Measuring health system resilience in a highly fragile nation during protracted conflict: South Sudan 2011-15



Odhiambo, Jackline, Jeffery, Caroline ORCID: 0000-0002-8023-0708, Lako, Richard Lno, Devkota, Baburam and Valadez, Joseph J ORCID: 0000-0002-6575-6592
(2020) Measuring health system resilience in a highly fragile nation during protracted conflict: South Sudan 2011-15. HEALTH POLICY AND PLANNING, 35 (3). pp. 313-322.

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Abstract

Health systems resilience (HSR) is defined as the ability of a health system to continue providing normal services in response to a crisis, making it a critical concept for analysis of health systems in fragile and conflict-affected settings (FCAS). However, no consensus for this definition exists and even less about how to measure HSR. We examine three current HSR definitions (maintaining function, improving function and achieving health system targets) using real-time data from South Sudan to develop a data-driven understanding of resilience. We used 14 maternal, newborn and child health (MNCH) coverage indicators from household surveys in South Sudan collected at independence (2011) and following 2 years of protracted conflict (2015), to construct a resilience index (RI) for 9 of the former 10 states and nationally. We also assessed health system stress using conflict-related indicators and developed a stress index. We cross tabulated the two indices to assess the relationship of resilience and stress. For maintaining function for 80% of MNCH indicators, seven state health systems were resilient, compared with improving function for 50% of the indicators (two states were resilient). Achieving the health system national target of 50% coverage in half of the MNCH indicators displayed no resilience. MNCH coverage levels were low, with state averages ranging between 15% and 44%. Central Equatoria State displayed high resilience and high system stress. Lakes and Northern Bahr el Ghazal displayed high resilience and low stress. Jonglei and Upper Nile States had low resilience and high stress. This study is the first to investigate HSR definitions using a resilience metric and to simultaneously measure health system stress in FCAS. Improving function is the HSR definition detecting the greatest variation in the RI. HSR and health system stress are not consistently negatively associated. HSR is highly complex warranting more in-depth analyses in FCAS.

Item Type: Article
Uncontrolled Keywords: Resilience, fragile and conflict-affected settings, FCAS, maternal and child health coverage, stress, complex adaptive systems, health system stress, South Sudan
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 08 Sep 2023 09:22
Last Modified: 08 Sep 2023 09:53
DOI: 10.1093/heapol/czz160
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3172619