Health System Resilience as the Basis for Explanation Versus Evaluation; Comment on “The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic”

Document Type : Commentary

Author

College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia

Abstract

The onset and impacts of COVID-19 have prompted attention to national health system preparedness for, and capacity to adapt in response to, public health emergencies and other shocks. This preparedness and adaptive capacity are often framed as ‘health system resilience’ a concept previously associated more with assessments of health systems in conflict-affected and fragile states. Yet health system resilience remains a slippery concept, defined and applied in multiple ways. Reflecting on the Hodgins and colleagues’ study “the COVID-19 system shock framework: capturing health system innovation during the COVID-19 pandemic,” this article restates the limitations of health systems resilience as a concept capable of anchoring evaluative assessments of health system performance but stresses its value in the context of explanatory research investigating how and why health systems adapt, with due attention to the power of actors’ whose choices inform the nature and direction of change.

Keywords

Main Subjects

References

  1. Wang Z, Duan Y, Jin Y, Zheng ZJ. Coronavirus disease 2019 (COVID-19) pandemic: how countries should build more resilient health systems for preparedness and response. Glob Health J. 2020;4(4):139-145. doi:1016/j.glohj.2020.12.001
  2. 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:1016/s0140-6736(20)30551-1
  3. 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:1136/bmjgh-2020-003317
  4. Alameddine M, Fouad FM, Diaconu K, et al. Resilience capacities of health systems: accommodating the needs of Palestinian refugees from Syria. Soc Sci Med. 2019;220:22-30. doi:1016/j.socscimed.2018.10.018
  5. 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. 2022;37(4):2032-2048. doi:1002/hpm.3446
  6. Arsenault C, Gage A, Kim MK, et al. COVID-19 and resilience of healthcare systems in ten countries. Nat Med. 2022;28(6):1314-1324. doi:1038/s41591-022-01750-1
  7. 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. 2021;11(10):2155-2165. doi:34172/ijhpm.2021.130
  8. Blanchet K. Thinking shift on health systems: from blueprint health programmes towards resilience of health systems Comment on "Constraints to applying systems thinking concepts in health systems: a regional perspective from surveying stakeholders in Eastern Mediterranean countries". Int J Health Policy Manag. 2015;4(5):307-309. doi:15171/ijhpm.2015.49
  9. Peters DH. The application of systems thinking in health: why use systems thinking? Health Res Policy Syst. 2014;12:51. doi:1186/1478-4505-12-51
  10. Kwamie A, Ha S, Ghaffar A. Applied systems thinking: unlocking theory, evidence and practice for health policy and systems research. Health Policy Plan. 2021;36(10):1715-1717. doi:1093/heapol/czab062
  11. Saulnier DD, Blanchet K, Canila C, et al. A health systems resilience research agenda: moving from concept to practice. BMJ Glob Health. 2021;6(8):e006779. doi:1136/bmjgh-2021-006779
  12. 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:1093/heapol/czx183
  13. Topp SM. Power and politics: the case for linking resilience to health system governance. BMJ Glob Health. 2020;5(6):e002891. doi:1136/bmjgh-2020-002891
  14. Odhiambo J, Jeffery C, Lako R, Devkota B, Valadez JJ. Measuring health system resilience in a highly fragile nation during protracted conflict: South Sudan 2011-15. Health Policy Plan. 2020;35(3):313-322. doi:1093/heapol/czz160
  15. Abimbola S, Topp SM. Adaptation with robustness: the case for clarity on the use of 'resilience' in health systems and global health. BMJ Glob Health. 2018;3(1):e000758. doi:1136/bmjgh-2018-000758
  16. Lee BY, Wedlock PT, Mitgang EA, et al. How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India. BMJ Glob Health. 2019;4(5):e001609. doi:1136/bmjgh-2019-001609
  17. Gore R. The power of popular opinion in everyday primary care provision in urban India. Glob Public Health. 2019;14(4):528-541. doi:1080/17441692.2018.1464587
  18. Schneider H, Mukinda F, Tabana H, George A. Expressions of actor power in implementation: a qualitative case study of a health service intervention in South Africa. BMC Health Serv Res. 2022;22(1):207. doi:1186/s12913-022-07589-z
  19. van de Pas R, Ashour M, Kapilashrami A, Fustukian S. Interrogating resilience in health systems development. Health Policy Plan. 2017;32(Suppl_3):iii88-iii90. doi:1093/heapol/czx110

Files

History

  • Receive Date: 19 June 2022
  • Revise Date: 17 January 2023
  • Accept Date: 18 January 2023
  • First Publish Date: 22 January 2023

Share

How to cite

Statistics