How do we resist COVID-19 and other crises in health systems?
How were some health systems in the COVID-19 pandemic better coped with than others? Certain answers can become evident if we could evaluate how resilient health systems are prepared in the first place for crises or shocks, such as the current pandemical and other emergencies, including financial ones. A new policy brief entitled “Strengthening health system resilience” has just been published by the European Health Systems and Policies Observatory which includes a framework which helps policymakers to recognize and improve the health system ‘s resilience.
What is health systems resilience?
The idea of resilience has been applied in many fields from physics to human psychology but is far from the original. The concept has been relevant to the response of society to health emergencies and major societal shocks over the last 2 decades. In recognition of the breadth of the concept, we propose to use a definition focused on shocks for operational (and evaluation) purposes that we consider to be sudden and extreme changes, affecting the healthcare system.
We define resilience as the ability to prepare for, manage (absorb, adapt and transform) and learn from shocks. Ideally, resilience is not about bouncing back to the pre-shock state but about evolving into something better.
This policy summary discusses the key characteristics of resilience and offers examples of approaches implemented in different countries.
In spite of the urgent daily stresses of operating a health system often eaten by policymakers, the COVID-19 pandemic has recalled the importance of long-term planning and preparedness. This awareness means an improved knowledge of the strengths and vulnerabilities of the health care systems and how to react with resilience to the outbreak, especially in light of the influenza season.
The authors reviewed the literature on strategies to increase health system resilience and to respond to system shocks, as well as national responses to the COVID-19 pandemic. Those approaches were mapped into the core functions of the health system: administration, financing, personnel and services. In which phases of a shock cycle they also indicated:
- Shock onset and alert
- Shock impact and management
- Recovery and learning
The most effective are potentially those resilience-enhancing strategies. The type of shock (e.g., financial crisis, pandemic, climate change), duration of shock process stage and particular country conditions depend on what approaches are to be pursued.
Shocks are dynamic: one shock may cause weakness or another shock in the health system. Yet recovery from one shock may also warn preparation for another, and for decision-makers, the experiences of different countries and structures provide valuable lessons.
Policymakers need to periodically review their health programs, evaluate their effectiveness and fix vulnerabilities. Understanding the directions of different shocks will also help policymakers plan for and better handle the shocks. Strengthening the general health system will do much to assist countries in shock preparation and resistance. However, addressing these vulnerable areas can also improve the stability of the network and the overall efficiency of the health system.