Table 2.

Project areas, health system building blocks, factors affecting health system capacity, and recommendations from Research Fellows.

Building blocks (no. of projects)	Project areas of focus (CD including TB, malaria, dengue, zika, measles, diarrhea, leptospirosis, and meningococcal disease)	Factors affecting surveillance and response capacity	Synthesized fellow recommendations
Health information systems (19 projects)	• Use of data for prediction, response, evaluation • Quality of data and adherence to protocols • Linked data (climate, geography, diseases)	• Under-reporting and double counting • Not using data for response/decision making/preparedness	• Strengthen surveillance and response systems, especially capacity of health workers to document and respond • Training for health and biosecurity workforce on recording, interpreting and sharing data
Workforce (11 projects)	• Clinical practices • Quality of training (and evaluation) • Surge capacity; barriers and enablers for workforce response • Knowledge and motivation • Health workforce numbers	• Inadequate knowledge and supervision • Motivation and adherence issues • Poor quality training • Inadequate staff numbers and exhaustion	• Invest in adequate health staff to respond to outbreaks (incl. surge) • Provide high quality ongoing training and professional development (incl. data recording) • Career pathways and support • Support training and PD in professionalism at all levels • QI processes around training and supervision
Community (8 projects)	• Health seeking behavior • Causes for delay • Lived experiences • Knowledge and behaviors re prevention (animal and human health)	• Limited health seeking behavior (related to knowledge and stigma) • Socio-economic and cultural determinants affecting ability to modify risk	• Target community education and health promotion to reduce stigma • Improve cultural safety of services • Consider role of community volunteers in surge capacity for education/health promotion
Medical products and infrastructure (6 projects)	• Antimicrobial resistance • Water, sanitation and waste disposal facilities • Supplies at health facilities	• Laboratory and health facilities ill–equipped with unreliable supplies • Lack of water and sanitation facilities at health facilities • Poor antibiotic stewardship • Limited surge capacity	• Review inventory and restocking systems • Ensure access to infrastructure required for safe care e.g., handwashing, waste management • Provision of basic equipment and maintenance
Service delivery (6 projects)	• Home based care • Community volunteers for dengue control • Improving immunization coverage • TB-DOTS • Net distribution	• Accessibility, affordability and acceptability issues • Inadequate health promotion • Underperforming community volunteers • Integration of volunteers with mainstream workforce	• Training and recognition of volunteers as important HRH • Budget to train family as partners in TB-DOTS • Free to user, distributed service provision • Mass immunization catch-up program
Governance (2 projects)	• Intersectoral collaboration (One Health) • International Health Regulations assessment	• Missing defined roles responsibilities, protocols, policies • Poor communications and inter-sectoral collaboration	• Standard operating procedures and policies for preparedness and response • Mechanisms for information sharing across sectors and levels of health system • Respond to feedback from HRH
Financing (1 project)	• Development assistance	• Important role of development assistance financing • Withdrawal/decline in financing leading to outbreak potentials	• Stable, ongoing programs of development assistance

CD, Communicable Diseases; TB-DOTS, Tuberculosis - Directly Observed Treatment- Short-course; PD, Professional Development; QI, Quality Improvement; HRH, Human Resources for Health.