Building Resilient Health Systems: Key Strategies and Need for Greater Conceptual Clarity

Since the COVID-19 virus was first identified early in 2020, it has killed an estimated 20 million people worldwide and wreaked economic damage estimated to be higher than $13 trillion by the end of 2024 (International Monetary Fund, 2022). The excess mortality around the world suggests that the virus continues to cause the deaths of several thousand people a day (Wallace-Wells, 2023). It has significantly affected the progress of the Sustainable Development Goals (SDG). COVID-19 pandemic affected not only SDG3 (good health and well-being) but also indirectly the progress of SDG1 (no poverty), SDG2 (zero hunger), SDG4 (quality education), SDG9 (investing in innovation and infrastructure) and SDG10 (reducing inequities) (Hollnagel et al., 2013). Nevertheless, as the crisis phase of COVID-19 passes, international efforts are gaining steam to put in place a more effective system to prepare for future pandemics. Since the global health emergency ended, many countries have begun dismantling the infrastructure, systems and other resources set up during the COVID-19 response. It is important to ensure that these capacities can be maintained and swiftly mobilised to respond to such outbreaks and other public health emergencies. Building resilient health systems will not only have the ability to cope with the shocks of public health emergencies but will also have the ability to recover to normalcy faster (Hollnagel et al., 2013). Individual countries need to improve their capacity to prevent, detect and respond to outbreaks. This does not just mean throwing money at the problem; however, now is the time for well thought out, targeted investments in resilient health systems that reflect the learnings from COVID-19 both within and between countries, as well as recognising the specific priorities and risks that countries face. In this editorial, we provide a summary of key strategies that improve the resilience of health systems. We also identify areas where greater clarity is needed on resilience and its relation to existing approaches to health systems strengthening. This mainstreaming of resilience, we hope, will assist in its inclusion as a key outcome of future health systems strengthening investments.