WALKING THE TALK
Shift 4: From fragility to resilience Pandemics like COVID-19—as well as other shocks, including conflict or natural disaster—can devastate health systems and reverse years of hard-won health, development, and economic progress. “Health security” refers to the activities required to minimize the danger and impact of health shocks. Neither health security nor UHC can be achieved without building resilient health systems (UHC 2030 and SHFA 2020); WHO has reminded countries that the best foundation for resilient systems is PHC (WHO 2020a).
What is meant by resilience in PHC? There is as yet no universally agreed definition of health system resilience. This report follows the influential definition proposed by Kruk et al. (2015) and widely adopted by the community of organizations working to advance UHC:
Health system resilience can be defined as the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learned during the crisis, reorganize if conditions require it. Health systems are resilient if they protect human life and produce good health outcomes for all during a crisis and in its aftermath. 62
Kruk et al.’s model characterizes resilient systems in terms of five fundamental attributes. Resilient health systems are (1) aware, (2) diverse, (3) self-regulating, (4) integrated, and (5) adaptable (Kruk et al. 2015). Resilience is closely related to another concept widely discussed in the current health systems literature: preparedness (IWG 2017). Linguistically and practically, “preparedness” emphasizes pre-crisis actions to anticipate health emergencies, while “resilience” as defined by Kruk encompasses preparation, response, and post-crisis recovery. In this sense, preparedness can be considered as a stage of the continuous cyclical process to improve health system resilience (Rajan et al. 2021).
