Published on Investing in Health

Change cannot wait: The need to make health systems more resilient

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A health worker vaccinate a man who has been in contact with an Ebola affected person A new report provides a roadmap for countries to build robust, resilient health systems that can prevent, prepare for, and respond to health emergencies. Photo: World Bank / Vincent Tremeau

As the world still struggles to end the COVID-19 pandemic and manage its devastating economic and societal impacts, countries are concurrently facing other new and old epidemic threats such as monkeypox and cholera outbreaks, as well as natural disasters.

Recent public-health crises highlight how vulnerable society is when we are unprepared—and how we must build robust, resilient health systems that not only can withstand shocks but also improve health outcomes between crises by preventing and managing threats.

Health emergencies will increase

The number and intensity of global health shocks are increasing exponentially, especially those that are rapidly spilling over to humans from animals and wildlife. As the pandemic showed, spillover events can threaten communities already struggling with a potent mix of other risk drivers—aging populations, chronic diseases, socio-economic and gender inequalities, climate change, urbanization, and neglect of essential public-health functions.

Countering these threats requires building health systems that are more resilient and can prevent, prepare for, and respond to health emergencies. Our new report, Change Cannot Wait: Building Resilient Health Systems in the Shadow of COVID-19 , describes the key features of health system resilience and provides a roadmap for countries to operationalize resilience within the health sector and a framework to prioritize investments.

More and better financing is pivotal for better health resilience

While many countries faced challenges during COVID-19, countries with prior foundational investments in public health were able to address head-on the challenges of the pandemic. Countries that adopted a One Health approach, which tackles the drivers of outbreaks through integrated interventions in human, animal, and environmental health, were also better able to respond to the pandemic.

For example, in Vietnam 92% of its population are covered by the national health insurance fund and a well-developed grassroots health system was at the heart of its effective COVID-19 response. Primary health care providers delivered health education and preventive measures to communities, helping slow the spread of COVID-19. Relying on its national disease surveillance system and public-health operations center, Vietnam swiftly deployed contact tracing, non-pharmaceutical interventions, and digital technology including mobile apps. Thanks to a huge mobilization of its health workforce, Vietnam was able to vaccinate 2.3 million people each day.

Despite challenges with vaccine rollout, strong political leadership and a multisectoral governance approach in Ghana played a critical role in the country’s pandemic response. Ghana scaled up testing immediately at its borders, significantly expanded its laboratory network, and developed 79 infectious disease centers. Ghana also ensured that vulnerable populations had access to information and care. The World Bank is supporting Ghana with close to $500 million for the country’s COVID-19 response.

So, what do resilient health systems look like?

Resilient health systems are integrated systems that are aware of threats, agile in response to evolving needs, absorptive of shocks, adaptive to minimize disruptions, and able to transform after a crisis, based on lessons learned. Strong health systems connect preparedness with health service delivery and are built on a foundation of robust primary health care.

Multisectoral collaboration and partnerships are also crucial. Ultimately, it will take the whole of government and society to achieve resilience. Investments in resilient health systems—including strong governance, partnerships, innovation, and health intelligence—will also advance progress toward the ultimate goal of Universal Health Coverage (UHC).

Achieving health-system resilience is within the reach of all countries

Investments in resilience are possible at all income levels. And because countries are facing economic pressures and multiple crises that demand financing, prioritization is key. Our report recommends spending first on upstream, preventive action including well-functioning primary health care, preparedness, public-health functions, and strong community-based surveillance. Then countries should finance detection at scale, containment, and mitigation of outbreaks before they spread widely. The final—and most costly—set of investments focuses on advanced case management and surge response.

The time for action is now

Our world seems to grow more interconnected by the day, and we have seen how quickly acute infectious diseases cross borders. Foundational investments in public health systems yields a median of $14 for every $ 1 invested . Yet, we still fall behind in investments that promote resilience to future epidemic threats and other health shocks. The costs for health system strengthening and pandemic preparedness and prevention are significantly lower than the cost of managing a full-fledged health crisis that rolls back development across all sectors.

Now is not the time for pandemic fatigue but the time for a renewed focus and for every country to meet its responsibility, not only to its own people but also to the global community, to make resilience investments before the next emergency strikes.

Change cannot wait. We delay at our own peril.



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Juan Pablo Uribe

Global Director, Health, Nutrition & Population and the Global Financing Facility, World Bank

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