Towards an understanding of resilience: responding to health systems shocks
Top Cited Papers
Open Access
- 9 January 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in Health Policy and Planning
- Vol. 33 (3), 355-367
- https://doi.org/10.1093/heapol/czx183
Abstract
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more ‘resilient’. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013–16; and the recent refugee and migration crisis in Europe. Based on this analysis, we identify ‘3 plus 2’ critical dimensions of particular relevance to health systems’ ability to adapt and respond to shocks; actions in all of these will determine the extent to which a response is successful. These are three core dimensions corresponding to three health systems functions: ‘health information systems’ (having the information and the knowledge to make a decision on what needs to be done); ‘funding/financing mechanisms’ (investing or mobilising resources to fund a response); and ‘health workforce’ (who should plan and implement it and how). These intersect with two cross-cutting aspects: ‘governance’, as a fundamental function affecting all other system dimensions; and predominant ‘values’ shaping the response, and how it is experienced at individual and community levels. Moreover, across the crises examined here, integration within the health system contributed to resilience, as does connecting with local communities, evidenced by successful community responses to Ebola and social movements responding to the financial crisis. In all crises, inequalities grew, yet our evidence also highlights that the impact of shocks is amenable to government action. All these factors are shaped by context. We argue that the ‘3 plus 2’ dimensions can inform pragmatic policies seeking to increase health systems resilience.Keywords
Funding Information
- MRC
- Wellcome Trust (102919/Z/13/Z)
- ESRC (ES/K009990/1)
This publication has 51 references indexed in Scilit:
- Austerity: a failed experiment on the people of EuropeClinical Medicine, 2012
- Building the Field of Health Policy and Systems Research: Social Science MattersPLoS Medicine, 2011
- The double burden of human resource and HIV crises: a case study of MalawiHuman Resources for Health, 2008
- Emergency Preparedness and Public Health Systems: Lessons for Developing CountriesAmerican Journal of Preventive Medicine, 2008
- Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retentionBMC Health Services Research, 2008
- Trust and health worker performance: exploring a conceptual framework using South African evidenceSocial Science & Medicine (1982), 2005
- Editorial: building trust and value in health systems in low- and middle-income countriesSocial Science & Medicine (1982), 2005
- Human resources for health: overcoming the crisisThe Lancet, 2004
- Resilient Individuals Use Positive Emotions to Bounce Back From Negative Emotional Experiences.Journal of Personality and Social Psychology, 2004
- Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC)Depression and Anxiety, 2003