How Is Health System Resilience Being Assessed? A Scoping Review

Document Type : Review Article

Authors

1 Expanded Programme on Immunization, Ministry of Public Health, Yaoundé, Cameroon

2 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

3 Regional Delegation of Public Health for the Centre, Ministry of Public Health, Yaoundé, Cameroon

4 Regional Delegation of Public Health for the SouthWest, Ministry of Public Health, Yaoundé, Cameroon

Abstract

Background 
It is commonly argued that resilient health systems ensure the well-being of populations even under critical conditions, whereas poorly resilient ones may be disrupted and collapse. We aimed to examine how health system resilience can be assessed as this issue is still under debate.
 
Methods 
We conducted a scoping review of peer-reviewed and grey literature published up to March 2022, following the Joanna Briggs Institute (JBI) guidance. CAIRN, DOAJ, E-Journals, Global Health Google Scholar, MedRxiv, OAIster, PubMed, reliefWeb, ScienceDirect, SmartResilience, SSRN, and World Health Organization (WHO) library were searched. The search strategy was based on key words from the research question and validated by an experienced librarian. We included full reports in English and French, whose primary focus was the health system, and that proposed or reported on the use of approaches for assessing health system resilience. Three independent reviewers did the selection and charting of reports. Extraction of information from the 34 reports that met the inclusion criteria followed predefined charting items.
 
Results 
Various definitions of the concept of health system resilience and diverging conceptual bases were found for the assessment of resilience, pointing at the lack of conceptual maturity. Three assessment approaches emerged from this review: (1) the system mapping approach which looks at health system core functions, (2) the capacity-based approach which focuses on the main characteristics of resilience, and (3) the strategy-based approach which examines resilience strategies. None of these approaches gives a full picture of resilience. They can be complementary; hence they are increasingly used in combination.
 
Conclusion 
This review identified three approaches to assessing health system resilience. The absence of a common understanding of what health system resilience represents still undermines its operationalisation and assessment. There is need for further testing and learning from empirical studies on the specific or integrated use of these frameworks. 

Keywords


  1. Kieny MP, Evans DB, Schmets G, Kadandale S. Health-system resilience: reflections on the Ebola crisis in western Africa. Bull World Health Organ. 2014;92(12):850. doi:2471/blt.14.149278
  2. Kieny MP, Dovlo D. Beyond Ebola: a new agenda for resilient health systems. Lancet. 2015;385(9963):91-92. doi:1016/s0140-6736(14)62479-x
  3. 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
  4. 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(suppl_3):iii91-iii94. doi:1093/heapol/czx118
  5. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910-1912. doi:1016/s0140-6736(15)60755-3
  6. 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
  7. Turenne CP, Gautier L, Degroote S, Guillard E, Chabrol F, Ridde V. Conceptual analysis of health systems resilience: a scoping review. Soc Sci Med. 2019;232:168-180. doi:1016/j.socscimed.2019.04.020
  8. Stephanie M. Topp, Walter Flores, Veena Sriram, Kerry Scott. Critiquing the Concept of Resilience in Health Systems. Resilience. 2015;3(2):154-159.
  9. 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;9(1):6-16. doi:15171/ijhpm.2019.71
  10. Kim H. The implicit ideological function of the global health field and its role in maintaining relations of power. BMJ Glob Health. 2021;6(4):e005620. doi:1136/bmjgh-2021-005620
  11. 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
  12. World Health Organization (WHO). The World Health Report 2000: Health Systems: Improving Performance. Vol 78. WHO; 2000. http://www.who.int/whr/2000/en/whr00_en.pdf.
  13. Chan M, Moncayo G. Adress of the Director-General of the World Health Organization to the Sixty-Ninth World Health Assembly. http://www.who.int/dg/speeches/2016/wha-69/en/. Published 2016.
  14. Ghebreyesus TA. Compelling Priorities for Global Health. WHO. http://www.who.int/dg/speeches/2017/compelling-priorities-health/en/. Published 2017.
  15. 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
  16. Harmer A, Eder B, Gepp S, Leetz A, van de Pas R. WHO should declare climate change a public health emergency. BMJ. 2020;368:m797. doi:1136/bmj.m797
  17. Ebi KL, Vanos J, Baldwin JW, et al. Extreme weather and climate change: population health and health system implications. Annu Rev Public Health. 2021;42:293-315. doi:1146/annurev-publhealth-012420-105026
  18. Ebi KL, Hess JJ. Health risks due to climate change: inequity in causes and consequences. Health Aff (Millwood). 2020;39(12):2056-2062. doi:1377/hlthaff.2020.01125
  19. Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet. 2021;397(10269):129-170. doi:1016/s0140-6736(20)32290-x
  20. Rocque RJ, Beaudoin C, Ndjaboue R, et al. Health effects of climate change: an overview of systematic reviews. BMJ Open. 2021;11(6):e046333. doi:1136/bmjopen-2020-046333
  21. Cianconi P, Betrò S, Janiri L. the impact of climate change on mental health: a systematic descriptive review. Front Psychiatry. 2020;11:74. doi:3389/fpsyt.2020.00074
  22. Garry S, Checchi F. Armed conflict and public health: into the 21st century. J Public Health (Oxf). 2020;42(3):e287-e298. doi:1093/pubmed/fdz095
  23. Goto R, Guerrero AP, Speranza M, Fung D, Paul C, Skokauskas N. War is a public health emergency. Lancet. 2022;399(10332):1302. doi:1016/s0140-6736(22)00479-2
  24. Kruk ME, Ling EJ, Bitton A, et al. Building resilient health systems: a proposal for a resilience index. BMJ. 2017;357:j2323. doi:1136/bmj.j2323
  25. 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;13:450. doi:1186/1472-6963-13-450
  26. Thomas S, Sagan A, Larkin J, Cylus J, Figueras J, Karanikolos M. Strengthening health systems resilience, Key concepts and strategies. European Observatory of Health Systems and Policies. WHO; 2020. https://apps.who.int/iris/handle/10665/332441.
  27. Rohova M, Koeva S. Health system resilience: review of the concept and a framework for its understanding. J IMAB. 2021;27(4):4060-4067. doi:5272/jimab.2021274.4060
  28. Foroughi Z, Ebrahimi P, Aryankhesal A, Maleki M, Yazdani S. Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis. BMC Public Health. 2022;22(1):287. doi:1186/s12889-022-12496-3
  29. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. JBI; 2020. doi:46658/JBIMES-20-12
  30. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91-108. doi:1111/j.1471-1842.2009.00848.x
  31. Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-2126. doi:11124/JBIES-20-00167
  32. Tonga C, Ateba OE, Edzoa EB, Verdonck K, Marchal B. Study protocol Assessment of health system resilience. figshare website. doi:6084/m9.figshare.20054291.v1
  33. Khalil H, Peters M, Godfrey CM, McInerney P, Soares CB, Parker D. An evidence-based approach to scoping reviews. Worldviews Evid Based Nurs. 2016;13(2):118-123. doi:1111/wvn.12144
  34. Khalil H, Peters MD, Tricco AC, et al. Conducting high quality scoping reviews-challenges and solutions. J Clin Epidemiol. 2021;130:156-160. doi:1016/j.jclinepi.2020.10.009
  35. Crowe S, Vasilakis C, Skeen A, et al. Examining the feasibility of using a modelling tool to assess resilience across a health-care system and assist with decisions concerning service reconfiguration. J Oper Res Soc. 2014;65(10):1522-1532. doi:1057/jors.2013.102
  36. Etemadi M, Tadayon MM. Lessons from assessment of health system resilience: political economy and policy coherence, two essential but neglected components. Iranian Politics and Law Quarterly. 2021;1(1):99-110.
  37. EU Expert Group on Health Systems Performance Assessment (HSPA). Assessing the Resilience of Health Systems in Europe: An Overview of the Theory, Current Practice and Strategies for Improvement. Luxembourg: Publications Office of the EU; 2020. doi:2875/191483
  38. Fitter DL, Delson DB, Guillaume FD, et al. Applying a new framework for public health systems recovery following emergencies and disasters: the example of Haiti following a major earthquake and cholera outbreak. Am J Trop Med Hyg. 2017;97(4_Suppl):4-11. doi:4269/ajtmh.16-0862
  39. Giarelli G. The governance of resilience. How the health systems have coped with the COVID-19 pandemic. Culture e Studi del Sociale. 2020;5(1):245-257.
  40. Gilson L, Ellokor S, Lehmann U, Brady L. Organizational change and everyday health system resilience: lessons from Cape Town, South Africa. Soc Sci Med. 2020;266:113407. doi:1016/j.socscimed.2020.113407
  41. 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;27(6):964-980. doi:1038/s41591-021-01381-y
  42. Jovanović A, Klimek P, Renn O, et al. Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks, resilience indicators, interdependencies and international standards. Environ Syst Decis. 2020;40(2):252-286. doi:1007/s10669-020-09779-8
  43. Kagwanja N, Waithaka D, Nzinga J, et al. Shocks, stress and everyday health system resilience: experiences from the Kenyan coast. Health Policy Plan. 2020;35(5):522-535. doi:1093/heapol/czaa002
  44. 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:1371/journal.pone.0261904
  45. Ling EJ, Larson E, Macauley RJ, et al. Beyond the crisis: did the Ebola epidemic improve resilience of Liberia's health system? Health Policy Plan. 2017;32(suppl_3):iii40-iii47. doi:1093/heapol/czx109
  46. Lo Sardo DR, Thurner S, Sorger J, Duftschmid G, Endel G, Klimek P. Quantification of the resilience of primary care networks by stress testing the health care system. Proc Natl Acad Sci U S A. 2019;116(48):23930-23935. doi:1073/pnas.1904826116
  47. Massuda A, Malik AM, Vecina Neto G, Tasca R, Ferreira Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cad EBAPE.BR. 2021;19(spe):735-744. doi:1590/1679-395120200185
  48. McKenzie A, Abdulwahab A, Sokpo E, Mecaskey JW. Creating the foundation for health system resilience in Northern Nigeria. Health Syst Reform. 2016;2(4):357-366. doi:1080/23288604.2016.1242453
  49. Meyer D, Bishai D, Ravi SJ, et al. A checklist to improve health system resilience to infectious disease outbreaks and natural hazards. BMJ Glob Health. 2020;5(8):e002429. doi:1136/bmjgh-2020-002429
  50. 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
  51. Ozen IC, Tuncay B. Predicting the resilience of the health care system to new arrivals: the case of the public health system of Turkey. J Epidemiol Public Health Rev. 2021;6(2):1-13. doi:16966/2471-8211.212
  52. Pilevari N, Valeh Shiva M. Country-wide resilience model for the health system: a case study on Iran, under coronavirus outbreak. Iran J Public Health. 2021;50(4):806-815. doi:18502/ijph.v50i4.6007
  53. Popic T, Moise AD, Fellows W. Health System Resilience in the Context of the COVID-19 Pandemic: The Gap Between Eastern and Western Europe. 2021. https://cadmus.eui.eu/handle/1814/71699.
  54. Rios CC, Ling EJ, Rivera-Gutierrez R, et al. Puerto Rico health system resilience after Hurricane Maria: implications for disaster preparedness in the COVID-19 era. Front Commun. 2021;5:593939. doi:3389/fcomm.2020.593939
  55. Rogers HL, Barros PP, Maeseneer J, et al. Resilience testing of health systems: how can it be done? Int J Environ Res Public Health. 2021;18(9):4742. doi:3390/ijerph18094742
  56. 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
  57. World Health Organization (WHO). The State of Health in the WHO African Region: An Analysis of the Status of Health, Health Services and Health Systems in the Context of the Sustainable Development Goals. WHO Regional Office for Africa; 2018. aho.afro.who.int.
  58. World Health Organization (WHO). Measuring the Climate Resilience of Health Systems. WHO; 2022. https://apps.who.int/iris/bitstream/handle/10665/354542/9789240048102-eng.pdf?sequence=1&isAllowed=y. Accessed May 26, 2022.
  59. 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;9:671833. doi:3389/fpubh.2021.671833
  60. Ammar W, Kdouh O, Hammoud R, et al. Health system resilience: Lebanon and the Syrian refugee crisis. J Glob Health. 2016;6(2):020704. doi:7189/jogh.06.020704
  61. 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. PLoS Curr. 2012;4:e5028b6037259a. doi:1371/5028b6037259a
  62. Bhandari S, Alonge O. Measuring the resilience of health systems in low- and middle-income countries: a focus on community resilience. Health Res Policy Syst. 2020;18(1):81. doi:1186/s12961-020-00594-w
  63. Bigoni A, Malik AM, Tasca R, et al. Brazil's health system functionality amidst of the COVID-19 pandemic: an analysis of resilience. Lancet Reg Health Am. 2022;10:100222. doi:1016/j.lana.2022.100222
  64. 64 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
  65. Thomas S, Sagan A, Larkin J, Cylus J, Figueras J, Karanikolos M. Strengthening Health Systems Resilience. Policy Brief 36: Key Concepts and Strategies Health Systems and Policy Analysis. 2020. http://www.euro.who.int/en/about-us/partners/.
  66. World Health Organization (WHO). Everybody's Business--Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. WHO; 2007. https://apps.who.int/iris/handle/10665/43918.
  67. Van Olmen J, Criel B, Bhojani U, et al. The health system dynamics framework: the introduction of an analytical model for health system analysis and its application to two case-studies. Health Cult Soc. 2012;2(1):1-21. doi:5195/hcs.2012.71
  68. 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):431-435. doi:15171/ijhpm.2017.36
  69. Serfilippi E, Ramnath G. Resilience measurement and conceptual frameworks: a review of the literature. Ann Public Coop Econ. 2018;89(4):645-664. doi:1111/apce.12202

Articles in Press, Corrected Proof
Available Online from 04 August 2024
  • Receive Date: 04 May 2023
  • Revise Date: 19 November 2023
  • Accept Date: 27 July 2024
  • First Publish Date: 04 August 2024