Strengthening Health Systems

A Practical Handbook for Resilience Testing

The COVID-19 pandemic underscored the critical need for health systems to be resilient against major disruptions. Despite the significant impact that crises such as pandemics, climate change effects, geopolitical conflicts, financial collapses or digital failures can have on economies and societies, policy makers in the health sector lack tools to test how their health systems would cope with extreme stress. Seizing a narrowing policy window in a post-pandemic context, the OECD and the European Observatory on Health Systems and Policies, with support from the European Commission, developed a comprehensive methodology culminating in a handbook on "Strengthening Health Systems: A Practical Handbook for Resilience Testing." Inspired by stress tests in various sectors, this methodology was piloted in Finland, Greece, and Spain throughout 2023. The handbook provides health policy makers with tools to assess and enhance their systems' resilience. This is intended to foster policy dialogues and the identification of structural weaknesses as the starting point for targeted investments and remedial policies that will allow health systems to withstand the impact of future shocks more effectively.

Published on March 19, 2024

HIGHLIGHTS

Pandemics, financial crises, natural disasters, and other shocks stress health systems. They affect response capabilities and ultimately contribute to poor performance, as exemplified by the COVID-19 pandemic, emphasizing the importance of understanding resilience to aid policymakers in improving system performance during crises
Developed as part of the EU's capacity building initiatives, the handbook outlines a collaborative testing methodology using the Health System Performance Assessment (HSPA) Framework to understand health system components and their interrelations. It also employs the shock cycle framework to evaluate the health system's response to shocks
The resilience testing methodology presented in this handbook requires countries to first identify a shock. Following this, they are prompted to commission tailored background research to shed light on the health system's capacity to absorb and adapt to the shock. Finally, countries are encouraged to convene a group of key stakeholders to collaboratively analyse the shock scenario, pinpointing vulnerabilities within the system

Conceptual framework of past shocks and the resilience test

We observe what happens to the health system 1 with a shock. The health system learns as part of the shock cycle (health system 2), and we undertake the resilience testing methodology to improve that health system (delivering health system 3).

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