ArticleHealth policy and planning2018
Towards an understanding of resilience: responding to health systems shocks.
Article in Health policy and planning, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 134 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
134 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Extreme weather effects on health services and communities in low and lower-middle income countries: a thematic systematic review.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2026Pooled it
- Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review.Implementation science : IS · 2023Pooled it
- Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review.Health policy (Amsterdam, Netherlands) · 2022Pooled it
- Strategic health policy and health system resilience in protracted crisis settings: policymaker perspectives from Yemen.Global health action · 2026Article
- U.S. Funding Cuts and Health System Challenges in Community-Based HIV Programmes in Rural KwaZulu-Natal, South Africa: A Qualitative Study.International journal of environmental research and public health · 2026Article
- Hospital system resilience in the face of armed conflicts; a cross sectional study from two regions in Lebanon.BMC health services research · 2026Observational
- When formal governance persists but resilience does not: health system governance and resilience in Yemen across a decade of conflict and crisis (2014-2025).BMC health services research · 2026Article
- Improving health sector coordination for resilient healthcare systems: European lessons from the COVID-19 pandemic.Globalization and health · 2026Article
- Health systems resilience and private for-profit sector engagement: lessons from the second COVID-19 wave in Uttar Pradesh, India.Health policy and planning · 2026Article
- Not Every Country Can Absorb a Shock: Unequal Capacity to Withstand World Health Organization Aid Cuts.Public health challenges · 2026Article
- Getting unstuck: reframing health systems strengthening and resilience in fragile and conflict-affected settings.BMJ global health · 2026Review
- Towards a coherent global health architecture: perspectives on integrating global health security and universal health coverage through diplomacy and governance reforms.Health policy and planning · 2026Article
- From inherent capacities to resilient systems: a multi-dimensional framework for assessing health system resilience.BMC health services research · 2026Article
- Resilience as recovery: stakeholder perspectives on Uganda's health system response to infectious disease shocks.Frontiers in health services · 2026Article
- From emergency adaptation to institutional resilience: a policy and practice review of Somalia's health system, 1991-2026.Frontiers in health services · 2026Review
- Financing fragility and pandemic preparedness in Central Asia: a policy review of aid volatility, donor dynamics, and health system resilience.Frontiers in public health · 2026Article
- Resilience of health systems in Africa to infectious disease shocks: A qualitative evidence synthesis.PLOS global public health · 2026Article
- Determinants and typologies of health system resilience: A data-driven framework for prioritising investment.PloS one · 2026Article
- Mapping Biomedical Engineering Education and Research in Sub-Saharan Africa: A Bibliometric and Systematic Analysis.Advances in medical education and practice · 2026Review
- Interpersonal Needs and Dysfunctional Self-Focus Mediate the Effect of Dysfunctional Pandemic Grief on Suicidality Among Nursing Professionals Who Witnessed Patients' Deaths.Journal of Korean medical science · 2025Article
74 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
10 authors.
Funding
Abstract
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more 'resilient'. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013-16; and the recent refugee and migration crisis in Europe. Based on this analysis, we identify '3 plus 2' critical dimensions of particular relevance to health systems' ability to adapt and respond to shocks; actions in all of these will determine the extent to which a response is successful. These are three core dimensions corresponding to three health systems functions: 'health information systems' (having the information and the knowledge to make a decision on what needs to be done); 'funding/financing mechanisms' (investing or mobilising resources to fund a response); and 'health workforce' (who should plan and implement it and how). These intersect with two cross-cutting aspects: 'governance', as a fundamental function affecting all other system dimensions; and predominant 'values' shaping the response, and how it is experienced at individual and community levels. Moreover, across the crises examined here, integration within the health system contributed to resilience, as does connecting with local communities, evidenced by successful community responses to Ebola and social movements responding to the financial crisis. In all crises, inequalities grew, yet our evidence also highlights that the impact of shocks is amenable to government action. All these factors are shaped by context. We argue that the '3 plus 2' dimensions can inform pragmatic policies seeking to increase health systems resilience.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.