Jatobá Alessandro, de Castro Nunes Paula, de Carvalho Paulo V R
Centro de Estudos Estratégicos Antônio Ivo de Carvalho Fundação Oswaldo Cruz Rio de Janeiro Brazil Centro de Estudos Estratégicos Antônio Ivo de Carvalho, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Instituto de Engenharia Nuclear Rio de Janeiro Brazil Instituto de Engenharia Nuclear, Rio de Janeiro, Brazil.
Rev Panam Salud Publica. 2023 Apr 28;47:e73. doi: 10.26633/RPSP.2023.73. eCollection 2023.
To develop and test a framework to assess the potential of public health systems to maintain a resilient performance.
Quantitative data from public databases and qualitative data from technical reports of Brazilian health authorities were used to develop the framework which was assessed and modified by experts. Fuzzy logic was used for the mathematical model to determine scores for four resilient abilities - monitoring, anticipation, learning, and response - and an aggregated coefficient of resilient potential in health care. The coefficient measures used data from before the coronavirus disease 2019 (COVID-19) pandemic. These were compared with measures of the actual performance of health systems in 10 cities in Brazil during the pandemic.
The coefficient of resilient potential in health care showed that the cities most affected by COVID-19 had lower potential for resilient performance before the pandemic. Some local health systems had adequate response capabilities, but other abilities were not well developed, which adversely affected the management of the spread of COVID-19.
The coefficient of resilient potential in health care is useful to indicate important areas for resilient performance and the different types of resilience capacities that can be considered in different contexts and levels of public health systems. Regular assessment of the potential of health systems for resilient performance would help highlight opportunities for continuous improvement in health system functions during chronic stress situations, which could strengthen their ability to keep functioning in the face of sudden disturbances.
开发并测试一个框架，以评估公共卫生系统维持弹性绩效的潜力。
使用来自公共数据库的定量数据和巴西卫生当局技术报告中的定性数据来开发该框架，该框架由专家进行评估和修改。模糊逻辑用于数学模型，以确定四种弹性能力（监测、预测、学习和应对）的得分以及医疗保健中弹性潜力的综合系数。该系数所使用的数据来自2019年冠状病毒病（COVID-19）大流行之前。将这些数据与巴西10个城市在大流行期间卫生系统的实际绩效指标进行比较。
医疗保健中的弹性潜力系数表明，受COVID-19影响最严重的城市在大流行之前的弹性绩效潜力较低。一些地方卫生系统具备足够的应对能力，但其他能力发展不佳，这对COVID-19传播的管理产生了不利影响。
医疗保健中的弹性潜力系数有助于指出弹性绩效的重要领域以及在不同背景和公共卫生系统层面可考虑的不同类型的弹性能力。定期评估卫生系统的弹性绩效潜力将有助于突出在长期压力情况下卫生系统功能持续改进的机会，这可以增强它们在面对突发干扰时继续运作的能力。
