What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

Nuzzo, Jennifer B.; Meyer, Diane; Snyder, Michael; Ravi, Sanjana J.; Lapascu, Ana; Souleles, Jon; Andrada, Carolina I.; Bishai, David

Independent reviews of the global response to the 2014-2016 Ebola outbreak have stressed the importance of establishing metrics to assess and monitor progress towards improving countries' capacity to respond to public health emergencies [9] [10] [11] . In 2016, the World Health Organization (WHO) created the International Health Regulations (IHR) Joint External Evaluation (JEE) tool-a framework and process designed to measure countries' capacities to implement the requirements of the IHR, which include the ability to prevent, detect, and respond to public health emergencies of international concern [12] . Since its introduction, the JEE has become an important tool used by countries to assess their capacities for infectious disease outbreaks and other public health emergencies. To-date, more than 100 countries have conducted JEE assessments [13] . Some countries that have undergone JEE assessments have also begun to develop action plans to address gaps found in their JEEs. Despite this progress, health facilities continue to be vulnerable to public health emergencies [14] . Important work has been done to describe the general attributes of a resilient health system [1, 2, [15] [16] [17] . For example, Kruk et al. describe a resilient health system as one that is "integrated with existing efforts to strengthen health systems," able to "detect and interpret local warning signs and quickly call for support," able to provide care for a diverse population, able to "isolate threats and maintain core functions," and is able to "adapt to health shocks" [2] . However, as highlighted by Turenne et al., there continues to be a lack of clarity around the conceptualization of health systems resilience [18] .