 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2021, vol. 27, issue4
Subject Area: Medicine
-
DOI: 10.5272/jimab.2021274.4060
Published online: 25 October 2021
Review article
J of IMAB. 2021 Oct-Dec;27(4):4060-4067
HEALTH SYSTEM RESILIENCE: REVIEW OF THE CONCEPT AND A FRAMEWORK FOR ITS UNDERSTANDING
Maria Rohova
, Stefka Koeva,
Department of Health Economics and Management, Faculty of Public Health, Medical University-Varna, Bulgaria.
ABSTRACT:
Resilience and capacity for resilience is an emerging concept in health system governance and a comparatively new dimension of health systems performance, an area in which health policy faces problems and challenges not sufficiently explored. Although it has been attracting significant attention, the conceptualization of health system resilience that goes beyond the normative interpretation of the construct is still not well developed.
The aim of the study is to review the concept of health system resilience and to extend the existing understanding in the context of health system governance. Drawing on the results of our review, we propose a framework for health system resilience.
The review shows that resilience is grasped as a property in the context of the health system as a complex adaptive system. Moreover, resilience is contextual; it is highly context-dependent and path-dependant. It refers to the dynamics of the system and reflects the changing environment. Resilience is interpreted as the capacity of the health system to resist shocks and disturbances and to anticipate, withstand and respond to crises, i.e. to maintain its core functions, which is related to the abilities to absorb shocks and stresses, adapt to changes and transform its structures and institutions. Our proposed framework builds on and extends the existing knowledge and core frameworks, identifying three types of mechanisms (compensatory, adaptive and transformative) that help the system to maintain short- and long-term resilience. The framework can advance the understanding of the health system resilience and guide actions to strengthen health systems.
Keywords: health system, resilience, framework, concept,
- Download FULL TEXT /PDF 690 KB/
Please cite this article as: Rohova M, Koeva S. Health system resilience: Review of the concept and a framework for its understanding. J of IMAB. 2021 Oct-Dec;27(4):4060-4067. DOI: 10.5272/jimab.2021274.4060
Correspondence to: Maria Rohova, Department of Health Economics and Management, Faculty of Public Health, Medical University – Varna; 55, Marin Drinov Str., Varna, Bulgaria; E-mail: mariarohova@abv.bg
REFERENCES:
1. Thomas S, Keegan C, Barry S, Layte R, Jowett M, Normand C. A framework for assessing health system resilience in an economic crisis: Ireland as a test case. BMC Health Serv Res. 2013 Oct 30;13:450. [PubMed]
2.Glonti K, Gordeev VS, Goryakin Y, Reeves A, Stuckler D, McKee M, et al. A systematic review on health resilience to economic crises. PLoS One. 2015 Apr 23;10(4):e0123117. [PubMed]
3.Witter S, Hunter B. Resilience of health systems during and after crises – what does it mean and how can it be enhanced? ReBUILD Research Programme Consortium; 2017. [Internet]
4.Massuda A, Hone T, Leles FAG, de Castro MC, Atun R. The Brazilian health system at crossroads: progress, crisis and resilience. BMJ Glob Health. 2018 Jul 3;3(4):e000829. [PubMed]
5.Kamal-Yanni M. Never again. Building resilient health systems and learning from the Ebola crisis. Oxford: OXFAM; 2015. [Internet]
6. Kieny MP, Dovlo D. Beyond Ebola: a new agenda for resilient health systems. Lancet. 2015 Jan 10;385(9963):91-2. [PubMed]
7.Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015 May 9;385(9980):1910-2. [PubMed]
8.Martineau FP. People-centred health systems: building more resilient health systems in the wake of the Ebola crisis. Int Health. 2016 Sep;8(5):307-9. [PubMed]
9.Ling EJ, Larson E, MacAuley RJ, Kodl Y, Vandebogert B, Baawo S, Kruk ME. Beyond the crisis: did the Ebola epidemic improve resilience of Liberia's health system? Health Policy Plan. 2017 Nov 1;32(suppl_3):iii40-7. [PubMed]
10.Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K, et al. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan. 2018 Apr 1;33(3):355-367. [PubMed]
11.Kutzin J, Sparkes SP. Health systems strengthening, universal health coverage, health security and resilience. Bull World Health Organ. 2016 Jan 1;94(1):2. [PubMed]
12.World Health Organisation/WHO. Regional Office for Europe. Building resilience: a key pillar of Health 2020 and the Sustainable Development Goals: examples from the WHO Small Countries Initiative. Geneva: WHO; 2017. [Internet]
13.Thomas S, Sagan A, Larkin J, Cylus J, Figueras J, Karanikolos M. Strengthening health system resilience: Key concepts and strategies. Health system and policy analysis. Policy brief 36. Copenhagen: WHO Regional Office for Europe, European Observatory on Health Systems and Policies; 2020. [Internet]
14.Grimm PY, Oliver S, Merten S, Han WW, Wyss K. Enhancing the understanding of resilience in health systems of low- and middle-income countries: A qualitative evidence synthesis. Int J Health Policy Manag. 2021 Jan 16 (in press);1-13. [PubMed]
15.World Health Organisation/WHO. World Health Assembly. Resolution 64.10. Strengthening national health emergency and disaster management capacities and resilience of health systems. WHO; 2011. [Internet]
16.Organisation of Economic Co-operation and Development/OECD. Guidelines for resilience systems analysis. Paris: OECD Publishing; 2014. [Internet]
17.Organisation of Economic Co-operation and Development/OECD. How resilient were OECD health care systems during the "refugee crisis"? Migration Policy Debates, No. 17. Paris: OECD Publishing; 2018.
18.European Commission. Communication on effective, accessible and resilient health systems. Brussels: European Commission; 2014; COM(2014) 215 final. [Internet]
19. Koeva S, Rohova M. Health system resilience: Concept development. J of IMAB. 2020 Jul-Sep; 26(3):3251-3258. [Crossref]
20.Bcheraoui CE, Weishaar H, Pozo-Martin F, Hanefeld J. Assessing COVID-19 through the lens of health systems' preparedness: time for a change. Global Health. 2020 Nov 19;16(1):112. [PubMed]
21.Legido-Quigley H, Asgari N, Teo YY, Leung GM, Oshitani H, Fukuda K et al. Are high-performing health systems resilient against the COVID-19 epidemic? Lancet. 2020 Mar 14;395(10227):848-850. [PubMed]
22.Eyles J, Harris B, Fried J, Govender V, Munyewende P. Endurance, resistance and resilience in the South African health care system: case studies to demonstrate mechanisms of coping within a constrained system. BMC Health Serv Res. 2015 Sep 29;15:432. [PubMed]
23.Witter S, Wurie H, Chandiwana P, Namakula J, So S, Alonso-Garbayo A, et al. How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia. Health Policy Plan. 2017 Nov 1;32(suppl_3):iii3-13. [PubMed]
24.Campbell J, Cometto G, Rasanathan K, Kelley E, Syed S, Zurn P, et al. Improving the resilience and workforce of health systems for women's, children's, and adolescents' health. BMJ. 2015 Sep 14;351:h4148. [PubMed]
25.Kruk ME, Kujawski S, Moyer CA, Adanu RM, Afsana K, Cohen J et al. Next generation maternal health: external shocks and health system innovations. Lancet. 2016 Nov 5;388(10057):2296-2306. [PubMed]
26.Shrivastava SR, Shrivastava PS, Ramasamy J. Ensuring health system resilience following a public health emergency. Ann Trop Med Public Health. 2017;10:282-3. [Crossref]
27.Naimoli J, Saxena S. Realizing their potential to become learning organizations to foster health system resilience: opportunities and challenges for health ministries in low- and middle-income countries. Health Policy Plan. 2018 Dec 1;33(10):1083-1095. [PubMed]
28.Gilson L, Barasa E, Nxumalo N, Cleary S, Goudge J, Molyneux S, et al. Everyday resilience in district health systems: emerging insights from the frontlines in Kenya and South Africa. BMJ Glob Health. 2017 Jun 2;2(2):e000224. [PubMed]
29.Barasa E, Mbau R, Gilson L. What is resilience and how can it be nurtured? A systematic review of empirical literature on organizational resilience. Int J Health Policy Manag. 2018 Jun 1;7(6):491-503. [PubMed]
30.Kruk ME, Ling EJ, Bitton A, Cammett M, Cavanaugh K, Chopra M, et al. Building resilient health systems: a proposal for a resilience index. BMJ. 2017 May 23;357:j2323. [PubMed]
31.Ammar W, Kdouh O, Hammoud R, Hamadeh R, Harb H, Ammar Z, et al. Health system resilience: Lebanon and the Syrian refugee crisis. J Glob Health. 2016 Dec;6(2):020704. [PubMed]
32.Razum O, Bozorgmehr K. Refugee migration to Germany: did the health system show resilience? Eur J Public Health. 2017 Nov;27(suppl_3). [Crossref]
33.Alameddine M, Fouad FM, Diaconu K, Jamal Z, Lough G, Witter S, Ager A. Resilience capacities of health systems: accommodating the needs of Palestinian refugees from Syria. SocSci Med. 2019 Jan;220:22-30. [PubMed]
34.Ager AK, Lembani M, Mohammed A, Ashir GM, Abdulwahab A, de Pinho H, et al. Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building. Confl Health. 2015 Oct 5;9:30. [PubMed]
35.Ridde V, Lechat L, Meda IB. Terrorist attack of 15 January 2016 in Ouagadougou: how resilient was Burkina Faso's health system? BMJ Glob Health. 2016 Jul 7;1(1):e000056. [PubMed]
36.Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ. 2001 Sep 15;323(7313):625-8. [PubMed]
37.Savigny D, de. Adam T. (Eds.). Systems thinking for health systems strengthening. Alliance for Health Policy and Systems Research, WHO; 2009. [Internet]
38.Pourbohloul B, Kieny MP. Complex systems analysis: towards holistic approaches to health systems planning and policy. Bull World Health Organ. 2011 Apr 1;89(4):242. [PubMed]
39.Paina L, Peters DH. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan. 2012 Aug;27(5):365-373. [PubMed]
40.Barasa EW, Cloete K, Gilson L. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening. Health Policy Plan. 2017 Nov 1;32(suppl_3):iii91-4. [PubMed]
41.Holland JH. Complex adaptive systems. Daedalus. 1992;121(1):17-30. [Internet]
42.Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. 2017 Aug 1;6(8):431-5. [PubMed]
43.Fridell M, Edwin S, von Schreeb J, Saulnier DD. Health system resilience: What are we talking about? A scoping review mapping characteristics and keywords. Int J Health Policy Manag. 2020 Jan 1;9(1):6-16. [PubMed]
44.Bene C, Godfrey Wood R, Newsham A, Davies M. Resilience: new utopia or new tyranny? Reflection about the potentials and limits of the concept of resilience in relation to vulnerability reduction programmes. Brighton: Institute of Development Studies; 2012. [Internet]
45.Rodin J. The resilience dividend: being strong in a world where things go wrong. New York: Public Affairs; 2014.
46.World Health Organisation/WHO. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: WHO; 2007. [Internet]
47.Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. PLoSCurr. 2012 Aug 22;4:e5028b6037259a. [PubMed]
48.Legido-Quigley H, Asgari-Jirhandeh N (Eds.). Resilient and people-centred health systems: progress, challenges and future directions in Asia. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 [Internet]
49.Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G et al. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ. 2017 Jul 1;95(7):537-9. [PubMed].
Received: 04 March 2021
Published online: 25 October 2021