Based on the response to the COVID-19 pandemic, health systems face three major groups of vulnerabilities when exposed to shocks. Health systems were under-prepared, under-staffed and suffered from under-investment before COVID-19, limiting effective responses to the pandemic and entrenching pre-existing health inequities. Even during the peak of the pandemic response, spending on prevention measures only reached 5% of total health spending, up from about 3% beforehand. Ensuring sufficient funding and resourcing is in place ahead of any future health emergency is key to boosting the long-term resilience of health systems.
Health system resilience
Health system resilience is the capacity of health systems to proactively foresee, absorb, recover from, and adapt to shocks such as pandemics, climate change, geopolitical conflicts, and cyberthreats. As countries recover from COVID-19, bolstering the overall capacity of health systems is more critical than ever. Health system resilience must be prioritised as one of the key objectives for high-performing health systems.
Key messages
The health sector is intricately linked to the rest of society, and therefore a whole-of-society response is needed when addressing large shocks. Building trust in institutions is key to this approach.
Misinformation and disinformation have the potential to undermine trust in institutions, and therefore undermine societal responses to crises. It is critical to actively counter this while promoting legitimate and transparent decision making.
Involving stakeholders early and communicating the evidence behind decisions is important to legitimacy. This is especially true when crisis responses involve measures that restrict people’s freedom and changing expected healthcare standards. In these circumstances, leadership at the highest level is required for rapid decision making in the face of uncertainty.
As countries seek to learn from the COVID-19 crisis and increase their resilience for the future, evaluations are important tools to understand what worked or not, why and for whom. Country evaluations are a way to assess the resilience of health systems, taking into consideration the direct and indirect effects of past crises.
Looking ahead, resilience testing is a key method to help improve the resilience of health systems to future shocks.
Context
Increasing health workforce capacity
As OECD countries emerge from the pandemic but health systems continue to face multiple pressures, a key priority is to increase the supply of doctors, nurses and health workers. OECD countries are using a range of policies to increase the supply and retention of doctors and nurses, as well as improve their skills. Many countries have increased student intakes for medical education and training programmes and have also introduced incentives to encourage more new doctors to choose general practice to address a shortage of GPs. Most countries (60%) have or are planning to introduce or expand the roles of other health professionals like nurses to reduce the workload and pressures on doctors.
Trust in healthcare systems
Vaccine hesitancy and scepticism are examples of factors that pose significant challenges to health systems, hindering their capacity to implement strategies for enhancing public health and post-pandemic recovery. It not only compromises the effectiveness of health systems during normal times but also jeopardizes responses to potential future outbreaks. Comparing with the first months of the COVID-19 pandemic, trust in healthcare systems declined in 12 out of 22 OECD countries. Addressing these issues is crucial for bolstering resilience and fostering trust in healthcare interventions, which in turn better prepares countries for future health crises.
