Re-Evaluating our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

Document Type : Review Article

Authors

1 Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden

2 Swiss Tropical and Public Health Institute, Basel, Switzerland

3 University of Basel, Basel, Switzerland

4 Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland

Abstract

Background 
Health challenges like COVID-19 are becoming increasingly complex, transnational, and unpredictable. Studying health system responses to the COVID-19 pandemic is an opportunity to enhance our understanding of health system resilience and establish a clearer link between theoretical concepts and practical ideas on how to build resilience.
 
Methods 
This narrative literature review aims to address four questions using a health system resilience framework: i) What do we understand about the dimensions of resilience? ii) What aspects of the resilience dimensions remain uncertain? iii) What aspects of the resilience dimensions are missing from the COVID-19 discussions? and iv) What has COVID-19 taught us about resilience that is missing? A scientific literature database search was conducted in December 2020 and in April 2022 to identify publications that discussed health system resilience in relation to COVID-19, excluding articles on psychological and other types of resilience. A total of 63 publications were included.
 

Results 
There is good understanding around information sharing, flexibility and good leadership, learning, maintaining essential services, and the need for legitimate, interdependent systems. Decision-making, localized trust, influences on interdependence, and transformation remain uncertain. Vertical interdependence, monitoring risks beyond the health system, and consequences of changes on the system were not discussed. Teamwork, actor legitimacy, values, inclusivity, trans-sectoral resilience, and the role of the private sector are identified as lessons from COVID-19 that should be further explored for health system resilience.
 

Conclusion 
Knowledge of health system resilience has continued to cohere following the pandemic. The eventual consequences of system changes and the resilience of subsystems are underexplored. Through governance, the concept of health system resilience can be linked to wider issues raised by the pandemic, like inclusivity. Our findings show the utility of resilience theory for strengthening health systems for crises and the benefit of continuing to refine existing resilience theory.

Keywords


  1. Tediosi F, Lonnroth K, Pablos-Mendez A, Raviglione M. Build back stronger universal health coverage systems after the COVID-19 pandemic: The need for better governance and linkage with universal social protection. BMJ Glob Health. 2020;5(10):e004020. doi:10.1136/bmjgh-2020-004020
  2. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: Time for a revolution. Lancet Glob Health. 2018;6(11):e1196-e1252. doi:10.1016/S2214-109X(18)30386-3
  3. Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s framework for action. WHO. 2007
  4. Bene C, Wood RG, Newsham A, Davies M. IDS Working Paper 405. Resilience: New utopia or new tyranny? Reflection about the potentials and limits of the concept of resilience in relation to vulnerability reduction programmes. Institute of Development Studies. 2012.
  5. 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;6(8):5. doi:10.15171/IJHPM.2017.36
  6. Abimbola S, Negin J, Martiniuk AL, Jan S. Institutional analysis of health system governance. Health Policy Plan. 2017;32(9):1337-1344. doi:10.1093/heapol/czx083
  7. Popay J, Roberts H, Sowden A, et al. Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme. Southhampton, UK; 2006.
  8. Legido-Quigley H, Asgari N, Teo YY, et al. Are high-performing health systems resilient against the COVID-19 epidemic? Lancet. 2020;395(10227):848-850. doi:10.1016/S0140-6736(20)30551-1
  9. Sheehan MC, Fox MA. Early warnings: The lessons of COVID-19 for public health climate preparedness. Int J Transgend Health. 2020;50(3):264-270. doi:10.1177/0020731420928971
  10. Chua AQ, Tan MMJ, Verma M, et al. Health system resilience in managing the COVID-19 pandemic: Lessons from Singapore. BMJ Glob Health. 2020;5(9):e003317. doi:10.1136/bmjgh-2020-003317
  11. Meyer C, Becot F, Burke R, Weichelt B. Rural telehealth use during the COVID-19 pandemic: How long-term infrastructure commitment may support rural health care systems resilience. J Agromedicine. doi:10.1080/1059924X.2020.1814921
  12. O’Sullivan B, Leader J, Couch D, Purnell J. Rural pandemic preparedness: The risk, resilience and response required of primary healthcare. Risk Manag Healthc Policy. 2020;13:1187-1194. doi:10.2147/RMHP.S265610
  13. Gupta I. Relying on serendipity is not enough: Building a resilient health sector in India. Indian Econ Rev. 2020;55:125-147. doi:10.1007/s41775-020-00091-5
  14. Collins T, Akselrod S, Bloomfield A, Gamkrelidze A, Jakab Z, Placella E. Rethinking the COVID-19 pandemic: Back to public health. Ann Glob Health. 2020;86(1):133. doi:10.5334/aogh.3084
  15. Lal A, Ashworth HC, Dada S, Hoemeke L, Tambo E. Optimizing pandemic preparedness and response through health information systems: Lessons learned from Ebola to COVID-19. Disaster Med Public Health Prep. October 2020:1-8. doi:10.1017/dmp.2020.361
  16. Alami H, Lehoux P, Fleet R, et al. How can health systems better prepare for the next pandemic? Lessons learned from the management of COVID-19 in Quebec (Canada). Front Public Health. 2021;9(101616579):671833. doi:10.3389/fpubh.2021.671833
  17. Hamadeh R, Kdouh O, Hammoud R, Leresche E, Leaning J. Working short and working long: Can primary healthcare be protected as a public good in Lebanon today? Confl Health. 2021;15(1). doi:10.1186/s13031-021-00359-4
  18. Hasan MJ, Khan MAS. Health system resilience for a concurrent outbreak of Coronavirus disease 2019 and Dengue: A response from Bangladesh. Asia Pac J Public Health. 2020;1:1010539520982717. doi:10.1177/1010539520982717
  19. Hodgins M, van Leeuwen D, Braithwaite J, et al. The COVID-19 system shock framework: Capturing health system innovation during the COVID-19 pandemic. Int J Health Policy Manag. doi:10.34172/ijhpm.2021.130
  20. Kwon S, Kim E. Sustainable health financing for COVID-19 preparedness and response in Asia and the Pacific. Asian Econ Rev. 2022;17(1):140-156. doi:10.1111/aepr.12360
  21. Oyri S, Wiig S. Articulating concepts matters! Resilient actions in the Norwegian governmental response to the COVID-19 pandemic comment on “Government actions and their relation to resilience in healthcare during the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada”. Int J Health Policy Manag. doi:10.34172/ijhpm.2022.6892
  22. Shaw M, Anderson T, Sinclair T, et al. rpavirtual: Key lessons in healthcare organisational resilience in the time of COVID-19. Int J Health Plann Manage. doi:10.1002/hpm.3430
  23. Singh PK, Guleria R. COVID-19 response to strengthen health security and resilience of health systems in WHO South-East Asia Region: Lessons learned. WHO South East Asia J Public Health. 2021;10(1):2-4. doi:10.4103/2224-3151.334415
  24. Burau V, Falkenbach M, Neri S, Peckham S, Wallenburg I, Kuhlmann E. Health system resilience and health workforce capacities: Comparing health system responses during the COVID-19 pandemic in six European countries. Int J Health Plann Manage. doi:10.1002/hpm.3446
  25. Burke S, Parker S, Fleming P, Barry S, Thomas S. Building health system resilience through policy development in response to COVID-19 in Ireland: From shock to reform. Lancet Reg Health Eur. 2021;9. doi:10.1016/j.lanepe.2021.100223
  26. Marshall F, Gordon A, Gladman JRF, Bishop S. Care homes, their communities, and resilience in the face of the COVID-19 pandemic: Interim findings from a qualitative study. BMC Geriatr. 2021;21(1):102. doi:10.1186/s12877-021-02053-9
  27. Cuschieri S, Falzon C, Janulova L, et al. Malta’s only acute public hospital service during COVID-19: A diary of events from the first wave to transition phase. Int J Qual Health Care. 2020;1. doi:10.1093/intqhc/mzaa138
  28. Haldane V, De Foo C, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: Lessons from 28 countries. Nat Med. 2021. doi:10.1038/s41591-021-01381-y
  29. Gopichandran V, Subramaniam S. Response to COVID-19: An ethical imperative to build a resilient health system in India. J Med Ethics. 2020;1(2):1-4. doi:10.20529/IJME.2020.026
  30. Hunte SA, Pierre K, St Rose R, Simeon DT. Health systems’ resilience: COVID-19 response in Trinidad and Tobago. J Trop Med. 2020;103(2):590-592. doi:10.4269/ajtmh.20-0561
  31. Peiffer-Smadja N, Lucet JC, Bendjelloul G, et al. Challenges and issues about organizing a hospital to respond to the COVID-19 outbreak: Experience from a French reference centre. Clin Microbiol Infect. 2020;26(6):669-672. doi:10.1016/j.cmi.2020.04.002
  32. Mazingi D, Navarro S, Bobel MC, Dube A, Mbanje C, Lavy C. Exploring the impact of COVID-19 on progress towards achieving global surgery goals. World J Surg. 2020;44(8):2451-2457. doi:10.1007/s00268-020-05627-7
  33. Thomson S, Garcia-Ramirez JA, Akkazieva B, Habicht T, Cylus J, Evetovits T. How resilient is health financing policy in Europe to economic shocks? Evidence from the first year of the COVID-19 pandemic and the 2008 global financial crisis. Health Policy. 2022;126(1):7-15. doi:10.1016/j.healthpol.2021.11.002
  34. Ahanhanzo C, Johnson EAK, Eboreime EA, et al. COVID-19 in West Africa: Regional resource mobilisation and allocation in the first year of the pandemic. BMJ Glob Health. 2021;6(5). doi:10.1136/bmjgh-2020-004762
  35. Amul G, Ang M, Kraybill D, Ong S, Yoong J. Responses to COVID-19 in Southeast Asia: Diverse paths and ongoing challenges. Asian Economic Policy Review. 2022;17(1):90-110. doi:10.1111/aepr.12362
  36. Sundararaman T, Muraleedharan V, Ranjan A. Pandemic resilience and health systems preparedness: Lessons from COVID-19 for the twenty-first century. J Soc Econ Dev 2021;23(SUPPL 2):290-300. doi:10.1007/s40847-020-00133-x
  37. Coccia M. Preparedness of countries to face COVID-19 pandemic crisis: Strategic positioning and factors supporting effective strategies of prevention of pandemic threats. Environ Res. 2022;203(ei2, 0147621):111678. doi:10.1016/j.envres.2021.111678
  38. Smaggus A, Long J, Ellis L, Clay-Williams R, Braithwaite J. Government actions and their relation to resilience in healthcare during the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada. Int J Health Policy Manag. 2021. doi:10.34172/ijhpm.2021.67
  39. De Ceukelaire W, Bodini C. We need strong public health care to contain the global Corona pandemic. Int J Health Serv. 2020;50(3):276-277. doi:10.1177/0020731420916725
  40. Etienne CF, Fitzgerald J, Almeida G, et al. COVID-19: Transformative actions for more equitable, resilient, sustainable societies and health systems in the Americas. BMJ Glob Health. 2020;5(8). doi:10.1136/bmjgh-2020-003509
  41. Bashier H, Ikram A, Khan MA, et al. The anticipated future of public health services post COVID-19: Viewpoint. JMIR Public Health Surveill. 2021;7(6):e26267. doi:10.2196/26267
  42. Orhan R, Paric M, Czabanowska K. Lessons learnt from the EU response to NCDs: A content analysis on building resilient post-COVID health systems. Healthcare. 2021;9(12). doi:10.3390/healthcare9121659
  43. Pilevari N, Shiva M. Country-wide esilience model for the health system: A case study on Iran, under Coronavirus outbreak. Iran J Public Health. 2021;50(4):806-815. doi: 10.18502/ijph.v50i4.6007
  44. Romani G, Dal Mas F, Massaro M, et al. Population health strategies to support hospital and intensive care unit resiliency during the COVID-19 pandemic: The Italian experience. Popul Health Manag. 2021;24(2):174-181. doi:10.1089/pop.2020.0255
  45. Angeli F, Montefusco A. Sensemaking and learning during the COVID-19 pandemic: A complex adaptive systems perspective on policy decision-making. World Dev. 2020;136:105106. doi:10.1016/j.worlddev.2020.105106
  46. Daszak P, Keusch GT, Phelan AL, Johnson CK, Osterholm MT. Infectious disease threats: A rebound to resilience. Health Aff. 2021;40(2):204-211. doi:10.1377/hlthaff.2020.01544
  47. Gebremeskel AT, Otu A, Abimbola S, Yaya S. Building resilient health systems in Africa beyond the COVID-19 pandemic response. BMJ Glob Health. 2021;6(6). doi:10.1136/bmjgh-2021-006108
  48. Phillips W, Roehrich J, Kapletia D. Responding to information asymmetry in crisis situations: Innovation in the time of the COVID-19 pandemic. Public Management Review. doi:10.1080/14719037.2021.1960737
  49. Mustafa S, McDarby G. Building resilience through integrated health systems strengthening: Policy and planning analysis. Eur J Public Health. 2021;31. doi: 10.1093/eurpub/ckab165.102
  50. Hsieh VCR. Putting resiliency of a health system to the test: COVID-19 in Taiwan. J Formos Med Assoc. 2020;119(4):884-885. doi:10.1016/j.jfma.2020.03.002
  51. Martineau FP. People-centered health systems: Building more resilient health systems in the wake of the Ebola crisis. Int Health. 2016;8(5):307-309. doi:10.1093/inthealth/ihw029
  52. Riccardo F, Guzzetta G, Urdiales AM, et al. COVID-19 response: Effectiveness of weekly rapid risk assessments, Italy. Bull World Health Organ. 2022;100(2):161-167. doi:10.2471/BLT.21.286317
  53. Arsenault C, Gage A, Kim M, et al. COVID-19 and resilience of healthcare systems in ten countries. Nat Med. doi:10.1038/s41591-022-01750-1
  54. Aristei L, D’Ambrosio F, Villani L, et al. Public health regulations and policies dealing with preparedness and emergency management: The experience of the COVID-19 pandemic in Italy. Int J Environ Res Public Health. 2022;19(3). doi:10.3390/ijerph19031091
  55. Leslie M, Fadaak R, Pinto N, et al. Achieving resilience in primary care during the COVID-19 pandemic: Competing visions and lessons from Alberta. Healthc Policy. 2021;17(2):54-71. doi:10.12927/hcpol.2021.26657
  56. Balqis-Ali NZ, Fun WH, Ismail M, Ng RJ, Jaaffar FSA, Low LL. Addressing gaps for health systems strengthening: A public perspective on health systems’ response towards COVID-19. Int J Environ Res Public Health. 2021;18(17). doi:10.3390/ijerph18179047
  57. Dhatt R. Investing in civil society for better democracy and better health. The BMJ. October 2020. http://blogs.bmj.com/bmj/2020/10/23/investing-in-civil-society-for-better-democracy-and-better-health/. Accessed February 2, 2021.
  58. Dasgupta J, Schaaf M, Contractor SQ, et al. Axes of alienation: Applying an intersectional lens on the social contract during the pandemic response to protect sexual and reproductive rights and health. Int J Equity Health. 2020;19(1):130. doi:10.1186/s12939-020-01245-w
  59. Costa Font J, Levaggi R, Turati G. Resilient managed competition during pandemics: Lessons from the Italian experience during COVID-19. Health Econ Policy Law. 2020:1-8. doi:10.1017/S1744133120000353
  60. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910-1912. doi:10.1016/s0140-6736(15)60755-3
  61. 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;7(6):491-503. doi:10.15171/ijhpm.2018.06
  62. 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;32:4. doi:10.1093/heapol/czx118
  63. Kirchhof P. A tale of two countries: How decentralized organization and long-term investment build resilient healthcare systems. Eur Heart J Qual Care Clin Outcomes. 2020;6(3):201-203. doi:10.1093/ehjqcco/qcaa036
  64. Legido-Quigley H, Mateos-Garcia JT, Campos VR, Gea-Sanchez M, Muntaner C, McKee M. The resilience of the Spanish health system against the COVID-19 pandemic. Lancet Public Health. 2020;5(5):e251-e252. doi:10.1016/S2468-2667(20)30060-8
  65. Khalili H, Lising D, Kolcu G, et al. Advancing health care resilience through a systems-based collaborative approach: Lessons learned from COVID-19. J Interprof Care. 2021;35(6):809-812. doi:10.1080/13561820.2021.1981265
  66. Narwal S, Jain S. Building resilient health systems: Patient safety during COVID-19 and essons for the future. J Health Manag. 2021;23(1):166-181. doi:10.1177/0972063421994935
  67. Larson A, Skolnik A, Bhatti A, Mitrovich R. Addressing an urgent global public health need: Strategies to recover routine vaccination during the COVID-19 pandemic. Hum Vaccin Immunother. 2022;18(1):1975453. doi:10.1080/21645515.2021.1975453
  68. Garcia Elorrio E, Arrieta J, Arce H, et al. The COVID-19 pandemic: A call to action for health systems in Latin America to strengthen quality of care. Int J Qual Health Care. 2021;33(1). doi:10.1093/intqhc/mzaa062
  69. Turner S. “We are all vulnerable, we are all fragile”: COVID-19 as opportunity for, or constraint on, health service resilience in Colombia? Public Management Review. doi:10.1080/14719037.2022.2052944
  70. UNICEF UK joins forces with Sustain and local community groups to feed vulnerable UK families this winter. UNICEF UK. https://www.unicef.org.uk/press-releases/unicef-uk-joins-forces-with-sustain-and-local-community-groups-to-feed-vulnerable-uk-families-this-winter/. Accessed February 5, 2021.
  71. UNICEF to feed hungry children in UK for first time in 70-year history. The Guardian. http://www.theguardian.com/society/2020/dec/16/unicef-feed-hungry-children-uk-first-time-history. Published December 16, 2020. Accessed February 5, 2021.
  72. OECD. Building resilience to the COVID-19 pandemic: The role of centres of government. OECD. 2020.
  73. Masumbuko Claude K, Underschultz J, Hawkes MT. Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study. PLoS One. 2019;14(9). doi:10.1371/journal.pone.0223104
  74. Blair RA, Morse BS, Tsai LL. Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia. Soc Sci Med. 2017;172:89-97. doi:10.1016/j.socscimed.2016.11.016
  75. Huang Y, Sun M, Sui Y. How digital contact tracing slowed COVID-19 in East Asia. Harv Bus Rev. April 2020. https://hbr.org/2020/04/how-digital-contact-tracing-slowed-covid-19-in-east-asia. Accessed February 2, 2021.
  76. Martin A, Hatzidimitriadou E. Optimising health system capacity: A case study of community care staff’s role transition in response to the coronavirus pandemic. Health Soc Care Community. 2021;10.1111/hsc.13653. doi:10.1111/hsc.13653
  77. 77.Bollyky TJ, Kickbusch I. Preparing democracies for pandemics. BMJ. 2020;371:m4088. doi:10.1136/bmj.m4088
  78. China defends COVID-19 response after criticism by experts. Al Jazeera. https://www.aljazeera.com/news/2021/1/19/china-defends-covid-responsive-action-after-criticism-by-experts. Published January 19, 2021. Accessed February 3, 2021.
  79. Fiske A, McLennan S, Buyx A. Ethical insights from the COVID-19 pandemic in Germany: considerations for building resilient healthcare systems in Europe. Lancet Reg Health Eur. 2021;9. doi:10.1016/j.lanepe.2021.100213
  80. Karamagi HC, Titi-Ofei R, Kipruto HK, et al. On the resilience of health systems: A methodological exploration across countries in the WHO African Region. PLoS ONE. 2022;17(2):e0261904. doi:10.1371/journal.pone.0261904
  81. Tokalic R, Vidak M, Kaknjo M, Marusic A. Antifragility of healthcare systems in Croatia and Bosnia and Herzegovina: Learning from man-made and natural crises. Lancet Reg Health Eur. 2021;9. doi:10.1016/j.lanepe.2021.100216
  82. Angeler DG, Eyre HA, Berk M, Allen CR, Hynes W, Linkov I. Adaptation, transformation and resilience in healthcare: Comment on “Government actions and their relation to resilience in healthcare during the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada”. Int J Health Policy Manag. 2022;0. doi:10.34172/ijhpm.2022.7043
  83. Islam SN, Cheng HWJ, Helgason KS, Hunt N, Kawamura H, LaFleur M. Variations in COVID strategies: Determinants and lessons. United Nations Department of Economic and Social Affairs; 2020:55.
  84. Yazdizadeh B, Majdzadeh R, Ahmadi A, Mesgarpour B. Health research system resilience: Lesson learned from the COVID-19 crisis. Health Res Policy Syst. 2020;18(1):136. doi:10.1186/s12961-020-00667-w
  85. Hanefeld J, Mayhew S, Legido-Quigley H, et al. Towards an understanding of resilience: Responding to health systems shocks. Health Policy Plan. 2018;33(3):355-367. doi:10.1093/heapol/czx183
  86. Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: A systematic review. BMC Health Serv Res. 2013;13(1):158. doi:10.1186/1472-6963-13-158
  87. Headey D, Heidkamp R, Osendarp S, et al. Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality. Lancet. 2020;396(10250):519-521. doi:10.1016/S0140-6736(20)31647-0
  88. Carducci B, Keats EC, Ruel M, Haddad L, Osendarp SJM, Bhutta ZA. Food systems, diets and nutrition in the wake of COVID-19. Nat Food. 2021;2(2):68-70. doi:10.1038/s43016-021-00233-9
  89. Lal A, Erondu NA, Heymann DL, Gitahi G, Yates R. Fragmented health systems in COVID-19: Rectifying the misalignment between global health security and universal health coverage. Lancet. 2021;397(10268):61-67. doi:10.1016/S0140-6736(20)32228-5
  90. Haldane V, Morgan GT. From resilient to transilient health systems: The deep transformation of health systems in response to the COVID-19 pandemic. Health Policy Plan. 2021;36(1):134-135. doi:10.1093/heapol/czaa169
  91. Plagg B, Piccoliori G, Oschmann J, Engl A, Eisendle K. Primary Health Care and Hospital Management During COVID-19: Lessons from Lombardy. Risk Manag Healthc Policy. 2021;14:3987-3992. doi:10.2147/RMHP.S315880
  92. Dorn A van, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet. 2020;395(10232):1243-1244. doi:10.1016/S0140-6736(20)30893-X
  93. Wang Z, Tang K. Combating COVID-19: Health equity matters. Nat Med. 2020;26(4):458. doi:10.1038/s41591-020-0823-6
  94. Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. 2020:jech-2020-214401. doi:10.1136/jech-2020-214401
  95. Addressing Inequality in Times of COVID-19. Food and Agriculture Organization of the United Nations. 2020:11.
  96. UNDP. Global Dashboard for Vaccine Equity. https://data.undp.org/vaccine-equity/. Accessed July 28, 2022.
  97. Brolin Ribacke KJ, Saulnier DD, Eriksson A, von Schreeb J. Effects of the West Africa Ebola Virus Disease on healthcare utilization - A systematic review. Front Public Health. 2016;4:222. doi:10.3389/fpubh.2016.00222
  98. Horton R. Offline: COVID-19 is not a pandemic. Lancet. 2020;396(10255):874. doi:10.1016/S0140-6736(20)32000-6
  99. Yadav UN, Rayamajhee B, Mistry SK, Parsekar SS, Mishra SK. A syndemic perspective on the management of non-communicable diseases amid the COVID-19 pandemic in low- and middle-income countries. Front Public Health. 2020;8. doi:10.3389/fpubh.2020.00508
  100. Downey LE, Harris M, Jan S, Miraldo M, Peiris D, Buse K. Global health system resilience is in everyone’s interest. BMJ. 2021;375(8900488, bmj, 101090866):n3043. doi:10.1136/bmj.n3043
  101. Atun R. Health systems, systems thinking and innovation. Health Policy Plan. 2012;27(suppl_4):iv4-iv8. doi:10.1093/heapol/czs088
  102. Blanchet K, James P. How to do (or not to do) … a social network analysis in health systems research. Health Policy Plan. 2012;27(5):438-446. doi:10.1093/heapol/czr055
  103. Häsler B, Bazeyo W, Byrne AW, et al. Reflecting on One Health in action during the COVID-19 response. Frontiers Vet Sci. 2020;7.
  104. Kruk ME, Ling EJ, Bitton A, et al. Building resilient health systems: a proposal for a resilience index. BMJ. 2017;357:j2323. doi:10.1136/bmj.j232

Articles in Press, Accepted Manuscript
Available Online from 15 November 2022
  • Receive Date: 28 July 2021
  • Revise Date: 02 August 2022
  • Accept Date: 12 November 2022
  • First Publish Date: 15 November 2022