A method for testing health system resilience: Development, application and lessons learned

Recent adverse events, such as the COVID-19 pandemic, economic crises, conflict, migration and extreme weather have demonstrated how a wide range of shocks can challenge health systems. While emergency preparedness and planning is a well established component of health system governance in many countries, no methodology has existed to systematically test the resilience of a health system to a broad range of shocks.

To share lessons learned from conducing resilience testing exercises.

The resilience testing methodology is a mixed-method country-led exercise designed for policy making. We developed this method to test the resilience of a health system. A specific shock scenario is chosen from a broad range of possible shocks to hypothetically challenge a given health system to its limits. The impact of the shock is assessed using the global HSPA framework and the shock cycle framework. The process culminates in a semi-structured resilience testing workshop that brings together policy makers, civil servants and other relevant stakeholders. The workshop is designed to identify key structural strengths and weaknesses of the health system, which then can be improved through remedial policy action. In this paper we use the RE-AIM framework to present findings from our mixed-methods formative evaluation.

Successful approaches involved carefully selected facilitators, a diverse range of participants performing different health system functions and support from the Ministry of Health.

Resilience testing can identify health system strengths, weaknesses and opportunities for remedial policy action.