Table 1. Summary of what worked well, what worked less well and key recommendations for the advanced 
Field Epidemiology Training Programme of Papua New Guinea, based on root cause analysis, April 2022.

Risk communications and community engagement
Worked well	Worked less well	Recommendations
Using established systems and community structures      Partnerships with key stakeholders      Community leaders trained and engaged in COVID-19 awareness      Risk communications training for health-care workers (HCWs) at provincial and district levels      Good political influence in the community      Other partners helped develop information, education and communication (IEC) materials that were easy to understand by the community	Misinformation about COVID-19 vaccination and the impact this has on COVID-19 vaccination and routine immunization      HCWs spreading false rumours about the virus and COVID-19 vaccination      Lack of established partnerships with communities affected communication and engagement efforts      Provincial communication officers not always available      Limited use of local languages in IEC materials	Establish and maintain strong working relationships with community leaders and partners      Establish high-quality training-of-trainers strategies to ensure HCWs at all levels are knowledgeable across response needs      Establish recruitment strategy at provincial level to ensure adequate professional health staff to raise public health awareness alongside risk communication experts      Continue to work with and build relationships with partners
Surveillance, case investigation, laboratory
Worked well	Worked less well	Recommendations
Roll out of rapid antigen test kits      Provincial-level management support for surveillance activities      Opportunities afforded to Field Epidemiology Training Programme (FETP) fellows to apply surveillance skills      Purchase of two-way radios for surveillance teams      Training of health extension officers at district level to collect specimens      Capitalizing on COVID-19 surveillance to strengthen other reporting systems      Proactive response supported by appropriate legislation	Turnaround time for polymerase chain reaction (PCR) results (2–4 weeks)      Turnaround time for whole genome sequencing      Lack of training in data management      No dedicated data management officers at provincial or district levels for COVID-19	Roll out COVID-19 rapid antigen tests at all facilities, including aid posts      Ensure supply of rapid antigen tests is adequate      Develop a sensitization programme to highlight the value of surveillance to management within the province
Case management and infection prevention and control
Worked well	Worked less well	Recommendations
When available, rapid antigen tests helped with timely case detection/diagnosis      Improved health facilities (e.g. construction of new wards and isolation facilities, instalment of incinerators, etc.)      Creation and dissemination of treatment protocols      Engagement of mental health counsellors	Limited or no patient transport available      No expertise to deal with mental health problems      Standard treatment protocols not always available, confusion around the use of ivermectin      Insufficient human resources for case management and infection prevention and control      Poor coordination and cooperation between clinical and public health response      Poor compliance with case isolation	Direct funding and resources to boost health-care workforce      Provide staff incentives for additional responsibilities      Target educational resources to promote vaccination among HCWs      Build new isolation facilities or separate COVID-19 wards with dedicated staff to work in them      Ensure resources are allocated to home isolation monitoring      Strengthen and invest in sustainability of call centres in all provinces (for example, integrate the call centre with the disaster office)      Offer staff incentive packages and infection prevention and control training for those who work with COVID-19 patients
Response, operational support and logistics
Worked well	Worked less well	Recommendations
Integration of COVID-19 response with other programmes      Establishment of rapid response teams (RRTs) to support the response      Strengthened emergency operations centres at the provincial level      Coordination of funding available for COVID-19 response      Involvement of partners/commercial properties to support response needs	Staff shortage – inadequate staffing resulted in multitasking, exhaustion and mental stress      Waste management issues (e.g. non-functional incinerators)      Delay in receiving funds for the response      Disruption to routine services, including routine childhood immunization      Funding impacts on other programmes      Poor compliance with control measures (mask wearing, physical distancing, isolation, quarantine, vaccination)	Establish and allocate funding for a RRT in every province; use existing workforce to formulate RRTs      Ensure there is a provincial budget for COVID-19 response and outbreaks with programme-based budgeting      Establish processes at provincial level to facilitate rapid mobilization of financial and human resources in response to public health emergencies (with minimal impact on routine services)      Provide targeted education and incentives to promote vaccination of HCWs at all levels