Improving health system resilience; which policy solutions are recommended?

Abstract Background Creating resilient health systems that can absorb shocks has been recognized as an important step towards ensuring the health of the global population. Throughout COVID-19 pandemic, international expert groups published an abundance of reports detailing lessons learned and recommendations to improve health system resilience. We set out to answer the question: “What do these reports say?”. We present the first top-level analysis of health system resilience recommendations made by international public authorities with a focus on the European Region, aiming to optimize understanding for researchers, policymakers, and practitioners. Methods We sampled 26 documents published by international public authorities during and after the COVID-19 pandemic and analyzed their content. First, we coded each document's level of engagement with seven major topic areas commonly cited in extant health system resilience literature. Second, we extracted every imperative recommendation made in each publication and coded them thematically at both a granular level and in relation to the seven aforementioned major topic areas. Results Nearly all the documents engaged with at least six of our seven major topic areas. The most frequently mentioned major topic area was Governance with twice the number mentions as the next most frequent mention, Collaboration and Coordination. The five most frequently mentioned minor code categories were International Coordination, Financing, Preparedness, Planning, and Information Availability. Conclusions While there are many recommendations to improve health system resilience, there was widespread consensus that action to build resilience needs to span across several functions of the health system. Most recommendations concerned governance and coordination structures. Many of these recommendations demand context-specific implementation efforts and thus implicitly reaffirm the role of scientific knowledge-brokering for policy and practice. Key messages • While governance and collaboration structures are most discussed in policy documents, improving health systems resilience requires action on multiple functions of the health system. • Most recommendations were high-level, which suggests that building resilience also requires tailored advice to make general recommendations work in specific contexts.