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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

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Page 1: Preparing for future shocks: Building resilient health systemsmini-university.com/wp-content/uploads/2016/03/Series-2_Preparing-… · Preparing for future shocks: Building resilient

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

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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

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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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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 News4

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Key elements of Health Systems

Resilience (Kruk)

Credit: Rockefeller Foundation5

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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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• Up-to-date

mapping of

human, physical

and information

assets

• Strategic

Information &

Epidemiological

Surveillance

• Inform planning

AwarenessDetects health threats before

they strike

Diversity Delivers range

of services with universal

health coverage

Self-Regulation

Prevents health disruptions from

turning into disasters

IntegrationRapidlydeploys

resources from beyond

the health system

AdaptabilityRebounds from shocks stronger

than before

Awareness

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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: USAID8

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Capacity to address

a broad range of

health issues, often

through a focus on

primary care or UHC

AwarenessDetects health threats before

they strike

Diversity Delivers range

of services with universal

health coverage

Self-Regulation

Prevents health disruptions from

turning into disasters

IntegrationRapidlydeploys

resources from beyond

the health system

AdaptabilityRebounds from shocks stronger

than before

Diversity

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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

Page 11: Preparing for future shocks: Building resilient health systemsmini-university.com/wp-content/uploads/2016/03/Series-2_Preparing-… · Preparing for future shocks: Building resilient

Contain health threats

while maintaining

basic services and

stability

AwarenessDetects health threats before

they strike

Diversity Delivers range

of services with universal

health coverage

Self-Regulation

Prevents health disruptions from

turning into disasters

IntegrationRapidlydeploys

resources from beyond

the health system

AdaptabilityRebounds from shocks stronger

than before

Self-Regulation

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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

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Multi-sector

coordination and

communication to

prepare and

respond to health

crises

Integration

AwarenessDetects health threats before

they strike

Diversity Delivers range

of services with universal

health coverage

Self-Regulation

Prevents health disruptions from

turning into disasters

IntegrationRapidlydeploys

resources from beyond

the health system

AdaptabilityRebounds from shocks stronger

than before

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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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Capacity to respond

to new health

challenges brought

about by changing

epidemiology,

demographics,

natural disasters,

conflict, and other

adverse conditions

Adaptability

AwarenessDetects health threats before

they strike

Diversity Delivers range

of services with universal

health coverage

Self-Regulation

Prevents health disruptions from

turning into disasters

IntegrationRapidlydeploys

resources from beyond

the health system

AdaptabilityRebounds from shocks stronger

than before

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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

reconnaissancePhoto Credit: HFG Project

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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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Mystery Country Case Study

• What country was it?

• Which investments have been tried to make

the health system more resilient?

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Page 19: Preparing for future shocks: Building resilient health systemsmini-university.com/wp-content/uploads/2016/03/Series-2_Preparing-… · Preparing for future shocks: Building resilient

Thank you!

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