What is a resilient health system in 2023? Synthesizing lessons from the field of health systems resilience

Overview

Health systems resilience has become increasingly important since the 2014–15 West Africa Ebola outbreak and the COVID-19 pandemic, as health systems have faced the challenge of responding to major shocks while maintaining essential routine services. This paper traces the multidisciplinary origins of health systems resilience and synthesizes lessons from 18 review articles to explore how the concept is defined, its key attributes, and its relevance to pandemic preparedness and health security.

The paper finds that resilient health systems are characterized by being aware, diverse, integrated, self-regulating, and adaptive and transformative, supported by effective leadership and governance, flexible financing, a capable workforce, reliable supplies and information systems, adaptable service delivery, and social capacities such as trust and collaboration. It highlights both the overlap and differences between health systems resilience and health security, and argues for stronger conceptual and operational links between the two. The paper also emphasizes the importance of incorporating complex adaptive systems thinking into how pandemic preparedness and health systems resilience are measured.