Health System

Information and communication technology can be used to improve the quality and safety of health care and to lower costs. But in both developed and developing countries, there is an inadequate supply of skilled individuals who have the technical skills to use this technology to improve health care. Some studies project workforce needs of tens of thousands in English-speaking developed countries, but it is not known what size workforce will be required in the developing world. It is important to identify and develop the skills, training, and competencies-consistent with local cultures, languages, and health systems-that will be needed to realize the full benefits of these technologies. We present a framework for answering these questions and for developing estimates of the size and scope of the workforce that may be needed.

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept.Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience.  Four  databases  and  gray  literature  were  searched  using  the  keywords  “health  system”  and  “resilience”  for  published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization  (WHO)  health  system  framework.  The  scoping  review  identified  eleven  sources  with  descriptions  and  24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience.Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience  primarily  focus  on  major  shocks.  Adjustments  to  long-term  changes  and  the  element  of  learning  should  be  considered  for  a  better  understating  of  health  system  resilience.