Trust and transformation: an agenda for creating resilient and sustainable health systems

Kluge, Hans; Azzopardi-Muscat, Natasha; Figueras, Josep; McKee, Martin

doi:10.1136/bmj.p651

Cited by 7 publications

(7 citation statements)

References 11 publications

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“…The global “crisis of trust” that has followed the COVID-19 pandemic is representative of a long standing issue affecting FCAS [ 79 ], including: community mistrust towards government health institutions and their capacity to respond to the community’s needs [ 41 , 51 , 54 , 60 , 65 , 66 ]; international organisations’ mistrust towards local institutions triggered by a lack of transparency while managing crises [ 49 ]; and government and citizens scepticism towards international organisations vis-à-vis allocating funds, prioritising actions, and managing resources [ 50 , 65 ]. Trust building is a key action to enable resilience, and CHWs, as an interface between communities and health institutions, could be key to enhancing trust-building efforts.…”

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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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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“…A trusting relationship is, inevitably, preferable to one characterised by distrust. In health systems, trust can be seen to underpin at least three important sets of relationships, while recognising the importance of other forms of relationships to the functioning of health systems [ 19 ].…”

Section: Main Textmentioning

confidence: 99%

Meeting the challenges of the 21st century: the fundamental importance of trust for transformation

McKee,

van Schalkwyk,

Greenley

2024

Isr J Health Policy Res

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Background This paper is one of a collection on challenges facing health systems in the future. One obvious challenge is how to transform to meet changing health needs and take advantage of emerging treatment opportunities. However, we argue that effective transformations are only possible if there is trust in the health system. Main body We focus on three of the many relationships that require trust in health systems, trust by patients and the public, by health workers, and by politicians. Unfortunately, we are seeing a concerning loss of trust in these relationships and, for too long, the importance of trust to health policymaking and health system functioning has been overlooked and under-valued. We contend that trust must be given the attention, time, and resources it warrants as an indispensable element of any health system and, in this paper, we review why trust is so important in health systems, how trust has been thought about by scholars from different disciplines, what we know about its place in health systems, and how we can give it greater prominence in research and policy. Conclusion Trust is essential if health systems are to meet the challenges of the 21st century but it is too often overlooked or, in some cases, undermined.

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“…These problems are exacerbated by the unreliability of obsolete or poorly maintained equipment and the high costs of locum or agency staff 28. Put simply, if staff and equipment are already working at almost full capacity, it is impossible to reduce their numbers and ultimately further reduce expenditures while ensuring complex packages of care can be assembled at the right time in the right place 36…”

Section: Efficiency Gains Are Only Marginalmentioning

confidence: 99%

“…Based on figure 1, for example, we estimate that NHS pay rates would need to increase by around 15% in 2023 to bring health worker salaries in line with the purchasing power NHS staff enjoyed in 2011. If the NHS is to avoid further reduction in the volume and quality of care it has only one viable option: a profound and sustained investment and transformation to build up a system that is fit for purpose and that can restore the trust that has been lost in the past decade 36. This will require not only higher spending levels today but also higher year-on-year growth in spending that more closely reflects what is happening in the wider economy.…”

Section: Nhs Requires More Funding To Raise Pricesmentioning

confidence: 99%

How inflation threatens the NHS and what policy makers can do about it

Rigby

Nacer

Field

et al. 2023

BMJ

Self Cite

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Trust and transformation: an agenda for creating resilient and sustainable health systems

Cited by 7 publications

References 11 publications

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

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

Meeting the challenges of the 21st century: the fundamental importance of trust for transformation

How inflation threatens the NHS and what policy makers can do about it

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