Shifting the paradigm: using disease outbreaks to build resilient health systems

ABSTRACT

[...]events push weak health systems to a breaking point, as witnessed during recent outbreaks of cholera, drug-resistant tuberculosis, Ebola virus disease and Zika virus disease.1–4 The current COVID-19 pandemic is testing the response and resilience of health systems worldwide, including well-resourced systems in Europe and North America, where health institutions and public health agencies are operating beyond capacity, diagnostics are lacking, triage systems are faltering, personal protective equipment are insufficient, and front-line health workers are facing risks of disease and death.5 Building responsive and resilient health systems is an imperative for the global health community. [...]many aspects of outbreak response lay the groundwork for health system strengthening (HSS), such as enhancing surveillance systems and training the health workforce.12 Over the last two decades, numerous mechanisms, frameworks and agreements have been developed to promote health systems that are resilient to outbreaks and major health emergencies, such as the International Health Regulations (IHR)—an agreement between 196 countries to work together to mitigate global health security threats and a cornerstone of efforts aimed at ensuring sufficient health system infrastructure to detect, assess and report major events impacting public health.13 Through the IHR, in 2016 the Joint External Evaluations were created to identify critical gaps within health systems and prioritise actions to enhance preparedness and response within a country.14 There is not yet a framework, toolkit or formalised targets for HSS activities during outbreaks. [...]during the current COVID-19 pandemic the USA approved a US$2 trillion-dollar stimulus bill, of which US$157 billion was directly allocated to the health system and research.15 While it is critical and ethically necessary to prioritise immediate response activities, the organisational infrastructure, capacity and networks which typically result from these investments could be leveraged to also strengthen health systems, in particular those components that are directly impacted during the outbreak, such as health information systems, healthcare services, medical and public health workforce, supply chain management and essential medicines and vaccines. Lessons could be learned from industries, such as military, nuclear, oil and gas and aviation that have similar high-pressure and complex environments as the biomedically oriented institutions and experience major events and disasters, and have used methodologies to effectively address acute challenges while building better, more sustainable systems and processes along the way.16 Methodologies like systems analysis and applied systems thinking could be adapted and used during an acute response to both further enhance response effectiveness and strengthen health systems.16 We have identified 10 activities that could be implemented during health emergencies to ensure that health systems are strengthened during the response.