Building Back Better: 10 Key Messages on Health Systems Recovery

Health systems recovery refers to the process undertaken to restore and strengthen the health system following a shock.

Building Back Better: 10 Key Messages on Health Systems Recovery

Building Back Better: 10 Key Messages on Health Systems Recovery

Health systems recovery refers to the process undertaken to restore and strengthen the health system following a shock. Emergencies, caused by disasters, climate change, pandemics, armed conflict, or social and economic crises, can significantly impact all aspects of health systems, including access to and the delivery of health services, health infrastructure, the availability of medical supplies, and the health workforce. In such contexts, the goal of health systems recovery is to (re)create a resilient, efficient, and equitable health system that can withstand future shocks and provide quality health services to the population. As such, recovery efforts aim not only to rebuild and repair, but also to address pre-existing weaknesses and inefficiencies within the health system. Health systems recovery is in effect an opportunity to implement health system reforms that can lead to better health outcomes and greater equity, and also improve preparedness to respond to future crises.

Given the importance of the topic, particularly in the region, the World Health Organization’s Eastern Mediterranean Region Office (WHO EMRO) has been working on building understanding and capacity for health systems recovery. In December 2023, WHO EMRO held a meeting in Cairo, Egypt with a diverse group of health system recovery experts, including academics, practitioners, donors, UN agencies, NGOs and national organizations. The goal was to share knowledge and experiences, discuss effective, innovative approaches and identify key principles and lessons learned to tackle complex recovery challenges in settings affected by conflicts and crises in the Eastern Mediterranean region and beyond.

In this blog hosted by the TWG FCAS, Ali Ardalan and Clara Affun-Adegbulu highlight ten strategic messages for health systems recovery emerging from the meeting.

  • Collaborative Recovery for Sustainable Health: Effective recovery and the sustainability of health systems rely on collaborative efforts that cross traditional boundaries. Engaging a wide range of stakeholders, including humanitarian and development actors, the public and private sectors, academia, and civil society, fosters innovative solutions tailored to specific community needs. This approach ensures smoother transitions between emergency response and long-term recovery and makes the path to recovery a collective journey.
  • Strategic Investments for Resilient Systems: The resilience of health systems post-crisis depends on strategic, forward-thinking investments that not only aim to restore but also to improve upon pre-crisis capabilities. Focusing on Universal Health Coverage, climate change resilience, equity, and community involvement ensures that health systems can withstand future shocks. Investing in capacity building and technological innovations can transform health services into more accessible, efficient, and resilient operations. This strategic approach to funding prioritizes long-term stability and equity, ensuring health systems can serve all community members, regardless of their socio-economic status.
  • Establishing a Strong Foundation: A strong, unified leadership and governance framework is essential for effective health systems recovery. This includes clear planning, budgeting, and the implementation of robust governance structures to guide the recovery process. A shared strategic direction, supported by unified indicators for monitoring and evaluation, ensures that all efforts are aligned and contribute to the overarching goals of recovery. Strong national coordination mechanisms are vital for orchestrating the diverse elements of health system recovery, from infrastructure rebuilding to service delivery optimization.
  • Resource Management for Adaptive Recovery: Adaptive recovery requires a flexible approach to resource management, with funding models that can accommodate the dynamic nature of post-crisis environments. Advocating for flexible funding models allows for resources to be allocated where they are most needed, ensuring that recovery efforts can be responsive to evolving challenges. Strategic management of these resources, including human, financial, and material assets, is crucial for building resilience and ensuring that health systems can respond effectively to both current recovery needs and future emergencies.
  • Fostering Trust through Partnerships: Building trust-based, long-term partnerships is essential for effective health systems recovery. Collaborating with a diverse set of stakeholders, from government agencies and NGOs to communities and private entities, allows for a comprehensive approach to recovery. Leveraging the unique strengths and capabilities of each partner enhances the effectiveness of recovery efforts. In conflict zones, prioritizing multi-sectoral collaboration is particularly important for addressing governance gaps, ethical concerns, and accountability issues, ensuring that recovery efforts are inclusive and equitable.
  • Empowering Communities for Sustainable Health: Putting local communities at the heart of recovery efforts ensures that health systems are rebuilt in a way that is sustainable and sensitive to local needs. Tailoring recovery plans to the specific context of each community, prioritizing local ownership, and involving community members at every stage of the process leverages local knowledge and expertise. This community-centric approach not only ensures that health systems are relevant and responsive but also fosters a sense of ownership and responsibility among local populations, contributing to the long-term sustainability of health services.
  • Integrating Risk Management and Health Systems: The integration of disaster risk reduction (DRR) strategies with health system planning is a critical component of effective recovery and future resilience. By considering health aspects in DRR frameworks and vice versa, stakeholders can ensure a coordinated and comprehensive approach to crisis management. The use of established frameworks, such as the Health Emergency and Disaster Risk Management (Health EDRM), guides the integration process, ensuring that health systems are prepared for and can effectively respond to future disasters. This holistic approach highlights the importance of preparedness and resilience in health systems, facilitating more rapid and efficient recovery processes.
  • Translating Plans into Action: The transition from planning to action is a critical step in health systems recovery. Implementing practical, context-specific guidelines and plans ensures that recovery efforts are grounded in reality and address the unique challenges of each context. Learning from successful recovery models and adapting strategies to meet local needs allows for continuous improvement and innovation in recovery approaches. Developing simple, practical tools for implementation ensures that recovery efforts are measurable and effective, contributing to the overall success of health system recovery efforts.
  • Evolving through Continuous Learning: Continuous learning and collaboration are foundational to the ongoing improvement of health systems recovery processes. Utilizing assessment tools and engaging in partnerships with academic institutions for research and evidence generation supports an evidence-based approach to recovery. This proactive stance encourages continuous adaptation and refinement of recovery strategies based on the latest evidence and best practices. Such an approach ensures that health systems are not only restored but also enhanced, with increased capacity to meet the current and future needs of the population.
  • Prioritizing Peace for Recovery: In conflict-affected areas, recognizing the importance of peace is paramount for successful health systems recovery. The complex nature of recovery in these contexts requires a nuanced understanding of the challenges involved, including navigating political dynamics and informal power structures. Developing strategies that contribute to sustainable stability and well-being requires a focus on peacebuilding alongside health system recovery efforts. By addressing the specific needs and challenges of conflict zones, stakeholders can ensure that health systems are rebuilt in a way that supports long-term peace and health security for all community members.

These ten strategic messages highlight the critical need for a pragmatic, holistic, and inclusive approach to health systems recovery, which ensures that health systems become more robust, adaptive, and responsive, fully prepared for all eventualities, and capable of meeting the diverse needs of their communities under any circumstances.

The Health Systems Resilience Unit, situated within the Department of Universal Health Coverage/Health Systems (UHC/HS) at WHO EMRO, plays a vital role in bridging health systems strengthening initiatives with emergency preparedness and response activities. To support its mission, the Unit has developed several resources, including the “Implementation Guide for Health Systems Recovery in Emergencies: Transforming Challenges into Opportunities.” Through detailed methods, practical strategies and examples, this guide is designed to equip stakeholders with the knowledge and tools needed to effectively manage the recovery of health systems that are resilient, equitable, and tailored to the specific needs of communities affected by emergencies, thus turning the challenges faced during such times into opportunities for strengthening and improving health systems.

Opening Remarks, Welcome Message, and Closing Remarks were given by:

Dr. Rana Hajjeh, Director of Program Management, WHO EMRO; Dr. Awad Mataria, Director, UHC/Health Systems, WHO EMRO; and Dr. Rick Brennan, Regional Emergency Director, WHO EMRO.

Presenters and Moderators included:

Dr. Sameen Siddiqi, Chair, Department of Community Health Sciences, Aga Khan University; Dr. Awad Mataria, Director, Department of UHC/Health Systems, WHO EMRO; Dr. Sohel Saikat, Senior Advisor & Lead, Health System Resilience and EPHFs, Special Programme on Primary Health Care, WHO HQ; Dr. Andre Griekspoor, Senior Policy Advisor, WHO Health Emergencies Program, WHO HQ; Dr. Ali Ardalan, Regional Adviser and Unit Head, Health Systems in Emergencies, WHO EMRO; Dr. Preeti Patel, Professor of Global Health & Conflict, Department of War Studies, King’s Global Health Institute; Dr. Paul Spiegel, Director, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health; Dr. Ahmed Zouiten, WHO Representative, Libya; Dr. Arturo Pesigan, WHO Representative, Yemen; Dr. Egbert Sondorp, Senior Advisor Health Systems, KIT Royal Tropical Institute; Dr. Virginia Murray, Head of Global Disaster Risk Reduction, UK Health Security Agency; Dr. Ibrahim Bou-Orm, Lecturer, Institution for Global Health and Development, Queen Margaret University, Edinburgh, Scotland; Dr. Hyam Bashour, Health Systems Officer, WHO Syria; Ms. Ellen Thom, Technical Officer/OIC, WHO Pakistan; Dr. Mai Hijazi, Director for the Office of Health Systems in the Bureau for Global Health, USAID; Ms. Mira Kristina Ihalainen, Director, Communications, Resource Mobilization & Partnership; Dr. Breshna Orya, Senior Health Finance Specialist, The Global Fund; Mr. Daniel De La Torre, Advisor, Partnerships, Challenging Operating Environments, Grant Management Division, The Global Fund.

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