Unveiling the Reality of Health System Resilience: A Critical Look at Empirical Research
The concept of health system resilience has become a prominent feature in the global health discourse, influencing UN policies, academic articles, and conferences. However, while significant effort has been invested in theorizing health system resilience, there has been a notable gap in reviewing how this complex concept has been operationalized in empirical studies.
A groundbreaking review by Biddle, Wahedi, and Bozorgmehr tackles this gap directly, synthesizing findings from 71 empirical studies published between 2008 and 2019, revealing a substantial increase in literature since 2017.
Key insights from this essential review include:
- Focus on Crises: The majority of studies (82%) addressed a specific crisis or challenge, most notably infectious disease outbreaks (20%), natural disasters (15%), and climate change (11%).
- Sidelined Building Blocks: A large proportion of research (48%) concentrated on service delivery, while other crucial health system building blocks, such as health information systems, medicines, and financing, were often overlooked.
- Mismatch Between Theory and Practice: The review reveals a fundamental discrepancy: despite extensive theoretical work on the domains constituting health system resilience (e.g., absorptive, adaptive, and transformative capacities, and management capacities like knowledge, uncertainties, interdependence, and legitimacy), most empirical literature only addressed particular aspects, frequently neglecting the legitimacy of institutions and transformative resilience.
- Methodological Nuances: Qualitative and mixed-methods research were found to capture a broader range of resilience domains than quantitative research, which is often constrained by the availability of measurable indicators.
- Lack of Explicit Frameworks: Crucially, very few empirical studies utilized an explicit conceptual framework to guide data collection or analysis, thereby weakening the link between theoretical understanding and practical operationalization of resilience.
This review highlights that the way resilience is currently applied in empirical literature does not adequately match its theoretical foundations. It underscores the urgent need for future research to develop a comprehensive assessment framework that seamlessly integrates both qualitative and quantitative evidence to capture health system resilience as a dynamic, complex phenomenon.
Reference:
Biddle, L., Wahedi, K., & Bozorgmehr, K. (2020). Health system resilience: a literature review of empirical research. Health Policy and Planning, 35(8), 1084–1109. https://doi.org/10.1093/heapol/czaa032
