Assessing and measuring community health system resilience - an updated scoping review of approaches.

backgroundA previous 2020 review on resilience in community health systems identified a small body of conceptual and empirical evidence but pointed to important limitations concerning the operationalisation of resilience assessment and measurement for these systems, and lack of consideration to measures of equity. In light of substantial research interest in health system resilience over recent years, the objective of this study was to revisit the literature for new insights concerning community health system resilience assessment and measurement in general, and in relation to climate-related hazards in particular.

methodsScoping review of published, peer-reviewed literature drawing on studies identified via keyword-structured searches of PubMed and Google Scholar covering the period 2019–2024. Following screening in duplicate, we included studies from all income settings that provided definition(s) of community health system resilience. Data were extracted in duplicate and narratively synthesised drawing on a conceptual framework from Disaster Risk Management to identify putative approaches to resilience assessment and/or measurement – including candidate metrics.

results12 studies were included, of which 5 explicitly focused on natural and/or climatic hazards. Definitions of community resilience were diverse, spanning process and attribute-based conceptualisations among others. Included studies yielded a total of 73 resilience indicators in addition to those 20 identified through the original scoping review. A large majority of indicators (n = 51) spanning both reviews covered background factors relating to community resilience such as markers of community social capital and local health system capacity. Other indicators considered, in order of frequency, community preparedness, event response and post-event recovery – although this last category included by far the fewest indicators. Equity considerations were often implicit rather than explicit within these – commonly focusing on equity in health service access at community level, and degree of participation in governance processes.

conclusionsThere is a continuing need to develop – and particularly to empirically test – indicators of community health system resilience to better understand utility for policy and practice. While some promising areas are identifiable for development of indicators relating to equity, these remain early stage and there is a need to better conceptualise links between these and established health system outcome measures.