For nearly 30 years, health professionals in more than 150 countries have collaborated through a global network to protect people from public health threats. While movies like “Contagion” and “Outbreak” highlight the dramatic aspects of the work, much of the impact comes from the daily behind-the-scenes work of health system strengthening, which generally goes unnoticed by the public. The global network known as TEPHINET – The Task Force for Global Health’s Training Programs in Epidemiology and Public Health Interventions Network – has established nearly 9,000 disease surveillance systems and investigated more than 14,000 disease outbreaks.
We spoke with TEPHINET’s Director of Strategy and Technical Initiatives George Shakarishvili about the important work of health system strengthening.
How does strengthening health systems improve a country’s ability to detect and contain disease outbreaks?
The key objective of health systems strengthening (HSS) is improving the capacity, responsiveness and resilience of a country’s health workforce, institutions and systems. Preventing and responding to disease outbreaks requires actions in multiple areas of the health system. For example, improved service delivery—such as better-equipped hospitals, clinics, and labs—enables faster testing, diagnosis, and treatment. A well-trained health workforce can detect unusual disease patterns, report cases accurately, and provide timely care. Strong public health systems can deploy epidemiologists and frontline workers to investigate outbreaks and take critical actions like contact tracing, vaccination, or quarantine. Health information systems with robust surveillance capabilities help detect and contain outbreaks early. Efficient supply chains ensure access to lifesaving medicines, vaccines, and personal protective equipment.
Importantly, health system strengthening also includes support for informal, community-based systems. Engaging local communities in prevention, detection, and response builds trust and enhances the effectiveness of public health interventions.
How are health system strengthening practices evolving?
The key objective of health systems strengthening (HSS) is improving the capacity, responsiveness and resilience of a country’s health workforce, institutions and systems. HSS interventions are aimed at improving performance of the “building blocks” of a health system: service delivery, health workforce, health information systems, access to essential medicines, vaccines and technologies, health system financing, and leadership and governance. Preventing and responding to disease outbreaks require actions in all these areas.
The international health systems strengthening approach has shifted from focusing on specific diseases to more comprehensive, country-led strategies that emphasize integration and resilience. Before the 2000s, global health organizations mainly targeted diseases like HIV, tuberculosis and malaria; maternal and child health; and immunizations. This “vertical approach” targeted each disease separately, but evidence showed that it was not sufficient for sustainable improvements in population health.
Subsequently, the focus shifted to integrated health systems strengthening, linking disease control with broader system improvements. The COVID-19 pandemic further pushed global health toward resilience and responsiveness to unexpected shocks, viewing national health systems as the first line of defense for global health security.This shift has prioritized strengthening primary healthcare, building strong supply chains, improving disease surveillance, and developing national pandemic response plans. International coordination, including data-sharing and equitable distribution of medical supplies, has become essential for managing outbreaks that cross borders.
How is TEPHINET working to advance health systems based on these changing needs and environments?
TEPHINET advances health systems by strengthening the public health workforce, especially in areas like disease surveillance, outbreak investigation and response to other public health emergencies. TEPHINET supports Field Epidemiology Training Programs (FETPs) around the world, which train health workers to detect, investigate and respond to health threats. Early detection of outbreaks leads to faster interventions, reducing the spread and impact of diseases.
With the proliferation of more than 95 FETPs serving 150+ countries and territories. TEPHINET spearheads quality assurance oversight through a robust accreditation program, ensuring and encouraging that training programs meet and maintain global standards of excellence. Central to our mission, TEPHINET actively works to connect public health professionals in all the countries we serve, creating an interactive global FETP network ready to share information, expertise and best practices during health emergencies.
For example, during the COVID-19 pandemic, TEPHINET fostered a connected global network of public health professionals by serving as a vital coordination hub—hosting monthly technical webinars and facilitating information-sharing across the FETP network.
FETP fellows’ work is expanding knowledge in areas such as pathogen detection, surveillance, diagnostics, and noncommunicable disease research, which influences policy at local and national levels.
How is the global health community, including TEPHINET, using these new trends and priorities to prepare for future health threats?
The future of global health is full of opportunities as well as challenges. The COVID-19 pandemic was important because it exposed critical gaps in global health systems. Moving forward, there will be more of a focus on developing stronger surveillance systems, supporting faster vaccine development, and improving global coordination mechanisms, such as the WHO Pandemic Agreement, recently adopted at the May World Health Assembly gathering, which aims to improve global preparedness, response and cooperation for future pandemics.
Rising temperatures, drought, floods, natural disasters, water scarcity and food insecurity are all expected to increase the prevalence of infectious diseases, mental health crises and displacements. Because of this, adopting approaches that emphasize the connectedness of humans, animals and the environment is a top priority.
Additionally, heart disease, diabetes, cancer, and mental disorders will continue to be the biggest killers worldwide, so it will be necessary to manage these noncommunicable diseases (NCDs) alongside infectious diseases. This will be a complex balancing act, but technological progress such as artificial intelligence, telemedicine, wearable health monitoring devices and genomics will help with this, as well as improve how healthcare is delivered, particularly in underserved areas.
TEPHINET is committed to addressing both longstanding and emerging health challenges through initiatives that support climate and health awareness, migrant health and the integration of noncommunicable diseases into field epidemiology. All of our efforts are creating a safer world for everyone.
Click here to learn more about how field epidemiology training programs battle outbreaks.
