A synthesis of concepts of resilience to inform operationalization of health systems resilience in recovery from disruptive public health events including COVID-19
Resilience; Health systems; Crisis; disruptive events; Public health; Integration; Essential public health functions
Abstract :
[en] Health systems resilience has become a ubiquitous concept as countries respond to and recover from crises such as the COVID-19 pandemic, war and conflict, natural disasters, and economic stressors inter alia. However, the operational scope and definition of health systems resilience to inform health systems recovery and the building back better agenda have not been elaborated in the literature and discourse to date. When widely used terms and their operational definitions appear nebulous or are not consistently used, it can perpetuate misalignment between stakeholders and investments. This can hinder progress in integrated approaches such as strengthening primary health care (PHC) and the essential public health functions (EPHFs) in health and allied sectors as well as hinder progress toward key global objectives such as recovering and sustaining progress toward universal health coverage (UHC), health security, healthier populations, and the Sustainable Development Goals (SDGs). This paper represents a conceptual synthesis based on 45 documents drawn from peer-reviewed papers and gray literature sources and supplemented by unpublished data drawn from the extensive operational experience of the co-authors in the application of health systems resilience at country level. The results present a synthesis of global understanding of the concept of resilience in the context of health systems. We report on different aspects of health systems resilience and conclude by proposing a clear operational definition of health systems resilience that can be readily applied by different stakeholders to inform current global recovery and beyond.
Disciplines :
Public health, health care sciences & services
Author, co-author :
McDarby, Geraldine
Seiffeldin, Redda
Zhang, Yu
Mustafa, Saqif
Petrova, Mila
Schmets, Gerard
Porignon, Denis ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique : aspects spécifiques
Dalil, Suraya
Saikat, Sohel
Language :
English
Title :
A synthesis of concepts of resilience to inform operationalization of health systems resilience in recovery from disruptive public health events including COVID-19
Bayntun C Rockenschaub G Murray V. A health system approach to all-hazards disaster managemenr: a systematic review. PLoS Curr. (2012) 4:e50081cad5861d. doi: 10.1371/5028b6037259a, PMID: 23066520
Kruk ME Myers M Varpilah ST Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. (2015) 385:1910–2. doi: 10.1016/S0140-6736(15)60755-3, PMID: 36854489
Parpia AS Ndeffo-Mbah ML Wenzel NS Galvani AP. Effects of response to 2014–2015 Ebola outbreak on deaths from malaria, HIV/AIDS and tuberculosis, West Africa. Emerg Infect Dis. (2016) 22:433–41. doi: 10.3201/eid2203.150977, PMID: 26886846
Brolin Ribacke KJ Saulnier DD Eriksson A von Schreeb J. Effects of the West Africa Ebola virus disease on health-care utilization-a systematic review. Front Public Health. (2016) 4:222. doi: 10.3389/fpubh.2016.00222, PMID: 27777926
WHO Health Services Resilience Team. Exploring health systems resilience in the context of disruptive emergencies: Taking forward an integrated approach to health systems strengthening. A working technical paper. Geneva: World Health Organization (2021).
Crosby S Dieleman JL Kiernan S Bollyky TJ. All bets are off for measuring pandemic preparedness. Think Global Health. (2020) Available at: https://www.thinkglobalhealth.org/article/all-bets-are-measuring-pandemic-preparedness
WHO Health Services Resilience Team. IHS. Taking forward an integrated approach to health systems and health security: Exploring resilience. Unpublished. Geneva: World Health Organization (2017).
World Health Organization. Health systems resilience toolkit: A WHO global public health good to support building and strengthening of sustainable health systems resilience in countries with various contexts. Geneva: World Health Organization (2022).
WHO Health System Resilience & Essential Public Health Functions Team. Health systems resilience indicators: Draft working document. A working technical document. Geneva: World Health Organization (2023).
World Health Organization and United Nations Children's Fund. Primary heallth care measurement framework and indicators: Monitoring health systems through a primary health care lens. Geneva: World Health Organization (2022).
Saunders B Sim J Kingstone T Baker S Waterfield J Bartlam B et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. (2018) 52:1893–907. doi: 10.1007/s11135-017-0574-8, PMID: 29937585
World Health Organization. Building health systems resilience for UHC and health security during the COVID-19 pandemic and beyond. Geneva: World Health Organization (2021).
Fridell M Edwin S von Schreeb J Saulnier D. Health system resilience: what are we talking about? A scoping review mapping characteristics and keywords1. Int J Health Policy Manag. (2020) 9:6–16. doi: 10.15171/ijhpm.2019.71, PMID: 31902190
Biddle L Wahedi K Bozorgmehr K. Health system resilience: a literature review of empirical research. Health Policy Plan. (2020) 35:1084–109. doi: 10.1093/heapol/czaa032, PMID: 32529253
Blanchet K Nam S Ramalingam B Pozo-Martin F. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. (2017) 6:431–5. doi: 10.15171/ijhpm.2017.36, PMID: 28812842
Jamal Z Alameddine M Diaconu K Lough G Witter S Ager A et al. Health system resilience in the face of crisis: analysing the challenges, strategies and capacities for UNRWA in Syria. Health Policy Plan. (2020) 35:26–35. doi: 10.1093/heapol/czz129, PMID: 31625558
Gilson L Barasa E Nxumalo N Cleary S Goudge J Molyneux S et al. Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa. BMJ Glob Health. (2017) 2:e000224. doi: 10.1136/bmjgh-2016-000224, PMID: 29081995
Barasa EW Cloete K Gilson L. From bouncing back, to nurturing emergence: a reframing the concept of resilience in health system strengthening. Health Policy Plan. (2017) 32:iii91–4. doi: 10.1093/heapol/czx118, PMID: 29149319
Martineau FP. People-centred health systems: building more resilient health systems in the wake of the Ebola crisis. Int Health. (2016) 8:307–9. doi: 10.1093/inthealth/ihw029, PMID: 27620922
European Observatory on Health Systems and Policies Covid-19 and health systems resilience: Lessons going forwards. Eurohealth (2020), 26, pp. 20–24.
Hanefeld J Mayhew S Legido-Quigley H Marrtineau F Karanikolos M Blanchet K et al. Towards and understanding of resilience: responding to health systems shocks. Health Policy Plan. (2018) 33:355–67. doi: 10.1093/heapol/czx183, PMID: 29325025
Tumusiime P Karamagi H Titi-Ofei R Amri M Seydi ABW Kipruto H et al. Building health system resilience in the context of primary health care revitalization for the attainment of UHC: proceedings from the fifth health sector Director's policy and Plannig meeting for the WHO African region. BMC Proc. (2020) 14:16. doi: 10.1186/s12919-020-00203-2, PMID: 33292240
Haldane V De Foo C Abdalla S Jung AS Tan M Wu S et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. (2021) 27:964–80. doi: 10.1038/s41591-021-01381-y, PMID: 34002090
Rogers H Barros PP De Maeseneer J Lehtonen L Lionis C McKee M et al. Resilience testing of health systems: how can it be done? Int J Environ Res Public Health. (2021) 18:4742. doi: 10.3390/ijerph18094742, PMID: 33946804
Burau V Falkenback M Neri S Peckham S Wallenburg I Kuhlman E. Health system resilience and health workforce capacities: comparing health system responses during the COVID-19 pandemic in six European countries. Int J Health Plann Manag. (2022) 37:2032–48. doi: 10.1002/hpm.3446, PMID: 35194831
Thomas S Keegan C Barry S Layte R Jowett M Normand C. A framework for assessing health system resilience in an economic crisis: Ireland as a test case. BMC Heallth Serv Res. (2013) 13:450. doi: 10.1186/1472-6963-13-450
Ghebreyesus TA Jakab Z Ryan MJ Mahjour J Dalil S Chungong S et al. WHO recommendations for resilient health systems. Bull World Health Organ. (2022) 100:240–240A. doi: 10.2471/BLT.22.287843
Kutzin J Sparkes SP. Health systems strengthening, universal health coverage, health security and resilience. Bull World Health Orgn. (2016) 94:2. doi: 10.2471/BLT.15.165050
Karamagi HC Titi-Ofei R Kipchumba Kipruto H Benitou-Wahebine Seydi A Droti B Talisuna A et al. On the resilience of health systems: a methodological exploration across countries in the WHO African region. PLos One. (2022) 17:e0261904. doi: 10.1371/journal.pone.0261904, PMID: 35130289
Forsgren L Tedios F Blanchet K Saulnier D. Health systems resilience in practice: a scoping review to identify strategies for building resilience. BMC Health Serv Res. (2022) 22:1173. doi: 10.1186/s12913-022-08544-8, PMID: 36123669
Chaberland-Rowe C Chiocchio F Bourgeault IL. Harnessing instability as an opportunity for health system strengthening: a review of resilience. Healthc Manage Forum. (2019) 32:128–35. doi: 10.1177/0840470419830105, PMID: 30971130
Rodin J. Accelerating action towards universal health coverage by applying a gender lens. Bull World Health Organ. (2013) 91:710–1. doi: 10.2471/BLT.13.127027, PMID: 24101789
Alameddine M Fouad FM Diaconu K Jamal Z Lough G Witter S et al. Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria. Soc Sci Med. (2019) 220:22–30.
Odhiambo J Jeffery C Lako R Devkota B Valadez JJ. Measuring health system resilience in a highly fragile nation during protracted conflict: South Sudan 2011-15. Health Policy Plan. (2020) 35:313–22.
Kruk ME Ling E Bitton A Cammet M Cavanaugh K Chopra M et al. Building resilient health systems: a proposal for a resilience index. BMJ. (2017) 357:j2323. doi: 10.1136/bmj.j2323, PMID: 28536191
Olu O. Resilient health system as conceptual framework for strengthening disaster risk management: an African viewpoint. Font Public Health. (2017) 5:263. doi: 10.3389/fpubh.2017.00263
Ammar W Kdouh O Hammoud R Hamadeh R Harb H Ammar Z et al. Health system resilience: Lebbanon and the Syrian refugee crisis. J Glob Health. (2016) 6:020704. doi: 10.7189/jogh.06.020704, PMID: 28154758
WHO Health System Resilience and Essential Public Health Functions Team. Health system resilience to public health challenges: Moving from concept to practice. Geneva Unpublished: WHO (2022).
Regional Committee for the Eastern Mediterranean. Building resilient health systems to advance universal health coverage and ensure health security in the eastern Mediterranean region. World Health Organization. Regional Office for the Eastern Mediterranean. (2022). Availalbe at: https://apps.who.int/iris/handle/10665/366621
World Health Organization. Report on Quality universal health coverage and resilience technical workshop. Convened by the WHO Service Delivery & Safety Department at the WHO Kobe Centre for Health Development Kobe. Geneva: World Health Organization (2016).
Parmet WE Rothstein MA. The 1918 Influenza Pandemic: Lessons Learned and Not-Introduction to the Special Section. Am J Public Health. (2018) 108:1435–6.
World Health OrganizationSheikh K Abimbola S. Alliance for Health Policy and Systems Research. Learning health systems: pathways to progress: flagship report of the Alliance for Health Policy and Systems Research. Geneva: World Health Organization (2021).
Foley T Fairmichael F. The potential of learning healthcare systems. S.l.: The Heallth foundation. Newcastle upon Tyne: Newcastle University, Institute of Health & Society (2015).
World Health Organization, United States Agency for International Development. Fostering resilience through integrated health system strengthening: technical meeting report. Geneva: World Health Organization (2021).
Bolongei M Ako-Egbe L Girmay A Saikat S Seifeldin R Mustafa S. Action brief: Operationalizing health systems resilience in Liberia and Ethiopia. Geneva: Health Services Learning Hub: World Health Organization (2021).
World Health Organization. Essential public health functions in Ireland: Perspectives to strengthen public health capacities and stewardship. Geneva: World Health Organisation (2022).
World Health Organization. 21st century health challenges: Can the essential public health functions make a difference? Geneva: World Health Organization (2021).
World Health Organization. Recovery toolkit: Supporting countries to achieve health service reseilience: A library of tools and resources available during the recovery period of a public health emergency. Geneva: World Health Organization (2016).