ABSTRACT
IntroductionIn 2020, the COVID-19 epidemic swept the world, and many national health systems faced serious challenges. To improve future public health responses, its necessary to evaluate the performance of each countrys health system. MethodsWe developed a resilience evaluation system for national health systems based on their responses to COVID-19 using four resilience dimensions: government governance and prevention, health financing, health service provision, and health workers. We determined the weight of each index by combining the three-scale and entropy-weight methods. Then, based on data from 2020, we used the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method to rank the health system resilience of 60 countries, then used hierarchical clustering to classify countries into groups based on their resilience level. Finally, we analyzed the causes of differences among countries in their resilience based on the four resilience dimensions. ResultsSwitzerland, Japan, Germany, Australia, South Korea, Canada, New Zealand, Finland, the United States, and the United Kingdom had the highest health system resilience in 2020. Eritrea, Nigeria, Libya, Tanzania, Burundi, Mozambique, Republic of the Niger, Benin, Cote dIvoire, and Guinea had the lowest resilience. Government governance and prevention of COVID-19 will greatly affect a countrys success in fighting future epidemics, which will depend on a governments emergency preparedness, stringency (a measure of the number and rigor of the measures taken), and testing capability. Given the lack of vaccines or specific drug treatments during the early stages of the 2020 epidemic, social distancing and wearing masks were the main defenses against COVID-19. Cuts in health financing had direct and difficult to reverse effects on health systems. In terms of health service provision, the number of hospitals and intensive care unit beds played a key role in COVID-19 clinical care. ConclusionResilient health systems were able to cope more effectively with the impact of COVID-19, provide stronger protection for citizens, and mitigate the impacts of COVID-19. Our evaluation based on data from 60 countries around the world showed that increasing health system resilience will improve responses to future public health emergencies. Key QuestionsO_ST_ABSWhat is already known?C_ST_ABSO_LIAccording to a report by the World Health Organization, the COVID-19 epidemic placed the health systems of many countries at risk of collapse. C_LIO_LIAt present, there is no evaluation index system to measure the resilience of each countrys health system against a pandemic, and there has been no quantitative assessment of the resilience of each countrys health system based on their responses to COVID-19. C_LI What are the new findings?O_LIWe assessed, ranked, and quantified the health system resilience of 60 representative countries based on their responses to COVID-19 using data from 2020 on four dimensions of resilience: government governance and prevention, health financing, health service provision, and the health workforce. C_LIO_LIWestern Europe, East Asia, North America, and Southern Oceania had better health system resilience, whereas Africa had low health system resilience, with very low health financing scores and weak health systems with structural and regional imbalances. C_LIO_LIHealth system resilience was heavily influenced by government governance and prevention, as well as by government emergency preparedness, the stringency of their response (a measure of the number and rigor of the measures taken), and their testing capability. C_LI What do the new findings imply?O_LIGlobal health system resilience varied widely among countries, and many health systems remain weak and unprepared for another pandemic such as COVID-19. As a result, future pandemics will remain a major problem for humanity if improvements are not made by each government. C_LIO_LIIn underdeveloped countries and regions, infectious diseases can be controlled more effectively through more efficient government governance and strict surveillance and detection measures, but achieving this depends heavily on the speed of government decision making and the level of policy formulation related to the most effective way to strengthen health systems and improve their resilience. Assistance from developed country will be essential in improving resilience. C_LI
