Building resilient health systems: a proposal for a resilience index

Kruk, Margaret E; Ling, Emilia J.; Bitton, Asaf; Cammett, Melani; Cavanaugh, Karen; Chopra, Mickey; El‐Jardali, Fadi; Macauley, Rose; Muraguri, Mwihaki Kimura; Konuma, Shiro; Marten, Robert; Martineau, Fred; Myers, Michael; Rasanathan, Kumanan; Ruelas, Enrique; Soucat, Agnès; Sugihantono, Anung; Warnken, Heiko

doi:10.1136/bmj.j2323

Cited by 196 publications

(285 citation statements)

References 30 publications

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“…It has also led to calls for major international investment in the region to help build robust, responsive, trustworthy, and efficient health systems. [8, 24, 25, 28, 34] This is no easy task but is the best insurance against another uncontained outbreak.…”

Section: Discussionmentioning

confidence: 99%

“…[6–8] While the complexity and centrality of social, political, and economic factors in the West African EVD outbreak and its death toll must be acknowledged, it is important to also carefully examine what happened at the level of patient care. There has been scant empirical evidence to document the unprecedented challenges faced by clinicians and decision-makers in Ebola treatment units (ETUs) in Sierra Leone, Guinea, and Liberia.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study

et al. 2018

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BackgroundDuring the 2013–2016 West Africa Ebola outbreak, supportive care was the only non-experimental treatment option for patients with Ebola virus disease (EVD). However, providing care that would otherwise be routine for most clinical settings in the context of a highly contagious and lethal pathogen is much more challenging. The objective of this study was to document and deepen understanding of barriers to provision of supportive care in Ebola treatment units (ETUs) as perceived by those involved in care delivery during the outbreak.MethodsThis qualitative study consisted of 29 in-depth semi-structured interviews with stakeholders (decision-makers, physicians, nurses) involved in patient care delivery during the outbreak. Analysis consisted of interview debriefing and team-based transcript coding in NVivo10 software using thematic analysis.FindingsParticipants emphasized three interconnected barriers to providing high-quality supportive care during the outbreak: 1) lack of material and human resources in ETUs; 2) ETU organizational structure limiting the provision of supportive clinical care; and 3) delayed and poorly coordinated policies limiting the effectiveness of global and national responses. Participants also noted the ethical complexities of defining and enacting best clinical practices in low-income countries. They noted tension between, on one hand, scaling up minimal care and investing in clinical care preparedness to a level sustainable in West Africa and, on the other, providing a higher level of supportive care, which in low-resource health systems would require important investments.ConclusionOur findings identified potentially modifiable barriers to the delivery of supportive care to patients with EVD in West Africa. Addressing these in the inter-outbreak period will be useful to improve patient care and outcomes during inevitable future outbreaks. Promoting community trust and engagement through long-term capacity building of the healthcare workforce and infrastructure would increase both health system resilience and ability to handle other outbreaks of emerging diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study

et al. 2018

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“…According to Kruk et al, 8 resilience in healthcare is a relatively new concept. A systematic review published in 2020, examined how resilient healthcare is conceptualised, described and interpreted in the published literature.…”

Section: Refection On Our Leadership During Covid-19: Challenging Ourmentioning

confidence: 99%

Refection on our leadership during COVID‐19: challenging our resilience

Hill

Butnoris

Dowling

et al. 2020

Pharmacy Practice and Res

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“…Resilience and intersectionality are principles to accelerate the achievements of universal health coverage (UHC) [1]. Health system resilience refers to "the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises, maintain core functions when a crisis appears and, based on lessons learned, reorganize the health system as needed" [2]. Resilience is not only about quality of health services, coverage, equity or nancial protection.…”

Section: Introductionmentioning

confidence: 99%

“…The global health agenda for 2030 emphasizes the importance of gender roles, SRH, the mitigation of climate emergencies, and the ways in which they interact with each other which are often the root cause of the disease burden of populations [9,10]. Health system resilience begins by measuring critical capacities ahead of a crisis [2]. The government of Colombia has been an advocate of health system strengthening to promote resilience and adaptation with robustness during the Zika outbreak.…”

Section: Introductionmentioning

confidence: 99%

Zika outbreak, resilient health systems, and women’s sexual and reproductive health: a qualitative study in Colombia

Rivillas

Forero-Martínez

Calderón‐Jaramillo

et al. 2020

Preprint

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Background There is substantial evidence of the profound consequences of Zika on women's Sexual and Reproductive Health. Health system resilience begins by measuring critical capacities ahead of a crisis such as Zika outbreak. Even though Zika as vector-borne disease is well documented, there is dearth of studies linking Zika with women's Sexual and Reproductive Health. The main objective of this study was to analyze the national response to the Zika epidemic and its relation to women’s sexual and reproductive health matters through key implementation mechanisms in order to promote resilience of the health system in five cities in Colombia.Methods This study used a qualitative design to enable an in-depth exploration of the national response to the Zika epidemic and sexual and reproductive health matters through key implementation mechanisms (based on facilitators and gaps) within the health system. The overall data set was comprised of 31 semi-structured individual interviews (23 women and 8 men), 25 interviews with key informants responsible for the implementation of the Zika Virus Response Plan; six interviews with pregnant women diagnosed with Zika; and five focus groups discussions with communities (n=122 participants) in five cities in Colombia: Barranquilla, Cucuta, Los Patios, San Andres and Soledad. Results The findings revealed the three major facilitators that promoted the implementation of actions to address the Zika epidemic: i) the role of health care providers; ii) the development of technical equipment capabilities; and iii) inter-institutional coordination. The study also identified implementation gaps: i) absence of a human rights and sexual and reproductive health approach; ii) focus on territorial actions centered on mosquito management; and iii) limited attitudes, behaviors and knowledge at the community level.Conclusion This study provided a comprehensive insight of critical facilitating processes and gaps in the implementation of the government response during the Zika epidemic in Colombia. This study reveals that the lack of understanding of the intersection between gender, the Zika epidemic and Sexual and Reproductive Health limited the adoption, development and implementation of a more comprehensive responses to address the impact on women’s sexual and reproductive health.

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Building resilient health systems: a proposal for a resilience index

Cited by 196 publications

References 30 publications

Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study

Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study

Refection on our leadership during COVID‐19: challenging our resilience

Zika outbreak, resilient health systems, and women’s sexual and reproductive health: a qualitative study in Colombia

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