From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening.
From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening.
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DOI：
10.1093/heapol/czx118
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发表时间：
2017-11-01
影响因子：
3.2
通讯作者：
Gilson L
中科院分区：
文献类型：
--
作者：
Barasa EW;Cloete K;Gilson L
最近的卫生系统冲击，如埃博拉疫情，使全球卫生注意力集中在有复原力的卫生系统的概念上。在本评论中，我们反思了卫生系统话语中复原力概念的当前框架，并提出了一种重构。具体而言，我们提出：(1)除了突发冲击外，卫生系统还面临多种因素的持续压力。卫生系统需要有能力继续提供高质量的服务，并有效应对更广泛的卫生挑战。我们称这种能力为日常弹性；(2)卫生系统的弹性不仅仅是从冲击中反弹。在复杂适应系统（CAS）中，复原力来自吸收、适应和变革策略的结合；(3)培养卫生系统的弹性需要理解卫生系统不仅包括硬件要素（如财政和基础设施），还包括软件要素（如领导能力、权力关系、价值观和适当的组织文化）。我们还反思了目前对韧性卫生系统概念的批评，例如，它假设系统不涉及政治，忽视行为者机构，促进不作为，并要求我们接受和拥抱脆弱性，而不是努力建立更强大和更具响应性的系统。我们注意到，这些批评是有道理的，因为它们提到的复原力概念与CAS等卫生系统的现实不匹配。我们认为，可以通过重构和应用更适合作为CAS的卫生系统属性的弹性镜头来解决观察到的弹性思维的弱点。
Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, we reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, we propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. We call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems (CAS), resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). We also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that we accept and embrace vulnerability, rather than strive for stronger and more responsive systems. We observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems as CAS. We argue that the observed weaknesses of resilience thinking can be addressed by reframing and applying a resilience lens that is better suited to the attributes of health systems as CAS.
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发表时间：
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影响因子：
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