Health system resilience: a critical review and reconceptualisation

Figure: The ReBUILD for Resilience resilience framework (more on that here)


This Lancet Global Health Viewpoint [opens new tab] focuses on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. The authors highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and — as amply shown during the COVID-19 pandemic — relationships with wider systems (eg economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. The framing of resilience as an outcome that can be measured is discouraged; instead, it is seen as emerging from systemic resources and interactions, which have effects that can be measured. The authors propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. They encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, they highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.

Download this Lancet Global Health paper [opens new tab]


Further information

This paper emerged from a webinar hosted by ReBUILD for Resilience and Systac. Watch Health system resilience – framing, debates and latest evidence as we start to emerge from the COVID-19 pandemic here.



Professor Sophie Witter 1, 2, Professor Steve Thomas 3, Stephanie M Topp 4, Professor Edwine Barasa 5, Mickey Chopra 6, Daniel Cobos 7, Professor Karl Blanchet 8, Gina Teddy 9, Professor Rifat Atun 10, Professor Alastair Ager 1

1 Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK

2 ReBUILD for Resilience

3 School of Medicine, Trinity College Dublin, Dublin, Ireland

4 Centre for Health Policy & Management, James Cook University, Townsville, QLD, Australia

5 KEMRI–Wellcome Trust Research Programme, Nairobi, Kenya

6 World Bank, Washington, DC, USA

7 Swiss Tropical and Public Health Institute, Basel, Switzerland

8 Geneva Centre of Humanitarian Studies, Geneva, Switzerland

9 Ghana Institute of Management and Public Affairs, Accra, Ghana

10 Harvard School of Public Health, Boston, MA, USA


Witter, S., Thomas, S., Topp, S., Barasa, E., Chopra, M., Cobos, D., Blanchet, K., Teddy, G., Atun, R., Ager, A. (2023) Health system resilience: a critical review and reconceptualisation. Lancet Global Health, 11, 9, e1454-e1458.