What is a Resilience in Healthcare System – Best Information?

The fragility of health systems has never been of greater interest—or importance—than at this moment, in the aftermath of the worst Ebola virus disease epidemic to date. The loss of life, massive social disruption, and the failure of even the most basic healthcare services demonstrate what happens when a crisis strikes, and healthcare systems are unprepared. This was not limited to West Africa; we saw it in Texas as well: the struggle to provide a coherent response and manage public sentiment (often manifested as fear) in a way that ensures disease does not spread while also allowing everyday life to continue. In other words, we observed a lack of resilience in healthcare system. This Viewpoint proposes a framework for resilient health systems and the characteristics that define them, based on insights from other fields that have adopted resilience as a practice.

What is Health system resilience?

Health system resilience is defined as the ability of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a problem occurs, and reorganize if conditions necessitate it. Health systems are resilient if they protect human life and produce positive health outcomes for all during and after a crisis. Resilient health systems can also provide everyday benefits and positive health outcomes. This dual benefit – improved performance in both good and bad times – has been dubbed the “resilience dividend.”

Response to a Crisis

Whether a disease outbreak or another disruption that increases demand for health care (for example, a natural disaster or a mass casualty event) necessitates both a vigorous public health response and a highly proactive and functional healthcare delivery system, these two systems must work in tandem during a crisis – and even before an emergency occurs.

Healthcare systems are complex adaptive systems, with resilience emerging as an emergent property rather than as a single dimension. Building resilience is thus context-dependent and iterative, necessitating advance assessments of system capacities and weaknesses, investments in vulnerable system components before a crisis, reinforcements during the emergency, and a post-crisis performance review. Moreover, resilience is not a static concept; for example, the speed one recovers from a problem is a crucial indicator of success.

The Ebola outbreak demonstrated that several prerequisites for resilience were lacking. The first of these prerequisites is an understanding of the global nature of severe health crises and clarity about the roles of actors at all levels of the global health system. Although national governments are fundamentally responsible for their healthcare systems, they must mobilize the full range of local actors and, if necessary, quickly draw on external resources.

A global resilience network is a moral imperative and acknowledges that pathogens do not respect borders. Shocks to a country’s healthcare system can reverberate across regions and the globe. As a result, health system resilience is a global public good that requires a collective response from the worldwide community. This response can be funded through traditional domestic and donor sources or, as recently proposed, through a new international health systems fund to which all countries contribute.

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