How ‘resilient’ ‘resilient health care models’ should be: The importance of ‘comprehensive primary healthcare’ and ‘whole-of-society approach’ in building a resilient health system

How ‘resilient’ ‘resilient health care models’ should be: The importance of ‘comprehensive primary healthcare’ and ‘whole-of-society approach’ in building a resilient health system

HSR2022 Participant Blog Series

How ‘resilient’ ‘resilient health care models’ should be: The importance of ‘comprehensive primary healthcare’ and ‘whole-of-society approach’ in building a resilient health system

This blog is part of a series of blogs written by participants at HSR 2022 reflecting on some of the key messages and learnings emerging from the symposium.

It was late in the evening on a Friday (4th Nov) in Bengaluru when I was all excited for my oral virtual-only session at the recently concluded 7th Global Symposium on Health Systems Research 2022 in Bogota, Colombia (#HSR 2022). Interesting insights emerged from this session on health systems response to the pandemic and what could have been a better way to connect than virtually with the chair attending from Singapore and six of my fellow presenters attending from different time zones across the globe (and of course the audience).

Aligning with the session theme which was not-so-new but on some timely topics [‘the changing dynamics of health provision models to promote equity, and the central role of human resources in health’ and ‘ innovative practice in health systems development’], I was presenting on the experience of implementing a ‘changed and holistic patient centred care pathway’ in noncommunicable disease (NCD) care continuum project during COVID 19 from a south Indian city (The Mysuru NCD Project). Alongside me, were equally thought-provoking and insightful presentations on pandemic resilience models from the Middle East and SEAR regions. There was Merette Khalil from the WHO, who presented on community and hospital resilience models during the pandemic in the Middle East, Shreya Hariyani from the John Hopkins Bloomberg SPH presented the Uttar Pradesh model of working with the private sector on furthering equity during the pandemic, Uche Ikenyei from Western Ontario University, Canada presented on the value of investing on human resource competency for better pandemic preparedness, then there was Lakshmi Josyula from the George Institute of Public Health, India who presented how the adoption of a ‘Whole-of- Society’ approach yields good dividend in not only mitigating COVID-19 risk in slum communities in India but also how collaboration, complementarity, and solidarity advanced the equity cause.

Overall, it was an interesting session and an all-around experience. Although all intervention models presented were unique in a way, the Mysuru model’s sustained focus on holistic primary health care in addressing NCDs amid the pandemic and the whole-of-society (WoS) approach to mitigate COVID risks in slums in India drew apt limelight. Both these models offered good real-world examples of resilient models: the former focused on building a strong comprehensive primary health care system as a foundation for bringing health services closer to vulnerable communities despite all odds and the latter on engaging the whole of society so that all sectors work together towards a common goal of health for all. The Mysuru model went a step ahead of all other models in addressing routine service disruption caused by COVID especially targeting chronic diseases than being only COVID-centric damage control systems. A sustained glycaemic control and clinical improvements among the affected population despite some of the worst waves of COVID spoke volumes of the Mysuru model and showcased the true value of an empowered community and community health worker-led virtual delivery of care. However, the two of the talked intervention models here had their fragility as well; the involvement of the private healthcare providers was the bare minimum raising concern about the sustainability of the resilience.

In summary, most of these presentations centred around a common theme: resilient health systems. As the pandemic unfolds, the whole focus and debate shifted to resilient health systems and adopting resilient frameworks (see here, here and here); however, what was understood from the discussion was without acknowledging a system’s local context, interconnectedness and circumstances it was always a challenge to adopt and adapt and hence reframing resilience in the local context is so crucial during the pandemic and beyond. In the context of this deliberation, WHO’s position on building health systems resilience towards UHC and health security during COVID-19 & beyond could easily be recalled where building resilient primary healthcare systems and Whole-of-Society approaches are duly highlighted as two musts in achieving service continuity and addressing inequity. Yet another learning from the session was resilience is not a static construct and that it varies with the crisis and the context. The pandemic has opened many weaknesses in not only health systems but in all aspects of society in general and widened the existing disparities truly underlying the urgency of an inter-sectoral/multi-sectoral/WoS approach, integrated/comprehensive primary care systems and overall rethinking resilience. As the session came to an end, everyone realised it is time to move from concept to practice.

By Dr Manoj Kumar Pati,

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