Reflections on resilience from the Global Symposium on Health Systems Research 2024

12 December 2024

As the dust settles on another successful symposium, Sophie Witter and Maria Bertone of Queen Margaret University reflect on some of the most interesting points of the week.

ReBUILD’s work is centred on resilience in fragile and shock-prone settings and there was much reflection on this topic. In a session called, ‘From policy to practice: advancing health system resilience through governance and multisectoral collaboration’, Robert Borst’s talk on ‘moving from what needs to be done to what people actually do’, using ethnographic methods, framed resilience as a way of working with deep uncertainties in the everyday realities faced by health system actors. He highlighted that resilience is not necessarily heroic, but more about our willingness to engage with uncertainty, so actually about being willing to be vulnerable. The work is never easy and never finished, it requires continuous effort – tactical and emotional.

We were also struck by Claudia Truppa’s presentation on the resilience capacities and strategies at the organisational rather than system level. Her case study was on ICRC in Lebanon. It clearly illustrated how the embeddedness of the organisation helped navigate difficult circumstances, pointing to the role of individuals but also the self-sabotaging of the organisation which hampered resilience and going beyond absorption strategies. It reinforced the idea that we should not consider absorption, adaptation and transformation as a sort of hierarchy with the latter preferable to the first. It depends on the context and the shock.

Engaged participants in a ReBUILD session

Other speakers reflected on time, and the time that is needed for change to happen. Health systems strengthening needs longer timeframes, and resilience capacities are build overtime and based on iterative learning from previous shocks and crises. But change itself can actually happen quite quickly, especially in fragile settings. The trick is that actors need to be well placed, have a deep understanding of the context, to have developed resilience capacities as individuals, and for institutions to be able to seize the opportunity to make change happen. This calls for long term engagement in fragile settings.

Finally, we were part of interesting debates on parallel health systems. We need to be nuanced in our understanding of health systems beyond the broad labels. There is much difference between the locally-grown, deeply embedded parallel systems of the Ethnic Health Organisations in the Myanmar border regions and the parallel systems set up by humanitarian actors in other settings. Our work needs to reflect this.

To read more about ReBUILD’s activity at the Global Symposium, see our roundup page.

Also, read a blog post reflecting on the session ‘Displaced populations and health systems: Round Table on the Policy & Practice of Health System Integration’.

Top image: Some of the ReBUILD for Resilience team at the symposium