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Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries—A systematic review

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  • Fleming, Pádraic
  • O'Donoghue, Catherine
  • Almirall-Sanchez, Arianna
  • Mockler, David
  • Keegan, Conor
  • Cylus, Jon
  • Sagan, Anna
  • Thomas, Steve

Abstract

Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.

Suggested Citation

  • Fleming, Pádraic & O'Donoghue, Catherine & Almirall-Sanchez, Arianna & Mockler, David & Keegan, Conor & Cylus, Jon & Sagan, Anna & Thomas, Steve, 2022. "Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries—A systematic review," Health Policy, Elsevier, vol. 126(12), pages 1195-1205.
    • Handle: RePEc:eee:hepoli:v:126:y:2022:i:12:p:1195-1205
    DOI: 10.1016/j.healthpol.2022.10.001
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    References listed on IDEAS

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    1. Paschoalotto, Marco Antonio Catussi & Lazzari, Eduardo Alves & Rocha, Rudi & Massuda, Adriano & Castro, Marcia C., 2023. "Health systems resilience: is it time to revisit resilience after COVID-19?," Social Science & Medicine, Elsevier, vol. 320(C).
    2. Camille Poroes & Laurence Seematter-Bagnoud & Kaspar Wyss & Isabelle Peytremann-Bridevaux, 2023. "Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework," IJERPH, MDPI, vol. 20(17), pages 1-23, August.
    3. Farsaci, Liz & Fleming, Padraic & Almirall-Sanchez, Arianna & O'Donoghue, Catherine & Thomas, Steve, 2024. "Understanding the legacies of shocks on health system performance: Exploring Ireland's management of recent crises and its implications for policy," Health Policy, Elsevier, vol. 143(C).

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