TY - JOUR T1 - Power and politics: the case for linking resilience to health system governance JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-002891 VL - 5 IS - 6 SP - e002891 AU - Stephanie M Topp Y1 - 2020/06/01 UR - http://gh.bmj.com/content/5/6/e002891.abstract N2 - Since the watershed moment of the 2014 Ebola epidemic in West Africa and again in the midst of the current COVID-19 crisis, the concept of health system resilience has been a recurring theme in global health discussions.1 2 Although most frequently used in the context of epidemic response, resilience has also been framed as a ‘key pillar’ of health,3 and invoked in high-level calls for countries to ‘lead the work on building health system resilience’.4 Yet, as the authors of one of several recent reviews observed, the concept of health systems resilience remains ‘highly confusing’ and ‘still polysemic’.5 What it means ‘depends on one’s perception, one’s discipline, one’s function and what one wants to achieve’.5 In this editorial, I will, from the perspective of a health policy and systems researcher, draw out and reflect on some of these tensions, and make some suggestions about how we might achieve greater clarity.Building on the observations of Turenne et al, the first point is definitional. In both peer reviewed and grey literature, there is still confusion about whether the concept of resilience (as it relates to health systems) should be understood as an outcome or an ability. This distinction is not semantic. Understood as an outcome, some in the field have suggested that health system resilience can and should be measured and monitored.6 By measuring resilience, it is argued, we can help to build more resilient health systems through identification of areas for action.7 8 But an important consequence of this framing is the implication that health system resilience is an uncomplicated, even monolithic ‘good’; a goal synonymous with optimised performance. But a question that then arises is whether health systems that produce suboptimal health outcomes are somehow less resilient than those producing … ER -