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

Health system resilience has been previously defined as "the 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 learnt during the crisis, reorganize if conditions require it" [1, 2] . For many countries, the 2014-2016 Ebola outbreak in West Africa was a wake-up call regarding the critical importance of having resilient health systems. In each of the three countries most affected by Ebola, a fragile health system was quickly overwhelmed by the complexity of tracking cases, the need to create and disseminate communication strategies, and the challenges of safely caring for a surge of critically ill patients. Health workers were 21-32 times more likely to have been infected with the virus than members of the general public [3] . Sickened health workers could no longer care for Ebola patients, and poor infection control in healthcare facilities contributed to nosocomial Ebola transmission. In turn, heightened risks of nosocomial Ebola infection increased public fear around hospitalization [4] . Rather than helping to contain Ebola, health systems became an amplifier of disease, exacerbating the human, economic, and political toll of the outbreak.