Center for Health Systems Research, National Institute of Public Health, 7a privada de Fray Pedro de Gante, Sección XVI, CDMX 14000, México.
Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Mor. CP 62100, Mexico.
Health Policy Plan. 2022 Nov 14;37(10):1278-1294. doi: 10.1093/heapol/czac055.
The concept of resilience was applied to the public health field to investigate the way health systems are impacted by health crises, what conditions allow them to mitigate the blow and how they reorganize once the crisis is over. In 2020, the COVID-19 pandemic caused by the SARS-CoV-2 virus represented a global challenge demanding immediate response to an unprecedented health crisis. Various voices drew attention to the intensity of the crisis in countries with greater inequalities, where the pandemic converged with other social emergencies. We documented the experiences of health personnel who faced the pandemic at the primary care level while simultaneously maintaining the functioning of other areas of medical care. Our results derived from a qualitative study comprising 103 participants from five states of Mexico. We aimed to show through inferential analysis their perspective on what we call 'the resilience of local health systems'. We observed three stages of experience during the crisis: (a) Preparation (official guidelines received to organize care, training and planning of epidemiological surveillance); (b) Adaptation (performance of community-based prevention activities, infrastructure modifications, telehealth); and (c) Learning (participatory governance with city councils, business sector and organized population). The study suggests that the local health systems analysed benefited from the initiatives of health personnel that in some cases positively exceeded their duties. In terms of the resilience analysis, they were able to handle the impact of the crisis and cope with it. Their transformative capacity came from the strategies implemented to adapt health services by managing institutional resources. Their experience represents a lesson on the strengthening of the essential functions of health systems and shows a way to address successfully the increasingly complex health challenges of the present and future times.
韧性概念被应用于公共卫生领域，以研究卫生系统如何受到卫生危机的影响、哪些条件允许它们减轻冲击，以及它们在危机结束后如何重组。2020 年，由 SARS-CoV-2 病毒引起的 COVID-19 大流行是一个全球性挑战，需要对一场前所未有的卫生危机做出立即反应。各种声音都提请注意不平等程度较高的国家中危机的严重性，在这些国家中，大流行与其他社会紧急情况同时发生。我们记录了初级保健层面的卫生人员在应对大流行病的同时维持其他医疗保健领域运作的经历。我们的结果源自一项包含来自墨西哥五个州的 103 名参与者的定性研究。我们旨在通过推理分析展示他们对我们所谓的“地方卫生系统韧性”的看法。我们观察到危机期间的三个体验阶段：（a）准备（收到组织护理、培训和规划流行病学监测的官方指南）；（b）适应（开展基于社区的预防活动、基础设施改造、远程医疗）；（c）学习（与市议会、商业部门和有组织的民众进行参与式治理）。该研究表明，所分析的地方卫生系统受益于卫生人员的倡议，在某些情况下，这些倡议超出了他们的职责范围。就韧性分析而言，它们能够应对危机的影响并应对危机。它们的变革能力来自于通过管理机构资源来调整卫生服务的策略。他们的经验提供了一个关于加强卫生系统基本职能的教训，并展示了一种成功应对当前和未来日益复杂的卫生挑战的方法。
