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This content is taken from the The University of Melbourne , The Nossal Institute for Global Health & UNICEF's online course, Health Systems Strengthening. Join the course to learn more.

Skip to 0 minutes and 11 seconds ARLETTY PINEL: If you ever go to San Francisco, California, in the United States, you will realise that there are no brick houses. It’s not just a matter of style. It so happens that in 1906, there was a great earthquake that brought down most of the city that was built by bricks. So bricks turned out to be not a good material to have in an earthquake-prone zone. Houses became brittle. After 1906, houses were rebuilt, but made out of wood, which was considered a material more flexible to be able to withstand future events. Supply chains are a little bit like that. For instance, sometimes you see a supply chain that looks very robust, very solid.

Skip to 0 minutes and 55 seconds But it has very strict and rigid systems and processes and procedures that when something happens, no matter how small, it can become very disruptive to the supply chain. This part of the module will take you through two different aspects. One is supply chains according to country contexts and the capacity of the systems. And the other one is to explore the concept of resilient supply chains. As mentioned before, UNICEF’s health system strengthening approach looks at country context and the capacity of their systems. And in emergency settings, supply chains will need to support the health system to provide supplies to face life-threatening situations.

Skip to 1 minute and 40 seconds Since more than 200 million peoples are affected by disasters each year around the world and the frequency of these events is increasing, there is pressing need for disaster risk reduction plan as instrument to increase the resilience of the supply chain. Persistent fragility is a challenge to system strengthening. Resilience will rely heavily on flexibility, agility, and social innovation. Low-, medium-, and high-capacity contexts are about economic growth, governance, and systems placement. But as countries grow, the equity gap increases. And once they reach middle income, health systems become vulnerable. Countries are no longer poor. So they receive less and less foreign aid. And they’re not rich. So they don’t have the structures that are consolidated for protection.

Skip to 2 minutes and 35 seconds And there is a search for foreign investment for wealth creation rather than for social protection. Supply chains are threatened every day by a myriad of factors, yet many supply chain systems do not always count with well-developed and socialised plans to increase the capacity to resist challenges and stabilise. And since resilience is often ill-defined, there is much confusion on what a resilient supply chain really means. A resilient supply chain needs to be able to have capacity for resistance to delay the onset of disruption and reduce its impact, and capacity for recovery to be able to stabilise after an event and return as soon as possible to its performance. The more fragile the health system, the more vulnerable the supply chain.

Skip to 3 minutes and 28 seconds But since both are dynamic processes, the more flexibility and agile construct, the more resilient they will be. The question for us now is, how do we help build resilient public health supply chains, especially when many of our guidelines, procedures, and technical assistant models are not flexible at all? It’s food for thought. Country contexts and their underlying elements influence all aspects of UNICEF’s health system strengthening approach.

What is the resilient health system?

There is a big difference between knowing what a resilient system is (able to be flexible and adapt to external shocks) and actually making changes that build resilience. We call this the ‘Know- Do’ gap and we see it played out throughout all health system change.

Margaret Kruk et al (2015) define health system resilience as

“the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learnt during the crisis, reorganise if conditions require it” (pg. 1).

And the challenge is that often you don’t know how resilient a health system is until the shock occurs, by which time it is too late to try and build resiliency!

Reflect on your own context – is there an explicit intent to build reserve capacity, map potential threats and develop flexible solutions?

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Health Systems Strengthening

The University of Melbourne

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