AUTHOR=Berman Peter , Cheng Michael , Bridget Elvira , Brubacher Laura Jane , Ruck Candice 

TITLE=How Public Health Organizational Structure Affected the Response to the COVID-19 Pandemic: A Case Study in British Columbia, Canada

JOURNAL=International Journal of Public Health

VOLUME=69

YEAR=2024

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2024.1606638

DOI=10.3389/ijph.2024.1606638

ISSN=1661-8564

ABSTRACT=<p><bold>Objectives:</bold> This study sought to examine how public health organizational structures affected decision-making and provides recommendations to strengthen future public health crisis preparedness.</p><p><bold>Methods:</bold> The Institutions-Politics-Organizations-Governance (IPOG) framework and an organizational lens was applied to the analysis of COVID-19 governance within British Columbia (BC). Organizational charts detailing the structure of public health systems were compiled using available data and supplemented with data collected through key informant interviews.</p><p><bold>Results:</bold> In response to the COVID-19 pandemic, BC initiated several changes in its public health organization. BC’s COVID-19 response attempted to utilize a centralized command structure within a decentralized health system. Four key themes were identified pertaining to the 1) locus of decision-making and action; 2) role of emergency structures; 3) challenges in organizational structure; and 4) balance between authority and participation in decision-making.</p><p><bold>Conclusion:</bold> The organizational adaptations enabled a substantively effective response. However, our findings also illustrate deficiencies in organizational structure in the current public health system. Two recommendations for consideration are: 1) a more formal vertical organizational structure; and 2) developing new mechanisms to link health and general emergency response structures.</p>