Before coming to the Fourth Global Symposium on Health Systems Research, my thinking about resilience, coming from a Northern Uganda, recovering from over 20 years of war, was generally negative – something that occurs to you, and you are helpless; a sort of adaptation. Our people were considered to be resilient because despite hearing gunshots almost daily for over 15 years, we somehow kept on going, we seemed unmoved, or unbothered, or just “normal”. This comes at a huge cost to us, and many times we don’t like to hear about it. In health, the resilient hospitals are those, like our Lacor Hospital, which never closed during the war, and the resilient health workers are those who never went away.
In the case of health systems, resilience should be different, even if the idea of a shock tends to linger in the air. Two particular pre-conference sessions by Karl Blanchet and Dina Balabanova of LSHTM shed more light on the issue for me, and highlighted that this is not just an affair of low and middle income countries, but a world-wide issue. Shocks in Greece and Spain following the credit crunch had a huge impact on the health systems, resulting in increased waiting time for surgical operations in Spain, and increased copayment and unmet health needs in Greece. Another presentation by Susannah Mayhew elucidated the need for resilience considering climate change and health.
Many conference sessions, and in particular the opening plenary grappled with how to define resilience. With words like “prepared to withstand disaster”, “stay undisrupted”, “flexible”, “people centered”, “elastic” “inclusive”, “collective” and “dynamic”, the symposium immersed resilience in settings like post-Ebola Liberia, refugee crisis settings, and politico-economic settings.
So is it just “fixing health problems in low income countries” as reported by a Vancouver newspaper? I think it is NOT. The experiences of recent natural disasters and refugee crises teach us that all systems are eligible to shocks, and we should build resilience and responsiveness in all of them, albeit with a strong focus on low- and middle- income counties.
Community involvement has been strongly emphasized as a strategy for building resilience. Communities can be a group, district, country, politicians, or countries… different stakeholders. At one point I wondered, “Could community engagement be the key to resilience?” But then I quickly thought that they would be “necessary but not sufficient,” since things like funding, and other systems-level actions are needed. Multiple examples of community initiatives were presented, including the work of Prof Henry Perry and others, doing a review in this area , and some good news of resilient communities from ReBuild Consortium’s Sarah Ssali.
I would love it if we could avoid the reaching the state the calls for responsive resilience. But can we prevent reaching that state: Can conflicts/shocks be prevented? That question, dear reader, I leave for you. As Regina Nassiaca from Mozambique demonstrated in her slide below, the plan can be good, but real implementation can be very tough.