Assessing resilience though a health system performance lens

Health system resilience testing has generated keen interest since the COVID-19 pandemic but so far no methodology for this complex exercise exists. Our concept of resilience testing is inspired by the experience of stress tests in the banking sector. The novel approach is a mixed-method country-led exercise, which applies a health system lens to a particular shock scenario, and identifies vulnerabilities using the Health System Performance Assessment Framework for Universal Health and the Shock Cycle. In the first part of the presentation we describe the resilience testing methodology, based on the two conceptual frameworks. We share lessons from the required preparatory work: shock scenario selection, scope of background research, formation of a resilience testing group, resilience test day structure and process, and the facilitator's role. We also discuss the outcomes of the resilience testing process, which includes a formal assessment of the resilience of the health system. This will provide workshop participants with an overview of key concepts to conduct a country-led resilience testing exercise. The second part of the presentation focuses on the overarching results from the country-led pilots. These show that the resilience testing method can identify specific health system weaknesses at different stages of the shock cycle. Given the appropriate selection of resilience test facilitator and participants, the method can also detect system-wide challenges, shock implications and spill-overs. The participant interaction on the test day may identify key priorities for action and strengthen relevant national multiprofessional networks. Overall, the resilience testing approach is an important new tool to identify strengths and weaknesses of the current health system and in scenario-specific preparedness planning.