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Resilience Testing of Health Systems: How Can It Be Done?

Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
IKERBASQUE Basque Foundation for Science, 48009 Bilbao, Spain
Nova School of Business and Economics, Universidade Nova de Lisboa, 2775-405 Lisbon, Portugal
Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
Department of Health Services and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
Department of Economics and Related Studies, University of York, York YO10 5DD, UK
Klinikum Bielefeld, Universitätsklinikum OWL der Universität Bielefeld, 33604 Bielefeld, Germany
National Insitute of Public Health Slovenia and University Medical Center, 1000 Ljubljana, Slovenia
Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(9), 4742;
Received: 20 April 2021 / Accepted: 26 April 2021 / Published: 29 April 2021
The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach to implementation of resilience testing that can be adapted to individual health systems. We develop a methodology for a test that is balanced in terms of standardization and system-specific characteristics/needs. We specify how to work with diverse stakeholders from the health ecosystem via participatory processes to assess and identify recommendations for health system strengthening. The proposed resilience test toolkit consists of “what if” adverse scenarios, a menu of health system performance elements and indicators based on an input-output-outcomes framework, a discussion guide for each adverse scenario, and a traffic light scorecard template. The five phases of implementation include Phase 0, a preparatory phase to adapt the toolkit materials; Phase 1: facilitated discussion groups with stakeholders regarding the adverse scenarios; Phase 2: supplemental data collection of relevant quantitative indicators; Phase 3: summarization of results; Phase 4: action planning and health system transformation. The toolkit and 5-phased approach can support countries to test resilience of health systems, and provides a concrete roadmap to its implementation. View Full-Text
Keywords: COVID-19; health system; resilience testing COVID-19; health system; resilience testing
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MDPI and ACS Style

Rogers, H.L.; Barros, P.P.; Maeseneer, J.D.; Lehtonen, L.; Lionis, C.; McKee, M.; Siciliani, L.; Stahl, D.; Zaletel, J.; Kringos, D. Resilience Testing of Health Systems: How Can It Be Done? Int. J. Environ. Res. Public Health 2021, 18, 4742.

AMA Style

Rogers HL, Barros PP, Maeseneer JD, Lehtonen L, Lionis C, McKee M, Siciliani L, Stahl D, Zaletel J, Kringos D. Resilience Testing of Health Systems: How Can It Be Done? International Journal of Environmental Research and Public Health. 2021; 18(9):4742.

Chicago/Turabian Style

Rogers, Heather L., Pedro P. Barros, Jan D. Maeseneer, Lasse Lehtonen, Christos Lionis, Martin McKee, Luigi Siciliani, Dorothea Stahl, Jelka Zaletel, and Dionne Kringos. 2021. "Resilience Testing of Health Systems: How Can It Be Done?" International Journal of Environmental Research and Public Health 18, no. 9: 4742.

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