Assessing retention of pandemic capacities from COVID-19 in humanitarian settings: A cross-sectional retrospective study of health workers in Honduras, Syria, and South Sudan.

The global health security landscape remains critically vulnerable to emerging pandemic threats. Humanitarian settings face particularly acute challenges in health workforce preparedness and response capabilities. Humanitarian settings have traditionally been left out of global health security and other health system strengthening investments. There is also a significant gap in the literature around building sustained health worker pandemic capacities in these challenging contexts. This novel study measured the retention or 'shelf-life' of perceived COVID-19 training benefits for health workers around knowledge, skills, and confidence to face future infectious disease threats. The Dynamic Sustainability Framework was used for conceptual framing. The study spanned three distinct humanitarian settings: Honduras, Syria, and South Sudan. Employing a cross-sectional, retrospective self-assessment design, 129 primary healthcare and community level health workers were surveyed in March-April 2024. Participants self-reported pandemic capacities on five-point Likert ratings across three time points - retrospective recall for pre- and post-training, and for present status, which was on average three years after training. Results demonstrated substantial increases post-training in self-reported knowledge (p < 0.001), skills (p < 0.001), and confidence (p < 0.001), and sustained or improved capacities at present (knowledge (p < 0.01), skills (p < 0.01), and confidence (p < 0.001)). Despite low access to ongoing training, resources, and support, 84.3% of health workers reported feeling prepared to face emergent disease risks (COVID-19 or other). The results call for further exploration of the individual, training-related, facility, and contextual factors affecting the capacity retention. Due to study design limitations, these results cannot be attributed to the trainings or generalized to all health workers in these countries. Still, this research contributes critical insights into the potential sustained benefits of frontline health workforce pandemic capacity building in humanitarian settings. Since capacities were retained despite limited ongoing training and support, targeted, sustained investments become crucial to preserve and enhance health security in the most fragile health systems.