Healthcare systems and public hospitals of the future: control and management of (re)emerging infectious diseases in the Brazilian context

"This project focuses on the changing role of hospitals within healthcare systems in the management of infectious and (re)emerging diseases (IEDs) in the post-covid era. We propose to approach this question by considering its interactions with a series of contemporary issues that go beyond (the walls of) the hospital: global economic, social, political and environmental crises. To our knowledge, this perspective is relatively understudied. Through this introductory contract, we begin an exploration of theoretical, methodological and epistemological paths that will best enable us to grasp these issues in interaction with hospitals and healthcare systems. We will also examine the way in which these complex, multi-dimensional dynamics impact hospitals and their work, by focusing on the analysis of the articulation between specialized hospitals and primary health care. We will reflect on the post-Covid period using the example of the reference hospitals of the Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro, Brazil's leading medical and research institution for infectious diseases. The Brazilian case is an exemplary case for initiating a wider reflection on the future of hospitals within healthcare systems on broader time horizons and scales (in a global health perspective). The country has been severely tested by Covid19 , and is experiencing a situation of socio-ecological instability that favors zoonotic emergence scenarios, as evidenced by the recent Zika and dengue epidemics. At the same time, the country continues to grapple with the persistence of older infectious diseases (HIV, tuberculosis) against a backdrop of extreme inequalities, limited public health resources and an unstable socio-economic and political situation. We'll be looking at the Evandro Chagas Infectious Diseases Hospital, built in 2020 in response to the Covid19 pandemic, and the Fernandes Figueira Institute, which specializes in women's, children's and adolescent health, and has an infectious diseases unit. How are the functions of epidemic surveillance and care of infectious patients being redefined at different levels? What hospital models are emerging to promote effective management of infectious risk in the post-covid context, and how do they project themselves into the future? To answer these questions, we will conduct two types of activity: - The application and translation, to the Brazilian context, of an analysis of the scientific and grey literature initiated as part of a scoping review currently being carried out as part of the "Hospitals of the Future" program at Ceped, through the mapping of key concepts and the organization of regular online working seminars with the Observatory of the History of Health team at the Casa de Oswaldo Cruz (COC) in Rio de Janeiro. - A multi-stakeholder workshop at the COC in the form of a "witness seminar" bringing together managers from these two hospitals, local and regional public health authorities and community organization leaders. The pilot project will enable the two teams, Ceped in Paris and the Observatoire de l'histoire de la santé de la COC in Rio de Janeiro, to strengthen, formalize and broaden their collaboration in order to formulate methodological and theoretical proposals for a multidisciplinary Franco-Brazilian research program, which could potentially include other countries. We define the following as its main objectives: to question the transformations of the "multiple hospital" confronted with plural and structural societal issues through its articulation with primary health care; to identify ethnographic inputs for a larger-scale program; and to test a formally new interdisciplinary and inter-institutional collaboration. A book in Portuguese will be published based on the compilation of data gathered during the seminar, and a journal article in English will report on the methodological process and its conceptual and theoretical scope."