Health Systems Resilience: The Domains and Characteristics

By Tariq Azim, Senior Technical Advisor  featured on The Pump, John Snow, Inc.

The Fourth Global Symposium on Health Systems Research  will be held this year in Vancouver on November 14–18. This year’s theme, “Resilient and Responsive Health Systems for a Changing World,” is timely, as the topic of health systems’ resilience has regained attention post the Ebola crisis. Last July, the Cracking the Nut Health Conference devoted its focus on “The Role of Communities in Building Resilient Health Systems.”

The medical journal, The Lancet, featured an article by Margaret Kruk that explores the subject using lessons learned from Ebola in its May 2015 publication. Kruk uses the Rockefeller Foundation’s City Resilience Framework to describe the five characteristics of a resilient health system:

  • Aware
  • Diverse
  • Self-regulatory
  • Integrated
  • Adaptive

Separately, an Oxfam briefing paper, published a month earlier, emphasizes the long-term investments in six key elements that are essential to build resilient health systems:

  • Adequate number of trained human resources for health
  • Available medicines
  • Robust health information system
  • Appropriate infrastructure
  • Sufficient public financing
  • Strong public sector

This framework of resiliency also parallels the World Health Organization’s approach in assessing health system capacity for crisis management, based on its six building blocks of health systems strengthening.

When considering this topic and both approaches, I believe we can look at a health system’s resilience in terms of its domains (the building blocks) and its characteristics (adaptability and responsiveness).

The Domains

With regard to the building blocks, it is vital to recognize the community itself as an essential component. The community is not only the beneficiary, but also an integral part of the health system. A simple example is the community volunteers, community-based organizations, and household members who play important roles in the resilience of the health system.

The Characteristics

In addition, the resilience of a health system is to not only withstand sudden disasters, natural or man-made, but to also deal with the slow, progressive crisis that erodes the ability to meet a growing demand of health services from the population. It’s akin to a supply and demand issue. Diminished capacity to meet demand can happen when the health workforce, infrastructure, and logistics system are directly affected or are overstretched from a disaster. An economic crisis can also have similar effects. However, a resilient health system should be able to respond to sudden surges of demand despite direct hits to its building blocks. It should also be capable to adapt to the decreasing/decreased capacity to supply needed health services in such a way that keeps the health system up and running. Thus, to effectively build a resilient health system, it is critical to always factor in the scenario where the health system itself is compromised.