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Commentary
Shifting the paradigm: using disease outbreaks to build resilient health systems
  1. Kara N Durski1,2,
  2. Michael Osterholm2,
  3. Suman S Majumdar3,4,
  4. Eric Nilles1,
  5. Daniel G Bausch5,
  6. Rifat Atun6
  1. 1 Harvard Humanitarian Initiative, Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
  2. 2 School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  3. 3 Burnet Institute, Melbourne, Victoria, Australia
  4. 4 University of Melbourne, Melbourne, Victoria, Australia
  5. 5 UK Public Health Rapid Support Team, Public Health England/London School of Hygiene & Tropical Medicine, London, UK
  6. 6 Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
  1. Correspondence to Kara N Durski; kdurski{at}hsph.harvard.edu

https://doi.org/10.1136/bmjgh-2020-002499

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    Summary box

    • Disease outbreaks and health emergencies can push health systems to a breaking point, especially fragile systems.

    • Building resilient and responsive health systems is an imperative for the global health community and there is an important opportunity to address health systems strengthening activities during outbreak response.

    • The resources dedicated to outbreaks create organisational infrastructure, capacity and networks that can be leveraged to simultaneously strengthen health systems.

    • It is necessary to shift the current paradigm of managing outbreaks to include health system strengthening as a critical component of the response. We identify 10 activities that could be implemented during health emergencies to achieve this goal.

    Disease outbreaks and health emergencies cause substantial human suffering, death and economic loss. Such events push weak health systems to a breaking point, as witnessed during recent outbreaks of cholera, drug-resistant tuberculosis, Ebola virus disease and Zika virus disease.1–4 The current COVID-19 pandemic is testing the response and resilience of health systems worldwide, including well-resourced systems in Europe and North America, where health institutions and public health agencies are operating beyond capacity, diagnostics are lacking, triage systems are faltering, personal protective equipment are insufficient, and front-line health workers are facing risks of disease and death.5

    Building responsive and resilient health systems is an imperative for the global health community. A resilient health system can absorb the shock of an emergency while continuing to provide regular health services.6–8 Most frameworks for building resilient health systems that effectively respond to disease outbreaks focus on enhancing preparedness or response capacity prior to an emergency9–11 or to strengthen health systems after the emergency, typically during the recovery phase. Indeed, many aspects of outbreak response lay the groundwork for health system strengthening (HSS), such as enhancing surveillance systems and training the health workforce.12 Over the last two …

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