HEALTH SYSTEM RESILIENCE: REVIEW OF THE CONCEPT AND A FRAMEWORK FOR ITS UNDERSTANDING

Resilience and capacity for resilience is an emerging concept in health system governance and a comparatively new dimension of health systems performance, an area in which health policy faces problems and challenges not sufficiently explored. Although it has been attracting significant attention, the conceptualization of health system resilience that goes beyond the normative interpretation of the construct is still not well developed. The aim of the study is to review the concept of health system resilience and to extend the existing understanding in the context of health system governance. Drawing on the results of our review, we propose a framework for health system resilience. The review shows that resilience is grasped as a property in the context of the health system as a complex adaptive system. Moreover, resilience is contextual; it is highly context-dependent and path-dependant. It refers to the dynamics of the system and reflects the changing environment. Resilience is interpreted as the capacity of the health system to resist shocks and disturbances and to anticipate, withstand and respond to crises, i.e. to maintain its core functions, which is related to the abilities to absorb shocks and stresses, adapt to changes and transform its structures and institutions. Our proposed framework builds on and extends the existing knowledge and core frameworks, identifying three types of mechanisms (compensatory, adaptive and transformative) that help the system to maintain short- and long-term resilience. The framework can advance the understanding of the health system resilience and guide actions to strengthen health systems.