Health system resilience: a literature review of empirical research

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.

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

“…13 Biddle et al applied this framework to the empirical literature and found that studies typically addressed single components of health systems rather than an inter-connected system as a whole and found a marked discrepancy between the frameworks of resilience and the applied cases of resilience, discrediting the legitimacy of the framework. 14 By using a best-fit framework synthesis, this review employed Kruk colleagues' resilience framework, which was built upon the experiences from the Ebola response and frameworks from other disciplines. 10,11 Not only did the review confirm the applicability of the framework's themes, but also revealed additional themes in the literature.…”

Building Resilient Health Systems: Patient Safety during COVID-19 and Lessons for the Future

“…Health systems’ performance depends on the interplay of its six ‘building blocks’; Governance and leadership, health financing, health workforce, health information systems, medicines and medical products and the service delivery (Biddle et al, 2020; WHO, 2010). A resilient health system is aware of strengths and vulnerability in each of these building blocks, as well as the spectrum of risks to which it is exposed.…”

Lessons learned from the resilience of Chinese hospitals to the COVID-19 pandemic: a scoping review

“…Our research also revealed that there are relatively few articles that have used the concept of resilience in a Chinese medical context, indicating that China's hospitals do not consider a resilience framework as part of their research. Despite increased use in academic and professional contexts, the popular concept of health systems resilience has not yet reached conceptual maturity (Turenne et al, 2019) and, according to a recent scoping review "empirical studies fundamentally differ in the way that resilience is understood in a healthcare context" (Biddle et al 2020). In China, the multiple possible translations for the term 'resilience': most prominently, tanxing ( Further research needs to be undertaken to understand how the concept of resilience translates and is understood across cultures and academic contexts.…”