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On the resilience of health systems: A methodological exploration across countries in the WHO African Region

The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to “prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, re...

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Autores principales: Karamagi, Humphrey Cyprian, Titi-Ofei, Regina, Kipruto, Hillary Kipchumba, Seydi, Aminata Benitou-Wahebine, Droti, Benson, Talisuna, Ambrose, Tsofa, Benjamin, Saikat, Sohel, Schmets, Gerard, Barasa, Edwine, Tumusiime, Prosper, Makubalo, Lindiwe, Cabore, Joseph Waogodo, Moeti, Matshidiso
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820618/
https://www.ncbi.nlm.nih.gov/pubmed/35130289
http://dx.doi.org/10.1371/journal.pone.0261904
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author Karamagi, Humphrey Cyprian
Titi-Ofei, Regina
Kipruto, Hillary Kipchumba
Seydi, Aminata Benitou-Wahebine
Droti, Benson
Talisuna, Ambrose
Tsofa, Benjamin
Saikat, Sohel
Schmets, Gerard
Barasa, Edwine
Tumusiime, Prosper
Makubalo, Lindiwe
Cabore, Joseph Waogodo
Moeti, Matshidiso
author_facet Karamagi, Humphrey Cyprian
Titi-Ofei, Regina
Kipruto, Hillary Kipchumba
Seydi, Aminata Benitou-Wahebine
Droti, Benson
Talisuna, Ambrose
Tsofa, Benjamin
Saikat, Sohel
Schmets, Gerard
Barasa, Edwine
Tumusiime, Prosper
Makubalo, Lindiwe
Cabore, Joseph Waogodo
Moeti, Matshidiso
author_sort Karamagi, Humphrey Cyprian
collection PubMed
description The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to “prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it”. There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes.
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spelling pubmed-88206182022-02-08 On the resilience of health systems: A methodological exploration across countries in the WHO African Region Karamagi, Humphrey Cyprian Titi-Ofei, Regina Kipruto, Hillary Kipchumba Seydi, Aminata Benitou-Wahebine Droti, Benson Talisuna, Ambrose Tsofa, Benjamin Saikat, Sohel Schmets, Gerard Barasa, Edwine Tumusiime, Prosper Makubalo, Lindiwe Cabore, Joseph Waogodo Moeti, Matshidiso PLoS One Research Article The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to “prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it”. There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes. Public Library of Science 2022-02-07 /pmc/articles/PMC8820618/ /pubmed/35130289 http://dx.doi.org/10.1371/journal.pone.0261904 Text en © 2022 Karamagi et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Karamagi, Humphrey Cyprian
Titi-Ofei, Regina
Kipruto, Hillary Kipchumba
Seydi, Aminata Benitou-Wahebine
Droti, Benson
Talisuna, Ambrose
Tsofa, Benjamin
Saikat, Sohel
Schmets, Gerard
Barasa, Edwine
Tumusiime, Prosper
Makubalo, Lindiwe
Cabore, Joseph Waogodo
Moeti, Matshidiso
On the resilience of health systems: A methodological exploration across countries in the WHO African Region
title On the resilience of health systems: A methodological exploration across countries in the WHO African Region
title_full On the resilience of health systems: A methodological exploration across countries in the WHO African Region
title_fullStr On the resilience of health systems: A methodological exploration across countries in the WHO African Region
title_full_unstemmed On the resilience of health systems: A methodological exploration across countries in the WHO African Region
title_short On the resilience of health systems: A methodological exploration across countries in the WHO African Region
title_sort on the resilience of health systems: a methodological exploration across countries in the who african region
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820618/
https://www.ncbi.nlm.nih.gov/pubmed/35130289
http://dx.doi.org/10.1371/journal.pone.0261904
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