The package of health system resilience indicators serves as a dedicated resource to measure and monitor health system resilience in routine operations as well as in the context of disruptive shocks and stressors. This work addresses an identified gap in measurement and monitoring of health system resilience. It complements the Health Systems Resilience Toolkit and supports implementation of the recommendations in WHO’s position paper on building health system resilience for UHC and health security. The package aims to support countries to progressively build their capacities to measure, monitor and build health system resilience from national to subnational levels covering health facilities and other service delivery platforms. It emphasizes an integrated approach to health system strengthening underpinned by essential public health functions, encompassing health emergency preparedness. It includes: - guidance on how to utilize and adapt the health system resilience indicators, including a step-by-step guide - a suite of recommended health system resilience indicators with technical specifications - supplementary indicators of relevance to health system resilience The primary target audience for this package is national and subnational health authorities (including planners and managers) and service providers, as well as local, regional, and global technical organizations and partners working on health system strengthening, including WHO, United Nations country teams, donors, nongovernment organizations, development and humanitarian agencies, and other health-related technical agencies.

Health system resilience is not an inevitable byproduct of any investment in health but must be intentionally programmed and developed with necessary input, investment and contextualization. This technical product aims to guide national, subnational and global health actors to operationalize the concept of health system resilience for advancement of universal health coverage, health security and ultimately better health for all. It supports the translation of relevant conceptual guidance and high-level recommendations into practical actions. The specific objectives are to: present a concise overview of the concept of health system resilience; provide a roadmap outlining practical and foundational steps for building health system resilience to be adapted to different contexts; share examples of actions and tools, including stakeholder roles, to support country application of the roadmap. The target audience for this work is the various stakeholders involved in strengthening health systems and public health including management of emergencies (from prevention and preparedness to response and recovery) and other public health challenges in countries. This ranges from the donors, policymakers and decision-makers at global, national and subnational levels to the implementing institutions and line managers of health system functions and services across the health system building blocks.

Since February 2020 the COVID-19 pandemic has strained health systems worldwide. This book explores the factors determining the ability of health systems to cope with and recover from a crisis, and therefore their level of resilience.

Properly performing health care systems require concepts and methods that match their complexity. Resilience engineering provides that capability. It focuses on a system’s overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. This book contains contributions from international experts in health care, organisational studies and patient safety, as well as resilience engineering. Whereas current safety approaches primarily aim to reduce the number of things that go wrong, Resilient Health Care aims to increase the number of things that go right.

Despite the common focus on deviations and failures in health systems, it is an undeniable fact that clinical work goes right far more often than it goes wrong, and that we only can make it better if we understand how this happens. This second volume of Resilient Health Care continues the line of thinking of the first book. It breaks new ground by analyzing everyday work situations in primary, secondary, and tertiary care to identify and describe the fundamental strategies that clinicians everywhere have developed and use with a fluency that belies the demands to be resolved and the dilemmas to be balanced.

Background: Health systems responsiveness is the key to addressing infectious disease threats such as pandemics. The paper outlines an assessment of health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19 across 203 countries using an ecological design. Methodology: Correlation analysis was performed to assess the relationship of each of the indicators with COVID 19 cases and deaths per million population. Stepwise multiple regression models were developed to determine the predictors of COVID-19 cumulative cases and deaths per million population separately. Results: Global health security indicators seemed to have a strong association when analyzed individually but those did not necessarily translate into less burden of cases or deaths in the multivariable analysis. The predictors of cumulative deaths per million population included general government expenditure on health as a proportion of general government expenditure, responsiveness of the system to prevent the emergence and release of pathogens and governance related voice and accountability. Conclusion: To conclude, health financing parameters and preventive activities with regard to emergence of pathogens were better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators.Key messages• Health financing parameters are better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators.• More robust and valid indicators are required to assess the performance of health system.