Resilient Health Systems, Prepared Communities, and Empowered Individuals
Health systems are complex. Making health systems resilient to shocks is even more complex. But, ultimately, what matters to making a health system operational and resilient is that the people who comprise it have the capacity and commitment to ensure that things don’t fall apart when challenges arise. Keeping a health system functioning during the best of times isn’t easy; keeping it working during times of shock and crisis requires that a greater number of factors work in coordination. Among those factors are empowered individuals who know what to do under different circumstances, prepared communities that have a unified plan and know how to work together, and effective planning and coordination efforts that bring public and private sector entities together to focus on the common goal of responding to people’s health needs during a crisis.
In the face of natural disasters, pandemic outbreaks, climate change, violence, and other shocks, health systems must be flexible, adaptive, and resilient. However, not all shocks are the same — and these systems need to be able to address and respond to the different types of shocks that a community can experience. USAID defines resilience as “the capacity of affected people, households, communities, countries, and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces chronic vulnerability and facilitates inclusive growth.” At the heart of a resilient health system is people — individuals who work together to overcome challenges and adversities.
Resilience is a continuum, and not all systems are equally resilient. The most basic level of resilience is a system with absorptive capacity — that is, a system that can continue to deliver the same basic health services with the same resources and capacities while experiencing a shock. A more resilient health system demonstrates adaptive capacity, able to respond to a shock with organizational adaptations that allow for the provision of the same level of healthcare services with fewer — or different — resources available. The most resilient health systems demonstrate transformative capacity, in which a system makes permanent changes to its structure and functions in response to a changing environment.”
It is a common misconception that resilience occurs at the highest levels and flows down through the health system. After all, the ministry of health oversees the system — putting policies in place, hiring and training human resources, investing in health information systems, etc.; all the blocks that comprise a health system. This conception of resilience may be theoretically sound, but the actual practice of resilience is different. Because health happens at the individual level, the groups that are most affected by a health system are the household and the community. All the plans that exist at the national level may be futile if the community has not developed its own resilience plan — with the right people working effectively to keep things going when the community is experiencing a shock.
A community resilience plan needs to extend beyond the formal health sector — both public and private — and take advantage of as many opportunities and resources in the community as possible. For example, the agriculture sector may be part of a nutrition-related response; the transportation sector may help people in need of emergency health services get to an appropriate facility; the industrial, financial, and construction sectors can all be mobilized to play a role in both preparedness for and responses to shocks. A coordinated response is critical to resilience, and all sectors need to contribute to one unified response, with each sector contributing its comparative advantage. Built into the plan should be program redundancy in key functions in case an element of the system breaks down.
In addition to providing services, the resilient community-based health system also needs to ensure that the public uses the services that are available. Resilience at the community level means that people trust the heath system and have confidence in its availability to provide services, diagnoses, and treatments. Without established confidence in the system under normal circumstances, the public will not trust the system to respond to their health needs in times of crisis.
Building a resilient health system is a monumental challenge. It encompasses layers of complexity, as these systems must establish links from national governments to households, from the public to the private health sector, as well as actively engage the non-health sector. Ultimately, resilience resides in the community, and requires a multisectoral commitment to develop and execute a unified response plan. In the face of shocks, the resilient health system must plan and coordinate, engage the right actors, and reach consensus on how to move forward — executing that plan while reflecting and adapting along the way.
Jay Gribble, Deputy Director, FP/RH for Health Policy Plus and Senior Fellow at Palladium, has expertise in policy, research, and communication and more than 25 years of experience in international family planning.
