Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.

https://gh.bmj.com/content/bmjgh/6/8/e006779.full.pdf

A health systems resilience research agenda: moving from concept to practice.

Gender related vulnerabilities and inequalities place female learners at high risk of school disengagement due to COVID-19 disruptions. Understanding the impacts of school closures and educational disruptions on female learners in South Africa is critical to inform appropriate, gender-sensitive policies, and programs, to mitigate further exacerbation of educational inequalities. We examined the effects that COVID-19 and lockdowns have had on the educational experiences of adolescent girls and young women (AGYW) aged 15–24, in six districts of South Africa characterized by high rates of HIV, teenage pregnancy and socio-economic hardship. Following a concurrent triangulation mixed-methods approach, we conducted a cross-sectional survey with 515 AGYW, and qualitative interviews with 50 AGYW. More than half of survey participants enrolled in education had been unable to continue with their studies. Factors associated with educational disruption included low socio-economic status, lack of cell phone access and household food insecurity. Qualitative narratives included challenges with online learning and studying at home in resource restricted settings, and insufficient support from schools and teachers. However, despite multiple barriers to continuing education, some AGYW demonstrated educational resilience, enabled by psychosocial and structural support, and resource access. Our findings lend support to an emerging evidence base showing that the closure of schools and tertiary institutions, combined with challenging home environments, and a lack of access to appropriate technology, has disproportionately impacted the most vulnerable AGYW, exacerbating pre-existing educational inequalities within the South African education system. Addressing structural barriers to educational equity, particularly in the pandemic context, including access of technology and the internet, is urgent.

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Navigating Education in the Context of COVID-19 Lockdowns and School Closures: Challenges and Resilience Among Adolescent Girls and Young Women in South Africa

The Covid-19 pandemic changes people’s behavior, determines the interpersonal distance of communication, and deepens the digitalization processes of public life. This paper aims to establish the social trust impact on the social sustainability of Ukrainian territorial communities in the Covid-19 pandemic. For an empirical study, four territorial communities of Ukraine were taken, which geographically represent the whole of Ukraine. It used the online survey method based on Google forms. A randomly selected 1530 respondents aged 18+ were interviewed in 2021, where the quota sampling by gender, age, and territorial community has been preserved. The study proves that the family remains the basis of social stability for Ukrainians. In difficult situations, the population expects help from their relatives and is ready to help themselves. However, institutional social trust is highly deficient, with only 5.8% of citizens wishing for help from local authorities in the face of the pandemic. The survey shows that the poorest part of the population is prone to atomization and demonstrates the lowest interpersonal and institutional trust level, weakening social stability due to the risks of numerous divorces, labor migration, and the problems of family members’ isolation during the Covid-19 pandemic. The pandemic has widened the gap between the poorest and wealthiest groups. Therefore, social resilience management should aim to improve institutional and interpersonal social trust. Furthermore, public authorities should unite the community using economic, social, cultural, and religious instruments since atomized individuals cannot withstand local and global challenges efficiently.
AcknowledgmentThe paper was prepared in the framework of the research project “Sustainable development and resource security: from disruptive technologies to digital transformation of Ukrainian economy” (№ 0121U100470) and “ Jean Monnet Chair in EU Economic Policies and Civil Society” (619878-EPP-1-2020-1-UA-EPPJMO-CHAIR).

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Social resilience management of Ukrainian territorial communities during the Covid-19 pandemic

The first coronavirus disease 2019 (COVID-19) outbreak in Daegu city was overcome by efforts, including; 1) prompt isolation and quarantine action by local government with cooperative help from expert groups and the central government, 2) high-intensity social distancing and active cooperation of citizens, 3) admission of asymptomatic and mild patients in ‘residential treatment centers’, and 4) use of a telephone scoring system for the allocation of patients, with a mortality rate of 2.5%. A continuous suppression policy with test, tracing, and treatment (3 Ts) was implemented as an active response to the initial outbreaks in Korea. With the introduction of vaccines and therapeutic agents, the COVID-19 crisis had improved. Recently, the omicron variant was responsible for most domestic outbreaks, albeit with a low mortality rate (0.1%). Since the omicron outbreak, a damage mitigation policy has been implemented, focusing on protecting vulnerable groups. In the future, preparation including below are needed; 1) improving the national public health emergency response system, 2) strengthening the crisis response capacity of local governments, 3) cooperation between public healthcare and private healthcare, and 4) establishing a resilient medical response system.

https://doi.org/10.3346/jkms.2022.37.e356

COVID-19 Outbreak in Daegu City, Korea and Response to COVID-19: How Have We Dealt and What Are the Lessons?

Background The COVID-19 pandemic has required urgent organisational and managerial adaptation, with hospital medical and administrative leaders under considerable pressure. Methods At a single French university hospital, we performed a sociological analysis of management adaptation by medical and administrative leaders during the first wave of the COVID-19 crisis. Two sociologists performed interviews with representative members of staff from all the structures involved in managing the crisis to analyse adaptation and the solutions found during this period. Results The answers collected during interviews were classified into three main topics describing the organisational adaptations of the hospital staff during the COVID-19 crisis: (1) exceptional mobilisation and collaboration; (2) crisis management based primarily on the principle of subsidiarity; and (3) survival of the administrative structure with interventions to support caregivers. Conclusion This study, focusing on a single hospital, identified a number of factors associated with successful mobilisation in the very specific conditions of this viral pandemic.

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Qualitative analysis of the organisational response of a university hospital during the first wave of the COVID-19 crisis

The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natural and human systems to prevent, react to and recover from shocks. Societal resilience to the current COVID-19 pandemic relates to the ability of societies in maintaining their core functions while minimising the impact of the pandemic and other societal effects. Drawing on the emerging evidence about resilience in health, social, economic, environmental and governance systems, this paper delineates a multisystemic understanding of societal resilience to COVID-19. Such an understanding provides the foundation for an integrated approach to build societal resilience to current and future pandemics.

https://gh.bmj.com/content/bmjgh/6/7/e006794.full.pdf

Building a multisystemic understanding of societal resilience to the COVID-19 pandemic.

This policy brief aims to promote a holistic mindset about the COVID-19 pandemic by 1) applying a complexity lens to understand its drivers, nature, and impact, 2) proposing actions to build resilient societies to pandemics, and 3) deriving principles to govern complex systemic crises. Building resilience to prevent, react to, and recover from systemic shocks need to become a core element of how societies are governed. This requires an integrated approach between health, social, economic, environmental, and institutional systems. The brief has been developed by a team of researchers coming from both the natural and social sciences.1 Reviewed by a group of policy actors,2 the brief aims to foster a dialogue between academic institutions and policymakers.

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Gaélane Wolff

Papers

Building a multisystemic understanding of societal resilience to the COVID-19 pandemic.

Governance in the age of complexity: building resilience to COVID-19 and future pandemics