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      Health systems resilience: is it time to revisit resilience after COVID-19?

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          Abstract

          The concept of health system resilience has been challenged by the COVID-19 pandemic. Even well-established health systems, considered resilient, collapsed during the pandemic. To revisit the concept of resilience two years and a half after the initial impact of COVID-19, we conducted a qualitative study with 26 international experts in health systems to explore their views on concepts, stages, analytical frameworks, and implementation from a comparative perspective of high- and low-and-middle-income countries (HICs and LMICs). The interview guide was informed by a comprehensive literature review, and all interviewees had practice and academic expertise in some of the largest health systems in the world. Results show that the pandemic did modify experts' views on various aspects of health system resilience, which we summarize and propose as refinements to the current understanding of health systems resilience.

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2025)
          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

            Victoria Haldane, Chuan De Foo, Salma M Abdalla … (2021)
            Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.
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              Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries

              Nirmal Kandel, Stella Chungong, Abbas Omaar … (2020)
              Summary Background Public health measures to prevent, detect, and respond to events are essential to control public health risks, including infectious disease outbreaks, as highlighted in the International Health Regulations (IHR). In light of the outbreak of 2019 novel coronavirus disease (COVID-19), we aimed to review existing health security capacities against public health risks and events. Methods We used 18 indicators from the IHR State Party Annual Reporting (SPAR) tool and associated data from national SPAR reports to develop five indices: (1) prevent, (2) detect, (3) respond, (4) enabling function, and (5) operational readiness. We used SPAR 2018 data for all of the indicators and categorised countries into five levels across the indices, in which level 1 indicated the lowest level of national capacity and level 5 the highest. We also analysed data at the regional level (using the six geographical WHO regions). Findings Of 182 countries, 52 (28%) had prevent capacities at levels 1 or 2, and 60 (33%) had response capacities at levels 1 or 2. 81 (45%) countries had prevent capacities and 78 (43%) had response capacities at levels 4 or 5, indicating that these countries were operationally ready. 138 (76%) countries scored more highly in the detect index than in the other indices. 44 (24%) countries did not have an effective enabling function for public health risks and events, including infectious disease outbreaks (7 [4%] at level 1 and 37 [20%] at level 2). 102 (56%) countries had level 4 or level 5 enabling function capacities in place. 32 (18%) countries had low readiness (2 [1%] at level 1 and 30 [17%] at level 2), and 104 (57%) countries were operationally ready to prevent, detect, and control an outbreak of a novel infectious disease (66 [36%] at level 4 and 38 [21%] at level 5). Interpretation Countries vary widely in terms of their capacity to prevent, detect, and respond to outbreaks. Half of all countries analysed have strong operational readiness capacities in place, which suggests that an effective response to potential health emergencies could be enabled, including to COVID-19. Findings from local risk assessments are needed to fully understand national readiness capacities in relation to COVID-19. Capacity building and collaboration between countries are needed to strengthen global readiness for outbreak control. Funding None.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Soc Sci Med
                Journal ID (iso-abbrev): Soc Sci Med
                Title: Social Science & Medicine (1982)
                Publisher: The Authors. Published by Elsevier Ltd.
                ISSN (Print): 0277-9536
                ISSN (Electronic): 1873-5347
                Publication date PMC-release: 20 January 2023
                Publication date (Electronic): 20 January 2023
                Electronic Location Identifier: 115716
                Affiliations
                [a ]David Rockefeller Center for Latin American Studies, Harvard University, USA
                [b ]Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
                [c ]Harvard T.H. Chan School of Public Health, Harvard University, USA
                Author notes
                [∗ ]Corresponding author. Av. 9 de julho, 2029 - Edifício John F. Kennedy - Bela Vista, São Paulo - SP, 01313-902, Brazil.
                Article
                Publisher Item ID: S0277-9536(23)00072-2 Publisher ID: 115716
                DOI: 10.1016/j.socscimed.2023.115716
                PMC ID: 9851720
                PubMed ID: 36702027
                SO-VID: 2a57db4a-c354-472d-858d-edf7f0f49a2c
                Copyright © © 2023 The Authors. Published by Elsevier Ltd.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 19 November 2022
                Date revision received : 12 January 2023
                Date accepted : 19 January 2023
                Categories
                Subject: Article

                ScienceOpen disciplines: Health & Social care
                Keywords: health systems,health system resilience,framework,covid-19,implementation
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: health systems, health system resilience, framework, covid-19, implementation

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