COVID-19 tests the ability of national health systems to withstand health shocks while maintaining routine functions. Kruk and colleagues define health-system resilience 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, reorganise if conditions require it”. Crucially, because crises such as COVID-19 do not occur in a vacuum, resilience necessitates intentional collaboration between traditionally distinct health and development agendas, including UHC, the Global Health Security Agenda, the One Health approach, and the UN Sustainable Development Goals.
Health-system resilience, which should be framed as an ability rather than an outcome, can be a powerful indicator of adaptability, responsiveness, and stability, and is, therefore, crucial to assess. Because traditional models (eg, pandemic-preparedness models, GHS indices, and IHR Joint External Evaluations) did not fully account for the varied effects of COVID-19, new indices should be developed that explore the resilience of health-system governance to cope with health crises.
These revised models should carefully contextualise explicit and implicit power dynamics, competing interests and priorities, and new and emerging stakeholders. Furthermore, existing assessments, such as the WHO Joint External Evaluations and Service Availability and Readiness Assessments, can be reviewed and pursued together in resilience models, alongside consideration of social determinants of health to assess effects on health inequities, to develop a cohesive understanding of GHS and UHC gaps in health governance.
Souce : Lancet