Short-term aid or long-term gains? Harnessing Sudan's humanitarian response for the resilience of its health system.

The Sudan 2023 Humanitarian Response Plan was revised in May, 2023, due to the escalating violence in the country. This revision increased the scale of assistance and protection activities and suspended the funding allocated for access to livelihood, access to basic services, and for the implementation of resilience solutions. We call to rethink Sudan's current humanitarian response through a pro-resilience and people-centred approach. A pro-resilience approach prioritises investments in national systems and institutions capable of delivering aid and anticipates, prevents, mitigates, and manages imminent and simultaneous shocks. A people-centred humanitarian response involves meaningful engagement of communities and collaborations with civil society organisations, which continue to be the key responders to the ongoing conflict in Sudan. Finally, we propose approaches to effectively operationalise health system resilience to enhance immediate and long-term health outcomes.

We need to talk about 'bad' resilience.

In this analysis, we argue against seeing health system resilience as an inherently positive concept. The rise in the popularity of health system resilience has led to its increasingly normative framing. We question this widely accepted perspective by examining the underlying assumptions associated with this normative framing of 'good' resilience. Our focus is on the risks of accepting the assumption, which can lead us to ignore the social nature of health systems and overlook the consequences of change if resilience is seen as a positive, achievable objective. Finally, we suggest that seeing resilience as a normative concept can be detrimental to health system policy and research, and encourage a critical rethinking of these assumptions so that we can maintain resilience's usefulness for health systems.

Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic.

BACKGROUND: Health challenges like coronavirus disease 2019 (COVID-19) are becoming increasingly complex, transnational, and unpredictable. Studying health system responses to the COVID-19 pandemic is an opportunity to enhance our understanding of health system resilience and establish a clearer link between theoretical concepts and practical ideas on how to build resilience. METHODS: This narrative literature review aims to address four questions using a health system resilience framework: (i) What do we understand about the dimensions of resilience? (ii) What aspects of the resilience dimensions remain uncertain? (iii) What aspects of the resilience dimensions are missing from the COVID-19 discussions? and (iv) What has COVID-19 taught us about resilience that is missing from the framework? A scientific literature database search was conducted in December 2020 and in April 2022 to identify publications that discussed health system resilience in relation to COVID-19, excluding articles on psychological and other types of resilience. A total of 63 publications were included. RESULTS: There is good understanding around information sharing, flexibility and good leadership, learning, maintaining essential services, and the need for legitimate, interdependent systems. Decision-making, localized trust, influences on interdependence, and transformation remain uncertain. Vertical interdependence, monitoring risks beyond the health system, and consequences of changes on the system were not discussed. Teamwork, actor legitimacy, values, inclusivity, trans-sectoral resilience, and the role of the private sector are identified as lessons from COVID-19 that should be further explored for health system resilience. CONCLUSION: Knowledge of health system resilience has continued to cohere following the pandemic. The eventual consequences of system changes and the resilience of subsystems are underexplored. Through governance, the concept of health system resilience can be linked to wider issues raised by the pandemic, like inclusivity. Our findings show the utility of resilience theory for strengthening health systems for crises and the benefit of continuing to refine existing resilience theory.

Health systems resilience in practice: a scoping review to identify strategies for building resilience.

BACKGROUND: Research on health systems resilience has focused primarily on the theoretical development of the concept and its dimensions. There is an identified knowledge gap in the research on how to build resilience in health systems in practice and 'what works' in different contexts. The aim of this study is to identify practical strategies for building resilient health systems from the empirical research on health systems resilience. METHODS: A scoping review included empirical research on health systems resilience from peer-reviewed literature. The search in the electronic databases PubMed, Web of Science, Global Health was conducted during January to March 2021 for articles published in English between 2013 to February 2021. A total of 1771 articles were screened, and data was extracted from 22 articles. The articles included empirical, applied research on strategies for resilience, that observed or measured resilience during shocks or chronic stress through collection of primary data or analysis of secondary data, or if they were a review study of empirical research. A narrative summary was done by identifying action-oriented strategies, comparing them, and presenting them by main thematic areas. RESULTS: The results demonstrate examples of strategies used or recommended within nine identified thematic areas; use of community resources, governance and financing, leadership, surveillance, human resources, communication and collaboration, preparedness, organizational capacity and learning and finally health system strengthening. CONCLUSIONS: The findings emphasize the importance of improved governance and financing, empowered middle-level leadership, improved surveillance systems and strengthened human resources. A re-emphasized focus on health systems strengthening with better mainstreaming of health security and international health regulations are demonstrated in the results as a crucial strategy for building resilience. A lack of strategies for recovery and lessons learnt from crises are identified as gaps for resilience in future.

'We have a plan for that': a qualitative study of health system resilience through the perspective of health workers managing antenatal and childbirth services during floods in Cambodia.

OBJECTIVE: Health system resilience can increase a system's ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding about what generates and influences resilience. This study aimed to generate empirical knowledge on health system resilience by exploring how public antenatal and childbirth health services in Cambodia have absorbed, adapted or transformed in response to seasonal and occasional floods. DESIGN: A qualitative study using semi-structured interviews and thematic analysis and informed by the Dimensions of Resilience Governance framework. SETTING: Public sector healthcare facilities and health departments in two districts exposed to flooding. PARTICIPANTS: Twenty-three public sector health professionals with experience providing or managing antenatal and birth services during recent flooding. RESULTS: The theme 'Collaboration across the system creates adaptability in the response' reflects how collaboration and social relationships among providers, staff and the community have delineated boundaries for actions and decisions for services during floods. Floods were perceived as having a modest impact on health services. Knowing the boundaries on decision-making and having preparation and response plans let staff prepare and respond in a flexible yet stable way. The theme was derived from ideas of (1) seasonal floods as a minor strain on the system compared with persistent, system-wide organisational stresses the system already experiences, (2) the ability of the health services to adjust and adapt flood plans, (3) a shared purpose and working process during floods, (4) engagement at the local level to fulfil a professional duty to the community, and (5) creating relationships between health system levels and the community to enable flood response. CONCLUSION: The capacity to absorb and adapt to floods was seen among the public sector services. Strategies that enhance stability and flexibility may foster the capacity for health system resilience.

A health systems resilience research agenda: moving from concept to practice.

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.

The transfer of clinical prediction models for early trauma care had uncertain effects on mistriage.

OBJECTIVES: This study aimed to assess how transfers of clinical prediction models for early trauma care between different care contexts within a single health system affected mistriage rates. STUDY DESIGN AND SETTING: Patients aged 15 years or older, registered between 2011 and 2016 in the Swedish national trauma registry, SweTrau, were included. Three data set groups were created: high- and low-volume centers, metropolitan and nonmetropolitan centers, and multicenters and single centers. Clinical prediction models were developed using logistic regression in each data set group and transferred between data sets within groups. Model performance was evaluated using mistriage rate, undertriage rate, and overtriage rate. Multiple imputation using chained equations was used to handle missing data. Model performance was reported as medians with 95% confidence intervals (CIs). RESULTS: A total of 26,965 patients were included. Changes in mistriage rates after transfer ranged from -0.25 (95% CI -0.21 to 0.04) to 0.29 (95% CI 0.13-0.39). Both overtriage and undertriage rates were affected. CONCLUSIONS: Transferring clinical prediction models for early trauma care is associated with substantial uncertainty in regards to the effect on model performance. Depending on the care context, model transfer led to either increased or decreased mistriage. Overtriage was more affected by model transfer than undertriage.

Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia.

INTRODUCTION: Resilient health systems have the capacity to continue providing health services to meet the community's diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system's joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system's capacity to absorb, adapt or transform as viewed through a framework on health systems resilience. METHODS: Eight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework. RESULTS: The theme 'Responsible for the status quo' reflected the community's responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding. CONCLUSIONS: The community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system's resilience by creating room for the community to adapt and transform when experiencing floods.

Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords.

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.

Balancing long-range interactions and quantum pressure: Solitons in the Hamiltonian mean-field model.

The Hamiltonian mean-field (HMF) model describes particles on a ring interacting via a cosine interaction, or equivalently, rotors coupled by infinite-range XY interactions. Conceived as a generic statistical mechanical model for long-range interactions such as gravity (of which the cosine is the first Fourier component), it has recently been used to account for self-organization in experiments on cold atoms with long-range optically mediated interactions. The significance of the HMF model lies in its ability to capture the universal effects of long-range interactions and yet be exactly solvable in the canonical ensemble. In this work we consider the quantum version of the HMF model in one dimension and provide a classification of all possible stationary solutions of its generalized Gross-Pitaevskii equation (GGPE), which is both nonlinear and nonlocal. The exact solutions are Mathieu functions that obey a nonlinear relation between the wave function and the depth of the mean-field potential, and we identify them as bright solitons. Using a Galilean transformation these solutions can be boosted to finite velocity and are increasingly localized as the mean-field potential becomes deeper. In contrast to the usual local GPE, the HMF case features a tower of solitons, each with a different number of nodes. Our results suggest that long-range interactions support solitary waves in a novel manner relative to the short-range case.

Quantum Spin Dynamics in Fock Space Following Quenches: Caustics and Vortices.

Caustics occur widely in dynamics and take on shapes classified by catastrophe theory. At finite wavelengths they produce interference patterns containing networks of vortices (phase singularities). Here we investigate caustics in quantized fields, focusing on the collective dynamics of quantum spins. We show that, following a quench, caustics are generated in the Fock space amplitudes specifying the many-body configuration and which are accessible in experiments with cold atoms, ions, or photons. The granularity of quantum fields removes all singularities, including phase singularities, converting point vortices into nonlocal vortices that annihilate in pairs as the quantization scale is increased. Furthermore, the continuous scaling laws of wave catastrophes are replaced by discrete versions. Such "quantum catastrophes" are expected to be universal dynamical features of quantized fields.

Hope for the Best, Prepare for the Worst-An Assessment of Flood Preparedness at Primary Health Care Facilities in Central Vietnam.

Background: Floods affect over 85 million people every year and are one of the deadliest types of natural disasters. The health effects of floods are partly due to a loss of access to health care. This loss can be limited with proper flood preparedness. Flood preparedness is especially needed at the primary health care (PHC) level. Flood preparedness assessments can be used to identify vulnerable facilities and help target efforts. The existing research on PHC flood preparedness is limited. We aimed to assess the flood preparedness of PHC facilities in a flood-prone province in central Vietnam. Methods: Based on flood experience, the PHC facilities in the province were grouped as "severe" (n = 23) or "non-severe" (n = 129). Assessments were conducted during monsoon season at five facilities from each group, using a pre-tested, semi-structured questionnaire. Data were checked against official records when possible. Results: Nine of the ten facilities had a flood plan and four received regular flood preparedness training. Six facilities reported insufficient preparedness support. Half of the facilities had additional funding available for flood preparedness, or in case of a flood. Flood preparedness training had been received by 21/28 (75%) of the staff at the facilities with severe flood experience, versus 15/25 (52%) of the staff at the non-severe experience facilities. Conclusions: Our results suggest that the assessed PHC facilities were not sufficiently prepared for the expected floods during monsoon season. PHC flood preparedness assessments could be used to identify vulnerable facilities and populations in flood-prone areas. More research is needed to further develop and test the validity and reliability of the questionnaire.

Violent relaxation in quantum fluids with long-range interactions.

Violent relaxation is a process that occurs in systems with long-range interactions. It has the peculiar feature of dramatically amplifying small perturbations, and rather than driving the system to equilibrium, it instead leads to slowly evolving configurations known as quasistationary states that fall outside the standard paradigm of statistical mechanics. Violent relaxation was originally identified in gravity-driven stellar dynamics; here, we extend the theory into the quantum regime by developing a quantum version of the Hamiltonian mean field (HMF) model which exemplifies many of the generic properties of long-range interacting systems. The HMF model can either be viewed as describing particles interacting via a cosine potential, or equivalently as the kinetic XY model with infinite-range interactions, and its quantum fluid dynamics can be obtained from a generalized Gross-Pitaevskii equation. We show that singular caustics that form during violent relaxation are regulated by interference effects in a universal way described by Thom's catastrophe theory applied to waves and this leads to emergent length scales and timescales not present in the classical problem. In the deep quantum regime we find that violent relaxation is suppressed altogether by quantum zero-point motion. Our results are relevant to laboratory studies of self-organization in cold atomic gases with long-range interactions.

The Effect of Seasonal Floods on Health: Analysis of Six Years of National Health Data and Flood Maps.

There is limited knowledge on the effect of seasonal flooding on health over time. We quantified the short- and long-term effects of floods on selected health indicators at public healthcare facilities in 11 districts in Cambodia, a flood-prone setting. Counts of inpatient discharge diagnoses and outpatient consultations for diarrhea, acute respiratory infections, skin infections, injuries, noncommunicable diseases and vector-borne diseases were retrieved from public healthcare facilities for each month between January 2008 and December 2013. Flood water was mapped by month, in square kilometers, from satellite data. Poisson regression models with three lag months were constructed for the health problems in each district, controlled for seasonality and long-term trends. During times of flooding and three months after, there were small to moderate increases in visits to healthcare facilities for skin infections, acute respiratory infections, and diarrhea, while no association was seen at one to two months. The associations were small to moderate, and a few of our results were significant. We observed increases in care seeking for diarrhea, skin infections, and acute respiratory infections following floods, but the associations are uncertain. Additional research on previous exposure to flooding, using community- and facility-based data, would help identify expected health risks after floods in flood-prone settings.

A Quantitative Point-of-Need Assay for the Assessment of Vitamin D3 Deficiency.

Vitamin D is necessary for the healthy growth and development of bone and muscle. Vitamin D deficiency, which is present in 42% of the US population, is often undiagnosed as symptoms may not manifest for several years and long-term deficiency has been linked to osteoporosis, diabetes and cancer. Currently the majority of vitamin D testing is performed in large-scale commercial laboratories which have high operational costs and long times-to-result. Development of a low-cost point-of-need assay could be transformative to deficiency analysis in limited-resource settings. The best biomarker of vitamin D status, 25hydroxyvitamin D3 (25(OH)D3), however, is particularly challenging to measure in such a format due to complexities involved in sample preparation, including the need to separate the marker from its binding protein. Here we present a rapid diagnostic test for the accurate, quantitative assessment of 25(OH)D3 in finger-stick blood. The assay is accompanied by a smartphone-assisted portable imaging device that can autonomously perform the necessary image processing. To achieve accurate quantification of 25(OH)D3, we also demonstrate a novel elution buffer that separates 25(OH)D3 from its binding protein in situ, eliminating the need for sample preparation. In human trials, the accuracy of our platform is 90.5%.

No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters.

Introduction How the burden of disease varies during different phases after floods and after storms is essential in order to guide a medical response, but it has not been well-described. The objective of this review was to elucidate the health problems following flood and storm disasters. METHODS: A literature search of the databases Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Cinahl (EBSCO Information Services; Ipswich, Massachusetts USA); Global Health (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science Core Collection (Thomson Reuters; New York, New York USA); Embase (Elsevier; Amsterdam, Netherlands); and PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA) was conducted in June 2015 for English-language research articles on morbidity or mortality and flood or storm disasters. Articles on mental health, interventions, and rescue or health care workers were excluded. Data were extracted from articles that met the eligibility criteria and analyzed by narrative synthesis. RESULTS: The review included 113 studies. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections all increased after storms. Gastrointestinal infections were more frequent after floods. Leptospirosis and diabetes-related complications increased after both. The majority of changes occurred within four weeks of floods or storms. CONCLUSION: Health changes differently after floods and after storms. There is a lack of data on the health effects of floods alone, long-term changes in health, and the strength of the association between disasters and health problems. This review highlights areas of consideration for medical response and the need for high-quality, systematic research in this area. Saulnier DD , Brolin Ribacke K , von Schreeb J . No calm after the storm: a systematic review of human health following flood and storm disasters. Prehosp Disaster Med. 2017;32(5):568-579.

Vortices and vortex lattices in quantum ferrofluids.

The experimental realization of quantum-degenerate Bose gases made of atoms with sizeable magnetic dipole moments has created a new type of fluid, known as a quantum ferrofluid, which combines the extraordinary properties of superfluidity and ferrofluidity. A hallmark of superfluids is that they are constrained to rotate through vortices with quantized circulation. In quantum ferrofluids the long-range dipolar interactions add new ingredients by inducing magnetostriction and instabilities, and also affect the structural properties of vortices and vortex lattices. Here we give a review of the theory of vortices in dipolar Bose-Einstein condensates, exploring the interplay of magnetism with vorticity and contrasting this with the established behaviour in non-dipolar condensates. We cover single vortex solutions, including structure, energy and stability, vortex pairs, including interactions and dynamics, and also vortex lattices. Our discussion is founded on the mean-field theory provided by the dipolar Gross-Pitaevskii equation, ranging from analytic treatments based on the Thomas-Fermi (hydrodynamic) and variational approaches to full numerical simulations. Routes for generating vortices in dipolar condensates are discussed, with particular attention paid to rotating condensates, where surface instabilities drive the nucleation of vortices, and lead to the emergence of rich and varied vortex lattice structures. We also present an outlook, including potential extensions to degenerate Fermi gases, quantum Hall physics, toroidal systems and the Berezinskii-Kosterlitz-Thouless transition.

Effects of the West Africa Ebola Virus Disease on Health-Care Utilization - A Systematic Review.

Significant efforts were invested in halting the recent Ebola virus disease outbreak in West Africa. Now, studies are emerging on the magnitude of the indirect health effects of the outbreak in the affected countries, and the aim of this study is to systematically assess the results of these publications. The methodology for this review adhered to the Prisma guidelines for systematic reviews. A total of 3354 articles were identified for screening, and while 117 articles were read in full, 22 studies were included in the final review. Utilization of maternal health services decreased during the outbreak. The number of cesarean sections and facility-based deliveries declined and followed a similar pattern in Guinea, Liberia, and Sierra Leone. A change in the utilization of antenatal and postnatal care and family planning services was also seen, as well as a drop in utilization of children's health services, especially in terms of vaccination coverage. In addition, the uptake of HIV/AIDS and malaria services, general hospital admissions, and major surgeries decreased as well. Interestingly, it was the uptake of health service provision by the population that decreased, rather than the volume of health service provision. Estimates from the various studies suggest that non-Ebola morbidity and mortality have increased after the onset of the outbreak in Sierra Leone, Guinea, and Liberia. Reproductive, maternal, and child health services were especially affected, and the decrease in facility deliveries, cesarean sections, and volume of antenatal and postnatal care visits might have significant adverse effects on maternal and newborn health. The impact of Ebola stretches far beyond Ebola cases and deaths. This review indicates that indirect health service effects are substantial and both short and long term, and highlights the importance of support to maintain routine health service delivery and the maintenance of vaccination programs as well as preventative and curative malaria programs, both in general but especially in times of a disaster.