The project aimed to enable international and national health policy makers to understand the comparative strengths and weaknesses of health systems, track change over time, and to assist in identifying policy action needed to strengthen them, via development and wide dissemination of an index report and web-based dashboard/atlas of health system sustainability and resilience. It fed into PHSSR’s high-impact international programme of policy engagement and knowledge exchange.
Increasing attention is being paid to the underlying resilience and sustainability of health care systems in the light of the shock imposed by the COVID-19 pandemic. Health systems are unable to identify, measure and thereby address weaknesses without reliable metrics for health system resilience and sustainability. However, while a number of teams have defined conceptual frameworks to understand health system resilience1,2,3, less work has been done in building and applying operational indices. Current rankings, like the Global Health Security Index (HSEI) or the WHO Joint External Evaluations (JEE), tend to focus on specific threats and responses, rather than capacity for resilience. Meanwhile, frameworks for health system sustainability tend to focus on specific programmes or policies, rather than taking a system-wide approach, and are largely conceptual in nature.
As part of a project with World Economic Forum and several private sector partners – the Partnership for Health System Sustainability and Resilience (PHSSR) – we have had some limited seed funding monies to build, since September 2020, a qualitative assessment framework to consider health system resilience and sustainability. This qualitative framework has been applied in a group of 20 countries to develop a series of case studies which provide a macro-level assessment of the health systems concerned, their strengths and weaknesses, and generate preliminary policy recommendations. These have underpinned in-country programmes of stakeholder engagement with the objective of informing policy change to strengthen health systems. Some recommendations have been taken up at the highest level within the various individual governements, and have already led to policy changes in some of these settings. Various reports on the qualitative work are available at the PHSSR website.
Building on this work, in partnership with the Office of Health Economics (OHE), we have developed the methodological basis for a quantitative index to enable measurement of health system sustainability and resilience at a country level, direct comparison between countries, and the tracking of change over time. Following validation of a pilot index applied to 5 countries, we seek to widen the application and populate a dashboard with data from the 20 countries that have been subject to a qualitative assessment by PHSSR. This work is not currently funded and will require research support. Subsequent to the population of the index with country data, we aim to publish the index and its methodology via an open-access article in a top-tier health policy journal. PHSSR has agreed to support dissemination of this quantitative work via the development of an interactive, web-based dashboard to enable interrogation of the data by international and national health policy stakeholders, and to incorporate its findings in PHSSR’s high-impact global programme of policy engagement.