A resilient health system is one that is able to function and adapt on an everyday basis even when exposed to shocks. The Ebola outbreak highlighted the urgent need to build resilient health systems, especially in poorer settings. The World Health Organization (WHO) recognises that in outbreak or disaster situations poorly functioning health systems contribute to immense human suffering, and there has recently been a global acknowledgement of the effects of Ebola and the importance of building resilient health systems. At the recent RESYST annual meeting participants discussed how research findings could be used to build resilient health systems as well as engaging in a critical assessment of the Sustainable Development Goals (SDGs).

SDGs & resilience

Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all ages) fails to recognise the importance of resilient health systems and while the importance of the health workforce is listed as a specific target other health system components have been excluded. Another of the SDG targets refers to Universal Health Coverage but fails to explicitly mention strengthening health systems. This is surprising given the centrality of the ‘resilience awareness’ which emerged during and after the Ebola situation, despite this the term ‘resilient’ was not mentioned in SDG3 or any of its targets.

SDGs & fragmentation

It can be argued that the SDG process started off well and followed comprehensive reports such as the Realizing the Future We Want for All Report to the United Nations Secretary General, but the adopted SDGs may not adequately shape the world over the next fifteen years, especially when it comes to health. A recent write-up in the Lancet argues that the importance of leadership and financing have been over-looked in the SDG process. Presently, the achievement of SGD3 is undoubtedly reliant and interlinked to other SGDs such as ‘Zero Hunger’ and ‘Clean Water and Sanitation’. This fragmentation is particularly concerning if governments need to prioritise certain goals over others and if implementation is not holistic.

What can we learn from Ebola?

Targets including those related to maternal mortality, diseases, UHC and SDG3 cannot be achieved without concrete recognition of strengthened health systems as an overall goal. The lessons from Ebola will be lost if the health system itself and its components are not strengthened holistically. As researchers it is critical that we do not contribute to further fragmentation by focusing on single targets and always place targets within the context of improving health systems. Governments and implementers must acknowledge the centrality of resilient health systems and its components even though it has not been formally included in SDG3.

What's next?

As we move towards the next Global Health Symposium in Vancouver, the SDGs must be further critiqued and discussed in terms of intended implementation and monitoring progress. As researchers it is our responsibility to ensure that implementation of the SDG agenda is influenced in a way which will put health systems squarely in the picture.