The role of health systems for health security: a scoping review revealing the need for improved conceptual and practical linkages

Abstract

Background Practical links between health systems and health security are historically prevalent, but the conceptual links between these fields remain under explored, with little on health system strengthening. The need to address this gap gains relevance in light of the COVID-19 pandemic as it demonstrated a crucial relationship between health system capacities and effective health security response. Acknowledging the importance of developing stronger and more resilient health systems globally for health emergency preparedness, the WHO developed a Health Systems for Health Security framework that aims to promote a common understanding of what health systems for health security entails whilst identifying key capacities required. Methods/ results To further explore and analyse the conceptual and practical links between health systems and health security within the peer reviewed literature, a rapid scoping review was carried out to provide an overview of the type, extent and quantity of research available. Studies were included if they had been peer-reviewed and were published in English (seven databases 2000 to 2020). 343 articles were identified, of those 204 discussed health systems and health security (high and medium relevance), 101 discussed just health systems and 47 discussed only health security (low relevance). Within the high and medium relevance articles, several concepts emerged, including the prioritization of health security over health systems, the tendency to treat health security as exceptionalism focusing on acute health emergencies, and a conceptualisation of security as ‘state security’ not ‘human security’ or population health. Conclusion Examples of literature exploring links between health systems and health security are provided. We also present recommendations for further research, offering several investments and/or programmes that could reliably lead to maximal gains from both a health system and a health security perspective, and why these should be explored further. This paper could help researchers and funders when deciding upon the scope, nature and design of future research in this area. Additionally, the paper legitimises the necessity of the Health Systems for Health Security framework, with the findings of this paper providing useful insights and evidentiary examples for effective implementation of the framework.

Evolution of assisted deliveries at primary healthcare centres in an unstable security context in Mali

“…In sub-Saharan Africa and the Sahel in particular, by disrupting access to care and the availability of human and financial resources, these conflicts contribute to high maternal mortality rates3 and a low rate of deliveries in health facilities 4. Although there are rich literature on the connections between5 conflict and access to healthcare, studies that estimate their impact on the use of maternal healthcare are still rare 6. These studies mainly address the impacts of armed conflict on maternal health, miscarriage or other adverse pregnancy outcomes 7.…”

“…4 Although there are rich literature on the connections between 5 conflict and access to healthcare, studies that estimate their impact on the use of maternal healthcare are still rare. 6 These studies mainly address the impacts of armed conflict on maternal health, miscarriage or other adverse pregnancy outcomes. 7 In Burkina Faso, studies suggest that armed groups have an immediate impact on the organisation of care 8 and various indicators of maternal care, including the number of antenatal care visits, assisted deliveries and caesarean sections.…”

Health Security: Definition Problems

“…In the first approach, seven studies were rejected because they related to patient security in patient safety meaning [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Subsequently, another seventeen were denied, because the definition of health security was not actually discussed there or was limited to the literal quotation of other authors’ definitions [ 7 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. Ultimately, the study criteria were met by four studies: P. Grzywna [ 37 ]; S. Jarmuszko [ 38 ]; J. Konieczny [ 39 ] and M. Paplicki [ 40 ].…”

“…There are various and incompatible definitions of the concept and, thus, significant differences in understanding and using it in different settings [ 6 ]. That is of great inconvenience to communication regarding the subject, leading to the breakdown of cooperation and development, especially as a linkage between health security and health systems [ 7 ]. Hence, there is still a need for a generally accepted definition of health security that is neither simple nor easy.…”

Topic: Securitization of Global Health Pandemic and Reiterating the Relevance of 2005 International Health Regulations: Covid-19 and Human Security in Africa.

“…The African Center for Disease Control and Prevention (CDC, 2020), informed that global health security is the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world. According to the World Health Organization (WHO), health security relates to ‗the activities that require, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries' (Brown, Bridge, & Martini, 2022). Feldbaum et al (2006) affirmed that global health is a humanitarian endeavour that seeks to improve the world's health including the most vulnerable peoples, while national security works to protect the interests of people within a given state … While there is potential to expand global health activities through partnership with the security and foreign policy communities.…”