How Is Health System Resilience Being Assessed? A Scoping Review

It is commonly argued that resilient health systems ensure the well-being of populations even under critical conditions, whereas poorly resilient ones may be disrupted and collapse. We aimed to examine how health system resilience can be assessed as this issue is still under debate. We conducted a scoping review of peer-reviewed and grey literature published up to March 2022, following the Joanna Briggs Institute (JBI) guidance. CAIRN, DOAJ, E-Journals, Global Health Google Scholar, MedRxiv, OAIster, PubMed, reliefWeb, ScienceDirect, SmartResilience, SSRN, and World Health Organization (WHO) library were searched. The search strategy was based on key words from the research question and validated by an experienced librarian. We included full reports in English and French, whose primary focus was the health system, and that proposed or reported on the use of approaches for assessing health system resilience. Three independent reviewers did the selection and charting of reports. Extraction of information from the 34 reports that met the inclusion criteria followed predefined charting items. Various definitions of the concept of health system resilience and diverging conceptual bases were found for the assessment of resilience, pointing at the lack of conceptual maturity. Three assessment approaches emerged from this review: (1) the system mapping approach which looks at health system core functions, (2) the capacity-based approach which focuses on the main characteristics of resilience, and (3) the strategy-based approach which examines resilience strategies. None of these approaches gives a full picture of resilience. They can be complementary; hence they are increasingly used in combination. This review identified three approaches to assessing health system resilience. The absence of a common understanding of what health system resilience represents still undermines its operationalisation and assessment. There is need for further testing and learning from empirical studies on the specific or integrated use of these frameworks.