On the resilience of health systems: A methodological exploration across countries in the WHO African Region.
The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to "prepare and effectively respond to crises; maintain core functions; and, informed by lessons learn...
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Public Library of Science (PLoS)
2022-01-01
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| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0261904&type=printable |
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| author | Humphrey Cyprian Karamagi Regina Titi-Ofei Hillary Kipchumba Kipruto Aminata Benitou-Wahebine Seydi Benson Droti Ambrose Talisuna Benjamin Tsofa Sohel Saikat Gerard Schmets Edwine Barasa Prosper Tumusiime Lindiwe Makubalo Joseph Waogodo Cabore Matshidiso Moeti |
| author_facet | Humphrey Cyprian Karamagi Regina Titi-Ofei Hillary Kipchumba Kipruto Aminata Benitou-Wahebine Seydi Benson Droti Ambrose Talisuna Benjamin Tsofa Sohel Saikat Gerard Schmets Edwine Barasa Prosper Tumusiime Lindiwe Makubalo Joseph Waogodo Cabore Matshidiso Moeti |
| author_sort | Humphrey Cyprian Karamagi |
| collection | DOAJ |
| description | The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to "prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it". There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes. |
| format | Article |
| id | doaj-art-0843f4b0a19f4b6c9e6a5329fbcc4cbb |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-0843f4b0a19f4b6c9e6a5329fbcc4cbb2025-08-20T03:25:20ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01172e026190410.1371/journal.pone.0261904On the resilience of health systems: A methodological exploration across countries in the WHO African Region.Humphrey Cyprian KaramagiRegina Titi-OfeiHillary Kipchumba KiprutoAminata Benitou-Wahebine SeydiBenson DrotiAmbrose TalisunaBenjamin TsofaSohel SaikatGerard SchmetsEdwine BarasaProsper TumusiimeLindiwe MakubaloJoseph Waogodo CaboreMatshidiso MoetiThe need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to "prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it". There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0261904&type=printable |
| spellingShingle | Humphrey Cyprian Karamagi Regina Titi-Ofei Hillary Kipchumba Kipruto Aminata Benitou-Wahebine Seydi Benson Droti Ambrose Talisuna Benjamin Tsofa Sohel Saikat Gerard Schmets Edwine Barasa Prosper Tumusiime Lindiwe Makubalo Joseph Waogodo Cabore Matshidiso Moeti On the resilience of health systems: A methodological exploration across countries in the WHO African Region. PLoS ONE |
| title | On the resilience of health systems: A methodological exploration across countries in the WHO African Region. |
| title_full | On the resilience of health systems: A methodological exploration across countries in the WHO African Region. |
| title_fullStr | On the resilience of health systems: A methodological exploration across countries in the WHO African Region. |
| title_full_unstemmed | On the resilience of health systems: A methodological exploration across countries in the WHO African Region. |
| title_short | On the resilience of health systems: A methodological exploration across countries in the WHO African Region. |
| title_sort | on the resilience of health systems a methodological exploration across countries in the who african region |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0261904&type=printable |
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