Conceptualising health system resilience and why it matters?

Abstract

Resilience is becoming a core concept across different disciplines and scientific areas. Building on social ecology, environmental science, organisational studies and psychology, resilience can be described as: the capacity of individuals, families, communities, systems and institutions to anticipate, withstand and/or judiciously engage with catastrophic events to maintain basic systems functions and/or meet basic needs. However, resilience is often insufficiently distinguished from effective system functionality and sustainability. Based on extensive conceptual and empirical work involved in the analysis of the response to the Ebola epidemic in Sierra Leone (‘Ebola-Systems’), an analytical framework has been developed that draws on common patterns across disciplines. In it, resilience of a social system is a function of vulnerability (how easy a system can be forced to change), adaptability (the degree to which a system can adjust to predictable and unpredictable change), and transformability (the ability of a system to reach a new equilibrium). These three aspects of resilience manifest differently at each level of the society: individuals, households, villages, district and national health systems, and decision making and actions at each level need to be understood. Both formal and informal institutions, and their culture and mode of operation contribute to resilience. Our conceptualisation suggest that resilience has to be studied as: a) relationships and power dynamics between multiple actors, b) a process over time and location; c) a process of transition from equilibrium, to crisis and transformation, and to a new equilibrium. More research is needed on understanding how social cohesiveness and networks, as well as individual resilience support health systems resilience. The significance of these concepts for policy and practice are discussed.