Structures and processes for coordinated policy and public health response in Federated Countries

The COVID‑19 crisis has underlined complexities for governments in establishing efficient mechanisms to respond to the health and health system challenges and determine the path to recovery, particularly for federated countries. In Canada, the health care system is more decentralized than other Organization for Economic Co-operation and Development (OECD) federal states. As the responsibilities are shared across levels of government, coordination challenges become more apparent.¹ The capacity for rapid, coordinated policy and public health efforts between national and sub-national levels of government is critical in the context of a global pandemic to optimize outcomes for populations and health systems. This issue note describes key structures and processes adopted in selected federated countries to promote a coordinated response. Similarities and differences in the approaches instituted by the federal governments are explored, and considerations for Canada are proposed. The evidence for this report draws from the academic and grey literature as well as expert opinion from Australia, Germany, Switzerland, and the United States of America to answer the questions:

How have other federated countries managed/are managing the pandemic? What structures and processes were used to coordinate policy and public health measures? 

For the countries included in this review, the federal governments’ policies and public health measures to enhance coordinated responses with states and local territories were well described in the literature. The papers retrieved presented detailed accounts of the policy measures and how particular structures and processes enabled coordination. However, evidence was lacking on the effectiveness of these policy measures to promote coordination, which remains bounded by history, the culture of federalism, and governmental capacities in these countries.

Key considerations for coordinated policy and public health measures

• In federated countries, federal governments can act effectively as ‘nerve centres’ for coordination in health emergencies, where the response and guidance need to be coherent and swift. Cabinets and the offices of prime ministers/chancellors can steer their respective federal responses by outlining the framework for response and providing leadership.
• Evoking emergency legislation or amending or crafting new acts have been the most common measures to enhance the federal role during the COVID‑19 pandemic. Such action has enhanced the swiftness of uniform decision-making. However, the need for caution and careful consideration was raised as a new legislative measure may not always suit unique local outbreak situations and could raise potential jurisdictional issues.
• Scientific advisory bodies integrated at a national level enhance a coordinated response by providing coherent, evidence-based scientific knowledge, enabling nimble navigation in an evolving pandemic.
• To overcome misinformation and to gain trust, regular public-facing communication and data transparency are essential.
• The relevance of structures and processes in non-crisis contexts requires careful consideration and more research to understand the associated costs and benefits.
• There are other factors beyond federalism, such as leadership, trust in government, the geographic size of the country, and government capacity that influence the trajectory of efforts to promote a coordinated response.

The conclusions of this paper are limited due to the following:  

• Some relevant data may have been missed due to the rapid timelines for developing the paper.
• Most documents in this report described policy recommendations and experiential evidence, and there was limited data or studies to support conclusive statements regarding the effectiveness of policy measures.
• This note captures only the structures and approaches relevant to a coordinated public health response, mainly at the federal level. Therefore, this paper does not cover measures in other sectors, or the measures established at the state and local levels.