Towards an understanding of resilience: responding to health systems shocks.


Hanefeld, J; Mayhew, S; Legido-Quigley, H; Martineau, F; Karanikolos, M; Blanchet, K; Liverani, M; Yei Mokuwa, E; McKay, G; Balabanova, D; (2018) Towards an understanding of resilience: responding to health systems shocks. Health policy and planning. ISSN 0268-1080 DOI: https://doi.org/10.1093/heapol/czx183

[img] Text - Accepted Version
Restricted to Repository staff only until 9 January 2019.
License:

Download (624kB) | Request a copy
[img] Text - Accepted Version
Restricted to Repository staff only until 9 January 2019.
License:

Download (326kB) | Request a copy

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.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Academic Services & Administration > Academic Administration
Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 29325025
URI: http://researchonline.lshtm.ac.uk/id/eprint/4646109

Statistics


Download activity - last 12 months
Downloads since deposit
0Downloads
33Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item