Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework

Abstract

With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a recognised framework that measures the performance of HSs throughout a crisis, i.e., one that explicitly includes time as a key aspect, we examined the literature about conceptual frameworks for measuring the performance and the resilience of HSs. This review highlighted a significant diversity among 18 distinct HS performance frameworks and 13 distinct HS resilience frameworks. On this basis, we developed a model that integrates the WHO’s widely recognised six building block framework in a novel approach derived from the European Observatory on HSs and Policies. The resulting framework adapts the building blocks to the different stages of a crisis, thereby allowing for a comprehensive assessment of an entire health system’s performance throughout the crisis’s duration, while also considering the key aspect of resilience. For a more pragmatic use of this framework in the future, indicators will be developed as a next step.

The Israeli health system’s rapid responses during the COVID-19 pandemic

“…A resilient response to a shock to the health system like COVID-19 entails not only rapid responses, but also being prepared for such shocks. Preparedness does not only mean having excess capacity and resources, as some frameworks suggest [ 7 – 9 , 11 ], as these can represent difficult tradeoffs with efficiency, particularly in a stretched health system such as the Israeli one [ 79 ]. Preparedness also means having response plans in place, with a coordinated governance that enables following these plans.…”