Syncing Strategy and Execution: A Systematic Review of Public Health Preparedness Policy Implementation

Background: The gap between public health preparedness and response policies and their practical implementation remains a critical challenge in global health security. This systematic review synthesizes evidence on barriers to effective policy implementation and identifies strategies for bridging this policy-practice gap. Methods: We systematically searched six electronic databases for peer-reviewed studies published between 2000 and 2023 focusing on the implementation of public health preparedness and response policies. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and AMSTAR-2. Results: Of 2,456 initially identified studies, 87 met the inclusion criteria. Studies addressed various public health emergencies, including infectious disease outbreaks (n=41, 47.1%), natural disasters (n=23, 26.4%), and man-made disasters (n=8, 9.2%). Key barriers to policy implementation included organizational factors (76 studies, 87.4%), resource constraints (72 studies, 82.8%), and communication challenges (68 studies, 78.2%). Promising strategies for bridging the gap included adaptive management approaches (38 studies, 43.7%), participatory policy development (35 studies, 40.2%), and integrated information systems (31 studies, 35.6%). Only 23 studies (26.4%) were assessed as high quality, with limited quantitative evidence on strategy effectiveness. Conclusions: While several promising strategies for bridging the policy-practice gap have been identified, there is a critical need for more rigorous evaluations of their effectiveness. Future research should focus on organizational reforms, flexible resource allocation, and leveraging emerging technologies to enhance policy implementation in public health preparedness and response.