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New Paper: Health Systems Resilience In Managing The COVID-19 Pandemic: Lessons From 28 Countries

Announcing a new Independent Panel paper “Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries”

New paper published in Nature Medicine has informed the Independent Panel’s evidence-based analysis of country responses and national recommendations

18 May 2021

This week, a paper examining country health systems produced for the Independent Panel for Pandemic Preparedness and Response is published in a leading scientific journal.

“Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries” is a comparative analysis of the COVID-19 responses in 28 countries and uses a novel health systems resilience framework that places community engagement at its heart. It’s published in Nature Medicine.

The health systems resilience framework includes analysis of governance and financing, the health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. It synthesizes four striking elements that underlie highly effective national responses and offers recommendations towards strengthening health systems resilience globally.

The paper identifies that while resilience is a core concept in disaster risk reduction, its application to health systems is relatively new. It has been defined broadly as institutions’ and health actors’ capacities to prepare for, recover from and absorb shocks, while maintaining core functions and serving the ongoing and acute care needs of their communities.

The authors argue that as COVID-19 has overwhelmed health systems worldwide, debates around resilience have become more urgent, and there is a need to better understand the elements of national responses through a resilience lens.

The authors, who include members of the Panel Secretariat, describe resilient health systems as those that have the capacity to:

  1. activate comprehensive responses that consider and address health and well-being as intertwined with social and economic considerations;
  2. adapt capacity within and beyond the health system to meet the needs of communities;
  3. preserve functions and resources within and beyond the health system to maintain pandemic-related and non-related routine and acute care; and
  4. reduce vulnerability to catastrophic losses in communities, both in terms of health and well-being, as well as individual or household finances. This occurs all while continually learning, monitoring, and adjusting in light of emerging evidence or the evolving epidemiological situation.


The authors underscore lessons upon which countries can draw while working to end the COVID-19 pandemic, and prepare for the next.

“It’s clear that resilient health systems are those that not only invest in pandemic-related planning and training of health workers, but also ensure their physical, mental, and economic protection in the workplace and beyond,” says Victoria Haldane, a lead author based at the University of Toronto.

Dr. Salma Abdalla, of Boston University, also stresses the role of community health workers. “Community health workers are key to resilient responses, and with adequate training and support are equipped to play substantial roles in outbreak response and community engagement.”

Additional findings include that public health functions, including surveillance, testing and contact tracing should be proactive, comprehensive, coordinated with the health system, and emphasise community engagement. Financial and social support should be provided for individuals and families to ensure they are able to adhere to public health measures.

Dr Anne-Sophie Jung of the London School of Hygiene and Tropical Medicine also highlighted that “whole-of-government responses must consider the intersections of gender, racialization, and human rights, and their impact on health and well-being before, during, and after crises.”

“COVID-19 provides a renewed prospect for solidarity, both within and between countries. It also serves as a reminder that health is more than healthcare and that a whole-of-government approach to health and well-being is needed to create healthy populations able to collectively prevent and respond to crises, leaving no one behind,” says Dr. Helena Legido Quigley, Associate professor at Saw Swee Hock School of Public Health and a Panel Secretariat member.

Additional notes:
This paper analysed health system resilience of 28 countries including positive and negative outliers. The paper does not compare country performance, but rather draws on lessons from all countries.

The Independent Panel:

The Independent Panel’s main findings and package of recommendations to end this pandemic and prepare now to avert a next are released in its new report entitled COVID-19: Make it the Last Pandemic. The Panel has also released an evidence-based narrative report of defining moments, and a series of background papers.

The Independent Panel was established by the World Health Organization (WHO) Director-General in response to the World Health Assembly resolution 73.1 issued in May 2020. The Panel’s Co-Chairs are the Rt Hon. Helen Clark, former Prime Minister of New Zealand, and Her Excellency Ellen Johnson Sirleaf, former President of Liberia.

The Independent Panel has a total of 13 members, selected by and including the Co-Chairs. The Panelists have a substantial mix of skills and expertise in infectious disease, global and national health policy and financing, outbreaks and emergencies, economics, youth advocacy, and in the wellbeing of women and girls. They also share knowledge of the international system, including of WHO, and experience from similar international processes.

The mission of the Independent Panel has been to provide an evidence-based path for the future, grounded in lessons of the present and the past to ensure countries and global institutions, including specifically WHO, effectively address health threats. Panel members have spent the last eight months independently, impartially, and rigorously reviewing evidence of the spread, actions, and responses to the COVID-19 pandemic.

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