Enhancing the Understanding of Resilience in Health Systems of Low- and Middle-Income Countries: A Qualitative Evidence Synthesis

Abstract

Background: A country’s health system faces pressure when hit by an unexpected shock, such as what we observe in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The concept of resilience is highly relevant in this context and is a prerequisite for a health system capable of withstanding future shocks. By exploring how the key dimensions of the resilient health system framework are applied, the present systematic review synthesizes the vital features of resilient health systems in low- and middle-income countries. The aim of this review is to ascertain the relevance of health system resilience in the context of a major shock, through better understanding its dimensions, uses and implications. Methods: The review uses the best-fit framework synthesis approach. An a priori conceptual framework was selected and a coding framework created. A systematic search identified 4284 unique citations from electronic databases and reports by non-governmental organisations, 12 of which met the inclusion criteria. Data were extracted and coded against the pre-existing themes. Themes outside of the a priori framework were collated to form a refined list of themes. Then, all twelve studies were revisited using the new list of themes in the context of each study. Results: Ten themes were generated from the analysis. Five confirmed the a priori conceptual framework that capture the dynamic attributes of a resilient system. Five new themes were identified as foundational for achieving resilience: realigned relationships, foresight and motivation as drivers, and emergency preparedness and change management as organisational mechanisms. Conclusion: The refined conceptual model shows how the themes inter-connect. The foundations of resilience appear to be critical especially in resource-constrained settings to unlock the dynamic attributes of resilience. This review prompts countries to consider building the foundations of resilience described here as a priority to better prepare for future shocks.

Evidence of health system resilience in Myanmar during Cyclone Nargis: a qualitative analysis

“…A recent qualitative synthesis highlighted social capital as the interconnecting mechanism common to both health system strengthening and resilient responses to crises, a powerful tool that can unlock resilience of the health system. 10 This study extends the notion a step further by demonstrating that the power of social capital can go beyond its health system capacity. Social capital may in fact play a more important role in providing relief from the cyclone, just as it had been reported as being more vital in mitigating the spread of the Ebola virus than any donor-driven short-term interventions.…”

“…A hybrid of deductive and inductive approaches provided for a broader structure of the categories and flexibility of codes from the open coding process. As illustrated in figure 1, Grimm et al 10 's conceptual framework was used to develop the analytical framework. The framework was then applied systematically to chart the relevant summary of the transcript with direct quotations structured around 10 categories and 21 codes, resulting in a complete framework matrix.…”

“…As Grimm et al's 10 five key foundations of resilience are critical inputs to activate Kruk et al's five key attributes of resilience, the paper has employed the five key attributes to develop the interview guide. The analysis applies Grimm et al's 10 framework composed of 10 characteristics of resilience to test its applicability in Myanmar's specific context. In addition to the relevant frameworks, the role of the communities is critical when discussing resilience in lowincome and middle-income countries.…”

“…Using a refined conceptual framework for health system resilience developed previously, this paper analyses Myanmar's assets and barriers to achieving health system resilience and highlights the lessons learnt from its devastating past with the hope that the lessons may be transferrable to other countries. 10…”

Civic Duty: A Booster for Resilience?

“…Building resilience is one way of managing such crises. One important driver of resilience may be social capital [ 1 ], which plays an important role during times of crisis and calm [ 2 ]. A component of social capital is civic capital.…”