Building resilient health systems: a proposal for a resilience index

The 2014 west African Ebola epidemic shone a harsh light on the health systems of Guinea, Liberia, and Sierra Leone. While decades of domestic and international investment had contributed to substantial progress on the Millennium Development Goals,1 2 national health systems remained weak and were unable to cope with the epidemic. Routine care of the population also deteriorated during the outbreak.1 2 3 4 Surveillance systems did not function effectively, allowing Ebola to spread within and between the countries. Global institutions were slow to respond to the crisis, squandering an opportunity to stem its course.5 6 7

Since then, diverse panels of experts have pointed to political and technical deficiencies in multilateral organisations in tackling health crises.8 9 10 11 These reports have noted that the first line of defence against future pandemics is an effective national health system. They have also called for better measurement of public health capacity, and investment to build resilient health systems—systems that can withstand health shocks while maintaining routine functions.10 The issue of how global bodies can support countries in withstanding future health shocks is playing out now in the election of the new director general of WHO, with several candidates making health system resilience part of their election planks.

Based on recent literature, this paper defines health system resilience as “the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learnt during the crisis, reorganise if conditions require it.”12 Health system resilience is relevant in all countries facing health shocks—whether sudden (Ebola, earthquakes, terror attacks, refugees), slower moving (new pathogens such as …