PDF(Pubmed)
Abstract：
Resilient health system (RHS) is crucial to achieving universal health coverage (UHC) and health security. However, little is known about strategies towards RHS to improve UHC and health security. This systematic review aims to synthesise the literature to understand approaches to build RHS toward UHC and health security.
A systematic search was conducted including studies published from 01 January 2000 to 31 December 2021. Studies were searched in three databases (PubMed, Embase, and Scopus) using search terms under four domains: resilience, health system, universal health coverage, and health security. We critically appraised articles using Rees and colleagues\' quality appraisal checklist to assess the quality of papers. A systematic narrative synthesis was conducted to analyse and synthesise the data using the World Health Organization\'s health systems building block framework.
A total of 57 articles were included in the final review. Context-based redistribution of health workers, task-shifting policy, and results-based health financing policy helped to build RHS. High political commitment, community-based response planning, and multi-sectorial collaboration were critical to realising UHC and health security. On the contrary, lack of access, non-responsive, inequitable healthcare services, poor surveillance, weak leadership, and income inequalities were the constraints to achieving UHC and health security. In addition, the lack of basic healthcare infrastructures, inadequately skilled health workforces, absence of clear government policy, lack of clarity of stakeholder roles, and uneven distribution of health facilities and health workers were the challenges to achieving UHC and health security.
Advanced healthcare infrastructures and adequate number of healthcare workers are essential to achieving UHC and health security. However, they are not alone adequate to protect the health system from potential failure. Context-specific redistribution of health workers, task-shifting, result-based health financing policies, and integrated and multi-sectoral approaches, based on the principles of primary health care, are necessary for building RHS toward UHC and health security.
A systematic search was conducted including studies published from 01 January 2000 to 31 December 2021. Studies were searched in three databases (PubMed, Embase, and Scopus) using search terms under four domains: resilience, health system, universal health coverage, and health security. We critically appraised articles using Rees and colleagues\' quality appraisal checklist to assess the quality of papers. A systematic narrative synthesis was conducted to analyse and synthesise the data using the World Health Organization\'s health systems building block framework.
A total of 57 articles were included in the final review. Context-based redistribution of health workers, task-shifting policy, and results-based health financing policy helped to build RHS. High political commitment, community-based response planning, and multi-sectorial collaboration were critical to realising UHC and health security. On the contrary, lack of access, non-responsive, inequitable healthcare services, poor surveillance, weak leadership, and income inequalities were the constraints to achieving UHC and health security. In addition, the lack of basic healthcare infrastructures, inadequately skilled health workforces, absence of clear government policy, lack of clarity of stakeholder roles, and uneven distribution of health facilities and health workers were the challenges to achieving UHC and health security.
Advanced healthcare infrastructures and adequate number of healthcare workers are essential to achieving UHC and health security. However, they are not alone adequate to protect the health system from potential failure. Context-specific redistribution of health workers, task-shifting, result-based health financing policies, and integrated and multi-sectoral approaches, based on the principles of primary health care, are necessary for building RHS toward UHC and health security.
摘要：
背景：弹性卫生系统（RHS）对于实现全民健康覆盖（UHC）和健康安全至关重要。然而,对RHS改善UHC和健康安全的策略知之甚少。本系统综述旨在综合文献，以了解针对UHC和健康安全构建RHS的方法。
方法：进行了系统搜索，包括2000年1月1日至2021年12月31日发表的研究。在三个数据库中搜索了研究(PubMed，Embase,和Scopus)在四个域下使用搜索词：弹性，卫生系统,全民健康覆盖,和健康安全。我们使用Rees及其同事的质量评估清单对文章进行批判性评估，以评估论文的质量。使用世界卫生组织的卫生系统构建块框架进行了系统的叙事综合，以分析和综合数据。
结果：共有57篇文章被纳入最终综述。基于上下文的卫生工作者再分配，任务转移政策，和基于结果的卫生筹资政策有助于建立RHS。高度的政治承诺，基于社区的应对计划，和多部门合作对于实现全民健康覆盖和健康安全至关重要。相反,缺乏访问,无响应，不公平的医疗服务，监控不力,领导能力薄弱,收入不平等是实现全民健康覆盖和健康安全的制约因素。此外,缺乏基本的医疗基础设施，技能不足的卫生劳动力，缺乏明确的政府政策，利益相关者角色缺乏明确性，卫生机构和卫生工作者分布不均是实现全民健康覆盖和卫生安全的挑战。
结论：先进的医疗基础设施和足够数量的医护人员对于实现全民健康覆盖和健康安全至关重要。然而,它们并不能单独保护卫生系统免受潜在故障的影响。根据具体情况重新分配卫生工作者，任务转移，基于结果的卫生筹资政策，以及综合和多部门方法，根据初级卫生保健的原则，对于建立面向UHC和健康安全的RHS是必要的。
方法：进行了系统搜索，包括2000年1月1日至2021年12月31日发表的研究。在三个数据库中搜索了研究(PubMed，Embase,和Scopus)在四个域下使用搜索词：弹性，卫生系统,全民健康覆盖,和健康安全。我们使用Rees及其同事的质量评估清单对文章进行批判性评估，以评估论文的质量。使用世界卫生组织的卫生系统构建块框架进行了系统的叙事综合，以分析和综合数据。
结果：共有57篇文章被纳入最终综述。基于上下文的卫生工作者再分配，任务转移政策，和基于结果的卫生筹资政策有助于建立RHS。高度的政治承诺，基于社区的应对计划，和多部门合作对于实现全民健康覆盖和健康安全至关重要。相反,缺乏访问,无响应，不公平的医疗服务，监控不力,领导能力薄弱,收入不平等是实现全民健康覆盖和健康安全的制约因素。此外,缺乏基本的医疗基础设施，技能不足的卫生劳动力，缺乏明确的政府政策，利益相关者角色缺乏明确性，卫生机构和卫生工作者分布不均是实现全民健康覆盖和卫生安全的挑战。
结论：先进的医疗基础设施和足够数量的医护人员对于实现全民健康覆盖和健康安全至关重要。然而,它们并不能单独保护卫生系统免受潜在故障的影响。根据具体情况重新分配卫生工作者，任务转移，基于结果的卫生筹资政策，以及综合和多部门方法，根据初级卫生保健的原则，对于建立面向UHC和健康安全的RHS是必要的。
