“It’s Feeding the Beast”: Lessons for Governance of Public Health Surveillance and Response From an Australian Case Study Analysis

Topp, Stephanie M.; Edelman, Alexandra; Nguyen, Thu; McBryde, Emma S.; Devine, Sue; Allen, Tammy; Warner, Jeffrey; Mudd, Julie; Horwood, Paul F.

doi:10.34172/ijhpm.8605

“It’s Feeding the Beast”: Lessons for Governance of Public Health Surveillance and Response From an Australian Case Study Analysis

Document Type : Original Article

Authors

Stephanie M. Topp ¹

Alexandra Edelman ²

Thu Nguyen ¹

Emma S. McBryde ³

Sue Devine ¹

Tammy Allen ¹

Jeffrey Warner ¹

Julie Mudd ⁴

Paul F. Horwood ¹

¹ Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

² Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia

³ Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia

⁴ College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

10.34172/ijhpm.8605

Abstract

Background
Public health is a core governmental responsibility, with ministries or departments of health responsible for setting and ensuring adherence to standards, managing performance and instituting reforms as required. Although North Queensland (NQ), Australia has a well-developed health infrastructure, the COVID-19 pandemic exposed significant vulnerabilities in its public health surveillance and response system. Globally, research has highlighted how human and cultural elements (“system software”) influence the effectiveness of infrastructure, governance, and data systems (“system hardware”). This study examines the interaction between these elements to examine specific governance challenges and opportunities for strengthening communicable disease surveillance and response in NQ.

Methods
Using an embedded case study design, we analysed four disease units—COVID-19, tuberculosis (TB), arboviruses, and sexually transmitted infections (STIs)—through interviews (n = 47), document review, and observations across NQ health services (October 2020–December 2021). Data were mapped against Sheikh and colleagues’ hardwaresoftware framework to examine the nature of governance bottlenecks in this region of northern Australia.

Results
Two key governance challenges emerged: (1) Accountability deficits—Hospital and Health Services (HHSs) lacked clear reporting or performance monitoring systems within Queensland’s devolved health service governance model, contributing to inconsistent prioritisation of resourcing for communicable disease functions by health service leadership. Within HHSs, public health units (PHUs) faced systemic underfunding, with prevention services accounting for as little as 0.1% of some health service budgets. (2) Data governance failures—Fragmented, siloed data systems, restrictive datasharing norms, and risk-averse culture hindered coordinated surveillance and response efforts. Weak interoperability and mistrust in data-sharing partnerships further compromised system effectiveness.

Conclusion
This study highlights how political, normative, and structural factors shape public health performance alongside the more commonly assessed functional and technical dimensions. Findings suggest the need to improve performance monitoring systems, leadership, and data governance to build an effective, accountable, and data-driven surveillance and response system in NQ.

Keywords

Public Health

Health System

Communicable Disease Control

Surveillance and Response

Governance

Queensland

World Health Organization (WHO). 21st Century Health Challenges: Can the Essential Public Health Functions Make a Difference? Geneva: WHO;2021.
Yang K, Qi H. The public health governance of the COVID-19 pandemic: a bibliometric analysis. Healthcare (Basel). 2022;10(2):299. doi:3390/healthcare10020299
Wang Z, Duan Y, Jin Y, Zheng ZJ. Coronavirus disease 2019 (COVID-19) pandemic: how countries should build more resilient health systems for preparedness and response. Glob Health J. 2020;4(4):139-145. doi:1016/j.glohj.2020.12.001
Jorm L, Gruszin S, Churches T. A multidimensional classification of public health activity in Australia. Aust New Zealand Health Policy. 2009;6:9. doi:1186/1743-8462-6-9
Australian Government Department of Health and Aged Care. National Notifiable Disease Surveillance System (NNDSS). https://www.health.gov.au/our-work/nndss#:~:text=The%20National%20Notifiable%20Diseases%20Surveillance,the%20impact%20of%20these%20diseases. Updated March 1, 2024. Accessed February 13, 2025.
Queensland Government. Public Health Act 2005. https://www.health.qld.gov.au/system-governance/legislation/specific/public-health-act#:~:text=The%20Public%20Health%20Act%202005,reducing%20risks%20to%20public%20health. Updated December 5, 2024. Accessed February 13, 2025.
Queensland Government. Public Health Regulation 2018. https://www.legislation.qld.gov.au/view/pdf/inforce/current/sl-2018-0117. Updated 1 July 2024. Accessed February 13, 2025.
Queensland Health. Health System and Governance. https://www.health.qld.gov.au/system-governance. Updated October 31, 2024. Accessed February 13, 2025.
World Health Organization (WHO). Application of the Essential Public Health Functions: An Integrated and Comprehensive Approach to Public Health. Geneva: WHO; 2024.
World Health Organization (WHO). Everybody's Business: Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action. Geneva: WHO; 2007.
World Health Organization (WHO). Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. Geneva: WHO; 2010.
de Savigny D, Adam T. Systems Thinking for Health Systems Strengthening. Geneva: World Health Organization; 2009.
Sheikh K, Gilson L, Agyepong IA, Hanson K, Ssengooba F, Bennett S. Building the field of health policy and systems research: framing the questions. PLoS Med. 2011;8(8):e1001073. doi:1371/journal.pmed.1001073
Haldane V, De Foo C, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27(6):964-980. doi:1038/s41591-021-01381-y
Nyimbili F, Nyimbili L. Types of purposive sampling techniques with their examples and application in qualitative research studies. British Journal of Multidisciplinary and Advanced Studies. 2024;5(1):90-99. doi:37745/bjmas.2022.0419
Topp SM, Edelman A, Horwood P, et al. Governance for Communicable-Disease Control in North Queensland: Fit-for-Purpose or Failing the Test? Paper presented at: Perth, Australia: Communicable Disease and Infection Control Conference; 2023.
Edelman A, Horwood P, Allen T, et al. “Hospital Respond to Demand. Public Health Needs to Respond to Risk”: The Governance of Communicable Disease Surveillance and Response Systems in Northern Queensland. Paper presented at: Cairns, Australia: Cairns and Hinterland Hospital and Health Service Research and Innovation Symposium; 2022.
Edelman A, Allen T, Devine S, et al. “Hospital Respond to Demand. Public Health Needs to Respond to Risk”: The Governance of Communicable Disease Surveillance and Response Systems in Northern Queensland. Paper presented at: Townsville, Australia: TropiQ Townsville Research Symposium; 2022.
Edelman A, Allen T, Devine S, et al. "Hospitals respond to demand. Public health needs to respond to risk": health system lessons from a case study of northern Queensland's COVID-19 surveillance and response. BMC Health Serv Res. 2024;24(1):104. doi:1186/s12913-023-10502-x
Queensland Health. Service Agreements and Deeds of Amendment. https://www.health.qld.gov.au/system-governance/health-system/managing/agreements-deeds. Updated August 30, 2024. Accessed February 13, 2025.
Queensland Government. Hospital and Health Board Act 2011. https://ww.legislation.qld.gov.au/view/whole/html/inforce/current/act-2011-032. Updated December 5, 2024. Accessed February 13, 2025.
Queensland Health. Queensland Health Annual Report 2011-2012. Queensland Health; 2012. https://www.publications.qld.gov.au/dataset/68d32ae2-eaac-49ca-8b59-d739aa516d62/resource/5f7617dc-b96b-40a5-8de6-0be2c365dd2a/download/annual-report-2011-12.pdf. Accessed February 13, 2024.
Queensland Health. North Queensland Aboriginal and Torres Strait Islander Sexually Transmissible Infections Action Plan 2016-2011. Brisbane: Queensland Health; 2016. https://www.health.qld.gov.au/__data/assets/pdf_file/0028/157555/sti-action-plan-2016-21.pdf. Accessed February 13, 2024.
Queensland Government. Information Privacy Act 2009. https://www.legislation.qld.gov.au/view/html/inforce/current/act-2009-014. Updated December 31, 2024. Accessed February 13, 2025.
Bevan G, Hood C. What’s measured is what matters: targets and gaming in the English public health care system. Public Adm. 2006;84(3):517-538. doi:1111/j.1467-9299.2006.00600.x
Shiell A, Garvey K, Kavanagh S, Loblay V, Hawe P. How do we fund public health in Australia? How should we? Aust N Z J Public Health. 2024;48(5):100187. doi:1016/j.anzjph.2024.100187
Williams CR, Webb CE, Higgs S, van den Hurk AF. Japanese encephalitis virus emergence in Australia: public health importance and implications for future surveillance. Vector Borne Zoonotic Dis. 2022;22(11):529-534. doi:1089/vbz.2022.0037
Horwood PF, McBryde ES, Peniyamina D, Ritchie SA. The Indo-Papuan conduit: a biosecurity challenge for Northern Australia. Aust N Z J Public Health. 2018;42(5):434-436. doi:1111/1753-6405.12808
Smith MJ, Upshur REG. Ebola and learning lessons from moral failures: who cares about ethics? Public Health Ethics. 2015;8(3):305-318. doi:1093/phe/phv028
Rowe SL, Stephens N, Cowie BC, Nolan T, Leder K, Cheng AC. Use of data linkage to improve communicable disease surveillance and control in Australia: existing practices, barriers and enablers. Aust N Z J Public Health. 2019;43(1):33-40. doi:1111/1753-6405.12846
Productivity Commission. Data Availability and Use: Overview & Recommendations, Report No. 82. Canberra: Productivity Commission, 2017. https://www.pc.gov.au/inquiries/completed/data-access/report/data-access-overview.pdf. Accessed February 13, 2025.
Jutla A, Whitcombe E, Hasan N, et al. Environmental factors influencing epidemic cholera. Am J Trop Med Hyg. 2013;89(3):597-607. doi:4269/ajtmh.12-0721
van Panhuis WG, Paul P, Emerson C, et al. A systematic review of barriers to data sharing in public health. BMC Public Health. 2014;14:1144. doi:1186/1471-2458-14-1144
Weeramanthri T. Queensland Public Health Review: Final Report. Queensland Health; 2023. https://www.health.qld.gov.au/__data/assets/pdf_file/0029/1216487/qld-public-health-review-finalreport.pdf. Accessed February 13, 2025.
NSW Public Health Training Program 2024. Centre for Epidemiology and Evidence. https://www.nmhs.health.wa.gov.au/Health-Professionals/Boorloo-PHU/Training-program. Update August 29, 2024. Accessed February 13, 2025.
Burnet Institute. The Victorian Public Health Training Scheme: The Melbourne Consortium. https://www.burnet.edu.au/media/zzvbdky1/vphmts-melbourne-corsortium-description_2025.pdf. Accessed February 13, 2025.
Noth Metropolitan Health Service. Perth Public Health Officer Training Program. 2025. https://www.nmhs.health.wa.gov.au/Health-Professionals/Boorloo-PHU/Training-program. Updated January 17, 2025. Accessed February 13, 2025.