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

The search yielded a total of 1108 articles after the removal of duplicates (Additional file 3: Figure S1 ). One hundred and fifty-eight articles were read in their entirety, of which 132 were deemed to be relevant and underwent thematic coding. After the completion of coding, we identified 77 key documents that described 16 high-level themes of health system resilience, which are summarized in Additional file 1: Table S2 (see Additional file 2: Appendix A and Appendix B for a comprehensive breakdown of sources organized by theme and author). Thirty-nine papers focused primarily on infectious diseases, while another 12 addressed natural hazards. The remaining 26 papers were not threat-specific, but rather articulated general principles for strengthening health systems and described baseline capacities required for health system functioning. While the themes found in our search were consistent with the five elements of a resilient health system previously outlined by Kruk et al. [1, 2] , we also identified three additional themes not included in previous reviews, including the need to: Develop policies for determining what level of care will be delivered when the level of demand exceeds existing resources; Plan for post-event recovery; and Commitment to quality improvement that ensures integration of lessons learned.