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How can we build the resilience of our healthcare systems?

Healthcare is an important determinant in promoting the general physical, mental, and social well-being of people across the globe. An effective and efficient healthcare system is a key to the good health of citizens and plays a significant contribution to their country’s economy and overall development. Poor health systems hold back the progress on improving health in countries at all income levels, according to a joint report by the OECD, World Health Organization (WHO), and the World Bank. The attainment of Universal Health Coverage, the overarching target that should facilitate achievement of health and non-health targets of Sustainable Development Goals, is directly concerned with the performance of the health system.

Globally, healthcare systems have experienced intensive changes and reforms over the past 30 years, which has led to improvement of healthcare. We have seen during the recent COVID-19 pandemic that the countries with robust healthcare systems were less affected compared to those with fragile health systems. However, in general, COVID-19 has also exposed weaknesses in our health systems that must be addressed. The crisis demonstrated the importance of equipping health systems with good governance and leadership, harnessing efficient human resource, maintaining uninterrupted supply chain systems, equitable allocation of financial resources, efficient information and surveillance mechanisms, along with robust service delivery to the community.

Resilience is defined as the capacity to recover quickly from difficulties; or physical, mental or emotional toughness. Thomas Edison once said “I have not failed. I just found 10,000 ways that won’t work.” Such is the ability of any health organization which is either not deterred by difficult circumstances or bounce back to the normal as soon as those circumstances tide off. The healthcare systems of all countries, especially low- and middle-income countries, should be resilient enough to view difficulty as a challenge and opportunity for growth, visualize the effects as temporary rather than permanent, and not let setbacks affect unrelated areas. These health organizations should invest their time and energy in strategic and operational planning; monitoring and evaluation of their key result areas; management of time, stress, and self; material, money, and man-power management; sound health information systems; undertaking innovations and developing good inter-sectoral partnerships and networking. Resilient organizations should also focus on good communication, quality assurance, patient satisfaction, health sector reforms, and building leadership and management skills among healthcare providers. 

There is a dire need for training of the public health managers in low- and middle-income settings on how to build a resilient healthcare system that is not only effective and efficient in routine healthcare but also able to adapt to crisis situations. Such trainings should be provided through live examples and case studies healthcare professionals can visualize and apply in resource constrained health settings. The experiences and expertise of people working in health systems, academia, and non-governmental organizations at various levels should be harnessed in such trainings for documentation of good and replicable practices pertaining to different building blocks of health system. 

There are a few forums in developing countries that aim at building the capacity of public health managers and students through developing essential skills required for strengthening healthcare systems. Besides these, there are no books on healthcare systems which are case study-based, practical, and holistically cover the subject. The current books are highly theoretical and are mostly from developed countries, the learning from which may not be fully applicable in our settings of low- and middle-income countries. The book Management of Healthcare Systems bridges the gap by providing a comprehensive, curriculum-based source of reference for faculty and students of health management and administration who are pursuing higher degrees in community medicine, public health, hospital and health management, and also to those who are practicing health and hospital management in public and private hospitals. 

So, what are the key takeaways? First, the most important thing is that the health system should be resilient enough to take on the adversities upfront without frailing. Second, we need to inculcate the necessary skills among healthcare providers so that they sustain the momentum even in the stressful situations. Third, we need to allay the myth that building resilience within the organization cannot be learnt. Fourth, health organizations need to spend time and energy in building certain management and leadership skills among healthcare providers to build a resilient healthcare system. 

In summary, as an industry, we need to critically look at how resilient our healthcare systems are. How can we build further resilience? What are our limitations and challenges which can be converted into opportunities and challenges? And lastly, do we have a strong healthcare system that can overcome any crisis, including COVID-19 and similar pandemics?

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