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As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic. In January 2021, the Amazonas state's health system collapsed, especially in the city of Manaus, where acute Covid-19 patients died due to scarcity of medical supplies for respiratory therapy.
The COVID-19 pandemic and its devastating health, economic, and societal impacts demonstrate how unprepared the world is for such immense public health emergencies. The increasing frequency of acute infectious disease outbreaks and trends such as population aging, rising chronic-disease burdens, and climate change raise the risk of syndemics - events in which two or more diseases adversely interact with each other and with political and economic conditions of inequality and poverty. COVID-19 is a bitter lesson in how these dynamics interact to cause profound suffering. The only way to prevent, prepare for, and manage these threats is by building resilient health systems to withstand shocks and improve health outcomes between crises. Enablers are crosscutting factors that influence all aspects of health systems: governance, partnerships, financing, human resources, and innovation. Core capacities essential for resilience include health intelligence; health service delivery, especially primary health care (PHC); community engagement and risk communication; and the health supply chain. The report details recommendations for countries to operationalize health system resilience and sets out a three-tier framework to help them prioritize investments based on their resilience impact: Tier 1: risk reduction - prevention and community preparedness. Tier 2: detection, containment, and mitigation capabilities. Tier 3: advanced case management and surge response.
This document is a consolidated, fit-for-purpose technical reference package to support countries in strengthening health systems resilience at national and subnational level from policy and planning, through operational and services delivery, to monitoring and evaluation. The Toolkit may be adapted to varying contexts and will also contribute to the dual agenda of universal health coverage (UHC) and global health security. The Toolkit serves as a compendium of technical resources to support countries in strengthening the resilience of their health systems and provides technical grounding and clarity on the conceptualization and operationalization of health systems resilience
The COVID-19 pandemic represents a health system shock of unprecedented scale. Health systems resilience – defined as the ability to absorb, adapt, and transform to cope with shocks – is needed to ensure sustained performance of the health system functions (governance, financing, resource generation, and service delivery) so that the ultimate health system goals, especially that of improving health of the population, can be achieved. As we have witnessed, few countries could achieve this goal and even fewer could do so in a sustained way – leaving all countries with important lessons to learn. The lessons derived in this study can inform both the ongoing efforts, while countries are still grappling with the pandemic, as well as help ensure these efforts also incorporate a longer-term perspective, thus improving preparedness to any future health system shocks.
resilisus@fiocruz.br
ResiliSUS - CEE/Fiocruz
@resilisus
