Worldwide, the management of health emergencies requires a high degree of preparedness and resilience on the part of governments and health systems. Indeed, disasters are becoming increasingly common, with significant health, social, and economic impacts. Living in a globalized world also means that emergencies that occur in one country often have an international, in some cases global, spread: the COVID-19 pandemic is a cogent example. The key elements in emergency management are central governance, coordination, investment of resources before the emergency occurs, and preparedness to deal with it at all levels. However, several factors might condition the response to the emergency, highlighting, as for Italy, strengths and weaknesses. In this context, policies and regulation of actions to be implemented at international and national level must be up-to-date, clear, transparent and, above all, feasible and implementable. Likewise, the allocation of resources to develop adequate preparedness plans is critical. Due to COVID-19 pandemic, the European Commission proposed the temporary recovery instrument NextGenerationEU, as well as a targeted reinforcement of the European Union’s long-term budget for the period 2021–2027. The pandemic highlighted that it is necessary to interrupt the continuous defunding of the health sector, allocating funds especially in prevention, training and information activities: indeed, a greater and more aware public attention on health risks and on the impacts of emergencies can help to promote virtuous changes, sharing contents and information that act as a guide for the population. The management of disasters and emergencies is a core function of Public Health. Indeed, natural or humanmade extraordinary events might constitute a public health risk that require a timely, coordinated, and efficient response from governments and healthcare systems. Disasters can be natural  or technological  , and theOf note, an important issue for Public Health at the international level is represented by microbiological emergencies, which are becoming increasingly frequent. Indeed, the World Health Organization (WHO) monitored worldwide 1483 epidemics in 172 Countries between 2011 and 2018 ,8,9, ecoIn this commentary, we present an overview of the policies, regulatory frameworks and legislation on health emergency management at global and European level. Then we focus on the Italian COVID-19 pandemic as an example of management of health emergencies. Finally, this paper concludes by proposing some directives about the management of future emergencies. The attempt to manage and coordinate the response to health emergencies at international level began in 19th century. The first International Health Conference, in fact, was organized in 1851 after the European cholera epidemy (1830–1847) . Then, tIn Europe, the first emergency regulation was approved in 1998 and Council Decision n. 2001/792 established the European Civil Protection, (reformed in 2013) to strengthen and coordinate disaster prevention, preparedness, and response . Then, tDuring the COVID-19 pandemic, the European Commission adopted Communication COM(2020)724 to strengthen European Union (EU)’s resilience and coordination to cross-border health threats . This CoOn 2 May 2018, the European Commission presented its proposal for the next long-term EU budget and on 27 May 2020, due to COVID-19, it proposed the temporary recovery instrument NextGenerationEU (NGEU)  and the The Italian Constitution does not contain specific rules on the state of emergency. However, based on article 77, the Government can adopt decrees in the cases of extraordinary necessity and urgency, concerning the concrete management of emergencies; also, article 120 allows the Government to replace local authorities in events of danger to public safety and security. Moreover, Article 117(3) states that the state must establish health principles. Law 8 December 1970, No. 996, was the first identifying ordinary  and extraordinary (Extraordinary Commissioner) Civil Protection’s bodies as well as their competences . In the Indeed, in case of emergency, a bottom-up pyramidal response mechanism is activated, starting from the level closest to citizens. Therefore, the mayor  directs and coordinates relief operations, assisting the population and organizing municipal resources . He/she Nationally, the Council of Ministers’ President coordinates measures with Civil Protection Department, appoints delegated Commissioners and specific task forces, and issues emergency ordinances to avoid dangerous or damaging situations. The Council of Ministers, based on President’s proposal, decrees the state of emergency indicating its territorial extension and duration  . Finally, Agencies in support of the Ministry of Health carry out technical-scientific consulting activities , drug regulatory activities , and health performance monitoring and control .The Italian Recovery and Resilience Plan was approved on 22 June 2021 by the European Commission . It respTo fight the pandemic, Italy also approved several decree laws for urgent measures that have provided for a significant increase finance in the standard national health requirement  . Cura ItItaly was the first western country affected by the COVID-19, representing the frontline against the pandemic, with a mortality rate among the highest in Europe, especially during the first wave . In thisHowever, several factors have made it difficult to implement a rapid and coordinated response. In particular, Italy has 20 different regional health care systems , and decFurthermore, Italy show several limits in capacity planning of the hospitals. In particular, the enormous pressure generated on the healthcare system during the first and the subsequent waves caused by variants (such as omicron) highlighted the need to develop models for hospital surge capacity planning ,50,51. IFinally, the constant defunding of the National Health Service in Italy in recent decades, which has led to a shortage of healthcare workers, insufficient structures and technology and the absence of integrated management, explains, at least partly, the difficulties in the management of the first wave of the pandemic ,44.The COVID-19 pandemic must represent a moment of awareness and reflection in order to improve governance processes and the ability to respond and react to disaster events. The COVID-19 emergency has confirmed that it is necessary to work more on the analysis of local contexts in order to design targeted interventions at regional and national level, improving the interaction and coordination between different settings. Planning and, therefore proper organization, represent the key to adapt and direct decision-making processes. The pandemic has highlighted how the current governance, often still anchored to laws, regulations and bureaucratic systems or apparatuses belonging to historical periods and contexts completely different from the current or future ones, is only partially able to provide a timely and coordinated response. Moreover, system resilience is a key issue in managing healthcare emergencies. In fact, the adaptive capacity of hospitals and in general of all healthcare facilities is essential to ensure rapid adaptation to an emergency. The pandemic has led to the development of predictive models and methodologies for risk assessment and quantification on which response measures to the spread and containment of the virus are developed. These models should be implemented and made feasible, not only in organizational and managerial terms but also in relation to structural, environmental, plant, engineering and technological aspects that can also be adapted to the context of other health emergencies, to ensure the presence of a resilient system capable of providing a quick, specific and personalized response as much as possible, with a major impact in terms of lives saved and reduction of social and economic damage. To make these models feasible, however, coordination and collaboration between the structures are necessary, both at a territorial and regional level, and mainly, at a national and central level, to overcome the regulatory conflicts, technical and legislative regulations that still exist and are not sufficiently corrected and updated on the basis of the current pandemic experience .In this context, the new European agency HERA represents an important step forward, although it is limited to the European Union and it still insufficient to ensure a timely, transparent, and coordinated response. It is necessary, in fact, to provide an agency not only with prerogatives of direction and control, but also with effective powers of intervention that are, when necessary, substitutive of national failures in emergency management. A control room, therefore, of rapid health intervention and civil protection, with its own budget and operational decision-making, free from the veto of a single state, which can act quickly, with consistent and coordinated measures, with the ability to collect homogeneous data, with professionally trained and constantly updated staff, with a production capacity—its own or supply—of tested machinery and protective devices, vaccines, and specific drugs. Thus, not only during an emergency, but also in ordinary times, it is desirable to lean on a Preparedness European Agency to share of resources and data, with harmonization of public health and social measures for response. Such a network would assure and promote accountability by synthesizing, reviewing and assessing operative information and knowledge, and for critically evaluating the effects of public health decisions. Basically, also to try to overcome the gap, which currently exists, between the time when there is awareness of a critical emergency event and the unharmonized decisions to effectively prevent, halt, or delay the consequences of this event. Considering the Italian situation, despite the health regionalism, it is necessary to identify an adequate “chain of command”, able to exercise a leadership role to coordinate and integrate the skills of all institutions and actors involved, on whose collaboration lies the readiness to respond and the resilience of an integrated system. Finally, the pandemic has highlighted the need to interrupt the continuous defunding of the health sector, allocating funds especially in prevention, training and information activities: indeed, a greater and more aware public attention toward health risks and on the impacts of emergencies can help to promote virtuous changes, to share contents and information that act as a guide for the population.


Undoubtedly, the COVID-19 pandemic is not the first and most frightening global pandemic, and it may not be the last. At the very least, this phenomenon has though seriously challenged the health systems of the world; it has created a new perspective on the value of national, regional, and international cooperation during crises. The post-coronavirus world could be a world of intensified nationalist rivalries on the economic revival and political influence. However, strengthening cooperation among nations at different levels will lead to the growth of health, economy, and security. The current situation is a touchstone for international actors in coordinating the efforts in similar future crises. At present, this pandemic crisis cannot be resolved except through joint international cooperation, global cohesion, and multilateralism. This perspective concludes that the pandemic could be an excellent opportunity for the scope of global health diplomacy (GHD) and how it can be applied and practiced for strengthening five global arenas, namely (1) International Cooperation and Global Solidarity, (2) Global Economy, Trade and Development, (3) Global Health Security, (4) Strengthening health systems, and (5) Addressing inequities to achieve the global health targets. GHD proves to be very useful for negotiating better policies, stronger partnerships, and achieving international cooperation in this phase with many geopolitical shifts and nationalist mindset among many nations at this stage of COVID-19 vaccine roll-out. The first case of COVID-19 reported in Wuhan, China, in December 2019, was declared as an international public health concern and a global pandemic by the World Health Organization (WHO) on March 11, 2020 . TherefoAccording to the WHO, GHD connects public health, law, international affairs, management, and economics, concentrating on negotiations and shaping the global policy climate for health. The central tenet of GHD is for countries to work together in international fora to address public health issues . AccordiHence, GHD is very critical and successful in addressing many of the global challenges as we have witnessed in the formulation of International Health Regulations (IHRs 2005), Framework Convention of Tobacco Control (FCTC), Universal Health Care (UHC) , SustainThis paper has highlighted the five main areas  where GHHealth is now a part of global food, environment, oil, and water agreements, and it is addressed at major global and regional summits, including the G7 and G20 summits. Every SDG that has been negotiated has shown that health is an important component and outcome. Therefore, this explains why GHD plays a central role in every subsequent round of SDG-related negotiations. Given this background, the global health agenda is now viewed as a common challenge for developing and developed nations . COVID-1In the case of previous epidemics of HIV, SARS, H1N1, MERS, Zika, and Ebola, they have mostly affected specific regions/nations or the global south more than the north, and therefore the support came in from the rich nations in Western Europe and North America. However, in the current COVID-19 pandemic, the rich nations have been affected more, with more cases and deaths resulting in global competition, lack of solidarity, and nationalist movements in addressing the domestic economic and health crises .In the United States' federalist system of public health governance, COVID-19, which is highly transmissible, crosses the borders efficiently, and impacts the economy and infrastructure, have exposed many weaknesses. Besides, the federal response was alarmingly slow to evolve, causing uncertainty about the existence of the virus and the measures taken to tackle it . DespiteIn China, following the outbreak of COVID-19 in Hubei province, China, the government imposed a lockdown on its cities. Still, the international air travel through flights was not canceled, which resulted in people traveling from outside to China and vice versa. Though China was initially seen primarily as the source of the virus, it has started to provide material and equipment such as masks, PPE to its neighbors, the Middle East, and Europe . These aWith 15.58 million confirmed cases and 434,715 deaths as of May 17, 2021 , and theThe impact of the COVID-19 pandemic, the withdrawal of the funding to the WHO by the US President, has resulted in an unprecedented situation. This, in turn, has affected the health of people living in the Americas as the Pan American Health Organization (PAHO) being a beneficiary  and the The rapid spread of the current epidemic taught us that the international environment could not be managed as an island. International solidarity and convergence and the abandonment of political games could be part of a related approach to confront neo-isolationism. However, isolationism (as long as not coupled with xenophobia) can also have benign effects from a health security perspective regarding the movement for disease vectors. Therefore, the more the global economy is affected, the greater political priority is paid to health and health diplomacy .Perhaps political leaders apply GHD as a soft tool; instead of taking impulsive actions, the fear of the global community of the spread of coronavirus could have been curbed . The decIn many recent cases, countries' officials initially denied, downplayed its severity, and even adopted a blame game strategy. The latter was represented by some leaders pointing the finger of blame at other countries for the spread of the disease and trying to bypass and downgrade the role of the WHO as the central coordinator in controlling the epidemic. The non-compliance of some countries with international health regulations (IHRs) and poor international and regional cooperation has been documented . MoreoveThe Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) and Public Health as part of the Doha Declaration has stated key flexibilities to countries in Article 31. Furthermore, clause 5(c) of the TRIPS Agreement stated that “public health crises, including those relating to HIV/AIDS, tuberculosis, malaria and other epidemics,” can constitute “a national emergency or other circumstances of extreme urgency.” The clause provides countries with some flexibility in managing the patents for pharmaceuticals (public goods), especially in situations of “national emergencies” and “other circumstances of extreme urgency” –35. HoweThe Global Health Security Initiative (GHSI) is an international partnership to strengthen health preparedness and response globally to biological, chemical, radio-nuclear, and pandemic influenza threats. They were launched in November 2001 by Canada, the European Commission, France, Germany, Italy, Japan, Mexico, the United Kingdom, and the United States of America. WHO provides technical support to the initiative, which is again a result of successful GHD . The gloThe health diplomacy landscape is essential if and when the multifaceted and devastating consequences of this hidden enemy subside . It is eHealth has become an issue of national security/global concern, and GHD aids in developing new bilateral or multilateral agreements to safeguard the health and well-being of people. As a result, many countries have implemented the IHRs, imposed travel restrictions, and implemented public health regulations. Some countries that enacted them in the early days of the pandemic are Canada , India , and theOnce again, the pandemic has proved that health should be placed at the center of the international agenda and considered the primary concern of countries' foreign policy strategies . The keyIn recent years, health has been something more than just a “purely humanitarian” effort based on national interests in helping to achieve other functions of foreign policy . We shouWhat COVID-19 pandemic has interestingly and ironically exposed to the world is such that many European and North American countries—arguably some of the best health systems of the world—are crumbling and struggling to contain the widespread infections; while some of the developing countries' health systems, as well as smaller health systems in Asia , are doing much better, evidenced by the lower number of infections and lower fatality rates in these health systems. Even though the Western European and North American health systems have higher capacities and are equipped with hi-technology equipment, they all suffered a severe strain during this pandemic. Nonetheless, one can also argue that it is the initial political and policy responses adopted by different countries toward the pandemic that put them on different trajectories. The initial policy directions had a huge influence and impact on health system capacities in the context of the pandemic as witnessed by the immediate actions by the heads of the states in Asia (as mentioned above) along with Canada , India , and CarThe recommendations of the Global Preparedness Monitoring Board for pandemics and emergency public health situations requires strengthening multilateral collaborations and closer cooperation between governments and other actors of the international system as well as mutual trust : (1) fulIf well-conducted, GHD results in improved global health, greater equity, better relations and trust between states, and a strengthened commitment on the part of stakeholders to work together with stakeholders nationally and globally . Many coThe primary goal of health diplomacy should be to reduce inequalities by making diagnostics, therapeutics, and vaccinations a global public good accessible to all. GHD will serve as a bridge for international collaboration in addressing public health issues, improving health services, and rebuilding multilateral institutions by emphasizing universal health coverage for sustainable and equitable growth . The aspThe pandemic has uncovered many weaknesses of the global health systems and increased the burden on the already fragile healthcare systems in many countries. The world has witnessed many nationalistic movements in many countries to secure drugs, vaccines, and personal protective equipment with a selfish attitude, which is not the right choice. The virus has no boundaries, and unless the nations work together with solidarity and help the developing countries with fragile health systems to build their health systems, health security cannot be ensured. Countries must improve their health systems, focusing on surveillance systems, infrastructure and investing more in science and technology to solve the challenges of today and in the future in more scientific and technologically sound ways. The GHD plays a critical role as the nations have been sensitized about the importance of the health sector and their citizens' health, ultimately running the nations' economies. It is high time that the Science, Technology, and Health domains should work more closely and contribute to the development of novel technologies, vaccines, drugs, medical devices, and kits for COVID-19 and future health threats. The countries should also prioritize and create expert teams in GHD at the national level to frame their interests and negotiate at the global platforms for better outcomes. Through successful GHD, the health ministries and the global health professionals could frame health as a high priority and reemphasize the strategy of Health in All Policies (HiAP) for a safer post-pandemic world. GHD can strengthen international cooperation, health systems, improve the global economy, trade, and address the inequities to achieve health-related global targets. Therefore, GHD can deal with several complex issues in the multipolar world which have strongly linked geo-socio-economic and political determinants and pave the way for health, development, security, and peace.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.ST, VC, EJ, and SK: conceptualization and preparation of initial draft. VC and ST: literature review. VC: data collection and analysis, preparation of figures, editing, and finalizing the manuscript. All authors have approved the final version of the draft before submission.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions.Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies.Conclusions: Meditation has been applied in different areas. This Evidence Map intends to be an easy visual tool to access valuable evidence-based information on this complementary therapy for patients, health professionals, and managers. The World Health Organization (WHO) has encouraged and strengthened the inclusion, recognition, and use of Integrative and Complementary Health Practices (ICPs) in national health systems at all levels: Primary Care, Specialized Care, and Hospital Care, through the recommendations of the WHO Strategy on Traditional Medicine 2014–2023 , the Brazilian Ministry of Health has signed a partnership with the Latin American and Caribbean Center for Health Sciences Information (BIREME-PAHO-WHO) and the Brazilian Academic Consortium for Integrative Health (CABSIN) to develop Evidence Maps on Integrative and Traditional Health Practices , includiAccording to Johnson , meditatThe first robust evidence in the health field can be found in the late 60's. In 1970 , WallaceSince then, the number and quality of studies on meditation has increased, becoming an integrative practice that has gained a growing interest among health professionals.About 19% of the non-institutionalized adult population in the USA practices some kind of meditation . A higheThe interest in Complementary and Alternative Medicine, classified by WHO within a broader scope as Traditional, Complementary, and Integrative Medicines (MTCI), has grown not only within the general population, but also among health professionals. In general, about 80% of complementary therapies have been considered as an option of treatment during the patient-doctor discussions . DespiteTo bridge this gap, this study intends to systematize research results on the prescription and adoption of meditation in a clear and concise map to boost confidence and inform decisions taken by health professionals and public administrators.This Evidence Map includes integrative and systematic reviews, meta-analysis, and meta-synthesis, and summarizes meditation related health interventions and outcomes. Systematic reviews were performed to obtain a reliable summary of the best evidence available in this area. The analysis was carried out following the PRISMA guidelines  and the Papers published in English, Spanish, and Portuguese were selected in searches conducted on PUBMED, BVS, and EMBASE databases from 1994 to November 2019. Experts on the topic were consulted and the search strategy was jointly developed with BIREME.List of the words used in the search in Systematic reviews/meta-analysis, and meta-syntheses on meditation with adequate description of health outcomes were eligible for inclusion in the Evidence Map. An integrative review study was considered as highly relevant and was also included. The selection of systematic reviews, meta-analysis, meta-synthesis, and integrative reviews was done based on the studies that self-identified as such. Participants of all ages, regardless of their health condition, were also eligible for inclusion as well as interventions of any kind, follow-up, and duration. Studies that did not focus on meditation and/or related health outcomes were excluded.Screening and blinding procedures were carried out by two independent reviewers using Rayyan software . CitatioA spreadsheet with various descriptors was developed to synthesize the findings. This matrix included: Full text citation; Interventions; Outcomes group; Outcomes; Effect; Population; Database ID; Country of focus; Country of publication; Year of publication; Type of review; Review design; Study design; Confidence level. The Evidence Map was organized considering the outcomes, effects, and confidence level of the studies included.n = 84 studies), 82 studies had a low confidence level, and 22 studies had a high confidence level. The two meta-syntheses and the integrative review could not be evaluated by this tool , followed by mixture of techniques (93 results), mantra-focused practices (15 results), state-focused practices (8 results), and focused mindfulness practices (1 result). According to AMSTAR2 classification, most studies showed a moderate level of confidence , followed by Canada (30 studies), United Kingdom (28 studies), and Australia (23 studies). One hundred and twenty one studies did not report the country of focus.It was observed that meditation has been used as an intervention in diverse health conditions. Within the 191 studies retrieved, effects were classified into five categories of health outcomes and considered as: negative (no results); positive (246 results); potentially positive (174 results); inconclusive/mixed (74 results); and no effect (13 results), reaching a total of 507 diverse effects, as shown in The Mental Health category included 270 results involving the practice of meditation  among whThe group including Physical and Metabolic outcomes presents a total of 87 results. The effect of meditation was positive in 41 results, potentially positive in 29 results, inconclusive in 15 results, and with no effects in two results. The most common outcomes were improvements regarding high blood pressure, general cancer symptoms, and chronic pain . RegardiThe vitality, well-being and quality of life group obtained 106 results for the practice of meditation as can be seen in The number of meditation practitioners has grown in recent years. One of the main reasons is the acknowledgment of the positive effects that meditation exerts on health in general , 9. HoweA survey carried out by Andrade et al. , found oIn the map, depression, and anxiety were the disorders with the highest number of results, with 71 and 67 results, respectively. On depression, there were 11 reviews with a high confidence level of which only one effect was inconclusive, one potential positive and 9 had positive effects related to meditation. All articles with a high confidence level were systematic review studies with meta-analysis , 24 repoGoldberg et al.  also conMental health costs in China increased more than 3-fold from 2005 to 2013 and could have reached much higher values if all patients with mental illness received adequate professional treatment. Anxiety is the most prevalent mental disorder, affecting up to a third of the population at some point in life , 32, 33 In the dimension of health promotion and vitality, 7 moderate quality reviews highlight relevant effects on quality of life , 43–48 oThe use of meditation as a health promotion resource is growing, with positive outcomes in terms of cognitive performance –53 and sIntegrative resources have been increasingly used in the context of health promotion . Sarris Along the same lines, other authors propose broad intervention programs involving lifestyle changes based on meditation . Thus, tAmong the interventions of the Complementary and Integrative Traditional Medicines (MTCI), meditation is the most comprehensive in terms of results and variety of effects. Among the systematic review studies included in the evidence maps presented in the BVS/MTCI, the meditation map is the largest of them, indirectly showing the substantial number of studies published on the subject in recent decades. Meditation techniques can be used by children and adolescents , pregnanOn the physical and metabolic effects of meditation, the literature has described several relevant factors. The ability to promote neural plasticity of meditation techniques is very relevant and has important physical and metabolic impacts . Black aIn this perspective, perhaps interventions such as meditation are part of a plausible solution to deal with the challenges related to quaternary prevention in collective health , 75 mainThe creation and publication of evidence maps consists of graphically representing the best evidence found, analyzed and categorized, with the corresponding bibliographic records and full texts (when available) of the studies, in order to facilitate access to information for all interested parties .As it is not the objective of an evidence map, the calculation of the effect sizes of a meta-analysis was not performed, nor was the risk of bias assessments performed, but we tried to overcome these limitations by assessing the quality of the included systematic reviews by applying AMSTAR 2.The outcomes and effects information presented in this Meditation Evidence Map will further advance the evidence-based knowledge of MTCI as proposed by PNPIC in Brazil and promoted by WHO 2014–2024 and BIREME.Meditation practices can be developed by healthy individuals or individuals who have different health conditions, from chronic diseases to different mental health disorders, with positive and potentially positive effects on various low-risk health outcomes.The practice of meditation can be a safe and effective strategy for implementing programs in the field of collective health. The possibility of applying it in groups facilitates access and reduces costs in relation to drug interventions, for example in mild cases of depression and anxiety, being a potential resource to avoid chronicity and the negative impact of stress on health.https://mtci.bvsalud.org/pt/mapas-de-evidencia-2/.Publicly available datasets were analyzed in this study. This data can be found here: CS and RA did the selection of articles and quality assessment, analysis of results, and writing of the discussion. VA designed the search strategies and accompanied the filtering of results by reviewers on the RAYYAN platform, collaborated in the data analysis, methodological design of the evidence maps, and writing of the manuscript. MS and RG collaborated in the methodological design of the evidence maps, data analysis, and writing of the manuscript and conclusions. All authors contributed to the article and approved the submitted version.The study was part of a project funded by the Ministry of Health of Brazil in partnership with the Latin American and Caribbean Center on Health Sciences Information BIREME-PAHO-WHO and the Brazilian Academic Consortium of Integrative Health to develop Evidence Maps in Integrative and Complementary Practices, including meditation. The Brazilian Ministry of Health funded the project and BIREME's research partners conducted the study and performed the collection; management; analysis; interpretation of data; preparation, review, and decision to submit the manuscript for publication.The results and conclusions of this publication are the responsibility of the authors responsible for its content; the findings and conclusions do not necessarily represent the views of the Ministry of Health of Brazil and BIREME-PAHO-WHO.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The capacity to detect, control and manage emerging and re-emerging zoonotic diseases in Africa has been limited by a lack of utilisation of available reporting structures and policies to support programmes at national and local levels. This study explored the impact of the Zambian government policies on animal and human disease reporting and management and on One Health opportunities. An in-depth review and analysis of strengths, weaknesses, opportunities, and threats in the existing policies and reporting structures in the departments responsible for Veterinary Services, Health, and Wildlife, was conducted. According to our findings, sub-optimal implementation of existing policies related to the control of zoonotic diseases was impacting disease reporting, and reporting structures play an important role in effective and sustainable reporting of zoonotic diseases. Further, the study explored capacities and strategies in trypanosomiasis control as a case study that could prompt effective adoption of a One Health approach, and as such, the study suggests measures that could help to assess the performance of a One Health system in the control of African trypanosomiasis and other zoonotic diseases. The occurrence of human and animal African trypanosomiasis is associated with the presence of tsetse flies. Mammalian wild animals such as lions, buffalos, hippos, and elephants are the main reservoirs for the tsetse-transmitted trypanosome parasites ,2. HowevWith about five-eighths (5/8) of Zambia estimated to be infested with tsetse flies, overall AAT prevalence in Zambia remains unknown. Based on trypanosomiasis studies conducted in different regions of the country, AAT prevalence in livestock ranges from 1% to as high as 90%. Over 60% of the country’s cattle population is under threat from trypanosomiasis with about 80% of the livestock owned by traditional farmers. The prevalence of trypanosomiasis in livestock and particularly in cattle has continued reporting alarming figures in affected areas ,11. AccoMost developing countries in Africa are faced with poor policy support with regard to animal disease surveillance . Poor anThe global health security agenda specifically identifies One Health as an integral part of efforts to achieve health security against the threat of infectious diseases and other public health emergencies. Analysis by the World Bank suggests that given the high economic and health burden of zoonotic diseases, strengthening human and veterinary health capacity, to facilitate One Health approaches to disease prevention and control at the country level, could yield high returns on investment, averaging $30 billion per year . DespiteThis study compared and examined the policies and reporting structures in Departments of Veterinary Services, Health and Wildlife, in Zambia, in the context of the existing strengths, weaknesses, opportunities and threats, with the aim of gaining some insights into prospects for effective multi-sectoral and coordinated surveillance systems for zoonotic diseases. The study also examined existing opportunities and capacities among personnel and available operational provisions, in the Departments of Veterinary Services, Health and Wildlife, that could be used in a One Health approach to better manage and control trypanosomiasis and other zoonotic diseases.Control of animal diseases falls under the jurisdiction of the Department of Veterinary Services in the Ministry of Livestock and Fisheries (MLF). The ministry is headed by a Minister who undertakes the sourcing of funds and oversees the allocation of resources to the various programmes and activities in the ministry a. The coWithin the structure, it is the VAs and the TCAs that interact routinely with farmers and hence with livestock, and as such, it is these personnel that constitute the front-line workers and the first and most important sources of information on disease occurrence. They are also the first line of defence in the control and management of livestock diseases, i.e., they are expected to be the first to see indicators of disease , take the first possible/recommended interventions where feasible, and relay the necessary information (reports) urgently to their supervising officers (at district level) on suspected disease outbreaks and also routinely  on the general disease situation in their areas (camps) of jurisdiction . Some districts have trained Community Livestock Assistants (CLAs) who help report cases of animal disease that occur in their communities to the VAs  . Thus, tHowever, regarding animal trypanosomiasis, active surveillance is carried out intermittently by the TTCU, and this information is made available through the specific reports.The Ministry of Health (MOH) is responsible for reporting all human diseases occurring in Zambia. Just like the MLF, the MOH is also headed by a Minister b. Under The Department of Wildlife and National Parks, formally known as Zambia Wildlife Authority (ZAWA), falls under the Ministry of Tourism and Arts c. The deThe results of the SWOT analysis are as shown in In total, 21 health centres and health posts from Mambwe district were involved in our survey, namely, Kamoto, Chilanga, Mphata, Kakumbi, Airport, Masumba, Nyamaluma, Kasamanda, Ncheka, St. Lukes, Malama, Kamubaba, Chikowa, Nyakatokoli, Lupande, Lusamdwa South, Chipako, Jumbe, Chisengu, Jumbe and Mphomwa . Only heDuring interviews, responses on the availability of parasitological and molecular tools  that coup = 0.001) (p = 0.04)  . On the  = 0.04) .Type of collaboration required as indicated by the Departments of Veterinary, Health and Wildlife during the survey included the following: staff training and capacity building, disease awareness and management and disease diagnosis.The results of the review of reporting structures for the Zambian Departments of Veterinary Services, Health, and National Parks and Wildlife  indicateFindings from the survey indicate limited government financial support for the three government departments to undertake surveys/surveillance for the control of trypanosomiasis and the need to strengthen collaboration between sectors for disease control and management. A previous study  conducteGovernments of endemic trypanosomiasis areas are, however, overwhelmed with the costs attached to the sustainable control of trypanosomiasis, thus, making its control difficult . The higThe Zambian government has made efforts to control tsetse and trypanosomiasis, but due to financial limitations and other disease burdens, trypanosomiasis control programmes have not been sustained ,31. ThisCurrently, in consideration of past lessons learnt and in adopting the approach of the African Union’s Pan African Tsetse and Trypanosomiasis Eradication Campaign (AU-PATTEC), Zambia has adopted the principle of an area-wide integrated pest management, which is based on interventions against trypanosomiasis . HoweverThrough review of reporting structures for the Departments of Veterinary Services, Health, and Wildlife, as shown in An analysis of reporting structures for the Departments of Veterinary, Wildlife, and Health reveals that each department had its strengths, weaknesses, opportunities, and threats, as indicated in The reporting structure for the Wildlife Department  is long,In general, the study identified levels, as indicated in The provisions in the Zambian Public Health Act, Animal health Act and Wildlife Act were evaluated in the context of providing the key elements on national policies and on animal disease reporting systems in Zambia. Organisational structures of each of the departments responsible for Veterinary Services, Health, and Wildlife, were also examined in relation to disease reporting systems . An onliIn Zambia, personnel that undertake disease diagnosis are of various training/professional backgrounds of human and animal health service providers. An interview-based questionnaire study targeting all officers based in Mambwe in Zambia was conducted within the Veterinary Department (9), Wildlife Department (15), and Health Department (21). The interviews looked at the management and control of African trypanosomiasis in their respective departments. To conduct the study, written informed consents were obtained from all respondents before administering the questionnaires. Participation in the study was voluntary, and participants were free to withdraw from the study without giving any reasons. Information sheets  were prop values < 0.05 were considered statistically significant. Fisher’s exact test was used to compare proportions between districts where expected values or responses were less than five.We conducted a SWOT analysis  of policEthical clearances were obtained from James Cook University (H7226 and A2498) and the Zambian Ethics Committee (Ref. No. 2018-Oct001), and the research was approved by the Zambia National Health Research AuthorityCoordinated surveillance systems within available organisational structures could play a key role in disease reporting and have the potential to impact the reporting of emerging and re-emerging diseases. A better One Health system could be applied in Zambia and other countries in the region and beyond by strengthening links for collaboration and coordination at national, provincial and district levels between sectors  and by creating improved reporting links within available reporting structures that will promote interactions and provide a more holistic response to disease control. This can be achieved through already existing institutions such as CVRI, ZNPHI, and TDRC, as well as through epidemic preparedness committees. With a slight shift in focus to include zoonotic diseases, the ZNPHI could provide the platform for disease reporting between partnering departments.More efficient use of existing capacity by implementing a One Health approach is possible between sectors. For example, in areas where veterinary services have laboratory capacity, samples from the Departments of Health and Wildlife can be sent to veterinary facilities for analysis and vice versa. In addition, community awareness programmes for zoonotic diseases and collaborated staff training/upscaling of skills related to veterinary, health and wildlife can be collaborative to save resources. The digitalisation of records for information sharing through national, provincial and district epidemic preparedness committees could be carried out in partnership to create a more efficient response system. To support sustainable zoonotic disease control approaches that can be implemented at national, provincial and district levels, new policies will need to be developed in the future.


Themodel was applied in a southern Brazilian city, in the following stages:documentary, questionnaire, mapping of gaps and educational proposal. in the first stage, after documentary research, a total of 14 general corecompetences were described and a questionnaire with specific corecompetences was chosen, with confirmation of correlation among them; in thesecond stage, the importance and expression competence at work degrees wereobtained, after the questionnaires were filled out by 74 municipal publichealth managers; in the third one, a formula was adopted for the trainingpriority degree and its classification; the fourth stage presented aneducational proposal for the development of one of the competences with thehighest priority degree. the model brings contributions by describing general core competences, afterdocumentary research; carrying out the correlation between a questionnaire,containing specific core competences with the general ones; by mapping gaps;and by the proposal of learning trails for the development ofcompetences. Since the promulgation of Decree nº 5707/2006, which consolidatedmanagement by competences as one of the models to be followed by the federaladministration, there has been a search and application of new models in theperspective of management by competencies for the public sector. Competency management is relatively new in Brazil, but its importance has beenincreased, being considered synonymous with good management practice. Since . Competency management is also applied in countries that have nationalhealth systems, such as Canada, which has been working with core public healthcompetences since 2008.Competency management models are present in the public and private sectors of manycountries, but several of them are complicated and conceptually focus on the needsof the past and present. The counterpoint would be dynamic Simplified CompetencyManagement Model focused on knowledge, competences and behaviors that will beessential for managers in the future. Competnce 2008.. The Association is composed by health schools from countries such asDenmark, Belgium, Switzerland, France, United Kingdom, Netherlands, Poland, Serbia,Hungary and others, presenting the fifth edition of the European List of CoreCompetences in 2018.The Association of Schools of Public Health in the Europe Region published its firstedition of the European List of Core Competences for the Public Health Professionalin 2006. The As. Specifically in the United Kingdom, the document Public Health Skillsand Knowledge Framework 2016 addresses the need for a competence structure toaddress issues such as: result, description of activities and functions ofprofessionals, professional development, educational curriculum and description offunctions in public health.Generally, core competencies provide parameters for the execution of public healthservices, as they deal with access to health services, surveillance, disease anddamage prevention, health promotion and protection. Specifc health.Competencias Esenciales en Salud Pública: Un Marco Regionalpara Las Américas (MRCESP), an instrument that defines essential knowledge, skills and attitudesfor the public health workforce. It also recognizes that the guarantee of compliancewith public health obligations depends on competent managers, even with insufficienttraining offers.In 2013, in Latin America, the Pan American Health Organization (PAHO) issued adocument named (MRCESP), an insg offers.Sistema Único de Saúde (SUS)demands from its managers local and regional commitments, participation in variouscouncils, creation and compliance with management instruments, in addition to theconstant evaluation of inspection and social control bodies. However, some managersare not prepared to assume the management function, even though they have excellentacademic credentials.In Brazil, the Unified Health System - dentials.. In the development of competences, it is assumed the balance betweenthe interests and needs of the organization and the individual with their knowledge,skills and attitudes. Thus, the consequence of investment in knowledge adds value,not only in the excellence and sustainability of the organization, but also in thesocial value of the individual. Core competencies improve public health by contributing to the development ofteamwork, capacity for situational analysis, planning and improvement of healthservices based on evidence and focused on the population in an equitable and ethicalway. In thedividual.  that present how competency management can be implemented.Due to the complexity of this theme, it is considered that the presentation of modelsthat correlate specific and general competencies through a mapping capable ofpointing out their priority degree and educational strategies for the development ofpublic health manager competences, is still a gap of knowledge to be filled. Thus,it is assumed that the health system can also not only benefit from the descriptionof core competences for public health, but also develop new technologies andtools that pr to the managers of own public health services of a Municipal HealthSecretariat (MHS).Therefore, this study aimed to present the contributions of a Simplified CompetencyManagement Model (SCMM) to the . Mixed methods research, exploratory descriptive type, which combines qualitative andquantitative approaches as a classification criterion, based on itsobjectives. .In the presentation of the SCMM contributions, a qualitative approach was used duringthe documentary stage of the SCMM, in which the meaning of words and phrases weresought in the study of the official documents found, indicating the vision of thefuture, mission, strategic objectives, management reports, status of municipal civilservants and performance indicators.. In the third stage, for the internal consistency tests of datacollection, we used the Cronbach' alpha coefficient per Domain after Main ComponentAnalysis (MCA), using the statistical software Predictive Analytics Software (PASWStatistics) 18.0.0, formerly named Statistical Package for the Social Sciences(SPSS®).The quantitative approach highlighted the contributions of the SCMM with the mappingof gaps in its second stage, performed with multivariate analysis of the datathrough statistical techniques, such as the analysis of main components and internalconsistency. In theThis study was carried out between October 2017 and June 2018 at the MHS of São Josedos Pinhais, located in the state of Paraná, southern Brazil, with approximately atotal of 320 thousand inhabitants and its own municipal public health network,comprising 46 services , with approximately 2 300 civil servants, of which 91are managers.Managers are called directors, heads or coordinators by means of a paid function, inthe case of statutory employees, or by commissioned position, indicated by technicalor political party criteria by the Municipal Health Secretary and endorsed by theExecutive Chief. The inclusion criteria were based on the typicality of the positionthat public health managers of MHS own services exercise . We included individuals with responsibility for directing, heading orcoordinating a department, division or public health service of MHS, who exerciseddecision-making, mediation, planning, control and evaluation activities, regardlessof gender, age, education, professional training, if effective or commissionedserver, time in office or time of management experience. who proposes the following: "competence is knowing how to actresponsibly and recognized, which implies mobilizing, integrating, transferringknowledge, resources and skills, which add economic value to the organization andsocial value to the individual". Thus, organizational competence was disseminatedinternationally with the term core competency, which encompasses a set of skills or aptitudes that unites individualefforts (merging expertise with the new) through harmony, communication, commitmentand work organization in its various functions, which finally have positive results. The definition of competence used in this study was based on an author who prompetency, which So, it was proposed to apply a SCMM with four stages: documentary, questionnaire,mapping of gaps and educational proposal ..In the first stage of the SCMM, documentary data collection took place in October andNovember 2017. The sources were the official documents of the Municipal Governmentand MHS, which addressed attributions or job descriptions related to the institutionmanagement and organizational strategy. These documents , with potential forinterpretation and description of content, were related to the competencies ofmanagers.After studying the official documents, the general core competences of MHS weredescribed, indicating the composition of an expected performance or behavior ofaction by means of a verb or an action object accompanied by a condition and acriterion ..Then, there was a correlation between the general core competences described for MHSand the specific core or external competences, understood as valid for the localneed, choosing the document of the PAHO MRCESP., based on the MRCESP.The second stage of the SCMM was applied for data collection through asemi-structured self-assessment questionnaire, translated and adapted to theBrazilian context, based e MRCESP..The questionnaire consists of response levels of five predefined, divalent,asymmetric interval points - Likert scale of five points - presented in a total of56 questions or core competences divided into six Domains: Domain 1 - HealthSituation Analysis; Domain 2 - Risk and Damage Surveillance and Control; Domain 3 -Health Promotion and Participation; Domain 4 - Policies, Planning, Regulation andControl; Domain 5 - Equity in Access and Quality in Individual and CollectiveServices; and Domain 6 - International and Global Health.The results of the structured questions (specific core competences) are presented bymeans of a central tendency measure (arithmetic mean) and a dispersion measure(standard deviation). The averages can vary between 1 and 5, with 1 being the lowestvalue regarding the lack of knowledge of the specific core competence and 5representing that the competence is put into practice, with the possibility ofteaching the competence to others.. The number five refers to the number of points on the Likertscale.In the third stage of the SCMM, the mapping of gaps was performed, resulting from theformula PD = CID (5 - CED), adapted from the one presented by Brandão(1), with theCompetence Importance Degree (CID) being the result pointed out by specialistmanagers(15), according to the different importance understood formanagement. The nu® electronic spreadsheet, it was possibleto generate the numerical representation of the gap between the specific corecompetencies by classifying the Training Priority Degree (PD).Thus, the Competence Expression Degree at Work (CED) was developed through theresponse of the managers participating in the study. So, when applying the formula,using the Microsoft Excel 2007.In the fourth stage of the SCMM, in March 2018, the educational proposal wasdiscussed during a meeting with four representatives of the Municipal Public HealthSchool (PHS), responsible for carrying out the educational actions, where thepossibilities for developing competences were presented as gaps through learningtrailsThe study was submitted to the Research Ethics Committee, Opinion No. 2068137 andCertificate of Presentation of Ethical Appreciation (CAAE) No. 67007517.5.3001.0100,and met the ethical recommendations for research with human beings contained inResolution No. 466/2012.As a result of the first stage, after searching the physical and digital collectionsof MHS, the Municipal Secretariat for Planning and Economic Development and the CityHall, the documentary consultation was carried out on eighteen official documents ofthe city, with possible interpretation potential and description of content relatedto the competences of managers, a survey carried out in November 2017.After a thorough reading of the eighteen documents found, it was understood that onlythree official documents stood out for their potential for interpretation anddescription of content related to the concept of competence. The selected documentswere: Municipal Organic Law, Civil Servant Statute and the Strategic Map of theMunicipal Government. In none of them the functions, attributions, qualifications,profile or responsibilities was clearly found, for any level of management. However, the three officialdocuments selected for their content served as a basis for describing 14 generalcore competences for MHS, as shown in Then, the 14 general core competences described for MHS were correlated to the sixdomains of specific  core competencies of the questionnaire based onMRCESP, demonstrating that the selected  questionnaire, with specific,selected competences holds potential for the development of the general competences described.Domain 1 (8) was correlated to General Core Competence(GCC) III. Domain 2 (Surveillance and Risk and Damage Control)(8) to GCC VII. Domain3 (8) to GCC I, II, VIII. Domain 4 (8) to GCC IX, XI, XII, XIII and XIV. Domain 5(8) to GCC IVand V; and, finally, Domain 6 (8) to GCC VI andX.In the second stage of the SCMM, a questionnaire was applied between October 2017 andJanuary 2018. Of the total of 91 managers approached, 85.71% (n=78) completed thequestionnaire between 22 and 50 minutes. Four questionnaires, which were incomplete,were removed from the study to guarantee the quality of the collected data, with81.39% (n=74) of the questionnaires being computed.The result of the mapping of gaps in the third stage, as shown in From this mapping, the gaps in Domain 2  standout - referring to risk management, health risk reduction, immediate response andreconstruction, all referring to disasters - and in Domain 6 , in which core competencies, mapped as gaps, address transnationalinitiatives, global and international health.The internal consistency of the collected data demonstrates a high coefficient forCronbach's alpha (reliability), for data collected in all domains and second orderconstructs (results above 0.75).As a result, a Classification by Score indicating the PD was also adapted, as shownin , according to As a result of the fourth stage, after meeting with the PHS team, one of the specificcore competences identified with the highest PD (DO2CO11) was selected to be used asan example in the definition of content and teaching theme, through Knowledge,Skills and Attitudes (KSA), accord, participate in risk management plans disasters in the face of natural,technological and biological threats to mitigate their effects (DO2CO11), are: As a learning proposal, options can be individualized according to the aspirationsand preferences of each manager, that is, some of the options that can composelearning trails to develop the specific core competence pointed out as agap, partic- Distance education course (Theme: Incident command system); - Face-to-face lecture (Theme: Technologies and innovations for disasterprevention); - Book (Reducing vulnerability to disasters: from knowledge to action);- Article ; - Videos ; - Internet pages ; - Mentoring ;- Forum (Disaster risk prevention); - Workshop (Comprehensive risk and disaster management); - Specialization Course (Disaster Management in protection and CivilDefense). .Finally, as a result of the study and search for evaluation techniques to perceivethe development of the specific core competence, identified as a gap after thelearning path has been covered, there is a proposal for impact indicators in thecategories: Level , Measurement Complexity (depth and orbreadth), Data Collection Instrument , DataCollection Source (manager or colleagues) and Observed Impacts (improving competenceor advances and achievements)..Depth refers to advances in the performance of activities related to the objectivesand contents taught (core competences) and impact on work. On the other hand, theamplitude refers to the positive effects in other activities not directly related tothe objectives and contents taught..In the case of Level of Assessment of the impact on the individual, a questionnaireis suggested to measure the Complexity of the Measure regarding depth (first sixquestions) and breadth (last six questions), to be applied after the manager meetsthe learning path, with a total of 12 questions with answers structured on a Likertscale of agreement.In order to measure the Level of Evaluation of the impact on the organization, theComplexity of the Measure is proposed only in depth and as a Data CollectionInstrument, the documentary analysis; the Data Collection Sources are the SUSManagement Instruments and the Observed Impacts are the advances and achievementsrelated to the competence developed registered in the management instruments, suchas the Previous Four-monthly Detailed Report (PFDR) and the Annual Management Report(AMR).Regarding the first (documentary) stage, the SCMM contribution to the finding, duringthe search for official documents, absence of a description of the functions,attributions, qualifications, profile or responsibilities of the managers stands out. The performance of themanager depends on clear specifications and provided by the organization, with anupdated job description, covering the responsibilities and duties, by department.Thus, the job description is like a road map of where they want to be andhow(19-20)..The first stage of the SCMM also provided the institution with a description of 14unprecedented general core competencies, which enhance the implementation oforganizational goals and strategies to promote motivation, monitoring, evaluation,coordination and synchrony of efforts in different services and accelerate publicmanagement decision-making processes by sharing defined objectives., a questionnaire chosen as a data collection instrument, which containsthe specific  core competences. Another contribution of the first stage is the correlation between the specificgeneral core competences described for the institution (MHS) and the six Domains ofMRCESP, a quesIt is understood that to put the SCMM into practice, you can choose any questionnairecontaining specific competences. However, it is recommended that a correlation bemade with the general core competences so that efforts are not expended, by pointingout gaps or time in educational projects, to develop external core competences,which do not add up to what is expected by the public administration..As a contribution of the second stage of the SCMM, there is the presentation of theevaluation of specific core competences by specialists, resulting in the CID. Thus,competencies receive individualized results, far from a unanimous ideal among allcompetencies for a proposition of level of acceptability, which can vary a lot orlittle between one competence and another, because without the evaluation, among thenumerous general and specific competencies that exist, it would be difficult todiscern priorities.In this same second stage, the CED is defined when the questionnaire respondentperforms a self-assessment regarding the possession of the knowledge, skills andattitudes necessary to put the specific core competence into practice. presents itself as a tool of effective contribution, because inaddition to practicality and simplicity in use, it results in the PD, providingfocus on specific core competencies pointed out as gaps, that is, with a higherscore. Still in the third stage of the SCMM, the Classification of the PDcontributes to the evaluation of the results of the applied formula, when observingthat the participating managers present satisfactory results, as they presented onlyeight gaps  with the maximum score being 10 (moderatepriority).In the third stage of the SCMM, the formula adapted from the one presented byBrandão present. The four gaps in Domain 2 (Surveillance and Control of Risks and Damages) presentedin the third stage of the SCMM address specific core competences referring tointersectoral planning for managing natural, technological, biological andpost-disaster reconstruction, with the damage identification and immediaterehabilitation. The relevance for the city of the core competences, identified asgaps related to disasters, is confirmed by the report of the State Coordination ofProtection and Civil Defense of the State, since in 2016 the city of this study hadthe highest number of occurrences in the State: 17 disasters. .Therefore, this is not a concern only in Brazil. In Africa, the World HealthOrganization, in partnership with public health training institutions, conducted apilot study on the development of core competences and training curriculum on Riskand Disaster Management.The four gaps in Domain 6  deal with corecompetences related to transnational intersectoral initiatives to overcomeinequalities, and global health, as contrasts between public health systems andtheir influence on health, welfare, social security and fundraising reforms, whichare important to the city, which, in addition to having an international airport, islocated in a vulnerable (metropolitan) region., and a 95% confidence interval level and a 5% margin of error. However,it is emphasized that the performance of statistical analysis is not mandatory forthe use of the SCMM.Regarding the statistical analysis of main components and internal consistency of thecollected data, the reliability results  were high forall domains, even with the number of items per domain, mostly below tenquestions, and a  and that, after extracting factors with the proper rotation, sampleadequacy, sphericity and factorial model tests, parallel analysis, determinantvalue, non-redundant residue, removal of possible outliers, and if necessary,maximum likelihood, goodness-of-fit index and adjusted goodness-of-fit index, beforecalculating Cronbach's alpha coefficient.On the other hand, if data are collected for scientific research, it is recommendedthat there be at least 50 participants and tha.The fourth stage of the SCMM contributes by exemplifying how the specific corecompetence, mapped as a gap, can be decomposed into knowledge, skills and attitudes,guiding the definition of content and teaching theme for the development ofcompetence on disasters. An educational structure is a set of competencies thattakes into account performance based on educational needs, personal experience,professional role and role in planning, mitigation, response and disasterrecovery.. The permeability of higher education, which advances to the field ofprofessional development, has been of interest in Europe and the United States as itenvisions greater potential for innovation with the activation of flexible personallearning paths.Competency-Based Education (CBE) assumes that different sets of competencies arefeasible to be customized for different education needs in the health professions,favoring the flexibility of time, place or learning pace, with multiplepaths. The peng paths.. This panorama converges to the use of the SCMM, which contributes tothe systematization in sequence, from the reflection and identification of problems(identification of gaps), to the search for practical solutions after thedevelopment of specific competences.A study carried out with managers of primary health care in southern Brazil pointedout the lack of training as a reason for dissatisfaction, and permanent healtheducation as a strategy for meaningful learning, with a methodological axis in theirwork processes. This p(-), because formal education, even in public health, does not, or little,develops the core competences expected of a manager(-).The process of shifting the focus from the transfer of knowledge to the developmentof competences must result from the tuning of the theory to real work situations,seeking excellence in public health practice and reducing the distance between whatis learned and what is practiced-32, b manager-34.. This study proposes the development of learning paths for the development of any corecompetence identified as a gap. It is based on the premise that, when the expectedcompetencies are not expressed, it is possible to manage the development ofcompetences in facing complexities and evolving demands. , even though they offer conveniences for organizational learning.The proposal for learning paths for public management is still incipient and littleknown, as an alternative to training grids. As a strategy to promote the developmentof competences by combining the expectations of the organization with thecharacteristics and profile of each person, the trails can be characterized asempirical and non-systematic strategies, even t, in addition to other better known as lectures, seminars, face-to-faceand distance courses, conferences, study trip, specialization course, books,manuals, articles, movies, forums, websites, videos, coaching and mentoring.The formatting that can be chosen for the learning paths is vast and unlimited,relying on the resources of Information Science to organize and representinformation, in add. Mentoring, recognized and recommended as an innovative, low-costcompetence development, has been implemented in health institutions, with thetemporary stay of a mentor, visits by an itinerant mentor, a team ofmulti-professional itinerant mentors, a mentor for two health services or permanentmanager-mentor.As an example of a resource, mentoring has been used for more than a decade in theframework of research in the field of health, in addition to being present inteaching situations. It is also appropriate in specific cases of work and in thedevelopment of leadership competences. Mentorr-mentor..Without evaluation, the teaching-learning cycle is not closed. The contribution ofthe fourth stage is also related to the assessment techniques for perceiving thedevelopment of the specific core competence identified as a gap. It is consideredimportant to evaluate the results of the impact of learning activities by theindividual, in the feedback for the proper improvement of the model and for theorganization, in ensuring that the efforts expended are being effective to thedisposition., there is a demand for new applications of the model for continuity ofthe process, since the services, contexts and their actors are dynamic.As limitations of this study, it is pointed out that the questionnaire used does notaddress financial aspects of management, and they have not been explored. Still, dueto the determined validity period of the SCMM, possibly around sixmonths, there This study analyzed the contributions of a SCMM consisting of four stages for a MHS andappears unprecedented in Brazilian public health. In the first stage, the SCMM made contributions by noting the lack of description ofthe functions, duties, qualifications, profile or responsibilities of managers in official municipal documents;exemplified how general core competencies can be described; detailed the correlationof general core competences with questionnaires containing specific  corecompetencies.In the second stage, the SCMM made explicit contributions to the generation of theImportance and the CED through the analysis of the questionnaire results.In the third stage, the SCMM evidenced contributions on how to generate the PD whenperforming the mapping of gaps through formula and Classification of the PD.In the fourth stage, the SCMM presented contributions on how to break down a specificcore competence in Knowledge, Skills and Attitudes; proposed an individualizededucational intervention through Learning Trails to develop competences; proposedimpact assessment techniques for the perception of competence development.As a recommendation for future studies, it is suggested that the experts consulted togenerate the Competences Importance Degree are from the service, as the importanceof different competencies is based on local needs, contexts and people. Also, theperformance of the gap mapping step must be separated by the different levels ofmanagers and or by departments, which allows more specificity in the planning of thelearning trails.


There are errors in the Funding statement. The correct Funding statement is as follows: The grant holder is Seblework Mekonen, Award agreement No = 4500384863. This work was carried out with aid of a grant from United Nations Educational, Scientific and Cultural Organization (UNESCO) and International Development Research Centre (IDRC), Ottawa, Canada. The views expressed herein do not necessarily represent UNESCO, IDRC or its board of governors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


Urban Renaissance (UR) Agency in Japan is one of the world's largest public housing institutions. When faced with the serious aging problems in Japan, the Japanese implemented innovative reform, with the smart medical and pension service launched according to the characteristics of resident population and their variation trends. As it well mastered the actual needs of residents by establishing the intelligent medical system, the occupancy rate was increased. Meanwhile, the problem of inadequate local medical resources was solved, with the satisfaction of residents as well as the cultural exchange and integration within communities ameliorated, which hence realized the sustainable development of communities. In this study, the smart medical experience of Urban Renaissance Agency in Japan was explored in the hope of providing enlightenment for the development of smart communities in China. Relevant Chinese enterprises can draw lessons from the experience of community services in Japan, and via the cooperation among industries, governments, and universities, they can collaborate with universities, scientific research institutions, high-tech enterprises, district governments, and grassroots communities to give full play to the advantages of the platform and improve service quality. Japan is one of the countries most affected by aging in the world. According to the demographic statistics report released by the Ministry of Internal Affairs of Japan in 2019, the elderly population there had reached 35 million, with an aging rate as high as 28.4% [With the development of a super-aging society, the single elderly population without spouses or children is increasing annually, which brings serious challenges in terms of pensions . In JapaTraditional medical treatment and elderly care are usually achieved by hospitalization and nursing home. However, due to practical problems such as insufficient resources, the medical industry in Japan is striving to penetrate into communities, which has progressively realized in-community medical treatment and in-community elderly care. According to the forecasting data of related institutions, the areas with a super-aging index approximate to Tokyo Megalopolis are basically consistent with the residential communities (groups) of UR Agency in Japan , and theBased on the survey data of Mizuho Bank, by 2030, the size of Japan's housing rental market will shrink by 30% from its current size because of an aging population with fewer children. Among them, the demand for multigeneration families and young single families will be greatly reduced, whereas at the same time, the demand for elderly people, especially single elderly people, will increase greatly. Urban Renaissance (UR) Agency in Japan is one of the world's largest public housing exclusive institutions. The number of elderly people will increase from 29.24 million in 2010 to 36.85 million in 2030, while the number of people in need of care will increase from 4.91 million to 8.36 million, and the number of facilities and houses for the elderly will increase from 1.48 million to 2.5 million. Besides, the demand for a large number of age-friendly housing also stimulates government agencies and private enterprises actively to participate in the layout of age-friendly community reconstruction as well as the construction of regional medical service centers.The full name of UR Agency is “Independent Administrative Legal Person Urban Renaissance Agency,” which controls 720,000 sets of rental homes across Japan. Since its establishment, the UR Urban Organization and its predecessors have solved the housing problems of millions of Japanese families and fulfilled the tasks during a certain historical period by providing houses for generations of families extensively. With the advent of a super-aging society, UR Agency has been endowed with new historical significance. Most of the rental houses of UR Agency are located in the suburbs where the super-aged population gathers. Especially, about 430,000 large group houses were constructed and supplied during the period from 1960 to 1970, which were difficult to meet the living needs of the existing residents in terms of area, pattern, and supporting facilities. Therefore, renovating communities to meet the living needs of the elderly has become the primary task for the UR Agency.Moreover, with the persistent elevation of living requirements and quality of life, the all-around environmental quality along with medical and old-age care services of residential communities are important factors for improving residents' satisfaction and happiness. Based on the existing large number of public housing, the variations of market demand, regional activation, and harmonious development of communities, UR Agency correspondingly adjusts and alters its housing products, aiming to adapt to the overall requirements of the super-aged society in Japan and improve the overall quality of communities.To adapt to the variations of Japan's super-aged society in the future, UR Agency sets up a special committee and organized Japanese experts and scholars to perform a special study in this regard and hence formulated three future-oriented reform policies according to the reality of UR and the development tendency of Japanese society.Sustainable and secure family medical and nursing services are provided for the residents in UR community. For the areas with insufficient medical and nursing resources, medical institutions and elderly care facilities are attracted by means of investment promotion. To provide medical and elderly care services on a larger scale, the cooperation with public and private institutions near the community is encouraged.Based on the analysis of the existing living conditions and community reality, the redesign and overall transformation should be implemented by taking safe, high-quality, and sustainable public housing as the target.It provides a community platform for young groups, family groups, and elderly groups to communicate and help each other and collects opinions and suggestions from different groups as far as possible, aiming to safeguard the common interests of all stakeholders in the community and promote the harmonious community development.Founded in the 1960s, Chiba-ken is not only a large-scale construction site near the JR railway station in Japan but also a typical suburb super-aging community in Japan. In recent years, as the University of Tokyo has established a new campus there, relevant scholars of the university have begun to investigate this place and put forward the idea of solving local practical problems through the cooperation between industries, governments, and the university. Under the joint efforts of the University of Tokyo, UR Agency, and local municipal governments, a new industry-government-university association, “Kashiwa Regional Super-Aged Society Comprehensive Research Association,” has been established. Aiming at the characteristics of fewer children and aging in the local areas, a series of targeted smart medical reform plans have been launched.∗24 hours regional medical support network through smart medical treatment to serve local communities.Due to its long distance from major hospitals in Tokyo, inconvenient travel for elderly residents, and difficulties in medical treatment, UR Agency has newly established and introduced smart medical institutions here to establish a “Medical Cooperation Center,” whose main functions are as follows: first of all, after leaving from medical institutions in Tokyo, patients can continue their medical treatment at home through the Internet and Internet of things devices, the corresponding attending physicians will be recommended to the patients, and corresponding medical institutions and specialized hospitals in the area will be arranged according to the patient's situation . Second,To meet the demand for medical services in a super-aged society, UR provides exclusive and personalized services for the elderly in the local community by cooperating with local private enterprises . In UR, The plan of regional comprehensive smart medical centers has been implemented in more than 100 UR agencies, which enriched the local medical resources, improved the satisfaction of local and surrounding residents, and exerted a favorable impact on promoting the sustainable development of communities . MeanwhiRelevant Chinese enterprises can draw lessons from the experience of community services in Japan, and via the cooperation among industries, governments, and universities, they can collaborate with universities, scientific research institutions, district governments, high-tech enterprises, and grassroots communities to give full play to the advantages of the platform, improve service quality, precisely analyze the resident group, and excavate residents' specific needs, so that personalized value-added services can be provided and all-round solutions can be formed. Therefore, it can be promoted in public housing communities in China. In addition to meeting the residents' needs and improving their sense of satisfaction and happiness, it can also yield value-added service benefits for enterprises while achieving certain social benefits and fulfilling corporate social responsibilities to establish favorable social images .