Strength in Crisis: Lessons from Japan on Building Resilient Health Systems

The resilience of health systems is crucial to provide lifesaving care during crises such as pandemics, disasters, and other major shocks.

During the COVID-19 pandemic, almost all countries struggled to deal with the unprecedented scale of the challenge. However, countries with better access during normal times to high-quality health care adapted more easily to the surge in patient numbers, managing to provide essential care for both COVID-19 and non-COVID-19 patients.

Similarly, in the aftermath of disasters caused by natural hazards, such as earthquakes, typhoons, and floods, health systems like Japan’s, which had integrated disaster preparedness and response, have demonstrated their ability to maintain critical services, including emergency medical care and public health support, despite damaged infrastructure and disrupted supply chains.

The World Bank is committed to strengthening the resilience of health systems against climate and disasters risks by building a robust knowledge base and promoting global knowledge sharing. As part of these ongoing efforts, a new report Preparing Health Systems for Shocks: Japan’s Experience of Enhancing the Resilience of its Health System was recently launched by the Global Facility for Disaster Reduction and Recovery (GFDRR), a World Bank-managed partnership, through its Japan-World Bank Program for Mainstreaming Disaster Risk Management (DRM) in Developing Countries, supported by the Government of Japan. This publication adds to a growing stream of knowledge products focused on health system resilience, complementing two earlier reports: the Frontline: Preparing Healthcare Systems for Shocks from Disasters to Pandemics and the Frontline Scorecard: An Assessment Tool for Climate and Disaster Risk Management in Health Systems, which provides a tool for conducting an initial broad-based assessment of a country’s health system resilience., which provides a tool for conducting an initial broad-based assessment of a country’s health system resilience.

The new report highlights how Japan has gradually strengthened its health system’s resilience by enhancing its ability to prepare for, respond to, and recover from crises. Drawing on valuable lessons from major earthquakes, floods, and infectious disease outbreaks, it showcases the country’s approach to linking health systems, disaster risk management, and quality infrastructure. The report emphasizes integrating these sectors through regulations, governance, and capacity building to help the health system better withstand shocks. For example, the report includes and defines the concept of disaster medicine —the delivery of emergency health and medical services to injured or ill victims of medical or environmental disasters— and explains how it is implemented in Japan (see figure below).

There are three critical lessons learned from this Japanese experience:

1. Strong foundational health systems, based on a culture of incremental learning from past and present experiences, are crucial to improving the efficiency and resilience of health services. Enhancing the capacity to deliver high-quality and accessible care is essential for managing the routine demands and enabling health systems to effectively respond to various types of shocks while maintaining continuous service delivery.

2. Robust mechanisms for ex-ante preparedness, emergency response, and early recovery, together with both structural and non-structural interventions to increase resilience, ensure minimizing service disruption and mitigating the impact of future disasters. The combination of strong foundations and robust ex-ante preparedness mechanisms enables a system of flexibility rather than redundancy, creating a more efficient shock-resilient health system.

3. Proactive support across various facets of the health sector at the national and local government levels, integrating evolving social needs and changes, is key to enhancing preparedness for emergencies and crises in advance. Strong cross-sectoral coordination and partnership mechanisms also help create an enabling environment for those working on the frontline.

The report was first shared in March 2025 at the Annual Conclave of the Global Learning Collaborative for Health System Resilience (GLC4HSR) in New Delhi, where policymakers and experts from health and disaster risk fields gathered to advance global efforts in building resilient health systems. 

Drawing on Japan’s historical experience and early lessons from COVID-19 pandemic, the Preparing Health Systems for Shocks report provided practical insights that sparked discussions on adaptive crisis response, resilient infrastructure, and institutional learning. These discussions focused on updating hazards and risk profiles, designing adaptive response systems, and strengthening overall health system resilience. The session also encouraged peer learning among countries like Nepal and India, where rebuilding health facilities after the 2015 earthquake remains a pressing concern. For stakeholders facing similar challenges the report serves as a timely and actionable resource to guide shock-resilient policy reforms and investments.  

As countries face increasingly frequent and complex shocks—from pandemics to disasters—the need to build resilient, adaptive, and inclusive health systems is more urgent than ever. By sharing concrete lessons and tested approaches, the World Bank and its partners are seeking to empower countries to turn past challenges into future preparedness, so that health systems remain strong, responsive, and ready to protect lives.

This report was made possible with support from the Global Facility for Disaster Reduction and Recovery (GFDRR) through its Japan-Bank Program for Mainstreaming Disaster Risk Management in Developing Countries, financed by the Government of Japan. The report was produced by GFDRR’s thematic area on Climate and Disaster Risk Management for Health Systems, created when COVID-19 hit.