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Seizing a narrowing policy window in a post-pandemic context, the OECD and the European Observatory on Health Systems and Policies, with support from the European Commission, developed a comprehensive methodology culminating in a handbook on "Strengthening Health Systems: A Practical Handbook for Resilience Testing." Inspired by stress tests in various sectors, this methodology was piloted in Finland, Greece, and Spain throughout 2023.
1. Health system resilience is key to coping with catastrophic events, such as the economic crisis and the coronavirus (COVID-19) pandemic, but there is much confusion about what resilience means, how to strengthen it and how to assess it.2. For operational and assessment purposes, and to foster a more consistent understanding and use of the key concepts, we adopt the following definitions of health system resilience and shock: - Health system resilience is the ability to prepare for, manage (absorb, adapt and transform) and learn from shocks.- Shock is a sudden and extreme change which impacts on a health system, and is thus different from the predictable and enduring health system stresses, such as population ageing. A shock cycle has four stages: Stage 1: Preparedness; Stage 2: Shock onset and alert; Stage 3: Shock impact and management; and Stage 4: Recovery and learning.3. Based on the existing literature and emerging evidence from the ongoing COVID-19 pandemic, we identify strategies for enhancing resilience and map them on to the key health systems functions: - Governance: effective and participatory leadership with strong vision and communication; coordination of activities across government and key stakeholders; an organizational learning culture that is responsive to crises; effective information systems and flows; and surveillance enabling timely detection of shocks and their impact.- Financing: ensuring sufficient monetary resources in the system and flexibility to reallocate and inject extra funds; ensuring stability of health system funding through countercyclical health financing mechanisms and reserves; purchasing flexibility and reallocation of funding to meet changing needs; and comprehensive health coverage.- Resources: appropriate level and distribution of human and physical resources; ability to increase capacity to cope with a sudden surge in demand; and motivated and well-supported workforce.- Service delivery: alternative and flexible approaches to deliver care.4. Assessing how each function is placed in terms of the strategies above can allow a country to identify the potential sources of vulnerability and plan for further action (to enhance resilience or the capacity to respond). Resilience can also be assessed after the crisis, providing an evaluation of the handling of the crisis.5. Assessment of health system resilience is crisis- and context-specific. It is important to employ a range of both quantitative and qualitative metrics that allow evaluation of particular aspects of health system resilience in order to provide a meaningful overall assessment.6. Analysing experiences of other countries provides useful lessons for policy-makers implementing resilience-enhancing strategies. It is particularly important to learn in the aftermath of the shock and make the link between recovering from the shock to preparedness for future shocks, which is an area often neglected once the health system returns to post-shock 'normality'.
Makes the case for systems thinking in an easily accessible form for a broad interdisciplinary audience, including health system stewards, programme implementers, researchers, evaluators, and funding partners.
Health system resilience is not an inevitable byproduct of any investment in health but must be intentionally programmed and developed with necessary input, investment and contextualization. This technical product aims to guide national, subnational and global health actors to operationalize the concept of health system resilience for advancement of universal health coverage, health security and ultimately better health for all. It supports the translation of relevant conceptual guidance and high-level recommendations into practical actions. The specific objectives are to: present a concise overview of the concept of health system resilience; provide a roadmap outlining practical and foundational steps for building health system resilience to be adapted to different contexts; share examples of actions and tools, including stakeholder roles, to support country application of the roadmap. The target audience for this work is the various stakeholders involved in strengthening health systems and public health including management of emergencies (from prevention and preparedness to response and recovery) and other public health challenges in countries. This ranges from the donors, policymakers and decision-makers at global, national and subnational levels to the implementing institutions and line managers of health system functions and services across the health system building blocks.
Since February 2020 the COVID-19 pandemic has strained health systems worldwide. This book explores the factors determining the ability of health systems to cope with and recover from a crisis, and therefore their level of resilience.
Properly performing health care systems require concepts and methods that match their complexity. Resilience engineering provides that capability. It focuses on a system’s overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. This book contains contributions from international experts in health care, organisational studies and patient safety, as well as resilience engineering. Whereas current safety approaches primarily aim to reduce the number of things that go wrong, Resilient Health Care aims to increase the number of things that go right.
In the devastation that follows a major disaster, there is a need for multiple sectors to unite and devote new resources to support the rebuilding of infrastructure, the provision of health and social services, the restoration of care delivery systems, and other critical recovery needs. In some cases, billions of dollars from public, private and charitable sources are invested to help communities recover. National rhetoric often characterizes these efforts as a "return to normal." But for many American communities, pre-disaster conditions are far from optimal. Large segments of the U.S. population suffer from preventable health problems, experience inequitable access to services, and rely on overburdened health systems. A return to pre-event conditions in such cases may be short-sighted given the high costs - both economic and social - of poor health. Instead, it is important to understand that the disaster recovery process offers a series of unique and valuable opportunities to improve on the status quo. Capitalizing on these opportunities can advance the long-term health, resilience, and sustainability of communities - thereby better preparing them for future challenges. Healthy, Resilient, and Sustainable Communities After Disasters identifies and recommends recovery practices and novel programs most likely to impact overall community public health and contribute to resiliency for future incidents. This book makes the case that disaster recovery should be guided by a healthy community vision, where health considerations are integrated into all aspects of recovery planning before and after a disaster, and funding streams are leveraged in a coordinated manner and applied to health improvement priorities in order to meet human recovery needs and create healthy built and natural environments. The conceptual framework presented in Healthy, Resilient, and Sustainable Communities After Disasters lays the groundwork to achieve this goal and provides operational guidance for multiple sectors involved in community planning and disaster recovery. Healthy, Resilient, and Sustainable Communities After Disasters calls for actions at multiple levels to facilitate recovery strategies that optimize community health. With a shared healthy community vision, strategic planning that prioritizes health, and coordinated implementation, disaster recovery can result in a communities that are healthier, more livable places for current and future generations to grow and thrive - communities that are better prepared for future adversities.
Public health emergencies continually reinforce the need for an integrated approach to health systems strengthening, underpinned by a public health approach, helping to build health systems resilience. As part of a collaboration between the USAID Office of the Health Systems and the WHO Integrated Health Services Department, a strategic meeting was convened on 14 April 2021. This had wide-ranging representation which included WHO Deputy Director-General, Executive leadership from USAID, IANPHI and WFPHA. The overarching aim was to examine this topic together and identify actionable steps to build an integrated approach to health system strengthening that brings together health security, humanitarian, disease-specific and life-course-specific programmes. The specific objectives of the meeting were to: facilitate strategic discussions on prevailing practices in health systems resilience for health protection and high-quality health services, to determine actionable next steps for global guidance; inform policy options for WHO, USAID and partners to maximize joint country support for health systems resilience; and identify immediate priorities for next steps following the meeting. To inform and support the proceedings of this meeting, complementary desk reviews were conducted to synthesise evidence, and inform the discussions and way forward. Together, this package consists of (i) a technical meeting report and (ii) two complementary desk reviews. The package was co-developed with and has received concurrence from the USAID Office of the Health Systems.
The COVID-19 pandemic has caused unprecedented disruption worldwide highlighting once again the interdependency of health and socioeconomic development, and the global lack of health systems resilience. Two years into the pandemic, most countries report sustained disruptions across service delivery platforms and health areas with a profound impact on health outcomes. The impact of these disruptions is magnified within marginalized communities and in countries experiencing protracted conflict. There is an urgent need to focus on recovery through investment in the essential public health functions (EPHFs) and the foundations of health systems with a focus on primary health care, and whole-of-government and -society engagement. The aim of this Research Topic is to gather, transfer and promote operationalization of key experiences from COVID-19 to inform global and country level recovery that better promote health; guide policy direction towards building health systems resilience; and thereby ensure economic and social prosperity. Experience with COVID-19 has demonstrated that traditional approaches to health system strengthening have failed to achieve the complementary goals of Universal Health Coverage (UHC) and health security with the divide between the most vulnerable and well-off only widening. Much of what had been learned from previous experiences such as Ebola in West Africa has not been widely applied. This has left health and economic systems vulnerable to 21 st century public health challenges, ranging from conflict and natural disasters to aging demographics and rising rates of non-communicable and communicable diseases and antimicrobial resistance. These challenges require intentional focus and investment as well as whole-of-government and -society engagement with health to build health system resilience. Greater action is needed to prevent the devastating effects of war and conflict on the health of the most vulnerable. This Research Topic will convene the knowledge and practices of leaders in public health, health systems, and humanitarian and development sectors. This is to ensure lessons from COVID-19 inform the recovery agenda and promote sustainable health and socioeconomic recovery for all. Lest we forget and find ourselves again unprepared and vulnerable in the face of an even greater threat.