the development of a flyer which was shared through agreed PHEOC networks, email distribution lists, and word of mouth.

Quality assurance of webinar content

The webinar coordination group was responsible for ensuring consistency of presentations with established terminologies, workflow, and alignment with existing guidance documents, except where innovative approaches were considered. Presenters were required to share final presentations along with any related reference documents prior to the webinar for review and agreement by the working group.

Webinar topics and series

During the early phases, topics for the webinars were identified and prioritised by the core team using a majority vote system to identify and prioritise topics. However, survey findings and consultations with key public health actors at the country level including national public health institutions and partners supporting emergency management were used to inform webinar topics tailored to the interests of participants in later months. Some of the prioritises topics were reorganised into series where they were covered in subsequent several sessions under each series to allow participants to take a deep dive into the content and gain a thorough understanding of the respective topic.

Based on the findings from this review, the average webinar length was 1.8 hours, with sessions lasting anywhere between 1.5 and 2.7 hours. During the webinar period, 56 topics were covered across eight thematic areas. Each of the IMS and incident leadership themes had 14 topics. The information management series covered seven topics, while the multi-sectoral coordination, PHEOC handbook, and legal framework series each covered five topics. Other series had four or fewer topics (Fig 1).

Fig 1. Webinar Series thematic areas and topics, 2020–2021.

Fig 1

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Development of PHEOC document part 2, IMS round-up, and development of PHEOC documents part 1 sessions were attended by 551 (4.3%), 466 (3.7%), and 382 (3.0%) participants, respectively. On the other side, 47 (0.4%), 25 (0.2%), and 12 (0.1%) attended Watch Mode operations: EBS tools, PHEOC information systems part 3, and PHEOC information systems part 4 webinar sessions, respectively (Fig 2 and S1 Table).

Fig 2. Webinar individual topics and Attendees, 2020–2021.

Fig 2

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Webinar participation

A total of 56 webinar sessions were held between June 2020 and December 2021, with initial sessions held on Thursdays, starting at 3:00 p.m. East Africa Time (EAT). However, an adjustment was made later to accommodate more participants and pushed the start time to 4 p.m. EAT.

S2 Table shows that a total of 95,230 participants were registered, with 12,715 (13%) unique attendees from 130 countries across the globe participated in at least one live webinar session. An 85% return rate (number of participants who attended more than one session) was recorded (uniquely identified by username and email address). Of those who attended, 8,528 (67%) were from the African continent. All 55 countries in the continent participated in at least one webinar. A total of 48 countries were represented in at least half of the 56 webinars with 36 (65%) coming from the African continent. Over the webinar period, an average of 33 with a range of 8 to 50 countries participated from the African continent (Fig 3). A cumulative 1,102,354 views of the webinars were recorded across Facebook and YouTube platforms where the live webinars were simultaneously broadcasted.

Fig 3. Webinar Global and African continent Attendees, 2020–2021.

Fig 3

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Seventeen countries were identified throughout the webinar periods as having the top three attendance rankings based on the number of attendees each week, with 13 being from the African continent. Nigeria, the United States of America (USA), Kenya, and Ethiopia accounted for 45% of all webinar attendees (Fig 4). Across all live webinar sessions, there was almost twice (1.7) the number of attempts to join the sessions compared to actual participation.

Fig 4. Webinar attendees top represented countries, 2020–2021.

Fig 4

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Post-webinar survey

During the period when the post-webinar surveys were administered starting with webinar 16, 4,084 (44%) of the webinar participants (9,283) responded. Over 95% responded positively to the topic’s relevance to their current role, the likelihood of recommending a topic to another colleague, the session’s contribution to improving their understanding of the issue, interest in attending another session, and that the content was easy to understand. Furthermore, 85% said there was enough time for discussion at the end of the sessions. An additional question was added on their role related to PHEOC and 2,404 (81%) of the 2970 webinar participants responded that they had a PHEOC-related role (Table 2).

Table 2. Responses of post-webinar surveys, 2020–2021.

Question Yes % No % Total (N = 4,084)
Topic relevant to the current role 4,034 98.8 50 1.2 4,084
Would recommend the session to someone else 4,024 98.5 60 1.5 4,084
The session improved understanding of the topic 4,009 98.2 75 1.8 4,084
Would attend another session 3,970 97.2 114 2.8 4,084
The content was easy to follow along with 3,901 95.5 183 4.5 4,084
Adequate time for questions and discussion 3,470 85.0 614 15.0 4,084
The current role relates to PHEOC 2,404 80.9 566 19.1 2,970
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Interaction and networking within the online CoP

In all the webinar sessions, participants had an opportunity to interact with other participants and facilitators or to ask a question and obtain an answer (Q&A) and share general opinions regarding the topic of the presentation and other areas related to PHEOC operations. There were 1,407 total interactions between webinar participants and facilitators. On average, there were 26 interactions between the participants and facilitators, ranging from 4 to 56 interactions per session.

The ‘Discord Platform’ was acknowledged by members of the online CoP to be an effective platform that enabled continuous engagement and networking across Member States and increased their knowledge and skills on the topics addressed. It facilitated peer-to-peer learning through country-to-country, PHEOC-to-PHEOC communication about implementing coordinated COVID-19 responses. The platform was utilised by participants, before, during, and after webinars sessions, to discuss real-time issues and needs (e.g., advocacy for decision-makers commitment, PHEOC funding, and legal framework development, etc.), sharing of experience, lessons learned and best practices (e.g., PHEOC-to-PHEOC mentorship on potential PHEOCs support in COVID-19 response), and required documentations for PHEOC operationalisation (e.g., sharing of relevant PHEOC manuals, SOPs, training materials and events, and other useful references).

As of September 2022, approx. 1789 online community members were found to be active on the platform, which is still active. The webinar coordination group members continuously work to improve and ensure that the online CoP and the virtual training through the Webinar Series endure beyond the COVID-19 pandemic.

Reward on participation

To encourage participation and intake of training as well as to reward active participants, e-certificates were provided to those who attended at least four webinar sessions and successfully completed the knowledge-check with an 80% pass rate. A total of 2,102 participants, 15% of those who attended the certificated series, received e-certificates, with logos of all coordinating partners.

Discussion

The study presents findings from the review of a multifaceted approach for virtual networking and learning focused on PHEOC capacity building from 2020–2021. The establishment of such a webinar series and CoP platform was aimed at providing just-in-time training in PHEOC operationalisation as hubs supporting the implementation of coordinated COVID-19 responses across Africa.

The outcomes of the review showed the virtual learning and networking platform served the intended primary audience with an extensive global reach, drawing in participation from over 130 countries, including all 55 African countries. The Webinar series significantly contributed to building and/or strengthening the knowledge of PHEOCs professionals through active networking, and country-to-country sharing of experience, lessons learned and best practices, and required documentation for implementing PHEOCs and coordinated COVID-19 responses. However, these findings should be interpreted with caution due to the limitations of the review and Webinar series.

There were sufficient registrants (over 95,000) interested in joining the PHEOC Webinar Series. However, there was an overall low attendance rate (13%), and close to half (47%) of the total webinar participants came from just 17 countries. This high registration rate may reflect the genuine need and interest in PHEOC management material at the time. Conversely, the low attendance rate may reflect several scenarios including a lack of time to attend a 1–2-hour long webinar during the COVID-19 pandemic, particularly for those working in a PHEOC, a lack of technological infrastructure to join the webinar online and conflicting commitments at the time of the webinars. However, the relevance of the webinars and the interest it garnered over time was demonstrated by a high return rate of 85% (that is, the percentage of unique attendees who participated in more than one live session). There was nearly twice (1.7) the number of attempts to join live sessions compared to actual participation. Recordings of the sessions were distributed by email and on the Discord platform to carter for this challenge, likely due to low internet bandwidth connectivity. Among the motivation strategies employed, the incorporation of attendance certificates to promote participation and engagement, based on the successful completion of a knowledge check, did not appear to act as a significant factor in webinar participation, with just 15% of those who attended at least 75% webinar sessions successfully obtaining a certificate.

Most (67% of 12,715) of the attendees across all webinars were from the African continent (Benin, Cameroon, Egypt, Ethiopia, Ghana, Kenya, Libya, Nigeria, Senegal, Somalia, South Africa, South Sudan, and Uganda). Nigeria, the United States of America (USA), Kenya, and Ethiopia accounted for 45% of all webinar attendees. This strong representation from the African continent and the United States could be interpreted on several levels including that there was a greater need for information and learning on PHEOC management and operationalisation from these countries. However, the inclusion of key partners of Africa CDC and US CDC in the PHEOC Webinar Series working group is likely to have resulted in an inordinately large number of participants from outside the Africa PHEOC network.

The adaptive and evolving nature of the webinar program helped to improve the delivery of the sessions and tailored it to the interests of participants across the continent and beyond. The average number of attendees (235) per session and approximately 70% of the webinar sessions had at least 200 attendees indicating a successful uptake of the webinars. This could be because the webinar topics were tailored to their interests and the fact that there were increasingly strong planning and coordination efforts between the working group and attendees/community of practice as the webinars continued.

Inviting countries to share their experiences in the management of COVID-19 helped other national PHEOC staff learn from peers and adapt the lessons in their context and to engage in an active exchange with other experts in the region. Webinar participants particularly engaged with sessions which focused on sharing experiences from Member States on their coordination through PHEOC. Through the process, 17 countries from Africa and several from outside the continent had a chance to share their experiences. The PHEOC webinar sessions containing the country experience sharing were mainly provided with the help of PowerPoint presentations by subject matter experts (SMEs) from invited countries and various public health organisations. Previous studies have indicated that most resource persons (74%) successfully delivered lectures during online capacity building with help of PowerPoint presentations [10].

Based on the findings from this review, the average webinar length was 1.8 hours, with sessions lasting anywhere from 1.5 to 2.7 hours, this reflected the complexity of the topic discussed and the engagement of the attendees in the subsequent Q&A session. Organisers recognised that participants tended to drop off the webinar after one hour, likely because of conflicting commitments. Therefore, it is recommended that future webinar sessions do not extend beyond one hour. Where it is likely to last longer up to 1.5 hours, it may be beneficial to inform participants ahead of time and keep them actively engaged [11]. In terms of the time taken per session, 85% of attendees agreed that enough time was allotted at the end of the webinar session for discussion and answering questions. There were 1,407 interactions between webinar participants and organises during the webinar period, including Q&A and opinion sharing, resulting in an average of 26 interactions per session. The interactions observed appear to be low as compared to the number of attendees per session (235 on average), which could be due to the limited time allocated for discussion. However other considerations may include the likelihood of attendees listening to the session while conducting other work, language barriers or their ability or confidence to engage with the other attendees and facilitators in a virtual environment.

The PHEOC webinar sessions were held on Thursdays, taking the recommendations of a study that attributed better participation in attending webinars on Tuesdays, Wednesdays, and Thursdays, these being the best days for live events in countries where Saturday and Sunday are the weekends [12]. In the first 12 months of the series, sessions were conducted at the same time each Thursday, on reflection and based on feedback from participants, it was decided that weekly sessions should use an alternating time to mitigate the chance of a clash with re-occurring pre-existing meetings.

Almost all respondents (over 95%) to the post-webinar surveys agreed that the topics of the webinar sessions were relevant, the contents were easy to comprehend and contributed to improving their understanding. Similar studies (91%) agreed that webinar topics were relevant [10]. The webinar coordination group met regularly (virtually) and were in frequent contact via email to discuss and refine the weekly content, using expertise from across all partner organisations. Likewise, the group was open to suggestions from international colleagues and attendees regarding on-topic content and presentation of content. An active and efficient secretariat was crucial in the development and distribution of Webinar brochures and links which were communicated via registrants’ email and published on the websites of the Africa CDC. Previous studies have indicated improved engagement (89%) of respondents when organisers provide webinar links well in advance for registration [10]. In addition, another study found that webinar participants (75%) were interested in the topic rather than the speaker or the company organising the webinar [12].

The success of the topic choice and strong communication of webinar sessions in advance is indicative of the commitment of the PHEOC Network partners, PHEOC Webinar working group, and secretariat. They emphasised the effort involved in conducting a weekly, interactive webinar series, especially when hosted by SMEs who themselves were engaged in COVID-19 response activities. The amount of effort involved in organizing similar public health learning tools/models should be taken into account by planning teams, and consideration given to the resources available, the ambitiousness of the scale of the learning program, and the level of commitment required.

Limitation

The low response rate of webinar surveys may have influenced the topic selection process, as those who did not vote may have preferred a different topic. Furthermore, missing data on participants’ relevant work experiences may have an impact on translating the learning into practice, as those who voted may not necessarily hold critical roles in the PHEOC.

Conclusions

In conclusion, the ‘just-in-time’ multifaceted approach designed to help address the gap in PHEOC capabilities during the initial days of the COVID-19 pandemic, provided many lessons for the organisers and reflection points for those embarking on similar initiatives. Key lessons included the scope of planning involved in such an approach; the logistical efforts required to ensure that presenters, facilitators, translation services and participants were present at each webinar; the engagement involved to ensure that the webinars and CoP platform were effective; the inclusion of a wide target audience; the potential of increasing participation of those registered to attend the webinar series; the evaluation of the approach and how it met the needs of PHEOC information sharing and strengthening. While the organisers recognise the limitations of such an approach, feedback from those who participated in the Webinars and CoP have been largely positive, with many of those participants continuing to engage in the PHEOC CoP, particularly from the African continent. The virtual approach used in delivery, bolstered by the changing attitudes to learning and working across online global platforms, proved useful for PHEOC knowledge sharing and we recommend that further investment should be considered in virtual learning platforms for PHEOC training in the Africa continent and in similar settings. This would allow swift implementation and up-scaling of alternative capacity strengthening and exchange approaches for public health staff leading response operations in Africa, when presential and on-site technical support and mentoring might not be possible to the extent required.

Supporting information

S1 Table. Webinar thematic areas, and topics by webinar registrants and attendees, 2020–2021.

(PDF)

Click here for additional data file. (65.6KB, pdf)
S2 Table. Frequency of attendance, Webinar series, 2020–2021.

(PDF)

Click here for additional data file. (41.3KB, pdf)
S1 Data. Database Analysis PHEOC Webinars 2022.9.26.

(XLSX)

Click here for additional data file. (28.3KB, xlsx)

Acknowledgments

We would like to acknowledge all countries that attended the webinar sessions and participants for completing the feedback survey and for continued support throughout the webinar period.

Data Availability

Data uploaded as supplementary information.

Funding Statement

The authors received no specific funding for this work.

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  • 12.Elshimaa A MM, Tasneem Mohammad A, Alahmady H. On line webinars during time of COVID-19: Does it increase the clinical and surgical skills of egyptian ophthalmologists? Journal of Clinical Research and Ophthalmology. 2020. p. 075–80. [Google Scholar]
PLOS Glob Public Health. doi: 10.1371/journal.pgph.0001386.r001

Decision Letter 0

Megan Coffee

2 Jan 2023

PGPH-D-22-01832

Strengthening response coordination through public health emergency operations centers in Africa: Lessons learned from 56-week webinar sessions, 2020-2021

PLOS Global Public Health

Dear Womi Eteng

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by February 15. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Megan Coffee, MD, PhD

Academic Editor

PLOS Global Public Health

Journal Requirements:

1. Please amend your online Financial Disclosure statement. If you did not receive any funding for this study, please simply state: “The authors received no specific funding for this work.”

2. Please update your online Competing Interests statement. If you have no competing interests to declare, please state: “The authors have declared that no competing interests exist.”

3. In the online submission form, you indicated that "Data could be accessed upon request to the author". All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information.

This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons by return email and your exemption request will be escalated to the editor for approval. Your exemption request will be handled independently and will not hold up the peer review process, but will need to be resolved should your manuscript be accepted for publication. One of the Editorial team will then be in touch if there are any issues.

4. We do not publish any copyright or trademark symbols that usually accompany proprietary names, eg (R), (C), or TM  (e.g. next to drug or reagent names). Please remove all instances of trademark/copyright symbols throughout the text, including © on page 7.

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Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an interesting paper, informative and well written. However I feel a little more analysis and some slight edits are needed

Line 122: data extraction too (correct to tool)

Line 194 - 197: A table // annex describing what these thematic / topics are and contain would be helpful. It isn't clear what is contained in PHEOC doc part 2 for example

Line 212 - Please describe what a 'discord platform' is

Line 251 - Nigeria and Ethiopia participation - authors should consider whether the populations of the countries (the two biggest in Africa) is a part explanation for the large participation. Further reflection on why such large US participation since US was not a target

Line 269-279 - the sentences here seem incomplete

General

Some information on languages used for delivering the webinars and reflection on the impact on participation would improve this review. Africa Union has 5 official languages, what proportion of sessions were delivered in English, French Arabic, Portuguese etc? A correlation between language of delivery and country participation may be informative

Impact on practice - some comment on the impact of the webinar series on actual practice - operationalization of PHEOCs would be informative. If this has not been done, perhaps the authors could indicate why not and how they propose to do this in the future to inform further development of the programme?

Reviewer #2: Thank you for the opportunity to review this paper, which examines the implementation of a knowledge support service by an inter-agency team during the COVID-19 pandemic. The intervention aimed to strengthen COVID-19 response of Public Health Emergency Operations Centres.

The adaptation of knowledge support and information dissemination practices are critical changes that took place during the pandemic, and which have had wide-reaching implications for public health interventions and crisis response. The intervention that is presented in this paper can provide an important addition to the literature, to improve our understanding of how to effectively adapt in a changing context with movement restrictions. The evaluation presented can help to inform agencies and organisations seeking to do similar work.

At present, the organization of the paper and also the content needs some revision to be able to provide clear evidence. In its current format, the manuscript provides a mix of information in the introduction, methods, results, and discussion, with some results described in the introduction, the methods are very short, some methods are described in the results, and some results are presented for the first time in the discussion. Also, the title implies that the paper reviews the webinar series, but the paper provides some interesting information about a Community of Practice, which is useful and important to share. The title should be revised to reflect this or perhaps to describe a multi-faceted intervention to share knowledge and experiences for teams engaged in the COVID-19 response (e.g. webinar series and CoP).

Another key issue is that the findings presented do not examine quality and it isn’t clear if it was possible to examine effectiveness or impact of the webinars (e.g. accurate knowledge acquisition and change in practice). In order to receive a certificate, participants had to attend all webinars and also complete a knowledge check. If the results of the knowledge check are available, this would help to provide some insight into quality.

The examination of the results and limitations is currently a bit superficial with descriptive statics, and the conclusions about effectiveness aren’t supported by the presented findings. I’ve provided some detailed comments below which I hope will be helpful.

Overall organization – The introduction should be used to provide information about the context and the need/justification for developing the intervention. The methods should describe what the author group has done (e.g. how was the intervention assessed/evaluated?). The results section should describe the intervention itself and any analyses that were possible. All components of the intervention – including the development of the Community of Practice (CoP), with clear descriptions of the aims and objectives for each component, should be included. The discussion should unpack the meaning of the results and consider findings of other relevant studies or interventions. It might also be helpful to provide a timeline which indicates the declaration of the pandemic and key interventions that this study examines (forming of secretariat, intervention planning, webinar start date, set up of CoP, start date of including participants’ inputs into the topics, start date of introducing language translation (if done), webinar finish date). It is also necessary to clarify who the different actors and contributors are. Is the PHEOC working group specific to this webinar series? Or the CoP? Or is it broader?

Page 4 line 122 – typo. “Data extraction tool” is missing an l at the end of “tool”

Page 4 Results – please indicate when the intervention was held (date range of webinars, date or month when the CoP was set up, etc)

Page 5-6 Table 1 – for the discussion, it would be interesting to unpack the overlaps in the “Summary of Challenges” and “Areas of Good Practice” as several topics appear in both.

Page 6 lines 160-162 – this information is presented earlier. Suggest to remove the earlier information and keep it here in the results section

Page 6 lines 170-174 – quality assurance. This is a crucial topic that should be significantly expanded. It is particularly important in the rapidly evolving context of the pandemic. Did the organizers succeed in obtaining and reviewing all presentations before they were given? Was the terminology kept consistent? Or were corrections made during the course of individual webinars? Were there any challenges in the quality assurance activities? Any gaps? Lessons learned?

Page 6 lines 175-183, Webinar delivery – was language translation done? It sounds like it may have been but it isn’t clear for which languages and the text implies it wasn’t done for all the sessions. This is a huge issue for reach and comprehension – and therefore quality, safety and effectiveness of the intervention – and should be addressed. Also were the surveys sent in multiple languages? Does the CoP have some support for translation or what is/are the functional languages?

Page 7 line 187 – who are the public health actors at country level? Please clarify which stakeholders were include in the design and content of the webinars

Page 7 line 189 – were the deep dive format of webinar for 1.5-2 hours enough to provide a “thorough” understanding? This statement will need to be defended or the language should be altered.

Page 7 paragraph 3 – the contents of this paragraph would be more effectively presented in a table. The table should list all the themes (column 1) and all the subtopics for each theme (column 2). It would help to also provide an additional column with number and % participants for each subtopic to get an idea of uptake and interest. Also consider including a column for the number of people who registered, to look for patterns in registration vs attendance. The text should examine the table and the patterns in uptake to help characterize the update and participation.

Page 7 – post-webinar survey- why was the period of post-webinar surveys limited? Why wasn’t it done for all of them? Was it delivered in multiple languages?

Page 8 paragraph 1 (Interaction and networking within the online CoP) – this paragraph is difficult to follow and should be reworked to clarify and improve the flow of the text. As mentioned above – this is a separate component of the intervention – with a different aim, different objectives and different delivery/management than online webinars and perhaps also a different time period (is the CoP still active?). Also, please explain with the “Discord Platform” is, as this is not widely known.

Page 8 Reward on Participation – the knowledge check is briefly mentioned here. If available, the findings/scores of the knowledge check should be presented to provide some idea of participant knowledge. If any pre-tests were done, then the pre- and post-tests should be compared.

Page 8 Discussion lines 231-2 – this is the first place where the reader learns that the webinars were biweekly. This should be put into the results in a description of the intervention.

Page 8 line 236 “outreached” – this is an unusual use of this term, would be more effective to rephrase. Suggest “reached beyond the intended primary audience” or something to that effect.

Page 8 line 237 – this conclusion is not supported by the data. Participants’ perceptions suggest the webinar strengthened knowledge but there isn’t any objective evidence to prove this happened. There is also no clear examination of the CoP impact on knowledge, access to information or networking.

Page 9 paragraphs 2-5. The discussion should critically examine the patterns in the findings, such as the changing pattern in attendance. There appeared to be higher uptake, then a lull and then a steady increase later on (Figure 1). Why did this happen? What changes were made in implementation that might have affected this? How could communication or advertising have impacted it? What about language, any concurrent discussions in the CoP, or the ability of participants to influence the topic? These and other factors may have affected participation in different seminars; it would be helpful to understand whether or not that might be the case and any evidence to support.

Page 9 lines 264-265 – Is there evidence that inviting countries to share experiences in this intervention helped other countries learn, adapt and engage? If so, it should be presented here. All conclusions must be supported by the findings.

Page 10 paragraph 2 – the second half of the paragraph presents the findings and should be put into the results section

Page 10 paragraph 3 – were these surveys done in English? How would that affect the reach and validity of the findings?

Page 10 lines 290-291 – the sentence is unclear, please rework to clarify

Page 10 lines 293-295 – This implies success when there appears to be variable uptake of the webinars. This is a good space to critically examine the findings.

Page 11 – Limitations – this section should be markedly expanded. My previous comments allude to a number of limitations that should be described. An especially important limitation is the lack of measurements for quality and impact of the webinars as well as the CoP. It’s a huge challenge for all knowledge and capacity strengthening programmes, whether online or in-person, and should be unpacked here and any activities/adaptations that were made to address the limitations should be described. Please also note that the survey is likely to be prone to response bias and pleasing.

Page 11 – Conclusions, line 315-318 – the findings presented do not support this conclusion. If there are data to support the conclusion, this should be included in the results and unpacked in the discussion.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Dr Ebere Okereke

Reviewer #2: No

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLOS Glob Public Health. doi: 10.1371/journal.pgph.0001386.r003

Decision Letter 1

Megan Coffee

23 Mar 2023

PGPH-D-22-01832R1

Strengthening COVID-19 pandemic response coordination through public health emergency operations centers in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020-2021

PLOS Global Public Health

Dear Mr Eteng

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

I would also streamline the discussion section and include the advice the reviewers have outlined in detail below.

Please submit your revised manuscript by May 1st. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Megan Coffee, MD, PhD

Academic Editor

PLOS Global Public Health

Journal Requirements:

1. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

2. In the online submission form, you indicated that "Data could be accessed upon request to the author". All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information.

This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons by return email and your exemption request will be escalated to the editor for approval. Your exemption request will be handled independently and will not hold up the peer review process, but will need to be resolved should your manuscript be accepted for publication. One of the Editorial team will then be in touch if there are any issues.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

Reviewer #4: (No Response)

Reviewer #5: All comments have been addressed

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2. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: I don't know

Reviewer #4: Yes

Reviewer #5: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: No

Reviewer #5: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: It is important to have this abbreviation PHEOC in the title as it appears in the short title => Strengthening COVID-19 pandemic response coordination through public health emergency operations centers (PHEOC) in Africa: Review of a multi faceted knowledge management and sharing approach, 2020-2021

Use the same language (British English or American English). For instance, the word “Centers” in the title but written as “Centre” in the key words section.

Abstract:

There must be an omission in the following sentence: In-person events including training workshops and on-site technical support were canceled to limit the spread of the ??? then fast-spreading COVID-19 pandemic. Or good to delete the word “then”. Method: Put full stop after the first sentence. The abbreviation PHEM is not defined at its first appearance.

Introduction:

There is a need to define what is a functional PHEOC and what are the criteria set to judge it functional. The text from line 86 to 112 seems describing the methods used and could be in the Method section. At line 122, the word “too” could read as “tool”. There is need for a specific paragraph describing the objective and research question for this study.

Methods

Well described for the process used. However, the study design is not clear. Is it a qualitative, quantitative, or mixed? It does not give details on how the data were analysed. Any test used? Statistical software? Database created with what software (STATA, SPSS, … Excel,…)? Was there a needed sample size for this study? How was this calculated?

By reading the following paragraph, we can conclude that it was a mixed method: A thematic analysis (i.e., inductive, and semantic approaches) was used to group, analyze, and describe major findings. Further descriptive statistics (percentages, tables, charts, etc.) were used to summarize the quantitative data.

However, when reading the table 1, it shows figures. The design should be clearly stated and described in detail. The thematic approach used should be clear as the manuscript is already written, it should not say i.e.

The Ethics statement is not detailed. As this includes live participants who responded to questions that were included in the analysis, there is a need to know if these participants gave their consent for their answers to be involved in any publication. Were they aware that these questions were asked for the purpose of research?

Results

The lines 153 to 155 should be in the “Methods” section. The lines 170 to 189 should be in the “Methods” section. The following sentence: In addition to this Africa, CDC had IT support… should read as: In addition to this, Africa CDC had IT support… At the line 204, it is good to clarify what the additional question is. In the table 1 (line 206), why percentages of No answers are in italic while they are not for Yes?

Line 210: The following sentence: In the individual webinar sessions, there were, on average, 26 interactions between the participants and facilitators, ranging from 4 to 56 interactions per session.

should read as: On average, there were 26 interactions between the participants and facilitators in the individual webinar sessions, ranging from 4 to 56 interactions per session.

It could be better to list some examples of best practices that were exchanged between countries through the webinars and understand how these were implemented where they are lacking to improve the response to the pandemic. Please include some practices that each PHEOC learned from each other.

Line 273: The sentence: Organizers recognized that participants tended to drop off the webinar after one hour, likely because of conflicting commitments, therefore, it is recommended that future webinar sessions do not extend beyond one hour.

should be split into 2 and should read as Organizers recognized that participants tended to drop off the webinar after one hour, likely because of conflicting commitments. Therefore, it is recommended that future webinar sessions do not extend beyond one hour.

Line 293: This sentence is too long: The success of the topic choice and strong communication of webinar sessions in advance is indicative of the commitment of the PHEOC Network partners, PHEOC Webinar working group, and secretariat, and emphasizes the effort involved in conducting a weekly, interactive webinar series, especially when hosted by SME’s whom themselves were engaged in COVID-19 response activities.

and can split into 2 as: The success of the topic choice and strong communication of webinar sessions in advance are indicative of the commitment of the PHEOC Network partners, PHEOC Webinar working group, and secretariat. They emphasize the effort involved in conducting a weekly, interactive webinar series, especially when hosted by SME’s whom themselves were engaged in COVID-19 response activities.

Line 304: This sentence is too long: The interactions observed appear to be low as compared to the number of attendees per session (235 on average), which could be due to the limited time allocated for discussion, however other considerations may include the likelihood of attendees listening to the session while conducting other work, language barriers or their ability or confidence to engage with the other attendees and facilitators in a virtual environment.

and can split into 2 as: The interactions observed appear to be low as compared to the number of attendees per session (235 on average), which could be due to the limited time allocated for discussion. However, other considerations may include the likelihood of attendees listening to the session while conducting other work, language barriers or their ability, or confidence to engage with the other attendees and facilitators in a virtual environment.

Conclusion

Line 321: This sentence is too long: Besides, there was an overall low attendance rate though the high number of registrants indicates interest and acceptance of the Webinar Series, and almost half of the participants came from just a few countries, possibly explained by biased in the advertisement of the webinars based on partners involved.

and can split into 2 as: Besides, there was an overall low attendance rate though the high number of registrants indicate interest and acceptance of the Webinar Series. Almost half of the participants came from just a few countries, possibly explained by biased in the advertisement of the webinars based on partners involved.

It could good to see how this program can be made sustainable and improved to serve as model for future health emergencies.

Reviewer #4: I am using the "Revised Version" of the manuscript for this review and am editing the text based on the accompanying Line Numbers.

GENERAL COMMENTS:

This article describes an innovative set of interventions to improve staff knowledge and overall public health capacity in Africa, as a response to the novel COVID-19 pandemic. It provides relevant information on the processes, and the evolving approaches over time, in response to participant feedback.

A major statistical issue that needs to be addressed is the percentage level of participation. The authors need to be more clear and precise as to what is the denominator that is being used to estimate the different types of participation. In the paragraph titled Webinar participation (Lines 228 to 242) you state that a total of 95,230 participants registered the the Webinar interventions. I assume that this is the denominator that measures levels of participation for many of the citations. However, this explanation doesn't appear until late in the paper. In addition, can you better define this? It would be helpful to describe how you advertised this approach broadly and how various public health persons signed onto an active e-mail list that was then used to notify participants of upcoming sessions and the availability of materials. I would recommend that you provide a short summary in the ABSTRACT of how this overarching denominator was established and then at the beginning of the METHODS section provide more detail. The relevant denominator becomes confusing, because in the Abstract and early in the Main article you cite that 112,354 persons interacted with Zoom and other webinar resources. Were these discrete individuals that had enrolled onto an e-mail contact list? Many readers will confuse this number with the registered participants number. I would recommend that you remove the 112,354 citation in the abstract and instead present the number of persons who registered for the approach (95,230)

Another major issue is that the article relies on participant self assessment to address the overall impact of the approach. It would be helpful in the Discussion session to briefly consider and present possible methods in future evaluations of this approach for a more impartial assessment as to whether public health services were actually improved. Did the quantity and quality of services get better and in what ways? Was there any impact on incidence, standards of care, patient outcomes, etc, etc??

SPECIFIC COMMENTS:

I have made multiple recommendations below, using the line numbering, to address spelling, grammatical, and technical issues.

ABSTRACT

In Line 40, replace the word, "through" with "utilizing."

In Line 54-55, the final phrase is awkward and needs to be rewritten. For example, "...and the simplicity of the delivery of the training, through interactive webinairs and a community of practice, encouraged a greater number of public health staff to participate, and to spread the word of the training to their own networks."

In Line 45 remove the sentence, " Major findings were synthesized and described per thematic area". You have duplicated the previous sentence.

In Lines 48 to 50 the authors refer to "112,354 persons interacted with the sessions across ZOOM, Facebook and You tube......" This is confusing because the reader may assume that this is a denominator for participation. But it isn't. The denominator is actually 95,230 participants that were registered to be part of the approach. Per my note at the beginning of this Comments section, it would be helpful if you provide information on the denominator for participation earlier in the document and remove the 112, 354 number from the Abstract section.

INTRODUCTION:

In lines 66-67, revise to "...abruptly interrupted, testing the recent increases in health security investments that African countries had received since the end of the West African Ebola outbreak in 2016."

Line 92, add "events" after face-to-face"

Line 93, replace "global" with "globally"

Line 94 replace "till" with "still."

In line 97, replace "suing" with "using."

In line 99, replace "...consiting of creating and online..." with "and included the creation of a Community of Practice (CoP, comprising mainly PHEOC professionals fro the African continent."

In Line 104, can you footnote the term "Discord" and provide a short description of the application?

METHODS

In Lines 120 to 123, can you add any information on the approximated number of staff in the secretariat and any information on the annual budgeting costs?

WEBINAR FACILITATION.

Line 125, rewrite, "The webinar series was initiated to respond to identified gaps in multiple....."

Line 127, can you find a different term for "take -off curriculum?" I don't know what this means.

Line 137, replace "tour" with "tours" and make "human resource" plural-resources"

Line 145, replace "series" with "multi-part series"

Liness 154-155. Use this sentence which describes DISCORD, as a footnote as noted above for Line 104.

Line 198, replace the word topic with the plural, "topics"

Lines 222-226, as stated in my general comments, the authors do not define the baseline numbers, so the participation percentages are not clear. Please provide the definition of and the actual number of persons who make up the audience for this exercise. Is there an enrollee email address list that was created??? How was this done?

Line 244, add the word, "with" just before the words, "...webinar 16,..."

DISCUSSION

Overall, I found the DISCUSSION section to be excellent. However, there are some key sections that could be improved.

Lines 307 to 310. This sentence is very confusing. Could you replace it with the following, "However, , the inclusion of key partners of the Africa CDC and US CDC in the PHEOC Webinar Series working group is likely to have resulted in an inordinately large number of of participants from outside the Africa PHEOC network."

Line 320, what is an "MS PHEOC?"

LIMITATIONS

Lines 367 to 370. I found this section to be extremely confusing. The authors are trying to describe possible biases in the topic selection, but these arguments are not well presented. Can you rewrite this section??

Lined 384. In this sentence the authors refer to the PHEM training. What does the abbreviation PHEM mean?

Again, overall I think the paper is good and deserves to be published. However, if the above revisions are incorporated the paper will be more accessible to the readers.

Reviewer #5: Great paper. I have recommended acceptance by the journal - however, please do take the time to integrate the suggestions I have made the the attached document.

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For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

Reviewer #4: Yes: Paul R De Lay, MD, DTM&H (Lond)

Reviewer #5: Yes: Beth A Tippett Barr

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PLOS Glob Public Health. doi: 10.1371/journal.pgph.0001386.r005

Decision Letter 2

Megan Coffee

11 May 2023

Strengthening COVID-19 pandemic response coordination through public health emergency operations centers (PHEOCs) in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020-2021

PGPH-D-22-01832R2

Dear Womi Eteng:

We are pleased to inform you that your manuscript 'Strengthening COVID-19 pandemic response coordination through public health emergency operations centers (PHEOCs) in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020-2021' has been provisionally accepted for publication in PLOS Global Public Health.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. Please do consider the changes reviewers 4 and 6 describe. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they'll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact globalpubhealth@plos.org.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Global Public Health.

Best regards,

Megan Coffee, MD, PhD

Academic Editor

PLOS Global Public Health

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Reviewer Comments (if any, and for reference):

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: All comments have been addressed

Reviewer #6: All comments have been addressed

Reviewer #7: All comments have been addressed

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2. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

Reviewer #6: N/A

Reviewer #7: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: This article presents an innovative set of interventions to improve staff knowledge and public health capacity, as a response the novel COVID-19 pandemic. All of my previous recommended revisions and suggestions for additional material have been accepted and have been adequately addressed. I recommend that the article be published. There were a few minor errors that should be corrected:

Line 76, the word "...standard..." should be "...standards...."

Line 275, the word"...documentations.." should be "documentation..."

Line 309, replace the words, "...carter for..." with "..respond to..."

Reviewer #6: Review Comments: Abstract

1. The title should be modified to ‘Impact of Knowledge Management and information sharing during COVID-19 pandemic response coordination using Public Health Emergency Operation Centre [PHEOC] as a pivot’

2. Abstract should not exceed 250 words

3. Restructure the aim of the study to reflect the impact or clarify if it is about building capacity of the attendees

4. Your methods should be clearly stated in a concise manner. What type of study is this? although how it was conducted was actually stated

5. Your conclusion should be based on the findings documented, was there any evidence may be after 3 months of stopping the webinar if the capacity has been grown or built as the case may be or was there any suggestions as to improvement in coordination mechanism at the PHEOC?

6. What does your recommendation aim to achieve?

Reviewer #7: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #4: Yes: Paul R De Lay, MD, DTM&H (Lond)

Reviewer #6: No

Reviewer #7: No

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Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Table. Webinar thematic areas, and topics by webinar registrants and attendees, 2020–2021.

    (PDF)

    Click here for additional data file. (65.6KB, pdf)
    S2 Table. Frequency of attendance, Webinar series, 2020–2021.

    (PDF)

    Click here for additional data file. (41.3KB, pdf)
    S1 Data. Database Analysis PHEOC Webinars 2022.9.26.

    (XLSX)

    Click here for additional data file. (28.3KB, xlsx)
    Attachment

    Submitted filename: Response to editorial and Reviewers.docx

    Click here for additional data file. (26.4KB, docx)
    Attachment

    Submitted filename: Rebuttal letter response to Reviewers.docx

    Click here for additional data file. (27.9KB, docx)

    Data Availability Statement

    Data uploaded as supplementary information.

    Articles from PLOS Global Public Health are provided here courtesy of PLOS

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