Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria

Alameddine, Mohamad; Fouad, Fouad M.; Diaconu, Karin; Jamal, Zeina; Lough, Graham; Witter, Sophie; Ager, Alastair

doi:10.1016/j.socscimed.2018.10.018

Cited by 49 publications

(86 citation statements)

References 20 publications

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“…Finally, three qualitative studies considered national health system resilience. Ager et al (2015) assessed key barriers to the provision of responsive service in the context of Boko Haram in Nigeria, Alameddine et al (2019) assessed the resilience of Lebanon and Jordan’s health systems in the context of the Syrian crisis and Ling et al (2017) assessed the resilience of Liberia’s health system during the Ebola crisis. All three studies used semi-structured interviews with health professionals and other key health stakeholders for data collection, with Ling et al (2017) complementing these with focus group discussions.…”

Section: Resultsmentioning

confidence: 99%

Health system resilience: a literature review of empirical research

Biddle

Wahedi

Bozorgmehr

2020

Health Policy and Planning

118

189

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The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. While substantial effort has gone into the conceptualization of health system resilience, there has been no review of how the concept has been operationalized in empirical studies. We conducted an empirical review in three databases using systematic methods. Findings were synthesized using descriptive quantitative analysis and by mapping aims, findings, underlying concepts and measurement approaches according to the resilience definition by Blanchet et al. We identified 71 empirical studies on health system resilience from 2008 to 2019, with an increase in literature in recent years (62% of studies published since 2017). Most studies addressed a specific crisis or challenge (82%), most notably infectious disease outbreaks (20%), natural disasters (15%) and climate change (11%). A large proportion of studies focused on service delivery (48%), while other health system building blocks were side-lined. The studies differed in terms of their disciplinary tradition and conceptual background, which was reflected in the variety of concepts and measurement approaches used. Despite extensive theoretical work on the domains which constitute health system resilience, we found that most of the empirical literature only addressed particular aspects related to absorptive and adaptive capacities, with legitimacy of institutions and transformative resilience seldom addressed. Qualitative and mixed methods research captured a broader range of resilience domains than quantitative research. The review shows that the way in which resilience is currently applied in the empirical literature does not match its theoretical foundations. In order to do justice to the complexities of the resilience concept, knowledge from both quantitative and qualitative research traditions should be integrated in a comprehensive assessment framework. Only then will the theoretical ‘resilience idea’ be able to prove its usefulness for the research community.

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Section: Resultsmentioning

confidence: 99%

Health system resilience: a literature review of empirical research

Biddle

Wahedi

Bozorgmehr

2020

Health Policy and Planning

118

189

View full text Add to dashboard Cite

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“…Second, Area South’s experience confirms other studies' conclusions that response strategies do not linearly evolve from absorption through adaptation to transformation but are deployed at the same time. They may, as in this experience, address different stressors, or be deployed against the same stressor by different actors ( Kagwanja et al, 2020 ) or, as suggested here and by Alameddine et al (2019) , be relevant to different time horizons (with transformative strategies supporting more fundamental, longer-term change). Importantly, however, as previously noted ( Gilson et al, 2017 ), absorption of stress by individuals does not itself demonstrate the collective resilience entailed in EHSR.…”

Section: Discussionmentioning

confidence: 95%

“…These included the burdens borne by all staff in responding to change, possible opportunity costs in terms of PHC improvements and concerns about the Ideal Clinic program. Resilience, like institutional change, is, then, an emergent and dynamic process ( Alameddine et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…Everyday health system resilience (EHSR) has been proposed as the characteristic of complex, adaptive health systems that allows them to respond to chronic stress in ways that transform how they function ( Barasa et al, 2017 ). Prior explorations of EHSR ( Gilson et al, 2017 ; Kagwanja et al, 2020 ) are among the few empirical analyses of health system resilience (see also Alameddine et al, 2019 ). Their unusual organizational and institutional analysis ( Currie et al, 2012 ; Swanson et al, 2015 ) draws attention to the importance of understanding the health system capacities underpinning EHSR.…”

Section: Introductionmentioning

confidence: 99%

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Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

Gilson

Ellokor

Lehmann

et al. 2020

Social Science & Medicine

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This paper reports a study from Cape Town, South Africa, that tested an existing framework of everyday health system resilience (EHSR) in examining how a local health system responded to the chronic stress of large-scale organizational change. Over two years (2017–18), through cycles of action-learning involving local managers and researchers, the authorial team tracked the stress experienced, the response strategies implemented and their consequences. The paper considers how a set of micro-governance interventions and mid-level leadership practices supported responses to stress whilst nurturing organizational resilience capacities. Data collection involved observation, in-depth interviews and analysis of meeting minutes and secondary data. Data analysis included iterative synthesis and validation processes. The paper offers five sets of insights that add to the limited empirical health system resilience literature: 1) resilience is a process not an end-state; 2) resilience strategies are deployed in combination rather than linearly, after each other; 3) three sets of organizational resilience capacities work together to support collective problem-solving and action entailed in EHSR; 4) these capacities can be nurtured by mid-level managers’ leadership practices and simple adaptations of routine organizational processes, such as meetings; 5) central level actions must nurture EHSR by enabling the leadership practices and micro-governance processes entailed in everyday decision-making.

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“…It is also important to connect HSS, often conceptualised as a (donor funded) external intervention in a health system, to the wider literature on resilience and learning health systems, which identifies desirable general features for strong health systems such as adaptability, good collaborative mechanisms, and intelligence gathering . Such features can be fostered by, for example, staff commitment, community cohesion, and organizational flexibility . HSS that is driven by national and subnational authorities as part of their continuing efforts to improve health systems is likely to be more enduring, although it is less studied within LMICs.…”

Section: Assessing Hssmentioning

confidence: 99%

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Witter

Palmer

Balabanova

et al. 2019

Health Planning & Management

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Summary Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.

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Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria

Cited by 49 publications

References 20 publications

Health system resilience: a literature review of empirical research

Health system resilience: a literature review of empirical research

Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

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