Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

Saulnier, Dell D; Duchenko, Anna; Ottilie-Kovelman, Sierra; Tediosi, Fabrizio; Blanchet, Karl

doi:10.34172/ijhpm.2022.6659

Cited by 6 publications

(9 citation statements)

References 93 publications

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“…These results also add further credence to the importance of governance in resilience to health shocks 30. A growing body of scholarship argues for the central role of leadership and coordination in defining national-level COVID-19 responses; our findings emphasise the additionally critical role of subnational leadership and coordination 6 31–35. Capable leadership is likely especially important; in our qualitative results, local leadership was described as enabling other resilience capabilities by supporting the LGA team in carrying out response strategies (eg, by steering coordination bodies, coordinating local funding, and motivating PHC planners and health professionals to engage in demand-side adaptations to drive service utilisation).…”

Section: Discussionsupporting

confidence: 65%

What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria

Neill,

Peters,

Bello

et al. 2023

BMJ Glob Health

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IntroductionThe SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes. Identifying characteristics of high-performing local government areas (LGAs) can improve understanding of subnational health systems resilience.MethodsEmploying a sequential explanatory mixed-methods design, we quantitatively identified ‘positive deviant’ LGAs based on their speed of recovery of outpatient and antenatal care services to prepandemic levels using service volume data from Nigeria’s health management information system and matched them to comparators with similar baseline characteristics and slower recoveries. 70 semistructured interviews were conducted with LGA officials, facility officers and community leaders in sampled LGAs to analyse comparisons based on Kruk’s resilience framework.ResultsA total of 57 LGAs were identified as positive deviants out of 490 eligible LGAs that experienced a temporary decrease in PHC-level outpatient and antenatal care service volumes. Positive deviants had an average of 8.6% higher outpatient service volume than expected, and comparators had 27.1% lower outpatient volume than expected after the initial disruption to services. Informants in 12 positive deviants described health systems that were more integrated, aware and self-regulating than comparator LGAs. Positive deviants were more likely to employ demand-side adaptations, whereas comparators primarily focused on supply-side adaptations. Barriers included long-standing financing and PHC workforce gaps.ConclusionSufficient flexible financing, adequate PHC staffing and local leadership enabled health systems to recover service volumes during COVID-19. Resilient PHC requires simultaneous attention to bottom-up and top-down capabilities connected by strong leadership.

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Section: Discussionsupporting

confidence: 65%

What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria

Neill,

Peters,

Bello

et al. 2023

BMJ Glob Health

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“…The majority of HSR research in these contexts has been conducted in response to infectious disease outbreaks on government health systems, rather than explicitly investigating the compounding effects of multiple stressors (economic, societal, political) that determine fragility and instability. A recent review on the responses to acute shocks in FCAS conducted by Thu et al found similar results, with 42 of the 60 studies focused on infectious disease triggers [ 33 ].While some of the findings from FCAS echo what is described in LMICs in general, other results emerged as new and specific to these contexts [ 78 ].…”

Section: Discussionmentioning

confidence: 87%

“…In this sense, knowledge and awareness appear to be overlooked dimensions for HSR. The fundamental role of information sharing and establishing feedback loops within and across systems has been recognised as a key determinant of HSR during the COVID-19 pandemic [ 78 ]. In FCAS, identifying potential sources of information needs to be a diverse and inclusive process because of the multiplicity of actors involved, including communities and non-state actors [ 2 , 29 , 54 , 65 ].…”

Section: Discussionmentioning

confidence: 99%

Health systems resilience in fragile and conflict-affected settings: a systematic scoping review

Truppa,

Yaacoub,

Valente

et al. 2024

Confl Health

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Background Health systems resilience (HSR) research is a rapidly expanding field, in which key concepts are discussed and theoretical frameworks are emerging with vibrant debate. Fragile and conflict-affected settings (FCAS) are contexts exposed to compounding stressors, for which resilience is an important characteristic. However, only limited evidence has been generated in such settings. We conducted a scoping review to: (a) identify the conceptual frameworks of HSR used in the analysis of shocks and stressors in FCAS; (b) describe the representation of different actors involved in health care governance and service provision in these settings; and (c) identify health systems operations as they relate to absorption, adaptation, and transformation in FCAS. Methods We used standard, extensive search methods. The search captured studies published between 2006 and January 2022. We included all peer reviewed and grey literature that adopted a HSR lens in the analysis of health responses to crises. Thematic analysis using both inductive and deductive approaches was conducted, adopting frameworks related to resilience characteristics identified by Kruk et al., and the resilience capacities described by Blanchet et al. Results Thirty-seven studies met our inclusion criteria. The governance-centred, capacity-oriented framework for HSR emerged as the most frequently used lens of analysis to describe the health responses to conflict and chronic violence specifically. Most studies focused on public health systems’ resilience analysis, while the private health sector is only examined in complementarity with the former. Communities are minimally represented, despite their widely acknowledged role in supporting HSR. The documentation of operations enacting HSR in FCAS is focused on absorption and adaptation, while transformation is seldom described. Absorptive, adaptive, and transformative interventions are described across seven different domains: safety and security, society, health system governance, stocks and supplies, built environment, health care workforce, and health care services. Conclusions Our review findings suggest that the governance-centred framework can be useful to better understand HSR in FCAS. Future HSR research should document adaptive and transformative strategies that advance HSR, particularly in relation to actions intended to promote the safety and security of health systems, the built environment for health, and the adoption of a social justice lens.

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“…The observation that staff in several NGOs reported limited strategic oversite and mixed messaging reflects findings from global reviews on conflicting leadership strategies and funding priorities in LMICs during the pandemic [ 57 ]. Evidence was also not identified on health system resilience and there is a need for more research on this in crisis-affected settings to support more effective health system responses, leadership and decision-making [ 58 , 59 ]. Studies with crisis-affected populations, such as in Eastern Democratic Republic of Congo, have highlighted how violence, mobility restrictions, and resource availability impede access to services.…”

Section: Discussionmentioning

confidence: 99%

The effect of COVID-19 on the non-COVID health outcomes of crisis-affected peoples: a systematic review

Thompson,

Kyaw,

Singh

et al. 2024

Confl Health

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Background The COVID-19 pandemic posed considerable risks to populations affected by humanitarian crises in low- and middle-income countries (LMICs). However, there is limited understanding of how the pandemic may have affected non-COVID health outcomes among crisis-affected populations. Our aim was to examine the evidence on the impact of the COVID-19 pandemic on non-COVID-19 health outcomes for crisis-affected populations in LMICs. Methods A systematic review methodology was applied following PRISMA guidelines. Eligibility criteria were: crisis-affected populations in LMICS; COVID-19; and all health topics, except for sexual and reproductive health which was covered in a linked review. Five bibliographic databases and additional grey literature sources were searched. The search period was from 2019 to 31 July 2022. Eligible papers were extracted and analysed using a narrative synthesis approach based on the study objectives and relevant health access and systems frameworks. A quality appraisal was also conducted. Findings 4320 articles were screened, and 15 eligible studies were identified and included in this review. Ten studies collected health outcomes data. Eight related to mental health, which generally showed worse mental health outcomes because of the pandemic, and pandemic-related stressors were identified. Two studies assessed physical health outcomes in children, while none addressed physical health outcomes among adults. Nine studies reported on access to healthcare, revealing worse access levels due to the pandemic and noting key barriers to care. Seven studies reported on the impact on health systems, with key challenges including reduced and distorted health care funding, reduced staff capacity, interrupted medicines and supplies, weak information and mixed-messaging, and weak leadership. All fifteen studies on the social determinants of health, particularly highlighting the effect of increasing poverty, the role of gender, and food insecurity on health outcomes. The quality of papers was limited overall. Conclusion This review found some limited evidence indicating negative mental health effects, increased barriers to accessing care, damage to health systems and magnified impacts on the social determinants of health for crisis-affected people during the COVID-19 pandemic. However, the small number and limited quality of the studies make the overall strength of evidence quite weak.

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Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

Cited by 6 publications

References 93 publications

What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria

What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria

Health systems resilience in fragile and conflict-affected settings: a systematic scoping review

The effect of COVID-19 on the non-COVID health outcomes of crisis-affected peoples: a systematic review

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