# A Public Value Crisis Model Approach to COVID-19 Outbreak Control in the Dominican Republic

## TL;DR

A public value crisis model called #PlanDuarte was used in the Dominican Republic to control a severe early COVID-19 outbreak, showing measurable improvements in reducing case growth.

## Contribution

This study evaluates a public value crisis model's impact on controlling a severe early COVID-19 outbreak using interrupted time series analysis.

## Key findings

- Duarte Province's daily new cases significantly decreased after implementing #PlanDuarte (β3 = -1.63, p < 0.001).
- Epidemiological improvements were linked to increased testing, expanded hospital capacity, and better coordination.
- The intervention showed reduced epidemic growth compared to non-intervention provinces.

## Abstract

Background: COVID-19 exposed critical vulnerabilities in health systems worldwide. The Dominican Republic faced an early and severe outbreak in Duarte Province, necessitating rapid action. The government implemented a localized “Public Value Crisis Model,” known as #PlanDuarte, integrating public-private collaboration, epidemiological intelligence, and community engagement.

Objective: To evaluate whether #PlanDuarte was associated with measurable epidemiological improvements using Interrupted Time Series Analysis (ITSA), and to examine how public value principles informed crisis governance.

Methods: We analyzed daily COVID-19 data from March to December 2020 using segmented regression with Newey-West standard errors. Duarte Province (intervention site) was compared with all other provinces (non-intervention group). Data sources included the Ministry of Public Health registry. We assessed changes in trends for daily new cases following the lockdown and the implementation of public value-driven actions.

Results: Prior to the intervention, Duarte experienced a significant daily increase in cases (β1 = 0.88, p < 0.001). Following implementation, the post-intervention trend decreased significantly (β3 = -1.63, p < 0.001), unlike the non-intervention provinces. Epidemiological improvements corresponded with increased testing, expanded hospital capacity, and strengthened intersectoral coordination.

Conclusion: The intervention in Duarte Province was associated with reduced epidemic growth and strengthened system responsiveness. Rooted in public value theory, #PlanDuarte illustrates how coordinated, community-empowering governance structures can improve crisis outcomes. Results reflect temporal association rather than definitive causality and underscore the need for context-sensitive governance in middle-income settings.