Enablers and barriers to public health practice during COVID-19: Perspectives from local public leadership from across Canada.

OBJECTIVE: Our study investigates the efforts of local medical health officers during COVID-19 in Canada, with a focus on explicating enabling factors and barriers to effectively respond through local public health efforts. METHODS: We conducted 26 semi-structured interviews with local-level public health leadership from across Canada and analyzed the transcripts for salient facilitators and barriers to effective local public health practice using the Consolidated Framework for Implementation Research. RESULTS: Effective local-level public health practice was facilitated by efforts that potentiated synergistic efforts inside and outside of the public health sector, including trust, buy-in, and ample resources. Barriers to effective practice involved uncertainty associated with governance, human resources, and the complexity of the pandemic itself. CONCLUSION: Sustained coordinated efforts across organizations together with clear governance mandates are required for robust local emergency management.