Strengthening Resilience of the PNG Health system in times of COVID-19 Pandemic

 Health specialist Antony Aindri has asked me to publish his essay on my blog. I read through this essay and have found it quite intriguing. This essay points out the loophole within our health system and is informative. Going through this essay will give you insights into the importance of the key term "resilience" discussed within the context of COVID19 pandemic. The essay is about "building a robust resilient health system that can withstand all health weather" for health is wealth.

Introduction

The most recent emergence and rapid spread of deadly infectious disease novel Coronavirus (COVID-19) is severely testing health systems around the world as well as threatening to damage the global economy and consequently leading to a human cost far beyond the impact of the disease itself Diane Meyer et.al (2020).While some countries’ systems manage to survive in those pandemic times, others did not.  Those which survived the shocks are those systems that fits within the definition of the term Resilience. Over the past decades, the term has been widely used in diverse fields. It is far from new and commonly understood to be related to multiple and broad fields, ranging from physics to human psychology. However, it is relatively a new concept in regards to its application within the health system. Resilience Health system is therefore defined as the ability to prepare for, manage (i.e. have the ability to absorb, adapt and transform) and learn from the shocks or events Thomas et.al. (2020).The health system resilience concept has gained popularity in the global health discourse. Its popularity has resulted in seeing the concept to be featured and discussed in variety of documentation mediums such as academic articles, conferences and UN Policies.  World Health Organization (WHO) in its 2016 editorial bulletin named the health system resilience as a critical concept for global health. They further describe it to have similar significance and equivalence to health system strengthening, universal health coverage and health security Kruk et.al. (2017)). Despite an increased interest in the concept of resilience and its practical applications among health systems analysts and Policy-makers, there is still much confusion about what resilience means, how to strengthen it and how to assess it. While acknowledging the breath of the concept this analytical essay will discuss the key characteristics and the frameworks which can be addresses not only to strengthen but could also enable the Papua New Guinea Health System to become more Resilience  as well as responsive. Meyer et.al (2020), Thomas et.al. (2020) & Kruk et.al. (2017)

 

Key Characteristics Essential for a Resilient Health System.

Resilient health systems are critical to safeguarding global health security during public health emergencies. With the ongoing COVID-19 pandemic that is hitting nearly every countries, it is clear that shocks does not have boundaries.  Apart from health, shocks does affect other sectors as well. This is now triggering the urgency to see the significance of the “Resilience health system” concept to be integrated within the health system. However, there is still much confusion with its practical application regarding it’s “definition, how to strengthen it and how to assess it”.

Thus, despite the complexity of the health system, it has to be flexible in nature. This means it has to be Absorptive, Adaptive and Transformative in nature. It has to have an Absorptive Capacity in which it has to deliver the same quantity, quality and equity of basic healthcare services and protection to population without any breakdown of baseline or basic services despite the shocks using the same level of the resources and capacities.

It also should entail an Adaptive capacity. The health system actors must have the capacity to deliver the same level of health care services with available resources that may requires organizational adaptations. Moreover apart from this two, the health system resilience concept has to be transformative where by enabling the health system actors to transform the functions and structure of the health system to respond to a changing environment, for instance, in the time of health shocks.

Strengthening PNG Health System to become more resilient in a time of COVID-19 pandemic based on WHO health system building blocks.

The failure to contain the outbreaks of the shocks throughout the world often brings attention to the role and responsiveness of the health systems in the face of shock. The recent and ongoing COVID-19 pandemic has demonstrated the critical significance of resilient health systems in safeguarding global health security. Most of the developed countries like USA, UK, New Zealand and many more were hit hard with the pandemic than developing nations like Papua New Guinea (PNG). This has brought a sharp focus and has instill adequate idea that health systems need not only to be robust but also must be more resilient in responding to the acute and chronic shocks which are imminent at any time Hanefeld et.al. (2018)

With the exception of other developing nations, PNG has fragile health system. The World Health Organization’s (WHO) six building blocks which stands as the core pillars of the National Health Plan 2011-2020 were not being fully achieved to its desired level. For the health system to be more resilient and responsive, the six building blocks are supposed to be strengthened to be able to achieve their desired target. The building blocks are inter-dependent, thus they often work in parallel although this has not been the case so far. With this challenge at hand, it precisely shows that the health system is more fragile and not even at a better state to respond to any shocks or events, and in this case-- the COVID-19 pandemic. The pandemic has so far tested our health system capacity as well as its capability to withstand and safeguard people’s health. Among the six building blocks that were tested during the COVID-19 pandemic, three (3) were seen to be of greatest importance and needs strengthening to respond to shocks in a more resilient way. They include; Financing, Health Work force, Leadership and Governance. Meyer et.al (2020)

Financing

Finance is seen to be the most pivotal catalyst in moving the resilience reaction within the health system. As health is everybody’s business, the financial support should not be considered to be a government responsibilities only. All parties within and outside of the health sector have to contribute to combat the shocks as shocks do not have boundaries.  There has to be sustainable health mechanisms in place inclusive of mechanisms that will increase value for money and enhance accountability.  With that, the flexibility to reallocate and inject extra funds are crucial to ensure sufficient monetary resources. Its flexibility has to promote stability of the funding within the countercyclical health financing mechanisms and reserves. These will attract more resources for improving quality of services and meeting the changing needs. Not only that but it will also as a result build trust in the services provided or delivered to the people in the time of shocks. Thomas et.al (2020), Meyer et.al (2020), Mills (2017).

Health Workforce

Health workers are the frontline and are often vulnerable to shocks or events arising. Thus it is important that their welfare and wellbeing should be given much consideration. These individuals play an important role in protecting the health of their families as well as their communities. And that falls within the vicinity of building resilience and responsive system in the community. The health workers do not demand much due to the fact that they usually devote their time and effort into playing their roles and responsibilities. So despite the circumstances within the health system, they are always striving in good and bad times to deliver quality and effective services to the people. However, there has to be recognition and motivation with good support from every health actors or players. This will ensure and enable the building of longer-term relationship between health workers and the individuals as well as communities they serve. Bhandari & Alongo (2020), Biddle et.al (2020), Thomas et.al (2020)

Leadership & Governance

The engine to drive and produce the desired outcomes from all the building blocks fall on the shoulder of Leadership and Governance. There has to be effective and participatory leadership with strong vision and communication. Every activities that are occurring across government urgencies and key stakeholders have to be coordinated under one umbrella. When a well coordination room is established, this will in turn enlighten us of learning organizational culture that is responsive to crises or shocks.  Within the domain of leadership and governance, it is the responsibility of the government as well as key stakeholders to steer the system in an approach to adapt itself to new objectives and priorities. Thus to respond to major challenges through key governance tools. Furthermore, the governance has to be emphasized with its ultimate capacity and ability to formulate long-term health strategy that embrace accountability, transparency and stakeholder involvement at all times. Kruk et.al (2020), Hanefeld et.al (2018), Meyer et.al (2020), Bloom & McKenzie (2015)

Conclusion:

Resilience was perhaps a common term being discussed in several fields however it is a newly concept being integrated into the health area, especially in public health domain.  It is very crucial in enabling a robust health system that is responsive to outbreaks or shocks while also sustaining basic functions of health services. Scaling or narrowing the concept from broad definitions to specific definitions especially within health domain, it is defined as a system that is absorptive, adaptive and transformative in nature. These three key characteristics of the resilience ensure that the allocation of resources are coordinated well. Also prioritization of the resources are done appropriately for a health system to respond in addressing the health shocks accordingly. This will further enable and ensure the concept feasibility and durability for long –term within the health systems-strengthening and peoples’ health security.

 

Reference

1.      Bhandari, S & Alonge, O. (2020) Measuring the resilience of health systems in low- and middle income countries: a focus on community resilience. Health Research Policy and Systems. Accessed from https://doi.org/10.1186/s12961-020-00594-w

2.      Biddle, L., Wahedi, K. & Bozorgmehr, K. (2020) ‘Health system resilience: a literature review of empirical research. Health Policy and Planning. 1–26 doi: 10.1093/heapol/czaa032

3.      Bloom, G. & Mckenzie, A. (2015) Strengthening Health Systems for Resilience.  IDS PRACTICE PAPER IN BRIEF 18. Acquired from: https://www.researchgate.net/publication/273257981

4.      Hanefeld, J., Mayhew, S., Legido. Q, H., Martineau, F., Karanikolos, M., Blanchet, K., Liverani, M., Mokuwa.Y, E., McKay, G., & Balabanova, D. (2018). Towards an understanding of resilience responding to health systems shocks: Health Policy and Planning. 33, 2018, 355–367. doi: 10.1093/heapol/czx183

5.      Kruk.E,M., Ling.J,E, Bitton,A., Cammett,M., Cavanaugh,K., Chopra,M.,Jardali-el,F., Macauley.J,R., Muraguri.K,M, Konuma,S, Marten,R.,, Martineau,F.,  Myers,M.,  Rasanathan,K., Ruelas,E., Soucat,A., Sugihantono,A. & Warnken,H. (2017). Building resilient health systems: a proposal for a resilience index. ANALYSIS. BMJ 357:j2323 doi: 10.1136/bmj.j2323

6.       Kruk, M. E., Myers, M., Varpilah, S. T., & Dahn, B. T. (2015). What is a resilient health system? Lessons from Ebola. The Lancet, 385(9980), 1910–1912. https://doi.org/10.1016/S0140-6736(15)60755-3.

7.      Hart,L., Street,D. & Kulatilaka,H. (2017) Building Capacity for Resilience Health Systems. Lessons learned from Sierra Leone, Guinea and Liberia in the time of Ebola. Accessed from: http:// www.measureevaluation.org

8.      Meyer,D. Bishai,D., Ravi.J,S., Rashid,H., Mahmood.S,S., Toner,E., &Nuzzo.B,J. (2020). A checklist to improve health system resilience to infectious disease outbreaks and natural hazards. BMJ Global Health 2020; 5:e002429. doi: 10.1136/bmjgh-2020-002429

9.      Mills, A. (2017) Resilient and responsive health systems in a changing world. Health Policy and Planning.32 1–2 doi: 10.1093/heapol/czx117

10.  Mirzoev.T. & Kane. S. (2017) What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework. BMJ Global Health. : e000486.doi:10.1136/bmjgh-2017-000486

11.  Thomas,S., Sagan, A., Larkin, J., Cylus, J., Figueras, J., & Karanikolos, M. (2020) Strengthen health systems resilience. Key concepts and strategies. Health Systems and Policy Analysis. Accessed from: http://www.euro.who.int/pub/request

12.  Witter, S. & Hunter, B. (2017) Resilience of health systems during and after crises – what does it mean and how can it be enhanced? Health systems during and after crisis: evidence for better policy and practice. Accessed from: http://bit.ly/2rUPRH9

 

Written by;

Anthony Jaol Aindri- BaPharm, MPH&HSM.

Date: 20th February 2023