Towards a Quantifiable Measure of Resilience

Conditions for health system resilience in the response to the COVID-19 pandemic in Mauritania

INTRODUCTION

A country's ability to manage a crisis depends on its level of resilience. Efforts are made to clarify the concept of health system resilience, but its operationalisation remains little studied. In the present research, we described the capacity of the local healthcare system in the Islamic Republic of Mauritania, in West Africa, to cope with the COVID-19 pandemic.

METHODS

We used a single case study with two health districts as units of analysis. A context analysis, a literature review and 33 semi-structured interviews were conducted. The data were analysed using a resilience conceptual framework.

RESULTS

The analysis indicates a certain capacity to manage the crisis, but significant gaps and challenges remain. The management of many uncertainties is largely dependent on the quality of the alignment of decision-makers at district level with the national level. Local management of COVID-19 in the context of Mauritania's fragile healthcare system has been skewed to awareness-raising and a surveillance system. Three other elements appear to be particularly important in building a resilient healthcare system: leadership capacity, community dynamics and the existence of a learning culture.

CONCLUSION

The COVID-19 pandemic has put a great deal of pressure on healthcare systems. Our study has shown the relevance of an in-depth contextual analysis to better identify the enabling environment and the capacities required to develop a certain level of resilience. The translation into practice of the skills required to build a resilient healthcare system remains to be further developed.

How community medical facilities can promote resilient community constructions under the background of pandemics

Nowadays, urban and community resilience have become the core issues of urban theoretical research and construction practices. While there are many studies on climate change, natural hazards and environmental pollution, relatively less attention has been paid to public and human health. However, the current COVID-19 pandemic, which is a major global public health crisis, is posing severe challenges to the resilience of cities and communities in the context of high-mobility, high-density and high-intensity, as well as expands the connotation of community resilience to public health. To compensate for the lack of current research, this study examined the characteristics of community medical facilities in response to pandemics at urban, community and individual multi-spatial scales based on a thorough review of current research and relevant practice. It also emphasized the significant role played by community medical facilities in improving resilient community constructions in the face of large-scale public health emergencies. These characteristics were fully utilized to explore ways to build and govern the 'resilience' of communities in the future, help people to survive better as well as develop in complex and changeable external environments.

The community resilience measurement throughout the COVID-19 pandemic and beyond -an empirical study based on data from Shanghai, Wuhan and Chengdu

Against the backdrop of the COVID-19 pandemic, there is widespread agreement in the field of public health that community resilience should be maintained and strengthened. However, there are significant differences in the pandemic prevention effects between different communities in different areas. To explore the main influencing factors on community resilience and the magnitude of their impact during the pandemic, this study collected 650 valid questionnaires from Shanghai, Wuhan and Chengdu by using the Communities Advancing Resilience Toolkit Assessment Survey (CART). Data collection was conducted from February to March 2020 when this three cities activated a Level One public health emergency response. The data were analyzed by using multiple linear regression analysis and structural equation model. Results indicate that: (1) Domains such as Information and Communication, and Connection and Caring scored higher, while Disaster Management, Resources and Transformative Potential scored lower; (2) A community got higher resilience scores if it took more effective measures to prevent and control the pandemic(Shanghai > Chengdu > Wuhan), people within the community participated more actively in disaster risk reduction activities and activities of volunteer responder groups, and people were more closely connected with the community; (3) Variables such as the participation in affiliated volunteer responder groups, and community disaster risk reduction activities exerted the biggest impact on community resilience. Therefore, it is urgent to establish a community-based, resilience-centered framework of community resilience in the post-pandemic era. This framework will strengthen a community's capacity to cope with disasters and risks.

Practitioner Approaches to Measuring Community Resilience: The Analysis of the Resilience of Communities to Disasters Toolkit

To be useful for operational programs, measures of resilience must not just be valid, but be easy to use and useful. Unfortunately, while resilience measurement techniques have progressed tremendously over the past decade, most progress has been on improving validity rather than utility and ease of use. In this article we present a new tool for measuring community resilience that incorporates issues of utility and ease of use, the Analysis of Resilience of Communities to Disasters (ARC-D) toolkit. The toolkit was developed over the course of ten years by the international humanitarian and development organization GOAL to enable aid organizations to measure community resilience in a way that supports resilience building interventions. It offers an approach to measurement that is cognizant of the resilience policy landscape, including the Sendai Framework, approaches to data collection and measurement uses relevant to aid agencies. We first present the core tenants of community resilience measurement before describing the toolkit, which consists of 30 measures, a guidebook, and an online platform. To illustrate its use, we a case study of a resilience building program in Tegucigalpa, Honduras. By developing one of the first resilience toolkits focused beyond validity and providing a description of how such an assessment works, this article has implications for resilience researchers and practitioners.

Global map and indicators of food system sustainability

This paper presents the first global map of food systems sustainability based on a rigorous protocol. The choice of the metric dimensions, as well as the individual indicators included in the metric, were initially identified from a thorough review of the existing literature. A rigorous inclusion/exclusion protocol was then used to refine the list and shorten it to a sub-set of 27 indicators. An aggregate sustainability score was then computed based on those 27 indicators organized into four dimensions: environment, social, food security & nutrition and economic. The paper shows how the availability of data (or lack therefore) results in an unavoidable trade-off between number of indicators and number of countries, and highlights how optimization can be used to present the most robust metric possible given the existence of this trade-offs in the data space. The process results in the computation of a global sustainability map covering 97 countries and 20 indicators. The sustainability scores obtained for each country are made available over the entire range of indicators.

Measurement(s)	food systems sustainability
Technology Type(s)	data transformation
Factor Type(s)	Country • Year
Sample Characteristic - Environment	climate system • cropland ecosystem • anthropogenic environment
Sample Characteristic - Location	Earth (planet)

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.10011860

Mapping Urban Resilience for Spatial Planning—A First Attempt to Measure the Vulnerability of the System

The concept of ‘resilience’ breaks down silos by providing a ‘conceptual umbrella’ under which different disciplines come together to tackle complex problems with more holistic interventions. Acknowledging the complexity of Davoudi’s approach (2012) means to recognize that ‘spatial resilience’ is influenced by many phenomena that are difficult to measure: the adaptation and transformation of a co-evolutive system. This paper introduces a pioneering approach that is propaedeutic to the spatial measure of urban resilience assuming that it is possible to define a system as being intrinsically vulnerable to stress and shocks and minimally resilient, as described by Folke in 2006. In this sense, vulnerability is counterpoised to resilience, even if they act simultaneously: the first includes the exposure to a specific hazard, whereas the second emerges from the characteristics of a complex socio-ecological and technical system. Here we present a Geographic Information System-based vulnerability matrix performed in ESRI ArcGIS 10.6 environment as an output of the spatial interaction between sensitivities, shocks, and linear pressures of the urban system. The vulnerability is the first step of measuring the resilience of the system by a semi-quantitative approach. The spatial interaction of these measures is useful to define the interventions essential to designing and building the adaptation of the built environment by planning governance. Results demonstrate how mapping resilience aids the spatial planning decision-making processes, indicating where and what interventions are necessary to adapt and transform the system.

Resilience from the ground up: how are local resilience perceptions and global frameworks aligned?

Numerous resilience measurement frameworks for climate programmes have emerged over the past decade to operationalise the concept and aggregate results within and between programmes. Proxies of resilience, including subjective measures using perception data, have been proposed to measure resilience, but there is limited evidence on their validity and use for policy and practice. This article draws on research on the Decentralising Climate Funds project of the Building Resilience and Adaptation to Climate Extremes and Disasters programme, which supports communities in Mali and Senegal to improve climate resilience through locally controlled adaptation funds. It explores attributes of resilience from this bottom-up perspective to assess its predictors and alignment with food security, as a proxy of well-being. We find different patterns when comparing resilience and the well-being proxy, illustrating that the interplay between the two is still unclear. Results also point to the importance of contextualising resilience, raising implications for aggregating results.

Defining pharmaceutical systems strengthening: concepts to enable measurement

Pharmaceutical products are indispensable for improving health outcomes. An extensive body of work on access to and use of medicines has resulted in an assortment of tools measuring various elements of pharmaceutical systems. Until now however, there has been little attempt to conceptualize a pharmaceutical system as an entity and define its strengthening in a way that allows for measuring systems strengthening. The narrow focus of available tools limits their value in ascertaining which interventions result in stronger, more resilient systems. We sought to address this shortcoming by revisiting the current definitions, frameworks and assessment tools related to pharmaceutical systems. We conducted a comprehensive literature review and consulted with select pharmaceutical experts. On the basis of our review, we propose that a pharmaceutical system consists of all structures, people, resources, processes, and their interactions within the broader health system that aim to ensure equitable and timely access to safe, effective, quality pharmaceutical products and related services that promote their appropriate and cost-effective use to improve health outcomes. We further propose that pharmaceutical systems strengthening is the process of identifying and implementing strategies and actions that achieve coordinated and sustainable improvements in the critical components of a pharmaceutical system to make it more responsive and resilient and to enhance its performance for achieving better health outcomes. Finally, we established that, in addition to system performance and resilience, seven components of the pharmaceutical system are critical for measuring pharmaceutical systems strengthening: pharmaceutical products and related services; policy, laws and governance; regulatory systems; innovation, research and development, manufacturing, and trade; financing; human resources; and information. This work adds clarity to the concept of pharmaceutical systems and their strengthening by proposing holistic definitions on the basis of systems thinking. It provides a practical starting point for measuring the progress of pharmaceutical systems strengthening.

Positioning resilience for 2015: the role of resistance, incremental adjustment and transformation in disaster risk management policy

Resilience is a ubiquitous term in disaster risk management and is an increasingly prominent concept in early discussions focused on elaborating the post-2015 international policy landscape. Riddled with competing meanings and diverse policy implications, however, it is a concept caught between the abstract and operational. This paper provides a review of the rise to prominence of the concept of resilience and advances an elaboration of the related concepts of resistance, incremental adjustment and transformation. We argue that these concepts can contribute to decision-making by offering three distinct options for risk management policy. In order to deliberately and effectively choose among these options, we suggest that critical reflexivity is a prerequisite, necessitating improved decision-making capacity if varied perspectives (including those of the most vulnerable) are to be involved in the selection of the best approach to risk management.