Frontline: Preparing Healthcare Systems for Shocks

Healthcare systems are at the frontline of delivering critical care during emergencies.

A new World Bank report - Frontline : Preparing Healthcare Systems for Shocks from Disasters to Pandemics - offers recommendations to better prepare health systems to respond to a wide range of shocks, from seasonal demand surges, to pandemics, climate change, and disasters. The report was funded by the Japan-World Bank Program for Mainstreaming Disaster Risk Management in Developing Countries (Japan Program). 

From flood-induced cholera outbreaks to earthquake casualties and zoonotic diseases, health care systems play a crucial role in mitigating the illnesses and deaths caused by emergencies. Countries’ ability to provide reliable essential healthcare during emergencies is critical to protect people’s well-being.  For example, World Health Organization data for 80 countries show that around 1.4 million fewer people received necessary care for tuberculosis in 2020 from a year ago from pandemic disruptions.

“In the recovery phase of the COVID-19 pandemic, we need to strengthen preparedness for future crises by building robust health systems through achieving universal health coverage, based on our experiences of the pandemic. Knowledge related to resilience against natural disasters is useful for ‘Building Back Better’ and the enhancement of preparedness for pandemics. In this regard, coordination between global health initiatives and disaster risk management has become more crucial,” said Masashi Tanabe, Director of Multilateral Development Banks Division, International Bureau, at Japan’s Ministry of Finance.

Yet, in low- and middle-income countries, resource and capacity constraints meant that, even before the pandemic, many healthcare systems struggled to meet routine demands. In coming years, disasters, climate change, pandemics, demographic change, and chronic diseases will further increase pressures on these already strained health systems.

“When overburdened and vulnerable healthcare services get disrupted during disasters, the consequences can affect human development gains for decades, with their effects often rippling across populations and generations. We need to build the resilience of health systems during the good times so it can withstand the bad,“ said David Wilson, Program Director in the Health Nutrition and Population Practice at the World Bank. Estimates for the COVID-19 pandemic suggest that inadequate nutrition and interruptions in essential health services are drastically increasing maternal and child deaths ─by 39 and 45% respectively─ in poorer countries. The World Bank’s Health Emergency and Preparedness and Response (HEPR) Umbrella Program, of which Japan is a founding donor, supports developing countries to prepare for, prevent, respond and mitigate the impact of health emergencies.

A framework for resilient healthcare systems

In January 2021, amidst the pandemic, a 6.2-magnitude earthquake struck the Indonesian island of Sulawesi. The four largest hospitals in the area where affected, with damaged and collapsed buildings severely obstructing critical relief and treatment efforts. Events like this highlight the importance of ensuring the disaster resilience of staff, buildings, equipment, and medical supply chains to provide continued care during emergencies.

“Building the resilience of health systems is an imperative for sustainable development and for managing systemic shocks like pandemics or disasters and mitigating the loss of life. To enable reliable and shock-resistant services, healthcare must be linked to the country’s overall emergency management and disaster response systems, and be dependent on quality infrastructure of lifeline services such as water, transport, and electricity,” said Sameh Wahba, Global Director in the Urban, Disaster Risk Management, Resilience and Land Global Practice at the World Bank.

The Frontline report , supported by Global Facility for Disaster Risk Reduction and Recovery which administers the Japan Program, applies lessons learned from disaster risk and emergency management practices to propose five areas of priority actions for more reliable, shock-resistant healthcare services.

Interdependence of resilient healthcare systems, wider disaster management, and lifeline infrastructure systems. Underpinning this framework is the ability to effectively manage routine demand.

1. Foundations: health systems that effectively manage routine demand are more resilient to shocks. A wide range of enabling factors need to be strengthened, such as adequate equipment, financing, skilled staff, effective information systems, and efficient management and operational protocols. Continued investments and policy actions are essential to ensure that health systems can offer inclusive, affordable, and quality services.
2. Individual healthcare facilities: demand, capacity, and readiness for shocks. Contingency planning can be key to prepare the capacity, skills, staff, equipment, management, supplies, and protocols needed for emergency contexts. Healthcare facilities themselves must also be resilient to shocks, such as floods or earthquakes.
3. Healthcare systems: strategies to increase surge capacity and coordination. When resources are limited, it is impossible to immediately equip every facility to the highest standard. Enhanced communication channels, data-driven approaches for coordinated service delivery, and mobile clinics can help to meet surge demand through a system-level and regionally coordinated response. This also includes anticipating resource and capacity constraints and having contingency plans for critical supply needs.
4. Integrated emergency response: coordination with disaster response and civil protection agencies. The emergency preparedness of health systems needs to be closely coordinated with a country’s overall emergency management and disaster response systems, such as the military, civil protection, and community groups, with clearly defined roles and mandates for crisis response. This is paramount when basic needs (food, shelter, etc.) and public services (security, social safety nets, healthcare, etc.) must be provided simultaneously in post-disaster situations.
5. Lifeline infrastructure for resilient healthcare services. Quality infrastructure is essential for effective healthcare services—even more so during disasters and pandemics. Resilient water, electricity, transport, and communication and digital systems are crucial to ensure adequate treatment capacity, equitable access to healthcare, and the functioning of supply chains. The resilience of healthcare services depends on the interdependence of these lifelines.

As part of a green, resilient, and inclusive recovery and development agenda, countries have a chance to turn this crisis into an opportunity to strengthen the resilience of healthcare systems. The World Bank is working with our partners to tailor technical and operational support to reduce healthcare disruptions on communities and to prevent the long-lasting impacts on lives and livelihoods.