Measuring integrated delivery of essential public health functions: a review of health systems and health security monitoring tools

Overview

Recent public health shocks, including the COVID-19 pandemic, have exposed persistent gaps in public health systems, particularly in routine monitoring and oversight. Essential Public Health Functions (EPHFs) are increasingly recognised as foundational to resilient, equitable, and people-centred health systems, yet current approaches to monitoring EPHFs remain fragmented across health system and health security frameworks. While countries routinely generate substantial data through existing monitoring mechanisms, these data are rarely organised to reflect the comprehensive, integrated delivery of EPHFs across health and allied sectors. 

This report examines key health system and health security measurement tools used in routine, voluntary, and emergency contexts, assessing their scope to support evaluation of public health functions and their integrated delivery. The analysis identifies strengths and gaps in current measurement approaches across EPHFs such as health promotion, disease prevention, health protection, public health emergency management and community engagement, highlighting the fragmented nature of existing tools and their variable capacity to reflect interconnections between functions. 

Drawing on available evidence and expert and stakeholder experiences, this report also provides practical guidance for country-level action to strengthen EPHF measurement and monitoring. Country examples and tools, including an adaptable checklist and example indicators, are provided to support more integrated and comprehensive assessment. 

This report is primarily intended for policy-makers, senior public health and emergency managers at national and subnational levels involved in planning, implementing, monitoring, and evaluating public health strategies, policies, plans and programmes, including those in ministries of health, national public health institutes, and sectors that influence population health.