Edited by Steve Thomas, Edward Kennedy Professor of Health Policy and Management and Padraic Fleming, Research Fellow, Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland

‘The resilience of any system is the real test of its sustainability. In this volume, Steve Thomas and Padraic Fleming bring together the most cutting-edge research on the resilience of these complex health systems, including chapters exploring and questioning the concept itself. Furthermore, these studies emphasise the extent to which more vulnerable segments of the population suffer from shocks and the need to have strategies which take this inequality into account.’

• Contents1 Introduction: health system resilience – a concept whose time has come 1Steve Thomas and Padraic FlemingPART I UNDERSTANDING HEALTH SYSTEMS RESILIENCE2 Key ideas and future directions for health system resilience 13Dell D. Saulnier and Karl Blanchet3 Economics insights into shocks and health system resilience 29Steve Thomas4 Everyday health system resilience: the theory 44Lucy Gilson and Edwine Barasa5 Critiquing the concept of health system resilience 61Stephanie M. ToppPART II FRAMEWORKS AND PERSPECTIVES6 Assessing health system sustainability and resilience: reporting on thePartnership for Health System Sustainability and Resilience (PHSSR) 73George Wharton and Alistair McGuire7 Using health system performance assessment to examine health systemresilience 89Irene Papanicolas, Moytrayee Guha, Marina Karanikolos, JuliaZimmermann, Jennifer Nuzzo, Andrea Prado, Piya Hanvoravongchai, andAnne Liu8 Enabling health system resilience through resilient cities 113Laura C. RosellaPART III RESILIENCE AND HEALTH SYSTEM FUNCTIONING9 Building health system resilience in and through service delivery 129Erin Webb, Astrid Eriksen, and Ewout van Ginneken10 Building health system resilience in financing 144Riya D. Doshi and Jonathan Cylus11 Building health system resilience in and through governance: lessonsfrom the Danish response to the first phase of the Covid-19 pandemic 156Karsten Vrangbæk12 Building health system resilience in and through the workforce 173Padraic FlemingPART IV LEARNING FROM DIFFERENT SHOCKSSECTION IVA: ECONOMIC CRISIS13 Learning from an economic crisis – health system resilience in Portugal 198Pedro Pita Barros14 Learning from the economic and the pandemic crisis. Health systemresilience in Greece: from Skylla to Charibdis 212Charalampos Economou15 Learning from the economic shock – health system resilience in Ireland 230Sara Burke, Sarah Parker, Catherine O’Donoghue, Steve Thomas, SarahBarry, and Padraic Fleming16 Health system resilience in Spain 248José R. Repullo17 Learning lessons from the austerity period and the COVID-19 crisis inEngland to help build a more resilient health system 262Gemma A. WilliamsSECTION IVB: CLIMATE AND CONFLICT18 Mapping health systems resilience in fragile and conflict-affected settings 280Alastair Ager and Elyse Callahan19 Health systems in conflict: governance fragmentation and health systemresilience in the context of COVID-19 in Yemen 292Bothaina Attal and Sharif A. Ismail20 Developing health system resilience for the climate crisis 307Peter Berry, Kristie L. Ebi and Paddy EnrightSECTION IVC: PANDEMICS21 Lessons from 2003 SARS in Taiwan – decisions against threat matter 330Shu-Ti Chiou22 Best practice reflections on health system responses to COVID-19 in Europe 348Anna Sagan, Scott L. Greer, and Holly Jarman23 Resilience in the Brazilian health system: impacts of the COVID-19 pandemic 365Michelle Fernandez, Marco Antonio Catussi Paschoalotto, Gabriela Lotta,and Adriano Massuda24 What can we learn about everyday health system resilience andpandemic response and preparedness from Kenyan and South AfricanCOVID-19 experiences? 380Lucy Gilson, Edwine Barasa, Keith Cloete, Kadondi Kasera, Benjamin Tsofa,and Krishna Vallabhjee25 Health systems resilience in Canada: a literature review and case studiesto inform strengthened resilience 403Sara Allin, Fahad Razak, Amol Verma, and Brian Baigrie26 U.S. health system resilience 419Lynn Unruh27 Health system resilience and COVID-19 – reflections from South Asia 439Malabika Sarker, Syeda Tahmina Ahmed, Mrittika Barua, and Syed Masud AhmedPART V LOOKING FORWARD28 Into the unknown—preparing for and learning from health system shocks 452Ossi Heino, Laura Kihlström, Pauli Rautiainen, Marjaana Viita-aho, IlmoKeskimäki, and Liina-Kaisa Tynkkynen29 Conclusions: so what have we learned? 465Steve Thomas, Liz Farsaci, Catherine O’Donoghue, AriannaAlmirall-Sanchez, Lucy Gilson, Stephanie M. Topp, Alastair Ager, Laura C.Rosella, Lynn Unruh, Shu-Ti Chiou, Marco Antonio Catussi Paschoalotto,Brian Baigrie, Sarah Barry, Sara Burke, Riya D. Doshi, CharalamposEconomou, Paddy Enright, Astrid Eriksen, Michelle Fernandez, MoytrayeeGuha, Laura Kihlström, José R. Repullo, Dell D. Saulnier, Malabika Sarker,Ewout van Ginneken, Karsten Vrangbæk, and Gemma A. Willi

Edited by Steve Thomas, Edward Kennedy Professor of Health Policy and Management and Padraic Fleming, Research Fellow, Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland

‘The resilience of any system is the real test of its sustainability. In this volume, Steve Thomas and Padraic Fleming bring together the most cutting-edge research on the resilience of these complex health systems, including chapters exploring and questioning the concept itself. Furthermore, these studies emphasise the extent to which more vulnerable segments of the population suffer from shocks and the need to have strategies which take this inequality into account.’

• Contents1 Introduction: health system resilience – a concept whose time has come 1Steve Thomas and Padraic FlemingPART I UNDERSTANDING HEALTH SYSTEMS RESILIENCE2 Key ideas and future directions for health system resilience 13Dell D. Saulnier and Karl Blanchet3 Economics insights into shocks and health system resilience 29Steve Thomas4 Everyday health system resilience: the theory 44Lucy Gilson and Edwine Barasa5 Critiquing the concept of health system resilience 61Stephanie M. ToppPART II FRAMEWORKS AND PERSPECTIVES6 Assessing health system sustainability and resilience: reporting on thePartnership for Health System Sustainability and Resilience (PHSSR) 73George Wharton and Alistair McGuire7 Using health system performance assessment to examine health systemresilience 89Irene Papanicolas, Moytrayee Guha, Marina Karanikolos, JuliaZimmermann, Jennifer Nuzzo, Andrea Prado, Piya Hanvoravongchai, andAnne Liu8 Enabling health system resilience through resilient cities 113Laura C. RosellaPART III RESILIENCE AND HEALTH SYSTEM FUNCTIONING9 Building health system resilience in and through service delivery 129Erin Webb, Astrid Eriksen, and Ewout van Ginneken10 Building health system resilience in financing 144Riya D. Doshi and Jonathan Cylus11 Building health system resilience in and through governance: lessonsfrom the Danish response to the first phase of the Covid-19 pandemic 156Karsten Vrangbæk12 Building health system resilience in and through the workforce 173Padraic FlemingPART IV LEARNING FROM DIFFERENT SHOCKSSECTION IVA: ECONOMIC CRISIS13 Learning from an economic crisis – health system resilience in Portugal 198Pedro Pita Barros14 Learning from the economic and the pandemic crisis. Health systemresilience in Greece: from Skylla to Charibdis 212Charalampos Economou15 Learning from the economic shock – health system resilience in Ireland 230Sara Burke, Sarah Parker, Catherine O’Donoghue, Steve Thomas, SarahBarry, and Padraic Fleming16 Health system resilience in Spain 248José R. Repullo17 Learning lessons from the austerity period and the COVID-19 crisis inEngland to help build a more resilient health system 262Gemma A. WilliamsSECTION IVB: CLIMATE AND CONFLICT18 Mapping health systems resilience in fragile and conflict-affected settings 280Alastair Ager and Elyse Callahan19 Health systems in conflict: governance fragmentation and health systemresilience in the context of COVID-19 in Yemen 292Bothaina Attal and Sharif A. Ismail20 Developing health system resilience for the climate crisis 307Peter Berry, Kristie L. Ebi and Paddy EnrightSECTION IVC: PANDEMICS21 Lessons from 2003 SARS in Taiwan – decisions against threat matter 330Shu-Ti Chiou22 Best practice reflections on health system responses to COVID-19 in Europe 348Anna Sagan, Scott L. Greer, and Holly Jarman23 Resilience in the Brazilian health system: impacts of the COVID-19 pandemic 365Michelle Fernandez, Marco Antonio Catussi Paschoalotto, Gabriela Lotta,and Adriano Massuda24 What can we learn about everyday health system resilience andpandemic response and preparedness from Kenyan and South AfricanCOVID-19 experiences? 380Lucy Gilson, Edwine Barasa, Keith Cloete, Kadondi Kasera, Benjamin Tsofa,and Krishna Vallabhjee25 Health systems resilience in Canada: a literature review and case studiesto inform strengthened resilience 403Sara Allin, Fahad Razak, Amol Verma, and Brian Baigrie26 U.S. health system resilience 419Lynn Unruh27 Health system resilience and COVID-19 – reflections from South Asia 439Malabika Sarker, Syeda Tahmina Ahmed, Mrittika Barua, and Syed Masud AhmedPART V LOOKING FORWARD28 Into the unknown—preparing for and learning from health system shocks 452Ossi Heino, Laura Kihlström, Pauli Rautiainen, Marjaana Viita-aho, IlmoKeskimäki, and Liina-Kaisa Tynkkynen29 Conclusions: so what have we learned? 465Steve Thomas, Liz Farsaci, Catherine O’Donoghue, AriannaAlmirall-Sanchez, Lucy Gilson, Stephanie M. Topp, Alastair Ager, Laura C.Rosella, Lynn Unruh, Shu-Ti Chiou, Marco Antonio Catussi Paschoalotto,Brian Baigrie, Sarah Barry, Sara Burke, Riya D. Doshi, CharalamposEconomou, Paddy Enright, Astrid Eriksen, Michelle Fernandez, MoytrayeeGuha, Laura Kihlström, José R. Repullo, Dell D. Saulnier, Malabika Sarker,Ewout van Ginneken, Karsten Vrangbæk, and Gemma A. Willi

Edited by Steve Thomas, Edward Kennedy Professor of Health Policy and Management and Padraic Fleming, Research Fellow, Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland

‘The resilience of any system is the real test of its sustainability. In this volume, Steve Thomas and Padraic Fleming bring together the most cutting-edge research on the resilience of these complex health systems, including chapters exploring and questioning the concept itself. Furthermore, these studies emphasise the extent to which more vulnerable segments of the population suffer from shocks and the need to have strategies which take this inequality into account.’

• Contents1 Introduction: health system resilience – a concept whose time has come 1Steve Thomas and Padraic FlemingPART I UNDERSTANDING HEALTH SYSTEMS RESILIENCE2 Key ideas and future directions for health system resilience 13Dell D. Saulnier and Karl Blanchet3 Economics insights into shocks and health system resilience 29Steve Thomas4 Everyday health system resilience: the theory 44Lucy Gilson and Edwine Barasa5 Critiquing the concept of health system resilience 61Stephanie M. ToppPART II FRAMEWORKS AND PERSPECTIVES6 Assessing health system sustainability and resilience: reporting on thePartnership for Health System Sustainability and Resilience (PHSSR) 73George Wharton and Alistair McGuire7 Using health system performance assessment to examine health systemresilience 89Irene Papanicolas, Moytrayee Guha, Marina Karanikolos, JuliaZimmermann, Jennifer Nuzzo, Andrea Prado, Piya Hanvoravongchai, andAnne Liu8 Enabling health system resilience through resilient cities 113Laura C. RosellaPART III RESILIENCE AND HEALTH SYSTEM FUNCTIONING9 Building health system resilience in and through service delivery 129Erin Webb, Astrid Eriksen, and Ewout van Ginneken10 Building health system resilience in financing 144Riya D. Doshi and Jonathan Cylus11 Building health system resilience in and through governance: lessonsfrom the Danish response to the first phase of the Covid-19 pandemic 156Karsten Vrangbæk12 Building health system resilience in and through the workforce 173Padraic FlemingPART IV LEARNING FROM DIFFERENT SHOCKSSECTION IVA: ECONOMIC CRISIS13 Learning from an economic crisis – health system resilience in Portugal 198Pedro Pita Barros14 Learning from the economic and the pandemic crisis. Health systemresilience in Greece: from Skylla to Charibdis 212Charalampos Economou15 Learning from the economic shock – health system resilience in Ireland 230Sara Burke, Sarah Parker, Catherine O’Donoghue, Steve Thomas, SarahBarry, and Padraic Fleming16 Health system resilience in Spain 248José R. Repullo17 Learning lessons from the austerity period and the COVID-19 crisis inEngland to help build a more resilient health system 262Gemma A. WilliamsSECTION IVB: CLIMATE AND CONFLICT18 Mapping health systems resilience in fragile and conflict-affected settings 280Alastair Ager and Elyse Callahan19 Health systems in conflict: governance fragmentation and health systemresilience in the context of COVID-19 in Yemen 292Bothaina Attal and Sharif A. Ismail20 Developing health system resilience for the climate crisis 307Peter Berry, Kristie L. Ebi and Paddy EnrightSECTION IVC: PANDEMICS21 Lessons from 2003 SARS in Taiwan – decisions against threat matter 330Shu-Ti Chiou22 Best practice reflections on health system responses to COVID-19 in Europe 348Anna Sagan, Scott L. Greer, and Holly Jarman23 Resilience in the Brazilian health system: impacts of the COVID-19 pandemic 365Michelle Fernandez, Marco Antonio Catussi Paschoalotto, Gabriela Lotta,and Adriano Massuda24 What can we learn about everyday health system resilience andpandemic response and preparedness from Kenyan and South AfricanCOVID-19 experiences? 380Lucy Gilson, Edwine Barasa, Keith Cloete, Kadondi Kasera, Benjamin Tsofa,and Krishna Vallabhjee25 Health systems resilience in Canada: a literature review and case studiesto inform strengthened resilience 403Sara Allin, Fahad Razak, Amol Verma, and Brian Baigrie26 U.S. health system resilience 419Lynn Unruh27 Health system resilience and COVID-19 – reflections from South Asia 439Malabika Sarker, Syeda Tahmina Ahmed, Mrittika Barua, and Syed Masud AhmedPART V LOOKING FORWARD28 Into the unknown—preparing for and learning from health system shocks 452Ossi Heino, Laura Kihlström, Pauli Rautiainen, Marjaana Viita-aho, IlmoKeskimäki, and Liina-Kaisa Tynkkynen29 Conclusions: so what have we learned? 465Steve Thomas, Liz Farsaci, Catherine O’Donoghue, AriannaAlmirall-Sanchez, Lucy Gilson, Stephanie M. Topp, Alastair Ager, Laura C.Rosella, Lynn Unruh, Shu-Ti Chiou, Marco Antonio Catussi Paschoalotto,Brian Baigrie, Sarah Barry, Sara Burke, Riya D. Doshi, CharalamposEconomou, Paddy Enright, Astrid Eriksen, Michelle Fernandez, MoytrayeeGuha, Laura Kihlström, José R. Repullo, Dell D. Saulnier, Malabika Sarker,Ewout van Ginneken, Karsten Vrangbæk, and Gemma A. Willi