Everyday health system resilience

What is everyday health system resilience and how might it be nurtured?

Discussion of resilience in the health sector is characterised by a focus on sudden shocks, such as disease outbreaks; but beyond sudden shocks, organisations and systems face ongoing strains caused by multiple factors.

RESYST research has shown that district health managers routinely face structural and policy instability, such as changes in governance structures, payment delays and abrupt and imposed policy directives. They also work with unstable authority delegations, manage unpredictable staff and address changing patient and community expectations. These stresses typically occur at the same time, in the same system, affecting the same set of people.

Everyday resilience is the ability of health systems to continue to deliver services in the face of constant challenge and strain. 

Current work on everyday resilience is focusing on how mid-level manager leadership practices, organisational relationships and their underpinning values influence health system resilience. More information is available here.

What has RESYST learned about everyday resilience in district health systems?

• Leadership is important: Exercised by people across the system, and not just at the centre; working in formal and informal positions, and practicing new forms of values-based leadership that empower others.

• Social networks and relationships are important: Social networks provide access to the multiple resources and forms of value (material, knowledge, reputational) that bestow resilience to health systems.

• Material resources and organisational structures matter: Ensuring that health systems have adequate resources and strong structures, especially low and middle income settings, contributes to, but does not by itself generate, resilience.

Ultimately, resilience is not a function of what a system has but of what it does. Strengthening capacity, and health systems, is ‘… more than simply providing assets or technology. It is about developing people’s agency, it is about governance and power’ (Béné et al. 2012: 28).

This work has emerged from the Learning Sites work in Kenya and South Africa – an approach to carrying out research in collaboration with health managers and frontline staff. 

Resources

 Key findings sheet: What is everyday health system resilience and how might it be nurtured?

 Research summary: How is everyday health system resilience influenced by mid-level managers?

Journal publications

 From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening

 Everyday resilience in health systems: emerging insights from the front lines in Kenya and South Africa