Presentation at USAID's Global Health Mini-University on Friday, March 4, 2016. Preparing for Future Shocks: Building Resilient Health Systems Kate Greene (HFG), Bob Emrey (USAID/GH/OHS), Jodi Charles (USAID/GH/OHS), Temitayo Ifafore, (USAID/GH/OHS) After the recent Ebola outbreak, global health experts have turned to resilience frameworks used by other fields such as agriculture and engineering to understand how to build health systems that can withstand shocks, including infectious disease outbreaks, natural disasters, and political conflict. Speakers will first briefly outline each of the five key elements of the Resilience Framework, adapted from the Rockefeller Foundation and presented in a Lancet article in 2015, that can be applied to health systems. Participants will then work in small groups to discuss which health systems interventions should be pursued in response to a one-page description of an unnamed country. Speakers will then reveal what real-world interventions they designed for the country example and answer questions.

1. Preparing for future shocks:
Building resilient health systems
Bob Emrey, USAID
Jodi Charles, USAID
Temitayo Ifafore, USAID
Kate Greene, Health Finance & Governance Project
Global Health Mini-University, March 4, 2016

2. Outline
• What are resilient
health systems?
• Features of resilient
health systems
• Country case study
exercise (small
groups)
• Case study
commentary and Q&A
Photo Credit: Glaxo Smith Kline 2

3. What is a Resilient Health System?
• Many disciplines have resiliency frameworks,
including engineering and psychology
• One example: Rockefeller Foundation’s City
Resilience Framework (2014)
• Ebola outbreak spurred thinking about
resilience and health systems (Kruk 2015)
• Health systems resilience is an evolving
framework that needs further testing and
research
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4. What are resilient health systems?
“Capacity of health actors, institutions, and populations to:
• prepare for and effectively respond to crises;
• maintain core functions when a crisis hits; and,
• informed by lessons during the crisis, reorganise if
conditions require it.”
--Kruk, et al., Lancet, 2015, 385: 1910-12
Photo Credit: NBC News
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5. Key elements of Health Systems
Resilience (Kruk)
Credit: Rockefeller Foundation
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6. Before a crisis strikes:
• Plan roles for the global health system
• Make laws and policies for response & accountability
• Develop a strong and committed health workforce
When a crisis strikes:
• Vigorous public health response
• Proactive health care delivery system
The Resilience Dividend:
• In times of crisis: Lives saved & livelihoods protected
• In times of calm: Healthier people & stronger nations
Preparing for
Resilient Health Systems
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7. • Up-to-date
mapping of
human, physical
and information
assets
• Strategic
Information &
Epidemiological
Surveillance
• Inform planning
Awareness
Detects health
threats before
they strike
Diversity
Delivers range
of services
with universal
health
coverage
Self-
Regulation
Prevents health
disruptions from
turning into
disasters
Integration
Rapidly
deploys
resources
from beyond
the health
system
Adaptability
Rebounds from
shocks stronger
than before
Awareness
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8. Building Awareness:
Ebola in West Africa
Challenges:
• Lack of capacity to deal with
public health threats
• Public health data/information not
well-linked to national, social
media
Investments:
• Building capacity of national and
regional disease surveillance
systems and response (IDSR)
• Strengthening routine data
reporting and mapping
• Integrating mobile data platforms
• Building public awareness
Photo Credit: USAID
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9. Capacity to address
a broad range of
health issues, often
through a focus on
primary care or UHC
Awareness
Detects health
threats before
they strike
Diversity
Delivers range
of services
with universal
health
coverage
Self-
Regulation
Prevents health
disruptions from
turning into
disasters
Integration
Rapidly
deploys
resources
from beyond
the health
system
Adaptability
Rebounds from
shocks stronger
than before
Diversity
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10. Building Diversity:
Post-conflict Afghanistan
Challenges:
• Low primary health care (PHC)
coverage
• Frequent outbreaks of malaria,
cholera, and other infectious
disease
Investments:
• Partnerships to create diverse
service delivery platforms that
offer essential package of
services and can respond to
unexpected problems
Photo Credit: USAID 10

11. Contain health threats
while maintaining
basic services and
stability
Awareness
Detects health
threats before
they strike
Diversity
Delivers range
of services
with universal
health
coverage
Self-
Regulation
Prevents health
disruptions from
turning into
disasters
Integration
Rapidly
deploys
resources
from beyond
the health
system
Adaptability
Rebounds from
shocks stronger
than before
Self-Regulation
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12. Building Self-Regulation:
Ebola in Liberia
Challenges
• Difficulties in donor and
health system coordination
• Health worker retention
• Health worker capacity to
respond to health
emergencies
Investments
• Mobilize and track resources
during health emergencies
• Provide incentives to health
workers involved in response
• Incorporate emergency
response into pre-service, in-
service and continuing
education
Photo Credit: USAID 12

13. Multi-sector
coordination and
communication to
prepare and
respond to health
crises
Integration
Awareness
Detects health
threats before
they strike
Diversity
Delivers range
of services
with universal
health
coverage
Self-
Regulation
Prevents health
disruptions from
turning into
disasters
Integration
Rapidly
deploys
resources
from beyond
the health
system
Adaptability
Rebounds from
shocks stronger
than before
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14. Building Integration:
Ebola in Liberia
Challenges
• Coordination of different ministries in Ebola response
Investments
• Support collaboration between Liberia’s Ministry of
Health, Ministry of Education, Ministry of Public
Works and Ministry of Finance to:
• Restore services during outbreak
• Re-engineer health facilities
• Ensure medical supplies reached last mile
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15. Capacity to respond
to new health
challenges brought
about by changing
epidemiology,
demographics,
natural disasters,
conflict, and other
adverse conditions
Adaptability
Awareness
Detects health
threats before
they strike
Diversity
Delivers range
of services
with universal
health
coverage
Self-
Regulation
Prevents health
disruptions from
turning into
disasters
Integration
Rapidly
deploys
resources
from beyond
the health
system
Adaptability
Rebounds from
shocks stronger
than before
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16. Building Adaptability:
Post-earthquake Haiti
Challenges:
• Health infrastructure
concentrated in Port-au-
Prince
• Variation in nursing
education quality, lack of
standards
Investments:
• Business planning to
strengthen hospitals
outside capital
• Improved accreditation
system for private nursing
schools, called
reconnaissance Photo Credit: HFG Project
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17. Mystery Country Case Study
• Break out into small groups (8-10 people)
• Read case study individually
• Discuss questions and document
recommended key investments
• Regroup to share recommendations
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18. Mystery Country Case Study
• What country was it?
• Which investments have been tried to make
the health system more resilient?
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19. Thank you!
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