As global efforts to build emergency-ready health systems intensify, the "Strategic Investment for Health System Resilience: A Three-Layer Framework" offers a practical investment framework and diverse country cases to guide decision-making and strategic resource allocations. This framework comprises three layers: risk reduction, which promotes emergency-ready primary health care, public health, prevention, and community preparedness; detection, containment, and mitigation capabilities; and advanced case management and surge response. The framework prioritizes interventions that prevent public health threats from developing (layer 1), limit their spread if they do emerge (layer 2), and manage widespread crises that compromise a health system's ability to deliver care sustainably (layer 3). The framework highlights the relatively low cost of investments in improving the weakest parts of the three layers, with layer 1 functions estimated to cost between US$2 per capita in low-income countries and US$4 per capita in lower-middle-income countries. It applies to both short-term epidemics of communicable diseases and slow-moving trends in noncommunicable diseases, emphasizing the need for a resilient system across multiple layers of response. While there is no universal blueprint for every setting, it is crucial for all countries to invest in the three layers in ways that fit their specific needs, ensuring a resilient health system capable of responding to various health threats effectively.
Authors
Zhao,Feng, Kovacevic,Rialda, Bishai,David M, Weintraub,Jeffrey
Related Organizations
- DOI
- https://dx.doi.org/10.1596/978-1-4648-2116-5
- Disclosure Date
- 2024/11/05
- Disclosure Status
- Disclosed
- Doc Name
- Strategic Investment for Health System Resilience : A Three-Layer Framework
- ISBN
- 978-1-4648-2116-5; 978-1-4648-2117-2
- Pages
- 202
- Product Line
- Advisory Services & Analytics
- Published in
- United States of America
- Rel Proj ID
- 1W-Preparedness And Health Systems Resilience Analytics And Covid- -- P176180
- Series Name
- Human Development Perspectives;
- Unit Owning
- People - HNP Global Engagement (HHNGE)
- Version Type
- Final
- Volume No
- 1
Table of Contents
- Front Cover 1
- Contents 9
- Foreword 15
- Acknowledgments 17
- About the Contributors 19
- Context for the Book 23
- Executive Summary 25
- Abbreviations 29
- Part 1 What Is the Three-Layer Framework, and How Are Countries Aligning Resources toward It? 31
- Chapter 1 Three Layers in Health Systems: Protecting Population Health Every Day and during Disease Outbreak 33
- In Summary 33
- Introduction 34
- A Closer Look at the Three-Layer Framework 37
- Cross-Cutting Elements of All Three Layers 52
- Conclusion 56
- Notes 57
- References 57
- Chapter 2 An Implementation Pathway to Build Resilience in Health System Layers 63
- Introduction 64
- Defining Resilience 65
- Building Resilience Requires Investment in Core Capabilities 65
- Achieving Resilience by Measuring Essential Public Health Functions 68
- Implementing a Pathway for Resilience 70
- Challenges and Options for the Way Forward 77
- Annex 2A: Tools for Assessing Essential Public Health Functions 78
- References 79
- Chapter 3 Minding What We Spend on Resilience: Global Data, Local Examples 81
- In Summary 81
- Introduction 82
- Methods to Track Spending on the Three Layers 84
- Mapping Health Accounts Data to the Three-Layer Framework 86
- Data Availability 86
- Results: Levels and Trends in the Three Layers of the Health System 91
- Discussion: Layered Spending Priorities in the Health System 95
- Investment Stewardship 96
- Setting an Agenda for the Future 99
- Setting an Agenda for Effective Country Engagement 100
- Note 100
- References 100
- Part 2 Country Case Studies 103
- Chapter 4 Financial Analysis of Local Public Health Activity in Urban Pakistan 105
- In Summary 105
- Introduction 105
- Methods 107
- Data Source 108
- Analysis 109
- Results 109
- District Health Office Spending by Public Health Capability 111
- Discussion 112
- Conclusion 113
- Note 114
- References 115
- Chapter 5 Three-Layer Health Sector Investment: Digital Health Interventions for Pandemic Preparedness in Low- and Middle-Income Countries 117
- In Summary 117
- Layer 1: Risk Reduction-Promoting Prevention and Community Preparedness 119
- Layer 2: Focus on Detection, Containment, and Mitigation Capabilities 124
- Layer 3: Advanced Case Management and Surge Response 130
- Notes 133
- References 133
- Chapter 6 From MERS to COVID-19: Building a Resilient Health System in the Republic of Korea 135
- In Summary 135
- Country Context: Demographic Profile and Health Risks 136
- Health System Structure and Features 136
- Three Layers of Health System Pandemic Preparedness in Korea 139
- Lessons Learned 147
- Notes 148
- References 148
- Chapter 7 Three-Layer Health Sector Investment in Thailand 151
- In Summary 151
- Country Context 152
- Health System Structure and Features 153
- Lessons Learned 160
- Notes 161
- References 161
- Chapter 8 Three-Layer Health Sector Investment in the Dominican Republic 163
- In Summary 163
- Country Context 164
- Health System Structure and Features 164
- Lessons Learned 170
- Challenges 171
- Notes 172
- References 172
- Chapter 9 Three-Layer Health Sector Investment in Costa Rica 173
- In Summary 173
- Country Context 173
- Health System Structure and Features 174
- Lessons Learned 182
- Challenges 182
- References 183
- Chapter 10 Three-Layer Health Sector Investment in Uganda 185
- In Summary 185
- Country Context 186
- Health System Structure and Features 187
- Lessons Learned 195
- Notes 196
- References 196
- Boxes 42
- Box 1.1: Community Health Worker Network in Liberia 42
- Box 1.2: Community-Based Surveillance in Somalia 44
- Box 1.3: Early and Effective Response to COVID-19 in Senegal 47
- Box 1.4: Information Systems and Strengthening Human Resources to Deliver Health Care 48
- Box 1.5: Early Detection and Response: Prior Crisis Experience Did Not Go to Waste in Singapore and Viet Nam 48
- Box 1.6: A Strong Layer 2 Response to COVID-19 in the Republic of Korea 49
- Box 1.7: Getting Ahead of COVID-19 Misinformation 56
- Box 2.1 Capabilities Assessment of District and Regional Health Authorities: A Case from Ghana 67
- Box 2.2 Using Tools to Build Capacity of Layer 1 at District Health Departments in Angola, Botswana, and Mozambique 73
- Box 2.3 Comparing Top-Down and Bottom-Up Measurement 76
- Box 3.1 Tracking Primary Health Care Spending in Nigeria 90
- Box 3.2 Financial Needs and a Package of Universal Health Coverage Health Benefits in Select Countries of Sub-Saharan Africa 93
- Box 3.3 Findings from an Experiment on Social Recognition to Improve Recordkeeping in Public Health Care Clinics in Select States in Nigeria 98
- Figures 38
- Figure 1.1 The Three-Layer Framework for Strengthening Health Systems 38
- Figure 3.1 Sources of Health Financing in Low-Income Countries and Globally, 1995-2022 83
- Figure 3.2 The SHA 2011 Framework and Its Three Classifications 85
- Figure 3.3 Incompleteness of NHA Data Sets Based on Reporting up to 2017 88
- Figure 3.4 Proportion of Countries That Reported Spending on Prevention, by Country Income Level, 2017 89
- Figure 3.5 Per Capita Spending on Health, by Country Income Level and Layer of the Health System, 2002-17 92
- Figure 4.1 Government Health Expenditures in Pakistan, by Source of Financing, 2017-18 107
- Figure 4.2 Average Self-Assessed Capacity Scores of Provincial and District Public Health Personnel in Sindh Province, Pakistan, 2014 108
- Figure 4.3 Share of Total Spending on District Full-Time Equivalent Staff in Karachi, Pakistan, by Public Health Activity, 2022 111
- Figure 4.4 Allocation of the District Health Budget in Karachi, Pakistan, by Public Health Capability, 2022 112
- Figure 5.1 Timeline of Key Events for the Development and Scale-Up of CommCare in Burkina Faso 121
- Figure 5.2 Data Flow and Integration of CommCare with the Levels of Burkina Faso’s Health System 122
- Figure 5.3 Multisectoral Approach to Use of the DHIS2 COVID-19 Response Package in Sri Lanka 126
- Figure 5.4 How SORMAS Operates in Nigeria 128
- Figure 5.5 Key Design Principles of the Unified COVID-19 Data Platform in Uttar Pradesh, India 131
- Figure 6.1 Number of COVID-19 Vaccine Doses Administered per 100 Population in Select Countries, as of November 20, 2022 146
- Figure 7.1 Contact-Tracing Efforts by Surveillance and Rapid Response Teams and Village Health Volunteers in Thailand 154
- Figure 8.1 Health System Financing in the Dominican Republic 165
- Figure 8.2 Total Occupancy of Intensive Care Units in the Dominican Republic, 2020-22 168
- Figure 9.1 The Costa Rican National Health System 175
- Figure 9.2 The Costa Rican Social Security Fund’s Integrated System of Health Care 176
- Figure 9.3 Contingency Fund Spending on COVID-19 Needs in Costa Rica, 2020 181
- Figure 10.1 Prepandemic Demographic Indicators for Uganda 186
- Map 123
- Map 5.1 Deployment of the CommCare App in Primary Health Care Facilities across Health Districts of Burkino Faso, June 2020–December 2021 123
- Tables 69
- Table 2.1 Comparison of Essential Public Health Functions and the Resilience Index 69
- Table 2A.1 Tools for Assessing Essential Public Health Functions 78
- Table 3.1 Linking the Three-Layer Framework and the SHA 2011 Framework 87
- Table 3.2 Number of Countries Reporting Any NHA Data, by Health Care Function, 2016 and 2017 89
- Table 3.3 Average Primary Health Care Spending per Capita, by Layer and Country Income Level, 2017 91
- Table 4.1 Government Health Expenditures in Pakistan, by Function, 2017-18 106
- Table 4.2 Descriptive Data on District Health Personnel in Karachi, Pakistan, by Basic Pay Scale and Median Income, 2022 109
