The package of health system resilience indicators serves as a dedicated resource to measure and monitor health system resilience in routine operations as well as in the context of disruptive shocks and stressors. This work addresses an identified gap in measurement and monitoring of health system resilience. It complements the Health Systems Resilience Toolkit and supports implementation of the recommendations in WHO’s position paper on building health system resilience for UHC and health security. The package aims to support countries to progressively build their capacities to measure, monitor and build health system resilience from national to subnational levels covering health facilities and other service delivery platforms. It emphasizes an integrated approach to health system strengthening underpinned by essential public health functions, encompassing health emergency preparedness. It includes: - guidance on how to utilize and adapt the health system resilience indicators, including a step-by-step guide - a suite of recommended health system resilience indicators with technical specifications - supplementary indicators of relevance to health system resilience The primary target audience for this package is national and subnational health authorities (including planners and managers) and service providers, as well as local, regional, and global technical organizations and partners working on health system strengthening, including WHO, United Nations country teams, donors, nongovernment organizations, development and humanitarian agencies, and other health-related technical agencies.

Health system resilience is not an inevitable byproduct of any investment in health but must be intentionally programmed and developed with necessary input, investment and contextualization. This technical product aims to guide national, subnational and global health actors to operationalize the concept of health system resilience for advancement of universal health coverage, health security and ultimately better health for all. It supports the translation of relevant conceptual guidance and high-level recommendations into practical actions. The specific objectives are to: present a concise overview of the concept of health system resilience; provide a roadmap outlining practical and foundational steps for building health system resilience to be adapted to different contexts; share examples of actions and tools, including stakeholder roles, to support country application of the roadmap. The target audience for this work is the various stakeholders involved in strengthening health systems and public health including management of emergencies (from prevention and preparedness to response and recovery) and other public health challenges in countries. This ranges from the donors, policymakers and decision-makers at global, national and subnational levels to the implementing institutions and line managers of health system functions and services across the health system building blocks.

Since February 2020 the COVID-19 pandemic has strained health systems worldwide. This book explores the factors determining the ability of health systems to cope with and recover from a crisis, and therefore their level of resilience.

India’s COVID-19 battle will be told and retold in the coming years, inspiring both praise for what the country has achieved, and critique for its shortfalls. As India’s story continues to unfold, two strands will mould the various assessments. First is India’s aggregate performance as a developing economy: It marshalled its meagre resources to respond to the exponential threat of the virus, and was determined, too, to be part of global solutions to this scourge, such as the manufacture and supply of life-saving vaccines. The second, and perhaps even more important story is on ground-zero: In its cities and villages, India’s success or failure would be a factor of the leadership and stewardship of Prime Minister Narendra Modi and his team in responding to the crisis, and the commitment of the chief ministers and state functionaries to beef up their health systems and save lives. Whichever way the India story is told, there are certain truths that cannot be hidden: We need to invest more in our health systems, and acknowledge the stellar role of our frontline workers and formal and informal health sector personnel, as well as India’s prowess in certain segments of the medical and health industry. In this context, it becomes interesting to see how in the country’s federal structure (where health is a State subject), the sub-national units—i.e., states and union territories (UTs)—have performed. The present work, Health Systems Resilience Index: A Sub-National Analysis of India’s COVID-19 Response, provides answers to that question. It builds on an earlier report published by the Observer Research Foundation in May 2020. That report, State of the States: Two Months of the Pandemic, evaluated India’s initial response to the pandemic shortly after the crisis was officially named by the World Health Organization (WHO). Two years since then, this report attempts a more ambitious goal: to devise a unique Resilience Index for the health systems of India’s states and UTs.

Seizing a narrowing policy window in a post-pandemic context, the OECD and the European Observatory on Health Systems and Policies, with support from the European Commission, developed a comprehensive methodology culminating in a handbook on "Strengthening Health Systems: A Practical Handbook for Resilience Testing." Inspired by stress tests in various sectors, this methodology was piloted in Finland, Greece, and Spain throughout 2023.

In this Handbook, Steve Thomas and Padraic Fleming compile invaluable and original insights on the resilience of health systems in the face of shocks and crises, from economic and climate emergencies, to conflicts and pandemics. They examine how health system resilience has been conceptualised by scholars and applied in specific contexts, assessing different theoretical models for measuring and evaluating resilience, as well as highlighting the growing challenges facing health systems now and in the future.

This document presents the OECD’s renewed health system performance assessment framework. It incorporates new performance dimensions, notably people-centredness, resilience, and environmental sustainability, and places increased emphasis on addressing inequalities, including those related to gender.

This report, jointly developed by the European Observatory, OECD, and WHO Europe, serves as a proof of concept for a Health Systems Performance Assessment (HSPA) dashboard. HSPA is pivotal for health system transformation, providing policymakers with key indicators to identify and address system performance issues. This brief represents a step towards more policy-friendly dashboards, emphasizing the need for a focused set of HSPA indicators aligned with policy goals. The brief highlights the alignment and complementarity of the WHO-Observatory global HSPA framework and OECD's renewed framework, which aid policymakers in navigating health systems with actionable, policy-relevant indicators. These frameworks establish connections between performance indicators, health system functions, and overarching goals, supporting a coherent policy dashboard. Tracer indicators, like workforce, digital health, and service delivery outcomes, are emphasized as crucial for assessing key policy areas. The report underscores the importance of investing in data collection and infrastructure at national and international levels to make HSPA effective. It advocates for continuous improvement and collaboration among major international organizations, including WHO, OECD, EU, and the Observatory, to align methodologies and support informed policy decision-making.

The COVID-19 pandemic has caused unprecedented disruption worldwide highlighting once again the interdependency of health and socioeconomic development, and the global lack of health systems resilience. Two years into the pandemic, most countries report sustained disruptions across service delivery platforms and health areas with a profound impact on health outcomes. The impact of these disruptions is magnified within marginalized communities and in countries experiencing protracted conflict. There is an urgent need to focus on recovery through investment in the essential public health functions (EPHFs) and the foundations of health systems with a focus on primary health care, and whole-of-government and -society engagement. The aim of this Research Topic is to gather, transfer and promote operationalization of key experiences from COVID-19 to inform global and country level recovery that better promote health; guide policy direction towards building health systems resilience; and thereby ensure economic and social prosperity. Experience with COVID-19 has demonstrated that traditional approaches to health system strengthening have failed to achieve the complementary goals of Universal Health Coverage (UHC) and health security with the divide between the most vulnerable and well-off only widening. Much of what had been learned from previous experiences such as Ebola in West Africa has not been widely applied. This has left health and economic systems vulnerable to 21 st century public health challenges, ranging from conflict and natural disasters to aging demographics and rising rates of non-communicable and communicable diseases and antimicrobial resistance. These challenges require intentional focus and investment as well as whole-of-government and -society engagement with health to build health system resilience. Greater action is needed to prevent the devastating effects of war and conflict on the health of the most vulnerable. This Research Topic will convene the knowledge and practices of leaders in public health, health systems, and humanitarian and development sectors. This is to ensure lessons from COVID-19 inform the recovery agenda and promote sustainable health and socioeconomic recovery for all. Lest we forget and find ourselves again unprepared and vulnerable in the face of an even greater threat.