TY - JOUR T1 - Shifting the paradigm: using disease outbreaks to build resilient health systems JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-002499 VL - 5 IS - 5 SP - e002499 AU - Kara N Durski AU - Michael Osterholm AU - Suman S Majumdar AU - Eric Nilles AU - Daniel G Bausch AU - Rifat Atun Y1 - 2020/05/01 UR - http://gh.bmj.com/content/5/5/e002499.abstract N2 - Summary boxDisease 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 … ER -