Why have some health systems coped better than others during the COVID-19 pandemic? Some answers might become clear if we could assess how resilient health systems are in response to crises or shocks, such as the current pandemic and other emergencies, including financial ones, or how well health systems were prepared for such events in the first place. The European Observatory on Health Systems and Policies has just published a new policy brief, “Strengthening health systems resilience”, which includes a framework to help policy-makers understand health system resilience and how to strengthen it. This policy brief highlights the key features of resilience and provides examples of strategies which have been applied in different countries.
While policy-makers are often consumed by the urgent day-to-day stresses of running a health system, the COVID-19 pandemic has reminded everyone of the importance of longer-term planning and preparedness. With this awareness comes the need to better understand health systems’ strengths and vulnerabilities and how to respond resiliently to the outbreak, particularly in the face of the influenza season, economic impacts and potential resurgence of COVID-19 cases.
Stages of a shock cycle
The authors of the brief reviewed the literature on strategies for strengthening health system resilience and for responding to system shocks, as well as emerging evidence from national responses to the COVID-19 pandemic. They then mapped those strategies to the key health system functions: governance, financing, resources and service delivery. They also indicated in which stages of a shock cycle – 1) preparedness, 2) shock onset and alert, 3) shock impact and management, and 4) recovery and learning – these resilience-enhancing strategies are likely to be the most effective. Which strategies should be pursued depends on the type of shock (e.g. financial crash, pandemic, climate event), its severity, the stage in the shock cycle, and the specific country context.
Shocks are dynamic in nature: one shock can cause a legacy of health system weakness or lead to another shock. But recovery from one shock can also inform preparedness for another, and the experiences of different countries and systems hold important lessons for decision-makers. It is important for policy-makers to review their health systems regularly, to assess their resilience and address weaknesses. Understanding the pathways of different shocks can also help policy-makers prepare for shocks and their fallout, and manage them better when they occur. General health system strengthening will do much to help countries prepare for and withstand shocks. Nevertheless, targeting specific weak areas may help both system resilience and overall health system performance.
What is health systems resilience?
The application of the concept of resilience is far from new and relates to multiple areas, ranging from physics to human psychology. Over the past 2 decades, the concept has become relevant in relation to societal response to health emergencies and major societal shocks. While acknowledging the breadth of the concept, for operational (and assessment) purposes we propose using a definition that focuses on shocks, which we consider to be sudden and extreme changes which will impact on a health system. We define resilience as the ability to prepare for, manage (absorb, adapt and transform) and learn from shocks. Ideally, resilience is not about bouncing back to the pre-shock state but about evolving into something better.