Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Ebola Virus | Research article

What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

Authors: Jennifer B. Nuzzo, Diane Meyer, Michael Snyder, Sanjana J. Ravi, Ana Lapascu, Jon Souleles, Carolina I. Andrada, David Bishai

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency.

Methods

We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations.

Results

We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings.

Conclusions

An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.
Appendix
Available only for authorised users
Footnotes
1
Kruk et al.’s definition of a resilient health system was used to inform the search terms because it was developed with broader expert input and because it addresses resilience within the context of infectious disease outbreaks and natural hazards.
 
Literature
1.
Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910–2.CrossRefPubMed
2.
Kruk ME, Ling EJ, Bitton A, Cammett M, Cavanaugh K, Chopra M, et al. Building resilient health systems: a proposal for a resilience index. BMJ. 2017;23:357–j2323.
3.
4.
Gostin LO, Friedman EA. A retrospective and prospective analysis of the west African Ebola virus disease epidemic: robust national health systems at the foundation and an empowered WHO at the apex. Lancet. 2015;385(9980):1902–9.CrossRefPubMed
5.
6.
Webb GF, Blaser MJ, Zhu H, Ardal S, Wu J. Critical role of nosocomial transmission in the Toronto sars outbreak. Math Biosci Eng MBE. 2004;1(1):1–13.CrossRefPubMed
7.
8.
Redlener I, Reilly MJ. Lessons from Sandy — preparing health systems for future disasters. N Engl J Med. 2012;367(24):2269–71.CrossRefPubMed
9.
10.
Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM independent panel on the global response to Ebola. Lancet. 2015;386(10009):2204–21.CrossRefPubMedPubMedCentral
11.
12.
13.
14.
15.
Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. 2017;6(8):431–5.CrossRefPubMedPubMedCentral
16.
17.
18.
Turenne CP, Gautier L, Degroote S, Guillard E, Chabrol F, Ridde V. Conceptual analysis of health systems resilience: a scoping review. Soc Sci Med. 2019;232:168–80.CrossRefPubMed
19.
20.
21.
Toner ES, McGinty M, Schoch-Spana M, Rose DA, Watson M, Echols E, et al. A community checklist for health sector resilience informed by hurricane Sandy. Health Secur. 2017;15(1):53–69.CrossRefPubMed
22.
Meyer D, Kirk Sell T, Schoch-Spana M, Shearer MP, Chandler H, Thomas E, et al. Lessons from the domestic Ebola response: improving health care system resilience to high consequence infectious diseases. Am J Infect Control. 2018;46(5):533-7.
23.
Mehta S. Disaster and mass casualty management in a hospital: how well are we prepared? J Postgrad Med. 2006;52(2):89.PubMed
24.
Elston JWT, Cartwright C, Ndumbi P, Wright J. The health impact of the 2014–15 Ebola outbreak. Public Health. 2017;143:60–70.CrossRefPubMed
25.
Moore BL, Geller RJ, Clark C. Hospital preparedness for chemical and radiological disasters. Emerg Med Clin North Am. 2015;33(1):37–49.CrossRefPubMed
26.
Shultz JM, Cooper JL, Baingana F, Oquendo MA, Espinel Z, Althouse BM, et al. The role of fear-related behaviors in the 2013-2016 West Africa Ebola virus disease outbreak. Curr Psychiatry Rep. 2016;18(11):104.CrossRefPubMedPubMedCentral
27.
Shibuya K, Hashimoto H, Ikegami N, Nishi A, Tanimoto T, Miyata H, et al. Future of Japan’s system of good health at low cost with equity: beyond universal coverage. Lancet Lond Engl. 2011;378(9798):1265–73.CrossRef
28.
Elliott A, Rehfisch N. Mortuary provision in emergencies causing mass fatalities. J Bus Contin Emer Plan. 2011;5(1):430–9.PubMed
29.
Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K, et al. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan. 2018;33(3):355–67.CrossRefPubMedPubMedCentral
30.
Lapão LV, Silva A, Pereira N, Vasconcelos P, Conceição C. Ebola impact on African health systems entails a quest for more international and local resilience: the case of African Portuguese speaking countries. Pan Afr Med J. 2015;22(Suppl):1–15.
31.
Lohman N, Hagopian A, Luboga SA, Stover B, Lim T, Makumbi F, et al. District health officer perceptions of PEPFAR’s influence on the health system in Uganda, 2005-2011. Int J Health Policy Manag. 2016;6(2):83–95.CrossRefPubMedCentral
32.
Loubet P, Mabileau G, Baysah M, Nuta C, Taylor M, Jusu H, et al. Likely effect of the 2014 Ebola epidemic on HIV care in Liberia. AIDS Lond Engl. 2015 Nov;29(17):2347–51.CrossRef
33.
Orenstein WA, Seib K. Beyond vertical and horizontal programs: a diagonal approach to building national immunization programs through measles elimination. Expert Rev Vaccines. 2016;15(7):791–3.CrossRefPubMed
34.
Reinhardt JD, Li J, Gosney J, Rathore FA, Haig AJ, Marx M, et al. Disability and health-related rehabilitation in international disaster relief. Glob Health Action. 2011;4:7191.CrossRefPubMed
35.
36.
37.
38.
Ardagh MW, Richardson SK, Robinson V, Than M, Gee P, Henderson S, et al. The initial health-system response to the earthquake in Christchurch, New Zealand, in February, 2011. Lancet. 2012;379(9831):2109–15.CrossRefPubMed
39.
Cancedda C, Davis SM, Dierberg KL, Lascher J, Kelly JD, Barrie MB, et al. Strengthening health systems while responding to a health crisis: lessons learned by a nongovernmental organization during the Ebola virus disease epidemic in Sierra Leone. J Infect Dis. 2016;214(suppl 3):S153–63.CrossRefPubMedPubMedCentral
40.
Jones S, Sam B, Bull F, Pieh SB, Lambert J, Mgawadere F, et al. “Even when you are afraid, you stay”: provision of maternity care during the Ebola virus epidemic: a qualitative study. Midwifery. 2017;52:19–26.CrossRefPubMed
41.
Kearns RD, Holmes JH, Skarote MB, Cairns CB, Strickland SC, Smith HG, et al. Disasters; the 2010 Haitian earthquake and the evacuation of burn victims to US burn centers. Burns J Int Soc Burn Inj. 2014;40(6):1121–32.CrossRef
42.
Kim CS, Pile JC, Lozon MM, Wilkerson WM, Wright CM, Cinti S. Role of hospitalists in an offsite alternate care center (ACC) for pandemic flu. J Hosp Med. 2009;4(9):546–9.CrossRefPubMed
43.
Kingham TP, Kamara TB, Cherian MN, Gosselin RA, Simkins M, Meissner C, et al. Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg. 2009;144(2):122–7.CrossRefPubMed
44.
Pouraghaei M, Jannati A, Moharamzadeh P, Ghaffarzad A, Heshmati Far M, Babaie J. Challenges of hospital response to the twin earthquakes of august 21, 2012, in East Azerbaijan. Iran Disaster Med Public Health Prep. 2017;11:1–9.CrossRef
45.
Rozeman PA, Mayeaux EJ. Hurricanes Katrina and Rita: evacuee healthcare efforts remote from hurricane affected areas. South Med J. 2006;99(12):1329–33.CrossRefPubMed
46.
Saghafi NM. Survey of the bam earthquake survivors’ opinions on medical and health system services. Prehosp Disaster Med. 2008;23(4):382.CrossRef
47.
48.
Tran TM, Saint-Fort M, Jose M-D, Henrys JH, Pierre Pierre JB, Cherian MN, et al. Estimation of surgery capacity in Haiti: nationwide survey of hospitals. World J Surg. 2015;39(9):2182–90.CrossRefPubMed
49.
50.
51.
DeBiasi RL, Song X, Cato K, Floyd T, Talley L, Gorman K, et al. Preparedness, evaluation, and care of pediatric patients under investigation for Ebola virus disease: experience from a pediatric designated care facility. J Pediatr Infect Dis Soc. 2016;5(1):68–75.CrossRef
52.
Elmahdawy M, Elsisi GH, Carapinha J, Lamorde M, Habib A, Agyie-Baffour P, et al. Ebola virus epidemic in West Africa: global health economic challenges, lessons learned, and policy recommendations. Value Health Reg Issues. 2017;13:67–70.CrossRefPubMed
53.
Felland LE, Katz A, Liebhaber A, Cohen GR. Developing health system surge capacity: community efforts in jeopardy. Res Brief. 2008;5:1–8.
54.
Harries AD, Zachariah R, Tayler-Smith K, Schouten EJ, Chimbwandira F, Van Damme W, et al. Keeping health facilities safe: one way of strengthening the interaction between disease-specific programmes and health systems. Tropical Med Int Health. 2010;15(12):1407–12.CrossRef
55.
56.
Karanikolos M, Heino P, McKee M, Stuckler D, Legido-Quigley H. Effects of the global financial crisis on health in high-income Oecd countries: a narrative review. Int J Health Serv Plan Adm Eval. 2016;46(2):208–40.CrossRef
57.
58.
59.
Zhong S, Clark M, Hou X-Y, Zang Y, FitzGerald G. Progress and challenges of disaster health management in China: a scoping review. Glob Health Action. 2014;7:24986.CrossRefPubMed
60.
Cleary V, Balasegaram S, McCloskey B, Keeling D, Turbitt D. Pandemic (H1N1) 2009: setting up a multi-agency regional response centre--a toolkit for other public health emergencies. J Bus Contin Emer Plan. 2010;4(2):154–64.PubMed
61.
Dhanoa T, Fuller H, Herechuk B, Trowbridge S, Raab V, MacDonald AM, et al. Response to a serious flood: the St Joseph’s healthcare experience. Healthc Q Tor Ont. 2014;17(4):58–62.CrossRef
62.
McMahon SA, Ho LS, Scott K, Brown H, Miller L, Ratnayake R, et al. “We and the nurses are now working with one voice”: How community leaders and health committee members describe their role in Sierra Leone’s Ebola response. BMC Health Serv Res. 2017;17(1):495.CrossRefPubMedPubMedCentral
63.
Regmi K, Gilbert R, Thunhurst C. How can health systems be strengthened to control and prevent an Ebola outbreak? A narrative review. Infect Ecol Epidemiol. 2015;5:28877.PubMed
64.
Varma JK, Prezant DJ, Wilson R, Quinn C, Asaeda G, Cagliuso NV, et al. Preparing the health system to respond to Ebola virus disease in New York City, 2014. Disaster Med Public Health Prep. 2017;11(3):370–4.CrossRefPubMed
65.
Yantao X. Assessment of hospital emergency management in the Beijing area. Prehosp Disaster Med. 2011;26(3):180–3.CrossRefPubMed
66.
Chi GC, Williams M, Chandra A, Plough A, Eisenman D. Partnerships for community resilience: perspectives from the Los Angeles County community disaster resilience project. Public Health. 2015;129(9):1297–300.CrossRefPubMed
67.
68.
Beard L, Clark C. SARS: a health system’s perspective. Hosp Q. 2003;6(4(4):55–8.PubMed
69.
Barasa EW, Cloete K, Gilson L. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening. Health Policy Plan. 2017;32(suppl_3):iii91–4.CrossRefPubMed
70.
Gizelis T-I, Karim S, Østby G, Urdal H. Maternal health care in the time of Ebola: a mixed-method exploration of the impact of the epidemic on delivery services in Monrovia. World Dev. 2017;98:169–78.CrossRef
71.
Martineau FP. People-centred health systems: building more resilient health systems in the wake of the Ebola crisis. Int Health. 2016;8(5):307–9.CrossRefPubMed
72.
Campbell A. The SARS commission interim report: SARS and public health in Ontario. Biosecurity Bioterrorism Biodefense Strategy Pract Sci. 2004;2(2):118–26.CrossRef
73.
Verni C. A hospital system’s response to a hurricane offers lessons, including the need for mandatory interfacility drills. Health Aff Proj Hope. 2012;31(8):1814–21.CrossRef
74.
Therrien M-C, Normandin J-M, Denis J-L. Bridging complexity theory and resilience to develop surge capacity in health systems. J Health Organ Manag. 2017;31(1):96–109.CrossRefPubMed
75.
Institute of Medicine (US). Barriers to integrating crisis standards of care principles into international disaster response plans: workshop summary [Internet]. Washington (DC): National Academies Press (US); 2012. (The National Academies Collection: Reports funded by National Institutes of Health). Available from: http://​www.​ncbi.​nlm.​nih.​gov/​books/​NBK91501/​
76.
Lewis JD, Enfield KB, Perl TM, Sifri CD. Preparedness planning and care of patients under investigation for or with Ebola virus disease: a survey of physicians in North America. Am J Infect Control. 2017;45(1):65–8.CrossRefPubMedPubMedCentral
77.
Raven J, Baral S, Wurie H, Witter S, Samai M, Paudel P, et al. What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal. Health Res Policy Syst. 2018;16(1):6.CrossRefPubMedPubMedCentral
78.
Rebmann T, McPhee K, Osborne L, Gillen DP, Haas GA. Best practices for healthcare facility and regional stockpile maintenance and sustainment: a literature review. Health Secur. 2017;15(4):409–17.CrossRefPubMed
79.
Reece S, Brown CS, Dunning J, Chand MA, Zambon MC, Jacobs M. The UK’s multidisciplinary response to an Ebola epidemic. Clin Med (Lond). 2017;17(4):332–7.CrossRef
80.
Schwanke Khilji SU, Rudge JW, Drake T, Chavez I, Borin K, Touch S, et al. Distribution of selected healthcare resources for influenza pandemic response in Cambodia. Int J Equity Health. 2013;12:82.CrossRefPubMedPubMedCentral
81.
82.
83.
Elston JWT, Moosa AJ, Moses F, Walker G, Dotta N, Waldman RJ, et al. Impact of the Ebola outbreak on health systems and population health in Sierra Leone. J Public Health. 2016;38(4):673–8.
84.
Pathmanathan I, O’Connor KA, Adams ML, Rao CY, Kilmarx PH, Park BJ, et al. Rapid assessment of Ebola infection prevention and control needs--six districts, Sierra Leone, October 2014. MMWR Morb Mortal Wkly Rep. 2014;63(49):1172–4.PubMedPubMedCentral
85.
Singh SR, Coker R, Vrijhoef HJ-M, Leo YS, Chow A, Lim PL, et al. Mapping infectious disease hospital surge threats to lessons learnt in Singapore: a systems analysis and development of a framework to inform how to DECIDE on planning and response strategies. BMC Health Serv Res. 2017;17(1):622.CrossRefPubMedPubMedCentral
86.
Subhash SS, Baracco G, Miller SL, Eagan A, Radonovich LJ. Estimation of needed isolation capacity for an airborne influenza pandemic. Health Secur. 2016;14(4):258–63.CrossRefPubMed
87.
88.
Hafner T, Walkowiak H, Lee D, Aboagye-Nyame F. Defining pharmaceutical systems strengthening: concepts to enable measurement. Health Policy Plan. 2017;32(4):572–84.PubMed
89.
90.
Fitter DL, Delson DB, Guillaume FD, Schaad AW, Moffett DB, Poncelet J-L, et al. Applying a new framework for public health systems recovery following emergencies and disasters: the example of Haiti following a major earthquake and cholera outbreak. Am J Trop Med Hyg. 2017;97(4_Suppl):4–11.CrossRefPubMedPubMedCentral
91.
McPake B, Witter S, Ssali S, Wurie H, Namakula J, Ssengooba F. Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone. Confl Heal. 2015;9:23.CrossRef
92.
93.
Tambo E, Chengho CF, Ugwu CE, Wurie I, Jonhson JK, Ngogang JY. Rebuilding transformation strategies in post-Ebola epidemics in Africa. Infect Dis Poverty. 2017;6(1):71.CrossRefPubMedPubMedCentral
94.
Palagyi A, Marais BJ, Abimbola S, Topp SM, McBryde ES, Negin J. Health system preparedness for emerging infectious diseases: a synthesis of the literature. Glob Public Health. 2019;14:1–22.CrossRef
95.
Metadata
Title
What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review
Authors
Jennifer B. Nuzzo
Diane Meyer
Michael Snyder
Sanjana J. Ravi
Ana Lapascu
Jon Souleles
Carolina I. Andrada
David Bishai
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7707-z

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

Time to poor treatment outcome and its predictors among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara region, Ethiopia: retrospective cohort study

Research article

Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial

Research article

Food bank operational characteristics and rates of food bank use across Britain

Research article

Healthcare bricolage in Europe’s superdiverse neighbourhoods: a mixed methods study

Research article

Strong effect of Ecuador’s conditional cash transfer program on childhood mortality from poverty-related diseases: a nationwide analysis

Research article

Identification of health-related behavioural clusters and their association with demographic characteristics in Irish university students