Tonga Calvin, Verdonck Kristien, Edzoa Brice Essomba, Ateba Olivia Ewokolo, Marchal Bruno, Michielsen Joris
Expanded Programme on Immunization, Ministry of Public Health, Yaoundé, Cameroon.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Int J Health Policy Manag. 2024;13:8097. doi: 10.34172/ijhpm.8097. Epub 2024 Sep 7.
It is commonly argued that resilient health systems ensure the well-being of populations even under critical conditions, whereas poorly resilient ones may be disrupted and collapse. We aimed to examine how health system resilience can be assessed as this issue is still under debate.
We conducted a scoping review of peer-reviewed and grey literature published up to March 2022, following the Joanna Briggs Institute (JBI) guidance. CAIRN, DOAJ, E-Journals, Global Health Google Scholar, MedRxiv, OAIster, PubMed, reliefWeb, ScienceDirect, SmartResilience, SSRN, and World Health Organization (WHO) library were searched. The search strategy was based on key words from the research question and validated by an experienced librarian. We included full reports in English and French, whose primary focus was the health system, and that proposed or reported on the use of approaches for assessing health system resilience. Three independent reviewers did the selection and charting of reports. Extraction of information from the 34 reports that met the inclusion criteria followed predefined charting items.
Various definitions of the concept of health system resilience and diverging conceptual bases were found for the assessment of resilience, pointing at the lack of conceptual maturity. Three assessment approaches emerged from this review: (1) the system mapping approach which looks at health system core functions, (2) the capacity-based approach which focuses on the main characteristics of resilience, and (3) the strategy-based approach which examines resilience strategies. None of these approaches gives a full picture of resilience. They can be complementary; hence they are increasingly used in combination.
This review identified three approaches to assessing health system resilience. The absence of a common understanding of what health system resilience represents still undermines its operationalisation and assessment. There is need for further testing and learning from empirical studies on the specific or integrated use of these frameworks.
人们普遍认为，具有韧性的卫生系统即使在危急情况下也能确保民众的福祉，而韧性较差的卫生系统可能会受到干扰并崩溃。鉴于这个问题仍在讨论中，我们旨在研究如何评估卫生系统的韧性。
我们按照乔安娜·布里格斯研究所（JBI）的指南，对截至2022年3月发表的同行评议文献和灰色文献进行了范围综述。检索了CAIRN、DOAJ、电子期刊、全球健康谷歌学术、MedRxiv、OAIster、PubMed、救济网、ScienceDirect、SmartResilience、SSRN和世界卫生组织（WHO）图书馆。检索策略基于研究问题的关键词，并由一位经验丰富的图书馆员进行了验证。我们纳入了以英文和法文撰写的完整报告，这些报告的主要重点是卫生系统，并且提出或报告了评估卫生系统韧性的方法的使用情况。三名独立评审员对报告进行了筛选和制表。从符合纳入标准的34份报告中提取信息遵循了预先定义的制表项目。
发现了卫生系统韧性概念的各种定义以及用于评估韧性的不同概念基础，这表明缺乏概念成熟度。本次综述出现了三种评估方法：（1）着眼于卫生系统核心功能的系统映射方法，（2）关注韧性主要特征的基于能力的方法，以及（3）审视韧性策略的基于策略的方法。这些方法都没有全面反映韧性。它们可以相互补充；因此越来越多地被结合使用。
本综述确定了三种评估卫生系统韧性的方法。对卫生系统韧性的含义缺乏共同理解仍然妨碍其实施和评估。需要对这些框架的具体或综合使用进行进一步的实证研究测试和学习。
