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publicationOctober 25, 2022

Change Cannot Wait: Building Resilient Health Systems in the Shadow of COVID-19

Building Resilient Health Systems in the Shadow of COVID-19


The COVID-19 pandemic has shown the world that fundamental change in health systems cannot wait. The probability of a pandemic with similar impact to COVID-19 is set to increase three-fold in the next few decades due to increasing risk drivers, such as urbanization, climate change, land use changes, fragility and conflict, and zoonotic spillovers. This report builds on previous work, leverages new research, and considers countries’ frontline experiences during COVID-19. It presents a new framework for making health systems resilient, shows how countries can build them, and where countries and partners can target investments to improve health outcomes.

COVID-19 revealed structural weaknesses in health systems worldwide and negatively impacted individuals, societies, and economies. Countries need to take transformative action to build stronger, more resilient health systems that can better prevent, prepare for, and respond to future shocks while maintaining essential health services.

Investments in health system resilience improve health and productivity, reduce mortality and morbidity from crises averted, and enable equity and public trust not just during crises but also between crises.

Key Messages:

  • Pandemic prevention, preparedness, and response (PPR) is integral to health system resilience (HSR). A country that is not prepared, cannot be resilient.
  • Robust health governance is the foundation for resilience and should be a top priority
  • Resilience goes beyond the health sector and requires cross-sectoral partnerships that include civil society and partners such as the private sector.
  • To boost health system resilience, countries need to:
    1. Invest in stronger public health institutions
    2. Improve early warning functions
    3. Expand community health workforce
    4. Prioritize and track investments
    5. Strengthen community engagement
    6. Reshape health service delivery
  • With shrinking health budgets following the COVID-19 crisis response, countries need to set priorities for high-yield resilience spending. The most impactful and cost-effective public investments are those that strengthen upstream interventions, especially public health functions, health promotion, disease prevention and primary health care.
  • Resilient health systems are integrated systems that are:
    • aware of threats and risk drivers
    • agile in response to evolving needs
    • absorptive to contain shocks
    • adaptive to minimize disruptions

The World Bank has long been committed to helping developing countries build stronger, more resilient health systems and provide quality, affordable health services to everyone – especially to the poorest and most vulnerable populations.