Towards an understanding of resilience: responding to health systems shocks

Abstract

The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more ‘resilient’. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013–16; and the recent refugee and migration crisis in Europe. Based on this analysis, we identify ‘3 plus 2’ critical dimensions of particular relevance to health systems’ ability to adapt and respond to shocks; actions in all of these will determine the extent to which a response is successful. These are three core dimensions corresponding to three health systems functions: ‘health information systems’ (having the information and the knowledge to make a decision on what needs to be done); ‘funding/financing mechanisms’ (investing or mobilising resources to fund a response); and ‘health workforce’ (who should plan and implement it and how). These intersect with two cross-cutting aspects: ‘governance’, as a fundamental function affecting all other system dimensions; and predominant ‘values’ shaping the response, and how it is experienced at individual and community levels. Moreover, across the crises examined here, integration within the health system contributed to resilience, as does connecting with local communities, evidenced by successful community responses to Ebola and social movements responding to the financial crisis. In all crises, inequalities grew, yet our evidence also highlights that the impact of shocks is amenable to government action. All these factors are shaped by context. We argue that the ‘3 plus 2’ dimensions can inform pragmatic policies seeking to increase health systems resilience.

Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

“…Health system resilience was swiftly taken up within global health as a way to strengthen health systems, 4 focusing primarily on acute shocks to the health system, such as the Ebola outbreak and natural disasters. 19 This focus has broadened since to include health systems facing chronic stresses that continuously challenge the performance of the system or its ability to adapt. 20 However, specific suggestions on how health systems can become resilient to either acute shocks or chronic stress remain comparatively vague.…”

“…11 There is no common description of health system resilience at this stage. 19 In order to build resilient health systems, a better understanding of what it means and should contain is needed. 21 Clarifying the meaning of health system resilience could help establish a shared understanding of the concept among researchers and policy-makers.…”

Are high-performing health systems resilient against the COVID-19 epidemic?

“…2 The second is that the spread of fake news and misinformation constitutes a major unresolved challenge. The first is that integration of services in the health system and across other sectors amplifies the ability to absorb and adapt to shock.…”

“…2 The history-as-lessons approach pivots on the assumption that epidemics are structurally comparable events, wherever and whenever they take place. How can the past assist in the real-time management of the crisis?…”

Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia

“…3 A resilient health system has the capacity to continue providing health services when BMJ Global Health Figure 1 The dimensions of resilience governance framework by Blanchet et al 10 shocked, for both new health needs caused by the shock and routine health needs. [4][5][6] Floods are a typical example of a shock to this capacity. [7][8][9] The Dimensions of Resilience Governance framework (figure 1) posits that if a health system is able to integrate and process knowledge, anticipate and cope with uncertainty, manage interactions with other systems at multiple levels (interdependence) and create a socially and contextually accepted system (legitimacy), it is then capable of managing shocks.…”