Institutional Capacity and Documented COVID-19 Response Among Romanian Public Health Directorates: A Reproducible Cross-Sectional Comparative Analysis

Background: The COVID-19 pandemic exposed substantial differences in the capacity of local public health authorities to adapt, coordinate, communicate, engage communities, and sustain essential public health functions. Methods: We conducted a secondary, institution-level cross-sectional analysis of the verified analytic dataset for 20 Romanian Public Health Directorates (PHDs), representing 20 of 42 county-level territorial units. The file contained structural variables, eight binary COVID-19 response indicators, four normalized components, and an equal-weight composite capacity–response index, but no repeated annual observations, five-domain resilience scores, source-document matrix, or coder-reliability records. Comparisons between counties with university medical centers (CU; n = 10) and counties without them (FU; n = 10) used Mann–Whitney U and Fisher’s exact tests with Holm correction. Results: CU institutions served larger populations and had more employees, larger total budgets, higher budget per capita, more previous-crisis experience, more documented COVID-19 measures, and a higher exploratory composite index. Staffing density did not differ significantly. Vaccination-center involvement and communication/education were more frequently documented in CU institutions after multiplicity correction. Bucharest, Iași, and Cluj illustrate meaningful within-group variation despite a shared university-center context. Conclusions: The available data support descriptive evidence of institutional disparities associated with university-center context, but do not support causal claims, a longitudinal five-domain resilience model, or conclusions about digital maturity. The findings point to practical priorities for PHD–university medical-center collaboration, bidirectional community engagement, systematic after-action review, transparent national data collection, and future instrument validation.