Spillover effects of COVID-19 on essential chronic care and ways to foster health system resilience to support vulnerable non-COVID patients: a multistakeholder study

Abstract Background: Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods: This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results: The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions: Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. Strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and may support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience.

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What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

BMC Public Health ◽

10.1186/s12889-019-7707-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 14

Author(s):

Jennifer B. Nuzzo ◽

Diane Meyer ◽

Michael Snyder ◽

Sanjana J. Ravi ◽

Ana Lapascu ◽

...

Keyword(s):

Public Health ◽

Infectious Disease ◽

Health System ◽

Natural Hazards ◽

Health Systems ◽

Scoping Review ◽

Disease Outbreaks ◽

World Health ◽

Infectious Disease Outbreaks ◽

System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

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Health system resilience in managing the COVID-19 pandemic: lessons from Singapore

BMJ Global Health ◽

10.1136/bmjgh-2020-003317 ◽

2020 ◽

Vol 5 (9) ◽

pp. e003317

Author(s):

Alvin Qijia Chua ◽

Melisa Mei Jin Tan ◽

Monica Verma ◽

Emeline Kai Lin Han ◽

Li Yang Hsu ◽

...

Keyword(s):

Health System ◽

Migrant Worker ◽

Health Service Delivery ◽

Contact Tracing ◽

Legal Foundation ◽

Imported Cases ◽

Rapid Transmission ◽

At Risk Populations ◽

System Resilience ◽

The Government

Singapore, one of the first countries affected by COVID-19, adopted a national strategy for the pandemic which emphasised preparedness through a whole-of-nation approach. The pandemic was well contained initially until early April 2020, when there was a surge in cases, attributed to Singapore residents returning from hotspots overseas, and more significantly, rapid transmission locally within migrant worker dormitories. In this paper, we present the response of Singapore to the COVID-19 pandemic based on core dimensions of health system resilience during outbreaks. We also discussed on the surge in cases in April 2020, highlighting efforts to mitigate it. There was: (1) clear leadership and governance which adopted flexible plans appropriate to the situation; (2) timely, accurate and transparent communication from the government; (3) public health measures to reduce imported cases, and detect as well as isolate cases early; (4) maintenance of health service delivery; (5) access to crisis financing; and (6) legal foundation to complement policy measures. Areas for improvement include understanding reasons for poor uptake of government initiatives, such as the mobile application for contact tracing and adopting a more inclusive response that protects all individuals, including at-risk populations. The experience in Singapore and lessons learnt will contribute to pandemic preparedness and mitigation in the future.

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Health system resilience: a literature review of empirical research

Health Policy and Planning ◽

10.1093/heapol/czaa032 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1084-1109

Author(s):

Louise Biddle ◽

Katharina Wahedi ◽

Kayvan Bozorgmehr

Keyword(s):

Health System ◽

Mixed Methods Research ◽

Quantitative Research ◽

Empirical Studies ◽

Disease Outbreaks ◽

Building Blocks ◽

Theoretical Work ◽

Empirical Literature ◽

Quantitative And Qualitative Research ◽

System Resilience

Abstract The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. While substantial effort has gone into the conceptualization of health system resilience, there has been no review of how the concept has been operationalized in empirical studies. We conducted an empirical review in three databases using systematic methods. Findings were synthesized using descriptive quantitative analysis and by mapping aims, findings, underlying concepts and measurement approaches according to the resilience definition by Blanchet et al. We identified 71 empirical studies on health system resilience from 2008 to 2019, with an increase in literature in recent years (62% of studies published since 2017). Most studies addressed a specific crisis or challenge (82%), most notably infectious disease outbreaks (20%), natural disasters (15%) and climate change (11%). A large proportion of studies focused on service delivery (48%), while other health system building blocks were side-lined. The studies differed in terms of their disciplinary tradition and conceptual background, which was reflected in the variety of concepts and measurement approaches used. Despite extensive theoretical work on the domains which constitute health system resilience, we found that most of the empirical literature only addressed particular aspects related to absorptive and adaptive capacities, with legitimacy of institutions and transformative resilience seldom addressed. Qualitative and mixed methods research captured a broader range of resilience domains than quantitative research. The review shows that the way in which resilience is currently applied in the empirical literature does not match its theoretical foundations. In order to do justice to the complexities of the resilience concept, knowledge from both quantitative and qualitative research traditions should be integrated in a comprehensive assessment framework. Only then will the theoretical ‘resilience idea’ be able to prove its usefulness for the research community.

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Harnessing instability as an opportunity for health system strengthening: A review of health system resilience

Healthcare Management Forum ◽

10.1177/0840470419830105 ◽

2019 ◽

Vol 32 (3) ◽

pp. 128-135 ◽

Cited By ~ 2

Author(s):

Caroline Chamberland-Rowe ◽

François Chiocchio ◽

Ivy Lynn Bourgeault

Keyword(s):

Global Health ◽

Health System ◽

Health Systems ◽

Health System Strengthening ◽

Operational Model ◽

Academic Literature ◽

System Resilience

In recent years, resilience has emerged as a prominent topic in global health systems discourse as a result of the increasing variety and volume of sources of instability inflicting strain on systems. In line with this study’s intent to bring together existing literature on health system resilience as a means to understand the process through which systems achieve resilience, a review of academic literature related to health system resilience was conducted. Emerging from this review is an operational model of resilience that builds on existing health systems frameworks. The model highlights health system resilience as a process through which leaders in all sectors need to be mobilized in order to harness instability as an opportunity for health system strengthening rather than a threat to the system’s sustainability and integrity.

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Rational trust in resilient health systems

Health Policy and Planning ◽

10.1093/heapol/czz066 ◽

2019 ◽

Vol 34 (7) ◽

pp. 553-557 ◽

Cited By ~ 4

Author(s):

Sonja Kristine Kittelsen ◽

Vincent Charles Keating

Keyword(s):

Public Health ◽

Health System ◽

Health Systems ◽

The Public ◽

Public Health Emergencies ◽

Health Authorities ◽

Cast Doubt ◽

Public Health Authorities ◽

System Resilience ◽

Relevant Component

AbstractThe 2014–15 Ebola epidemic in West Africa highlighted the significance of trust between the public and public health authorities in the mitigation of health crises. Since the end of the epidemic, there has been a focus amongst scholars and practitioners on building resilient health systems, which many see as an important precondition for successfully combatting future outbreaks. While trust has been acknowledged as a relevant component of health system resilience, we argue for a more sustained theoretical engagement with underlying models of trust in the literature. This article takes a first step in showing the importance of theoretical engagement by focusing on the appeal to rational models of trust in particular in the health system resilience literature, and how currently unconsidered assumptions in this model cast doubt on the effectiveness of strategies to generate trust, and therein resilience, during acute public health emergencies.

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