Towards an understanding of resilience responding to health systems shocks

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 r...

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Published inHealth policy and planning Vol. 33; no. 3; pp. 355 - 367
Main Authors Hanefeld, Johanna, Mayhew, Susannah, Legido-Quigley, Helena, Martineau, Frederick, Karanikolos, Marina, Blanchet, Karl, Liverani, Marco, Mokuwa, Esther Yei, Gillian, McKay, Balabanova, Dina
Format Journal Article
LanguageEnglish
Published England Oxford University Press 01.04.2018
Oxford Publishing Limited (England)
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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. La récente épidémie de la maladie à virus Ebola (MVE) en Afrique de l’Ouest a attiré l’attention sur le rôle et la réactivité des systèmes de santé face au choc. Elle a mis en évidence l’idée que les systèmes de santé doivent non seulement être plus forts, mais aussi plus «résilients». Dans le présent article, nous soutenons que la réponse aux chocs est un aspect important de la résilience, en examinant le comportement du système de santé face à quatre types de chocs contemporains: la crise financière en Europe à partir de 2008; les catastrophes liées au changement climatique; l’épidémie de MVE en Afrique de l’Ouest de 2013 à 2016; et la récente crise des réfugiés et des migrations en Europe. Sur la base de cette analyse, nous identifions les dimensions critiques «3 plus 2» particulièrement pertinentes pour la capacité des systèmes de santé à s’adapter et à réagir aux chocs; les actions dans tous ces domaines vont déterminer le niveau de réussite d’une riposte. Il s’agit-l à de trois dimensions fondamentales correspondant à trois fonctions des systèmes de santé: les «systèmes d’information sur la santé» (disposer des informations et des connaissances nécessaires afin de prendre une décision sur ce qui doit être fait); les «mécanismes de financement/financement» (investir ou mobiliser des ressources pour financer une riposte); et le «personnel de santé» (qui devrait planifier, mettre en œuvre et la manière de le faire). Celles-ci recoupent deux aspects transversaux: la «gouvernance», en tant que fonction fondamentale affectant toutes les autres dimensions du système; et les «valeurs» prédominantes façonnant la riposte, et comment elle est vécue aux niveaux individuel et communautaire. De plus, dans toutes les crises examinées ici, l’intégration au sein du système de santé a contribué à la résilience, tout comme la connexion avec les communautés locales; à preuve, les ripostes communautaires réussies face à Ebola et les mouvements sociaux répondant à la crise financière. Dans toutes les crises, les inégalités ont augmenté, mais nos données montrent également que l’impact des chocs se prête à l’action du gouvernement. Tous ces facteurs sont façonnés par le contexte. Nous soutenons que les dimensions «3 plus 2» peuvent éclairer des politiques pragmatiques visant à renforcer la résilience des systèmes de santé. 西非的埃博拉病毒 (EVD) 暴发引发人们关注卫生体系在冲 击中的作用以及应对冲击的能力。核心的想法是卫生体系不 仅需要更强, 而且要更有韧性。我们认为应对冲击是韧性的重 要方面, 在本文中将剖析面对当代四种冲击时的卫生体系行 为:自2008年起的欧洲金融危机;气候变化灾害;2013至 2016年西非EVD疫情;以及近期欧洲难民和移民危机。依据 这一分析, 我们发现了卫生体系应对冲击时至关重要 的”3+2”维度;在这些维度采取行动可决定应对是否成功。 其中包括3个核心维度, 对应卫生体系的3个功能:”卫生信息 系统”(具备决策所需的信息和知识);”资金/筹资机 制”(投入或调度应对所需的资源);”卫生人力”(规划和实 施人员以及工作方案)。以上维度又与两个方面交叉:”治 理”, 是影响所有体系维度的基本功能;主导”价值观”, 指导 应对措施, 决定其对个人和社区的影响。此外, 在本文探讨的 所有危机中, 卫生体系内部整合有助于提高韧性, 埃博拉疫情 中的成功社区应对机制和应对金融危机的社会动员还证明, 与 地方社区联合同样有助于提高卫生体系韧性。所有危机都带 来了不平等现象, 但我们的证据也显示, 冲击的影响与政府行 动相关。所有因素都随环境而改变。我们认为”3+2”维度可 以指导制定提高卫生体系韧性的务实政策。 El reciente brote de la Enfermedad del Virus del Ébola (EVE) en África Occidental ha llamado la atención sobre el papel y la capacidad de respuesta de los sistemas de salud frente al choque. La EVE resaltó la idea de que los sistemas de salud necesitan no solo ser más fuertes sino también más “flexibles”. En este artículo, argumentamos que la respuesta a los choques es un aspecto importante de la capacidad de recuperación, examinando el comportamiento del sistema de salud frente a cuatro tipos de choques contemporáneos: la crisis financiera en Europa a partir de 2008; desastres del cambio climático; el brote de EVE en África Occidental 2013-2016; y la reciente crisis de refugiados y migración en Europa. Con base en este análisis, identificamos las dimensiones críticas ‘3 más 2’ de relevancia particular para la capacidad de los sistemas de salud para adaptarse y responder a los choques; las acciones en todos estos determinarán el grado de éxito de una respuesta. Estas son tres dimensiones básicas que corresponden a tres funciones de los sistemas de salud: ‘sistemas de información de salud’ (tener la información y el conocimiento para tomar una decisión sobre lo que se debe hacer); ‘mecanismos de fondos/financiación’ (inversión o movilización de recursos para financiar una respuesta); y ‘personal ’de la salud’ (quién debería planearlo e implementarlo y cómo). Estas dimensiones se cruzan con dos aspectos transversales: ‘gobernanza’, como una función fundamental que afecta a todas las demás dimensiones del sistema; y ‘valores’ predominantes que dan forma a la respuesta, y cómo ésta se experimenta a niveles individual y comunitario. Además, a través de las crisis examinadas aquí, la integración dentro del sistema de salud contribuyó a la capacidad de recuperación, al igual que la conexión con las comunidades locales, evidenciado por las respuestas comunitarias exitosas al Ébola y los movimientos sociales que respondieron a la crisis financiera. En todas las crisis, las desigualdades crecieron, pero nuestra evidencia también resalta que el impacto de los choques es susceptible a la acción gubernamental. Todos estos factores están formados por el contexto. Argumentamos que las dimensiones ‘3 más 2’ pueden informar las políticas pragmáticas que buscan aumentar la capacidad de recuperación de los sistemas de salud.
AbstractList 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.
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.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.
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. La récente épidémie de la maladie à virus Ebola (MVE) en Afrique de l’Ouest a attiré l’attention sur le rôle et la réactivité des systèmes de santé face au choc. Elle a mis en évidence l’idée que les systèmes de santé doivent non seulement être plus forts, mais aussi plus «résilients». Dans le présent article, nous soutenons que la réponse aux chocs est un aspect important de la résilience, en examinant le comportement du système de santé face à quatre types de chocs contemporains: la crise financière en Europe à partir de 2008; les catastrophes liées au changement climatique; l’épidémie de MVE en Afrique de l’Ouest de 2013 à 2016; et la récente crise des réfugiés et des migrations en Europe. Sur la base de cette analyse, nous identifions les dimensions critiques «3 plus 2» particulièrement pertinentes pour la capacité des systèmes de santé à s’adapter et à réagir aux chocs; les actions dans tous ces domaines vont déterminer le niveau de réussite d’une riposte. Il s’agit-l à de trois dimensions fondamentales correspondant à trois fonctions des systèmes de santé: les «systèmes d’information sur la santé» (disposer des informations et des connaissances nécessaires afin de prendre une décision sur ce qui doit être fait); les «mécanismes de financement/financement» (investir ou mobiliser des ressources pour financer une riposte); et le «personnel de santé» (qui devrait planifier, mettre en œuvre et la manière de le faire). Celles-ci recoupent deux aspects transversaux: la «gouvernance», en tant que fonction fondamentale affectant toutes les autres dimensions du système; et les «valeurs» prédominantes façonnant la riposte, et comment elle est vécue aux niveaux individuel et communautaire. De plus, dans toutes les crises examinées ici, l’intégration au sein du système de santé a contribué à la résilience, tout comme la connexion avec les communautés locales; à preuve, les ripostes communautaires réussies face à Ebola et les mouvements sociaux répondant à la crise financière. Dans toutes les crises, les inégalités ont augmenté, mais nos données montrent également que l’impact des chocs se prête à l’action du gouvernement. Tous ces facteurs sont façonnés par le contexte. Nous soutenons que les dimensions «3 plus 2» peuvent éclairer des politiques pragmatiques visant à renforcer la résilience des systèmes de santé. 西非的埃博拉病毒 (EVD) 暴发引发人们关注卫生体系在冲 击中的作用以及应对冲击的能力。核心的想法是卫生体系不 仅需要更强, 而且要更有韧性。我们认为应对冲击是韧性的重 要方面, 在本文中将剖析面对当代四种冲击时的卫生体系行 为:自2008年起的欧洲金融危机;气候变化灾害;2013至 2016年西非EVD疫情;以及近期欧洲难民和移民危机。依据 这一分析, 我们发现了卫生体系应对冲击时至关重要 的”3+2”维度;在这些维度采取行动可决定应对是否成功。 其中包括3个核心维度, 对应卫生体系的3个功能:”卫生信息 系统”(具备决策所需的信息和知识);”资金/筹资机 制”(投入或调度应对所需的资源);”卫生人力”(规划和实 施人员以及工作方案)。以上维度又与两个方面交叉:”治 理”, 是影响所有体系维度的基本功能;主导”价值观”, 指导 应对措施, 决定其对个人和社区的影响。此外, 在本文探讨的 所有危机中, 卫生体系内部整合有助于提高韧性, 埃博拉疫情 中的成功社区应对机制和应对金融危机的社会动员还证明, 与 地方社区联合同样有助于提高卫生体系韧性。所有危机都带 来了不平等现象, 但我们的证据也显示, 冲击的影响与政府行 动相关。所有因素都随环境而改变。我们认为”3+2”维度可 以指导制定提高卫生体系韧性的务实政策。 El reciente brote de la Enfermedad del Virus del Ébola (EVE) en África Occidental ha llamado la atención sobre el papel y la capacidad de respuesta de los sistemas de salud frente al choque. La EVE resaltó la idea de que los sistemas de salud necesitan no solo ser más fuertes sino también más “flexibles”. En este artículo, argumentamos que la respuesta a los choques es un aspecto importante de la capacidad de recuperación, examinando el comportamiento del sistema de salud frente a cuatro tipos de choques contemporáneos: la crisis financiera en Europa a partir de 2008; desastres del cambio climático; el brote de EVE en África Occidental 2013-2016; y la reciente crisis de refugiados y migración en Europa. Con base en este análisis, identificamos las dimensiones críticas ‘3 más 2’ de relevancia particular para la capacidad de los sistemas de salud para adaptarse y responder a los choques; las acciones en todos estos determinarán el grado de éxito de una respuesta. Estas son tres dimensiones básicas que corresponden a tres funciones de los sistemas de salud: ‘sistemas de información de salud’ (tener la información y el conocimiento para tomar una decisión sobre lo que se debe hacer); ‘mecanismos de fondos/financiación’ (inversión o movilización de recursos para financiar una respuesta); y ‘personal ’de la salud’ (quién debería planearlo e implementarlo y cómo). Estas dimensiones se cruzan con dos aspectos transversales: ‘gobernanza’, como una función fundamental que afecta a todas las demás dimensiones del sistema; y ‘valores’ predominantes que dan forma a la respuesta, y cómo ésta se experimenta a niveles individual y comunitario. Además, a través de las crisis examinadas aquí, la integración dentro del sistema de salud contribuyó a la capacidad de recuperación, al igual que la conexión con las comunidades locales, evidenciado por las respuestas comunitarias exitosas al Ébola y los movimientos sociales que respondieron a la crisis financiera. En todas las crisis, las desigualdades crecieron, pero nuestra evidencia también resalta que el impacto de los choques es susceptible a la acción gubernamental. Todos estos factores están formados por el contexto. Argumentamos que las dimensiones ‘3 más 2’ pueden informar las políticas pragmáticas que buscan aumentar la capacidad de recuperación de los sistemas de salud.
Author Gillian, McKay
Martineau, Frederick
Balabanova, Dina
Mayhew, Susannah
Mokuwa, Esther Yei
Hanefeld, Johanna
Karanikolos, Marina
Blanchet, Karl
Liverani, Marco
Legido-Quigley, Helena
AuthorAffiliation 2 Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, Singapore
5 Njala University, PMB, Freetown, Sierra Leone
1 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
3 European Observatory on Health Systems and Policies, London, UK
4 Health in Humanitarian Crisis Centre, London School of Hygiene and Tropical Medicine, London, UK
AuthorAffiliation_xml – name: 1 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
– name: 5 Njala University, PMB, Freetown, Sierra Leone
– name: 2 Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, Singapore
– name: 3 European Observatory on Health Systems and Policies, London, UK
– name: 4 Health in Humanitarian Crisis Centre, London School of Hygiene and Tropical Medicine, London, UK
Author_xml – sequence: 1
  givenname: Johanna
  surname: Hanefeld
  fullname: Hanefeld, Johanna
– sequence: 2
  givenname: Susannah
  surname: Mayhew
  fullname: Mayhew, Susannah
– sequence: 3
  givenname: Helena
  surname: Legido-Quigley
  fullname: Legido-Quigley, Helena
– sequence: 4
  givenname: Frederick
  surname: Martineau
  fullname: Martineau, Frederick
– sequence: 5
  givenname: Marina
  surname: Karanikolos
  fullname: Karanikolos, Marina
– sequence: 6
  givenname: Karl
  surname: Blanchet
  fullname: Blanchet, Karl
– sequence: 7
  givenname: Marco
  surname: Liverani
  fullname: Liverani, Marco
– sequence: 8
  givenname: Esther Yei
  surname: Mokuwa
  fullname: Mokuwa, Esther Yei
– sequence: 9
  givenname: McKay
  surname: Gillian
  fullname: Gillian, McKay
– sequence: 10
  givenname: Dina
  surname: Balabanova
  fullname: Balabanova, Dina
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29325025$$D View this record in MEDLINE/PubMed
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Snippet 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...
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SubjectTerms Climate change
Crises
Cross cutting
Cutting parameters
Decision making
Delivery of Health Care
Disaster Planning
Disasters
Ebola virus
Ebolavirus
Economic crisis
Editor's Choice
Financing, Organized
Governance
Government Programs
Health behavior
Health information
Health Information Systems
Health insurance
Health Resources
Health services
Humans
Inequality
Information sources
Information systems
Information technology
Local communities
Migration
Natural disasters
Original
ORIGINAL ARTICLES
Outbreaks
Refugees
Resilience
Resources
Responsiveness
Social inequality
Social movements
Social response
Viral diseases
Viruses
Workforce
Subtitle responding to health systems shocks
Title Towards an understanding of resilience
URI https://www.jstor.org/stable/48509185
https://www.ncbi.nlm.nih.gov/pubmed/29325025
https://www.proquest.com/docview/2430063044
https://www.proquest.com/docview/1989599141
https://pubmed.ncbi.nlm.nih.gov/PMC6277919
Volume 33
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