Resilience and Efficiency: How we understand?

“A resilient system (or society) can face shocks and persistent structural changes in such a way that it does not lose its ability to deliver societal wellbeing in a sustainable way (i.e., deliver current societal wellbeing, without compromising that of future generations)”.

Health system resilience-enhancing elements include

  1. protected and diversified health system revenue generation/financing mechanism;
  2. adequate buffers/rapidly deployable reserve capacity (material, human and financial resources);
  3. regularly revised and updated risk management plans;
  4. built-in redundancies/alternative ways to deliver care;
  5. existence of a high-quality (i.e., sufficiently sensitive and specific) epidemiological surveillance system;
  6. easy access to detailed and timely health information by health system managers and policymakers;
  7. high level of “social capital” (institutional trust, cooperation capacity, public awareness of health risks);
  8. effective communication and coordination across government entities and other relevant stakeholders;
  9. explicitly defined public/statutory health insurance health benefit basket;
  10. Universal health coverage;
  11. well-functioning health system performance monitoring and forecasting practices;
  12. well-motivated and supported health workforce of appropriate size and diverse skills;
  13. strong and transparent health system leadership;
  14. existence of an organisational learning culture / ”learning from failure” within the health system;
  15. governance for health in other sectors.

COVID-19 induced crisis has redefined resilience. Existence is understood to be centred around the health of the populations. The perennial problem of not having enough money for keeping the health system dynamically relevant for the population beyond national boundaries has found its reason to act. Systems thinking within national boundaries has been proved to be inadequate for having that sought after resilience for the citizens. Effort to exist with benefit / cost ratio has failed its mission. Global co-operation and raising systemwide awareness have found the relevance towards building a resilient system (or society).

Furthermore, COVID – 19 pandemic infestations in the World followed by the transitioning of the World order in rapid succession precipitated by the geopolitical activism has reinforced the need to manage uncertainty and reduce complexity for public policies with stronger linkage between the political necessities and the societal need (individual and collective wellbeing).

So, is it possible for the national Health system to have that “resilience” without establishing sustainable development pathways and / or when the decision realities ignore time, risks and the interlinkages between and within the policy effects?

Next, what is the trade-off between Efficiency of the national Health system in the short run and long-term Resilience of the national Health system?

Finally, what is the drawn boundary between “static” efficiency and “dynamic” efficiency when we measure Health system’s Efficiency?

Hence, for having the resilience in the system, the focus is to shift from

  1. “equity in opportunity” to “equity in outcomes”;
  2. “concern for plurality and diversity” to “context specific adjustments”; and
  3. “promoting green growth” to “impact and resources decoupling” in a new paradigm of Social Solidarity Economy for sustainability.

Dr. (med.) Pavitra PAUL, PhD. (health economics)

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