Concept analysis of health system resilience

Abstract Background: Although several definitions of health systems resilience have many common characteristics, there is no agreed-upon framework that could be used to measure resilience. In this review, we review the concept of resilience, identifying definitions, attributes, antecedents, and consequences and present the findings of the ‘concept analysis’ of Health System Resilience. Methods: In this paper, we follow Schwarz-Barcott and Kim’s Hybrid model, which consists of theoretical, fieldwork and final analytical phases. This review identifies the health systems resilience definitions, attributes, antecedents, and consequences with the aim of developing a framework to identify the domains that could constitute a measure. We searched PubMed, PsycINFO, CINAHL Complete, Ebscohost- Academic Search Premier to download titles and abstracts on Covidence. The articles were screened by two reviewers and disagreements were resolved by discussion with the third reviewer. Each of the three reviewers examined the eligible publications for definitions, attributes, antecedents, and consequences using a pre-defined data extraction form. Results: The initial search yielded 3357 articles. Duplicates and ineligible articles were removed. These were further screened, and 66 of them were removed because they did not include a discussion of health systems resilience, discussed resilience but not in a health systems context, were in languages other than English and did not discuss resilience, and we could not access two full articles. Finally, we included 130 studies in the analysis. Conclusions: Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking, and finally, diversification of the staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy, and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health, and maintenance of health services that support UHC throughout crises. We propose a framework as a basis of a measurement tool for health system resilience.