Re-evaluating Our Knowledge of Health System Resilience During COVID-19 Lessons From the First Two

Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

Background Health challenges such as coronavirus disease 2019 (COVID-19) are becoming increasingly complex, cross-border and unpredictable. Studying health systems responses to the pandemic COVID-19 is an opportunity to deepen our understanding of health systems resilience and to establish clear links between theoretical concepts and practical thinking on how to build resilience.

Methods This narrative literature review aims to answer four questions using the health systems resilience framework: (ii) What aspects of the dimensions of resilience remain uncertain? (What aspects of the resilience dimensions are missing from the COVID-19 discussion? and (iv) What has COVID-19 taught us about resilience that is missing from this framework? A database search of the scientific literature was conducted in December 2020 and April 2022 to identify papers discussing health system resilience in the context of COVID-19, excluding papers on psychological resilience or other types of resilience. A total of 63 publications were included.

Outcomes There is a good understanding of the need for information sharing, flexibility and good leadership, learning, maintaining essential services, and a legitimate and interdependent system. Decision-making, local trust, the impact of interdependence, and transformation remain uncertain. Vertical interdependence, risk oversight beyond the health system, and the impact of system change were not discussed. Teamwork, actor legitimacy, values, participation, cross-sectoral resilience, and the role of the private sector were cited as lessons from COVID-19 that should be further explored for health system resilience.

Conclusions Knowledge about health system resilience will remain important after the pandemic. The potential impact of system change and subsystem resilience has not been explored so far. Through governance, the concept of health system resilience can be linked to broader issues raised by the pandemic, such as inclusion. Our findings indicate that resilience theory is useful for strengthening health systems against crises, and that it would be beneficial to continue to refine existing resilience theory.

Highlights

Comments published in this paper

Assessing the resilience of health systems requires a combination of different approaches. Leave a comment on "Reassessing knowledge about health system resilience in the context of COVID-19: lessons from the first two years of the pandemic"

Durable: What do you do? Re-evaluation of the recovery of medical systems in COVID-19: Leave a comment in the first two-year lessons of pandemic

Factors of power and fairness: Enhance the framework of recovery research on medical systems "Re-evaluation of knowledge about medical systems in COVID-19: Leave a comment in the first two years of pandemic"

The health learning system will leave a comment in the recoloring health system, "Re-evaluation of the recovery of the health system in COVID-19: lessons from the first two years of pandemic".

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Full Text

Background

The global health community has recognized the importance of systematic approaches for global health issues, the importance of enhancing health systems and working on health social and economic decisions. Universal Health Coverage and High Quality System Movement Unit have redefined the role of health systems that are working on more widespread contextual and systematic health determination. 1, 2 Enhancement of health systems promotes initiatives to improve high quality services, outcomes and achievements. It is not just a components, but a recognition of the interaction of the context and system between system elements, syste m-related people. 3 The health system needs to be more tough as the healthy issues cross the borders and become unpredictable.

The resilient health system has the ability to use existing resources to absorb shocks while maintaining the same basic functions as before, the ability to adjust and adapt the use of functions and resources, or reduce risks. It has the ability to fundamentally change the function to do. 4, 5 Such a changing ability is dominated by the rules, norms, and power structures that affect the interaction, relationships, and decisio n-making between medical systems. 6. Considering the resilience can help build a stronger health system, but if you want to evaluate the ability of the health systems, you need to investigate all of these aspects of the health system. Durability: What do you do? Re-evaluation of the recovery of medical systems in COVID-19: Leave a comment in the first two-year lessons of pandemic

Factors of power and fairness: Enhance the framework of recovery research on medical systems "Re-evaluation of knowledge about medical systems in COVID-19: Leave a comment in the first two years of pandemic"

The health learning system will leave a comment in the recoloring health system, "Re-evaluation of the recovery of the health system in COVID-19: lessons from the first two years of pandemic".

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Methods

Search Strategies and Selection

The resilient health system has the ability to use existing resources to absorb shocks while maintaining the same basic functions as before, the ability to adjust and adapt the use of functions and resources, or reduce risks. It has the ability to fundamentally change the function to do. 4, 5 Such a changing ability is dominated by the rules, norms, and power structures that affect the interaction, relationships, and decisio n-making between medical systems. 6. Considering the resilience can help build a stronger health system, but if you want to evaluate the ability of the health systems, you need to investigate all of these aspects of the health system. Durable: What do you do? Re-evaluation of the recovery of medical systems in COVID-19: Leave a comment in the first two-year lessons of pandemic

The health learning system will leave a comment in the recoloring health system, "Re-evaluation of the recovery of the health system in COVID-19: lessons from the first two years of pandemic".

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Coronavirus disease 2019 (COVID-19) is defined as a compound shock that is multifactorial and multiscale in its causes and effects. Studying health system responses to a pandemic, a shock of global scale, is an opportunity to deepen the current understanding of health system resilience. The aim of this paper is to reassess what is known about health system resilience by assessing the overlap between concepts of resilience discussed in recent literature on resilience and COVID-19 and those of existing health system resilience frameworks. 5 The widely cited Governance Dimensions of Resilience framework 5 is used as a structure for analyzing the literature on health system resilience and COVID-19. The framework has four dimensions that create the capacity to absorb, adapt, and transform. 5 A system needs the ability to integrate, process, and make decisions about its resources, risks, and health needs while interacting with different actors and groups within and outside the health system. A system can anticipate and manage uncertainty through the actions and decisions of individuals, groups, and networks in response to shocks. They must also be able to manage interactions with other systems outside the health system (interdependencies) and recognize the influence of contextual and external factors on the system's behavior, capacities, and resources. Finally, the system must establish trustworthy and legitimate systems to provide socially acceptable and contextually appropriate care. These dimensions are not mutually exclusive.

Data Extraction and Analysis

This review addresses four questions: (i) What do we understand about the dimensions of resilience in the context? (ii) What aspects of the dimensions of resilience remain uncertain? (iii) What aspects of the dimensions of resilience are missing in the COVID-19 discussion? And (iv) What has COVID-19 taught us about resilience?

Results

COVID-19 Through the Dimensions of Resilience Governance framework

Which Dimensions Are Documented?

Narrative synthesis methods are well suited to explore new literature on new topics and to synthesize a wide range of research designs. 7 We conducted a data synthesis of publications that discussed COVID-19 and health system resilience and organized the synthesis around the Governance Dimensions of Resilience framework. 5

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Due to the lack of empirical research on COVID-19 and resilience at the start of pandemic, all kinds of English papers published in academic journals clearly discussed medical systems resilience in connection with COVID-19 (Including comments and opinion peas) was used as a criterion. Papers on personal and psychological resilience at the individual level were excluded. Papers on resilience in individuals or community resilience and other types of systems (eg, political systems) were excluded if they were not directly related to the discussion of the health system. The first author examined the title, abstract, and full text in light of the qualified standards. A paper whose qualification was unclear was confirmed with other authors.

In the first search, 184 papers were identified. After confirming the title and abstract, I read 104 full texts and analyzed 19 papers (Fig. 1). In the second search, 1152 papers were identified, of which the full text was read and 43 papers were analyzed (Fig. 2). The main reason was excluded was a paper on the resilience of the medical system or another type of resilence.

Figure 1. The flowchart of COVID-19 and resistant papers in December 2020. Abbreviation: COVID-19, Coronavirus disease 2019.

Vicinity

Figure 2. Flowchart of COVID-19 and resistant papers in April 2022. Abbreviation: COVID-19, Coronavirus disease 2019. We searched for a scientific database to identify the recovery force of the medical system and the COVID-19. The search was performed by Medline, Web of Science, and Cinahl (Supplementary File 1) with the keywords with medical systems, resilience, and COVID-19. The same literature search was performed twice: The first was conducted in December 2020, and the second time was performed in April 2022, and the related literature was identified from all pandemic stages.

Figure 1. The flowchart of COVID-19 and resistant papers in December 2020. Abbreviation: COVID-19, Coronavirus disease 2019.

Vicinity

Figure 2. Flowchart of COVID-19 and resistant papers in April 2022. Abbreviation: COVID-19, Coronavirus disease 2019. A search for a scientific database was searched to identify the recovery power of the medical system and the COVID-19 literature. The search was performed by Medline, Web of Science, and Cinahl (Supplementary File 1) with the keywords with medical systems, resilience, and COVID-19. The same literature search was performed twice: The first was conducted in December 2020, and the second time was performed in April 2022, and the related literature was identified from all pandemic stages.

Figure 1. The flowchart of COVID-19 and resistant papers in December 2020. Abbreviation: COVID-19, Coronavirus disease 2019.

Vicinity

Figure 2. Flowchart of COVID-19 and resistant papers in April 2022. Abbreviation: COVID-19, Coronavirus disease 2019.

What Remains Uncertain?

From each study, if there were knowledge and issues related to the resilience of the medical system and the COVID-19, it was extracted in data format. Next, the first author grouped the data for each of the four dimensions of the framework, reviewed with other authors, and confirmed that the data was associated with the dimensions arranged below. After that, the first author r e-sampled the data, whether the data matches the concept of a certain dimension (understood about the dimension), or has any unknown points about the dimension. I decided to be there). The authors discussed the match and mismatch until the consensus reached. The concept of the dimension of context that was not observed in the data was recorded as not discussed. If there were issues or discoveries from papers not described in the context, they were identified and summarized. During the analysis, six new theme areas that reflect these new issues have been identified: teamwork, legitimacy of medical systems, impact of values, fairness, medical system resilience and society Related to resilience, governance in the private sector. Two analysis were performed separately. One is the first search, and the other is the second search. The two analysis results were compared and integrated into one analysis.

Learning: Health systems had to adapt multiple structures and functions to meet the nature of pandemic, which continues to change as knowledge of viruses increased. The 8-28 system uses a strategy that meets both needs, such as implementing remote medical services and integrating folk medical providers into public systems, so that both the essential medical services and COVI services are indispensable. D-19, 13, 15, 17-32, adjusted to prevent and control infection while trying to provide them at the same time.

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Figure 3. A summary of the main fields specified in the literature on COVID-19 and the resilience of the medical system that conforms to the degree (line) of the resilience governance framework. The white frame indicates an area outside the current framework from the literature. If you have knowledge and issues regarding the resilience of the medical system and the COVID-19 from each study, it was extracted in data format. Next, the first author grouped the data for each of the four dimensions of the framework, reviewed with other authors, and confirmed that the data was associated with the dimensions arranged below. After that, the first author r e-sampled the data, whether the data matches the concept of a certain dimension (understood about the dimension), or has any unknown points about the dimension. I decided to be there). The authors discussed the match and mismatch until the consensus reached. The concept of the dimension of context that was not observed in the data was recorded as not discussed. If there were issues or discoveries from papers not described in the context, they were identified and summarized. During the analysis, six new theme areas that reflect these new issues have been identified: teamwork, legitimacy of medical systems, impact of values, fairness, medical system resilience and society Related to resilience, governance in the private sector. Two analysis were performed separately. One is the first search, and the other is the second search. The two analysis results were compared and integrated into one analysis.

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Figure 3. A summary of the main fields specified in the literature on COVID-19 and the resilience of the medical system that conforms to the degree (line) of the resilience governance framework. The white frame indicates an area outside the current framework from the literature. From each study, if there were knowledge and issues regarding the resilience of the medical system and the COVID-19, it was extracted in data format. Next, the first author grouped the data for each of the four dimensions of the framework, reviewed with other authors, and confirmed that the data was associated with the dimensions arranged below. After that, the first author r e-sampled the data, whether the data matches the concept of a certain dimension (understood about the dimension), or has any unknown points about the dimension. I decided to be there). The authors discussed the match and mismatch until the consensus reached. The concept of the dimension of context that was not observed in the data was recorded as not discussed. If there were issues or discoveries from papers not described in the context, they were identified and summarized. During the analysis, six new theme areas that reflect these new issues have been identified: teamwork, legitimacy of medical systems, impact of values, fairness, medical system resilience and society Related to resilience, governance in the private sector. Two analysis were performed separately. One is the first search, and the other is the second search. The two analysis results were compared and integrated into one analysis.

What Resilience Aspects Are Missing From the Discussions?

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In COVID-19's 8-10, 13-16, and 33-37, the systems of each country have been learned from past success and shock without a clear definition of successful response. The emphasis on learning has been placed on creating successful response. For example, before the COVID-19, Australian health systems learned how to reduce the extent of the past, a great trend of SARS (severe acute respiratory syndrome), which occurred in the past. 38

What Is Missing From the Framework?

After COVID-19, it was also an important learning case to predict future impacts in order to strengthen the public health system in preparation for an emergency of global health hygiene. 14, 23, 29, 34, 36, 38-44 The impact of the context in learning was relatively overlooked, except for a very small number of exceptions: the trend of SARS in 2003 was a local community against Singapore's public health. Research 8, 10, which describes how to change the values and policy environments and redefine the framework of the health system before COVID-19 There is a study that states how the policy culture for developing a new framework has been affected. 42 In some papers, repeatedly evaluating how the policies and strategies worked during pandemics for a long time, and as an important solution to make use of the lessons in future policies Is listed. 23, 36, 42, 43 COVID-19 8-10, 13-16, 33-37, without a clear definition of how successful response is defined, The emphasis on learning is placed on learning from past successes and shocks and creating successful response. For example, before the COVID-19, Australian health systems learned how to reduce the extent of the past, a great trend of SARS (severe acute respiratory syndrome), which occurred in the past. 38

After COVID-19, it was also an important learning case to predict future impacts in order to strengthen the public health system in preparation for an emergency of global health hygiene. 14, 23, 29, 34, 36, 38-44 The impact of the context in learning was relatively overlooked, except for a very small number of exceptions: the trend of SARS in 2003 was a local community against Singapore's public health. Research 8, 10, which describes how to change the values and policy environments and redefine the framework of the health system before COVID-19 There is a study that states how the policy culture for developing a new framework has been affected. 42 In some papers, repeatedly evaluating how the policies and strategies worked during pandemics for a long time, and as an important solution to make use of the lessons in future policies Is listed. 23, 36, 42, 43covid-19, 8-10, 13-16, 33-37, has no clear definition of how successful response is defined, and the system of individual countries is in the past. Learning from success and shocks and the emphasis on learning is placed on creating successful response. For example, before the COVID-19, Australian health systems learned how to reduce the extent of the past, a great trend of SARS (severe acute respiratory syndrome), which occurred in the past. 38

Sharing of knowledge: It is considered important to communicate, integrate, and use from various sources for control, resource allocation, health services, and adjustment of support. 。 23, 33-35, 46-49 The importance of knowledge that supports decision-making is not surprising because health communication, survey lance, and information gathering are the basics of public health and plague. (15) Integration of knowledge from other sector and system into a health system can support the use of innovation and evidence in response, and improve risk evaluation and decisio n-making. 23, 34, 35, 46-49 However, it seems that there are few systems that integrate information from other information sources, such as transportation and immigration data, and need to be improved for the future shock. Suggests. Similarly, it is decided to make a decision to integrate the standard information sources of groups and individual levels, such as health management systems and information systems, with new information sources inside and outside the health system, such as contact tracking applications, travel databases, and survey data. Is easier. Similar results have been obtained even in past trends such as 8, 10, 15, 23, 29, 36, 50 Ebola fever. 51

In some health systems, stakeholders have changed their ways to identify the risks of the system by evolving existing report mechanisms and incorporating new data sources from inside and outside the health sector. 16, 24, 26, 27, 34, 44, 52 For these, management data to monitor the performance of the health system, the construction of unofficial networks between regional facilities for monitoring resource levels 26, infection Includes rea l-time algorithm on risk and health services. 27, 52 A challenge when using information for decisio n-making may be that actor does not have specific instructions or information on specific services and information. 19, 44, 48, 54-56 In such a situation, actors in the medical system reported that it would be difficult to respond without a clear guidelines or protocols according to their situations. Sharing of knowledge: Transmission, integrating, and using information from various sources is important for COVID-19 control, resource allocation, health service planning, and corresponding adjustments. It is being. 23, 33-35, 46-49 The importance of knowledge that supports decision-making is not surprising because health communication, survey lance, and information gathering are the basics of public health and plague. (15) Integration of knowledge from other sector and system into a health system can support the use of innovation and evidence in response, and improve risk evaluation and decisio n-making. 23, 34, 35, 46-49 However, it seems that there are few systems that integrate information from other information sources, such as transportation and immigration data, and need to be improved for the future shock. Suggests. Similarly, it is decided to make a decision to integrate the standard information sources of groups and individual levels, such as health management systems and information systems, with new information sources inside and outside the health system, such as contact tracking applications, travel databases, and survey data. Is easier. Similar results have been obtained even in past trends such as 8, 10, 15, 23, 29, 36, 50 Ebola fever. 51

In some health systems, stakeholders have changed their ways to identify the risks of the system by evolving existing report mechanisms and incorporating new data sources from inside and outside the health sector. 16, 24, 26, 27, 34, 44, 52 For these, management data to monitor the performance of the health system, the construction of unofficial networks between regional facilities for monitoring resource levels 26, infection Includes rea l-time algorithm on risk and health services. 27, 52 A challenge when using information for decisio n-making may be that actor does not have specific instructions or information on specific services and information. 19, 44, 48, 54-56 In such a situation, actors in the medical system reported that it would be difficult to respond without a clear guidelines or protocols according to their situations. Sharing of knowledge: It is considered important to communicate, integrate, and use from various sources for control, resource allocation, health services, and adjustment of support. 。 23, 33-35, 46-49 The importance of knowledge that supports decision-making is not surprising because health communication, survey lance, and information gathering are the basics of public health and plague. (15) Integration of knowledge from other sector and system into a health system can support the use of innovation and evidence in response, and improve risk evaluation and decisio n-making. 23, 34, 35, 46-49 However, it seems that there are few systems that integrate information from other information sources, such as transportation and immigration data, and need to be improved for the future shock. Suggests. Similarly, it is decided to make a decision to integrate the standard information sources of groups and individual levels, such as health management systems and information systems, with new information sources inside and outside the health system, such as contact tracking applications, travel databases, and survey data. Is easier. Similar results have been obtained even in past trends such as 8, 10, 15, 23, 29, 36, 50 Ebola fever. 51

To persuade people to follow the regulations of COVID-19, it is necessary to have a consistent, concise and transparent communication from the medical system and the government to residents according to the level of cultural norms and health literacy. there were. 8, 10, 14, 18, 18, 18, 29-31, 35, 50, 52, 56 For example, the general citizens developed tools developed to classify the risk level of COVID-19 infections in Italy. When a negative reaction was performed, the National Institute of Public Health held a weekly presentation and questio n-an d-answer session released to the general public. The 52 authors recognize that open and transparent information sharing is a useful way to compete against public opinion criticism of tools. Sharing top-down information can compete with misinformation related to COVID-19 if it is information from reliable authority, but how to prevent and reduce misinformation was an unresolved issue. 8, 31, 35, 54

The community should be regarded not only as a beneficiary but also as an indispensable source of knowledge in the health system. 23 individuals and communities are important sources for COVID-19-related activities, such as identifying contacts, providing expertise, sharing information on regional resources. 15, 26, 28 However, neglecting the participation of civil society in decisio n-making may lead to weakening and distrust of the health system and the government. 57 Health systems that do not gather knowledge from civil society may lower resilience management capabilities. Many governments have adopted a dominant and mainstream approach, with few mechanisms involving civil society in the early pandemic stage. 23, 52, 58 In order to improve resilience, what kind of community participation processes were well used during COVID-19, and what effects of these processes in the effectiveness and appropriateness of correspondence. It is important to clarify whether it brought. To persuade people to follow the regulations of COVID-19, according to the level of cultural norms and health literacy, a clear, concise and transparent communication from the medical system and the government to residents. Wanted. 8, 10, 14, 18, 18, 18, 29-31, 35, 50, 52, 56 For example, the general citizens developed tools developed to classify the risk level of COVID-19 infections in Italy. When a negative reaction was performed, the National Institute of Public Health held a weekly presentation and questio n-an d-answer session released to the general public. The 52 authors recognize that open and transparent information sharing is a useful way to compete against public opinion criticism of tools. Sharing top-down information can compete with misinformation related to COVID-19 if it is information from reliable authority, but how to prevent and reduce misinformation was an unresolved issue. 8, 31, 35, 54

The community should be regarded not only as a beneficiary but also as an indispensable source of knowledge in the health system. 23 individuals and communities are important sources for COVID-19-related activities, such as identifying contacts, providing expertise, sharing information on regional resources. 15, 26, 28 However, neglecting the participation of civil society in decisio n-making may lead to weakening and distrust of the health system and the government. 57 Health systems that do not gather knowledge from civil society may lower resilience management capabilities. Many governments have adopted a dominant and mainstream approach, with few mechanisms involving civil society in the early pandemic stage. 23, 52, 58 In order to improve resilience, what kind of community participation processes were well used during COVID-19, and what effects of these processes in the effectiveness and appropriateness of correspondence. It is important to clarify whether it brought. To persuade people to follow the regulations of COVID-19, it is necessary to have a consistent, concise and transparent communication from the medical system and the government to residents according to the level of cultural norms and health literacy. there were. 8, 10, 14, 18, 18, 18, 29-31, 35, 50, 52, 56 For example, the general citizens developed tools developed to classify the risk level of COVID-19 infections in Italy. When a negative reaction was performed, the National Institute of Public Health held a weekly presentation and questio n-an d-answer session released to the general public. The 52 authors recognize that open and transparent information sharing is a useful way to compete against public opinion criticism of tools. Sharing top-down information can compete with misinformation related to COVID-19 if it is information from reliable authority, but how to prevent and reduce misinformation was an unresolved issue. 8, 31, 35, 54

Within the health system, open and clear communication between services, teams and levels helped actors to make timely decisions while the system was adapted. 8, 12, 19, 26, 31, 55, 59 For example, lack of information on existing supplies, health system infrastructure and resource availability between organisations created challenges in resource allocation. 15 A study on care homes identified hospital knowledge intermediaries, such as hospital staff, as valuable resources to link smaller facilities and smaller providers with each other, other local facilities and information on resources and guidelines. 26 Such social networks were also useful, for example, in developing local guidelines. However, not all communication mechanisms were able to successfully integrate target groups, who had to find their own ways of accessing information that supported their decisions. Incident management systems designed to streamline communication through a single point of contact eliminated lower-level networks and actors, reinforcing top-down information sharing in the system and duplication of effort at lower levels. 55	Leadership: The role of strong and transparent leadership in managing uncertainty has been recognized before, 60-62 and continues to be relevant in the COVID-19 pandemic. Rapid, flexible and transparent leadership for coordination and clear roles and responsibilities of individuals and teams across the system characterized effective health system responses to COVID-19. For example, they were able to improve communication about errors and coordinate similar processes across different ministries. Good leaders were also seen as having a clear and transparent vision that allowed others to understand their decisions. For example, in a situation with large unknowns, making a somewhat flawed decision quickly and swiftly was seen by the public as a better approach than any repercussions that might result from waiting to make a more informed decision. 48	In order to respond to pandemic (global trends), resources and infrastructure must be available immediately. It has been pointed out that public health systems, especially infrastructure and human resources, are widely lacking in many systems. 13, 14, 18, 18, 20, 23, 29, 63-66 The assumed result is a system that lacks flexibility and cannot mobilize the growth ability. 64 For COVID-19, a large amount of financial resources were assigned to public health and health systems, but in many cases, past austerity, subjective funding, and rationalization to build a more efficient medical system. It was held in connection with the period. In Spain and the UK, previous reductions have hindered the capabilities of the system that increase contact with contact, detection and isolation, leading to underestimating intensive treatment beds and ventilators. 63, 64 COVID-19, like India, which had been a problem with shortage of resources, has created a vulnerable base in public health and primary care. In order to respond to < SPAN> pandemic (global trends), resources and infrastructure must be available immediately. It has been pointed out that public health systems, especially infrastructure and human resources, are widely lacking in many systems. 13, 14, 18, 18, 20, 23, 29, 63-66 The assumed result is a system that lacks flexibility and cannot mobilize the growth ability. 64 For COVID-19, a large amount of financial resources were assigned to public health and health systems, but in many cases, past austerity, subjective funding, and rationalization to build a more efficient medical system. It was held in connection with the period. In Spain and the UK, previous reductions have hindered the capabilities of the system that increase contact with contact, detection and isolation, leading to underestimating intensive treatment beds and ventilators. 63, 64 COVID-19, like India, which had been a problem with shortage of resources, has created a vulnerable base in public health and primary care. In order to respond to pandemic (global trends), resources and infrastructure must be available immediately. It has been pointed out that public health systems, especially infrastructure and human resources, are widely lacking in many systems. 13, 14, 18, 18, 20, 23, 29, 63-66 The assumed result is a system that lacks flexibility and cannot mobilize the growth ability. 64 For COVID-19, a large amount of financial resources were assigned to public health and health systems, but in many cases, past austerity, subjective funding, and rationalization to build a more efficient medical system. It was held in connection with the period. In Spain and the UK, previous reductions have hindered the capabilities of the system that increase contact with contact, detection and isolation, leading to underestimating intensive treatment beds and ventilators. 63, 64 COVID-19, like India, which had been a problem with shortage of resources, has created a vulnerable base in public health and primary care.	The system had to find a flexible and innovative method for creating and using resources to compete with uncertainty about the possibility of resources. In the case of funding, it is standardized to change funds and funds as needed (for example, eliminate the need to approve spending up to a certain threshold) and distribute funds. Including procedures, negotiating a better procurement agreement, reducing dependence on external resources, 16, 19, 20, 28, 33 Health and medical human resources, and benefits. Reducing uncertainty about it means that health and medical systems need to be adapted. For example, in Trinidado Tobago, Cuba was hired by Cuban, and in Spain, medical and graduate students from the Faculty of Nursing were hired. 30, 64 adaptation also needed a change in organizational culture. For example, they allow medical professionals to work in a new way that they were not accepted before pandemic.
Pandemic affected all health systems, but did not affect all levels of each health system. As a result, general policies were ineffective and led to inappropriate implementation at different levels. By using a more democratic approach in the botto m-up, the participation of people in various levels and sectors in the decisio n-making process, making decisions on response are appropriate for the various levels of the health system and reducing uncertainty. I thought I could do it. 18, 19, 26, 54, 56, 69 This is also to reduce the burden of the hig h-level level due to the central response and consider the difference in the background of the response. 54, 56 < SPAN> The system had to find flexible and innovative methods for creating and using resources to compete with uncertainty about the possibility of resources. In the case of funding, it is standardized to change funds and funds as needed (for example, eliminate the need to approve spending up to a certain threshold) and distribute funds. Including procedures, negotiating a better procurement agreement, reducing dependence on external resources, 16, 19, 20, 28, 33 Health and medical human resources, and benefits. Reducing uncertainty about it means that health and medical systems need to be adapted. For example, in Trinidado Tobago, Cuba was hired by Cuban, and in Spain, medical and graduate students from the Faculty of Nursing were hired. 30, 64 adaptation also needed a change in organizational culture. For example, they allow medical professionals to work in a new way that they were not accepted before pandemic.	Pandemic affected all health systems, but did not affect all levels of each health system. As a result, general policies were ineffective and led to inappropriate implementation at different levels. By using a more democratic approach in the botto m-up, the participation of people in various levels and sectors in the decisio n-making process, making decisions on response are appropriate for the various levels of the health system and reducing uncertainty. I thought I could do it. 18, 19, 26, 54, 56, 69 This is also to reduce the burden of the hig h-level level due to the central response and consider the difference in the background of the response. The system had to find flexible and innovative methods for creating and using resources to compete with uncertainty about the possibility of 54, 56 resources. In the case of funding, it is standardized to change funds and funds as needed (for example, eliminate the need to approve spending up to a certain threshold) and distribute funds. Including procedures, negotiating a better procurement agreement, reducing dependence on external resources, 16, 19, 20, 28, 33 Health and medical human resources, and benefits. Reducing uncertainty about it means that health and medical systems need to be adapted. For example, in Trinidado Tobago, Cuba was hired by Cuban, and in Spain, medical and graduate students from the Faculty of Nursing were hired. 30, 64 adaptation also needed a change in organizational culture. For example, they allow medical professionals to work in a new way that they were not accepted before pandemic.	Pandemic affected all health systems, but did not affect all levels of each health system. As a result, general policies were ineffective and led to inappropriate implementation at different levels. By using a more democratic approach in the botto m-up, the participation of people in various levels and sectors in the decisio n-making process, making decisions on response are appropriate for the various levels of the health system and reducing uncertainty. I thought I could do it. 18, 19, 26, 54, 56, 69 This is also to reduce the burden of the hig h-level level due to the central response and consider the difference in the background of the response. 54, 56	Mutual dependence: Each country was required to take long-term national level to COVID-19. Covid-19 prevention and containment countermeasures have affected many fields. The opinion is that the range of COVID-19 is wide, so it is necessary to integrate and recognize mutual dependence while responding. 9, 13-16, 18, 22, 23, 28, 31, 31, 40, 40, 43, 47, 49, 50, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 69 It was necessary to cooperate with the government (education, labor, etc.), coordinated, share information, and make decisions, which required excellent communication skills and leadership at the national level. This helps the health system to absorb or adapt, support decisio n-making, and overcome different purposes between the departments. 10, 20, 23, 30, 39, 49, 50, 54
Second, the health system should strengthen internal connections, such as between medical facilities and public health and clinical medicine, and also strengthen cooperation with international organizations and other health systems. 13-15, 39 In addition, a solidarity between stakeholders is required to avoid competition over resources and make it consistent in response. 12, 14, 59, 63 working in an interdisciplinary way is to perform a clear and consistent role at all levels of the system, training on the interdisciplinary and specialized jobs. It was considered to be a learning process that requires that it is necessary to establish a plan between sector, and to enable new cooperation methods for development. 16, 25, 48 < SPAN> Mutual dependence: Each country was required to take long-term national level to COVID-19. Covid-19 prevention and containment countermeasures have affected many fields. The opinion is that the range of COVID-19 is wide, so it is necessary to integrate and recognize mutual dependence while responding. 9, 13-16, 18, 22, 23, 28, 31, 31, 40, 40, 43, 47, 49, 50, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 69 It was necessary to cooperate with the government (education, labor, etc.), coordinated, share information, and make decisions, which required excellent communication skills and leadership at the national level. This helps the health system to absorb or adapt, support decisio n-making, and overcome different purposes between the departments. 10, 20, 23, 30, 39, 49, 50, 54	Second, the health system should strengthen internal connections, such as between medical facilities and public health and clinical medicine, and also strengthen cooperation with international organizations and other health systems. 13-15, 39 In addition, a solidarity between stakeholders is required to avoid competition over resources and make it consistent in response. 12, 14, 59, 63 working in an interdisciplinary way is to perform a clear and consistent role at all levels of the system, training on the interdisciplinary and specialized jobs. It was considered to be a learning process that requires that it is necessary to establish a plan between sector, and to enable new cooperation methods for development. 16, 25, 48 Mutual dependence: Each country was required to provide long-term national level response to COVID-19. Covid-19 prevention and containment countermeasures have affected many fields. The opinion is that the range of COVID-19 is wide, so it is necessary to integrate and recognize mutual dependence while responding. 9, 13-16, 18, 22, 23, 28, 31, 31, 40, 40, 43, 47, 49, 50, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 69 It was necessary to cooperate with the government (education, labor, etc.), coordinated, share information, and make decisions, which required excellent communication skills and leadership at the national level. This helps the health system to absorb or adapt, support decisio n-making, and overcome different purposes between the departments. 10, 20, 23, 30, 39, 49, 50, 54	Second, the health system should strengthen internal connections, such as between medical facilities and public health and clinical medicine, and also strengthen cooperation with international organizations and other health systems. 13-15, 39 In addition, a solidarity between stakeholders is required to avoid competition over resources and make it consistent in response. 12, 14, 59, 63 working in an interdisciplinary way is to perform a clear and consistent role at all levels of the system, training on the interdisciplinary and specialized jobs. It was considered to be a learning process that requires that it is necessary to establish a plan between sector, and to enable new cooperation methods for development. 16, 25, 48	COVID-19 has forced an interdependent global response. Understanding how interdependence works at the international level when normal patterns of interaction change, with borders closing and competition for access to masks, oxygen, and vaccines, presents new challenges. 16, 17, 20, 24, 36, 42, 46 COVID-19 has forced established health systems in high-income countries to face new and different challenges. For example, the United Nations International Children’s Emergency Fund launched its first emergency response in the UK to provide food for vulnerable children. 70, 71 Low-income countries may no longer be able to access technical and financial support from high-income countries that respond to shocks on their own. 14, 17, 20 Global supply chains have become unpredictable, highlighting the primacy of international supply chains and the inability of many countries to produce resources domestically. 28 The pandemic offers an opportunity to understand interdependence at the international level and the value of effective global health governance in a world where borders and national preferences have re-emerged. COVID-19 has forced an interdependent global response. Understanding how interdependence works at the international level when normal patterns of interaction change, with borders closing and competition for access to masks, oxygen, and vaccines, presents new challenges. 16, 17, 20, 24, 36, 42, 46 COVID-19 has forced established health systems in high-income countries to face new and different challenges. For example, the United Nations International Children's Emergency Fund launched its first emergency response in the UK to provide food for vulnerable children. 70, 71 Low-income countries may no longer be able to access technical and financial support from high-income countries that respond to shocks on their own. 14, 17, 20 Global supply chains have become unpredictable, highlighting the primacy of international supply chains and the inability of many countries to produce resources domestically. 28 The pandemic offers an opportunity to understand interdependence at the international level and the value of effective global health governance in a world where borders and national preferences have re-emerged. COVID-19 has forced an interdependent global response. Understanding how interdependence works at the international level when normal patterns of interaction change, with borders closing and competition for access to masks, oxygen, and vaccines, presents new challenges. 16, 17, 20, 24, 36, 42, 46 COVID-19 has forced established health systems in high-income countries to face new and different challenges. For example, the United Nations International Children’s Emergency Fund launched its first emergency response in the UK to provide food for vulnerable children. 70, 71 Low-income countries may no longer be able to access technical and financial support from high-income countries that respond to shocks on their own. 14, 17, 20 Global supply chains have become unpredictable, highlighting the primacy of international supply chains and the inability of many countries to produce resources domestically. 28 The pandemic offers an opportunity to understand interdependence at the international level and the value of effective global health governance in a world where borders and national preferences have re-emerged.
Legitimacy: 8, 13, 16, 18, 21, 43, 46, 64 COVID-19, so the government is responsible for adjusting and managing the countermeasures. It was an institution. This was a challenge for healthcare professionals because the health system could not be completely separated from the government's legitimacy. As for 43 cases, political and social anxiety that influenced the trust of the government on the government's information on pandemic, opposition to a new Cabinet Order regarding the blockade, and worsening past tension between the federal government and the state government. Is listed. 8, 13, 16, 17, 46, 64, but this is not the case. For example, in the Democratic Republic of Congo and Sierra Leone, deep political distrust has led to sustainable infections of Ebola hemorrhage. In the 73, 74 COVID-19 pandemic, low-legitimate governments and leaders reduce residents' acceptance of management measures (for example, decrease vaccination rates), and ultimately respond to the health system. There is a concern that it will hurt. 43, 46 < SPAN> legitimacy: 8, 13, 16, 18, 21, 43, 64 COVID-19, so the government is responsible for adjusting and managing the countermeasures. It was the only institution with abilities. This was a challenge for healthcare professionals because the health system could not be completely separated from the government's legitimacy. As for 43 cases, political and social anxiety that influenced the trust of the government on the government's information on pandemic, opposition to a new Cabinet Order regarding the blockade, and worsening past tension between the federal government and the state government. Is listed. 8, 13, 16, 17, 46, 64, but this is not the case. For example, in the Democratic Republic of Congo and Sierra Leone, deep political distrust has led to sustainable infections of Ebola hemorrhage. In the 73, 74 COVID-19 pandemic, low-legitimate governments and leaders reduce residents' acceptance of management measures (for example, decrease vaccination rates), and ultimately respond to the health system. There is a concern that it will hurt. 43, 46 legitimacy: 8, 13, 18, 18, 21, 43, 64 COVID-19, the government has the legitimacy and ability responsible for adjusting and managing the countermeasures. It was the only institution. This was a challenge for healthcare professionals because the health system could not be completely separated from the government's legitimacy. As for 43 cases, political and social anxiety that influenced the trust of the government on the government's information on pandemic, opposition to a new Cabinet Order regarding the blockade, and worsening past tension between the federal government and the state government. Is listed. 8, 13, 16, 17, 46, 64, but this is not the case. For example, in the Democratic Republic of Congo and Sierra Leone, deep political distrust has led to sustainable infections of Ebola hemorrhage. In the 73, 74 COVID-19 pandemic, low-legitimate governments and leaders reduce residents' acceptance of management measures (for example, decrease vaccination rates), and ultimately respond to the health system. There is a concern that it will hurt. 43, 46	Second, the health system should strengthen internal connections, such as between medical facilities and public health and clinical medicine, and also strengthen cooperation with international organizations and other health systems. 13-15, 39 In addition, a solidarity between stakeholders is required to avoid competition over resources and make it consistent in response. 12, 14, 59, 63 working in an interdisciplinary way is to perform a clear and consistent role at all levels of the system, training on the interdisciplinary and specialized jobs. It was considered to be a learning process that requires that it is necessary to establish a plan between sector, and to enable new cooperation methods for development. 16, 25, 48 Mutual dependence: Each country was required to provide long-term national level response to COVID-19. Covid-19 prevention and containment countermeasures have affected many fields. The opinion is that the range of COVID-19 is wide, so it is necessary to integrate and recognize mutual dependence while responding. 9, 13-16, 18, 22, 23, 28, 31, 31, 40, 40, 43, 47, 49, 50, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 56, 69 It was necessary to cooperate with the government (education, labor, etc.), coordinated, share information, and make decisions, which required excellent communication skills and leadership at the national level. This helps the health system to absorb or adapt, support decisio n-making, and overcome different purposes between the departments. 10, 20, 23, 30, 39, 49, 50, 54	In all discussions of health system change during COVID-19, transformation capacity has received the least attention compared to absorptive and adaptive capacity. Examples of transformation have been described, such as the creation of parallel systems for COVID-19 care, 30 or the triggers for implementing health system reforms during the pandemic. 25 One reason for the focus on adaptation and absorption may be the tendency of manuscripts to define resilience as the capacity to prepare for and respond to shocks while maintaining core functions and responding to health needs, 10, 13, 28-32, 40, 49, 50, 59, 80 or the capacity to withstand and adapt to specific shocks, 18, 20, 33, 52, 67, 81, emphasizing the capacity for profound change. The tendency to equate resilience with the ability to bounce back in maintaining essential health services or with emergency preparedness may also distract from potential structural and operational changes and focus attention on short-term changes in specific subsystems or regions. This focus on performance has a view on the underlying capacities that allow health systems to change radically. The absorptive and adaptive focus can also be explained by the timeline of the paper.	However, the pandemic also transformed itself from a crisis into a clear opportunity to initiate reforms that support transformation. 16, 17, 25, 28, 69 Rather than following the “temptation to revoke health reforms”25 in Covid-19, the pandemic became an opportunity to break away from the status quo. For example, the pandemic changed the perception of recent public management approaches in Quebec and created new possibilities to change the management structure of the health system. 16 To reconcile the focus on absorption and adaptation with seeing the crisis as an opportunity for transformation, it is necessary to recognize that endless absorptive and adaptive capacities are not sustainable, since health systems are embedded in unpredictable and ever-changing conditions. 82
While the need to integrate and use multiple sources and formats is clear, it remains unclear which sources and formats will have the greatest impact on the system's ability to respond and resilience. When it is clearly described as beneficial to link knowledge from sources such as the community and other sectors to the response, knowledge does not stop at linking sources. Strengthening the process of knowledge generation, collection, synthesis, and interpretation may safeguard the health system's response to future shocks. 42, 48 Investing in local research capacity to generate local knowledge, for example, local production of vaccines, may reduce the system's reliance on the international community during future shocks. 34	An emerging idea from Covid-19 is the need to build the capacity of health workers and other health system actors to make decisions in response to shocks. This is not just about who can make what decisions, but how to build individual and collective capacity to act. 19, 26, 28 For example, health workers in care gained confidence in their leadership as the unique skills they developed during the pandemic, such as negotiating with local suppliers, were recognized and repeatedly used. 50 Supporting the capacity of health system actors to make and act on decisions is useful for their ability to adapt to future changes.	The second issue that has emerged is the need to make decision-making processes transparent, including clearly articulating the rationale for decisions. The various decision-making processes for responding to COVID-19 have been relatively overlooked so far. This may be because many of the response decisions at the national level were viewed as political decisions that went beyond public health objectives. 83 Policymakers were under pressure to rapidly assess the changing situation, respond to new information, and provide expertise on the novel virus. 84 Some authors argue that clarity in the process would have reduced health system actors’ uncertainty that the decisions were correct and trustworthy. 23, 38, 44, 48, 52 The government was criticized for not openly discussing the uncertainty of the decisions they were making and that future circumstances might change the decisions. 23 However, distrust in decision-making may be more related to the alleged lack of participation of groups of health system actors in the decision-making process. 48, 49, 55, 56 A less inclusive decision-making process may have led to inefficiencies in the health system response. Without access to a centralized case management system to make decisions about care, primary care providers could not:	Many public health interventions for COVID-19 relied on individuals and communities to change their behavior and comply with regulations. The public’s willingness to comply is closely linked to their trust in the government, the health system, and the acceptance of the intervention. It remains uncertain how to understand local trust and how to leverage it to improve compliance with national policies that require rapid collective behavior change. Trust in public health messages and the effectiveness of local responses can be improved by engaging local residents and local actors and soliciting their feedback. 15, 30, 44 Theoretically, trust relationships may be stronger in rural areas and primary care sectors where service providers have closer ties to the community. 12, 36 Future discussions on resilience should explore the impact of implementing top-down interventions on legitimacy.
When responding to COVID-19 and other crises, the health system may need to be adapted to low reliability, but the most effective and appropriate method is still unknown. 28, 49, 52, 67, for example, maximizing vaccination and inoculation rates is essential for preventing infection, but is greatly affected by residents' trust in vaccination and health systems. Depending on the context, it may be possible to implement a policy that obliges vaccination, as in the previous COVID-19 policy that emphasizes individual responsibilities, 10. 10. Sometimes it is. If you can't achieve vaccination goals, how should the health system adapt? The strategy for adapting is not the system preference of the system, but to the residents' wishes (for example, expanding regular vaccination systems to a more convenient place for patients), and preparing for emergency situations. On the side, there are the areas of care quality, and so on. 49 In the future crisis, medical systems may need to reconsider their response strategies in order to create socially accepted solutions in light of the trust level of residents. < SPAN> Corresponding to COVID-19 and other crisis may require the health system to adapt to low reliability, but the most effective and appropriate method is still unknown. 28, 49, 52, 67, for example, maximizing vaccination and inoculation rates is essential for preventing infection, but is greatly affected by residents' trust in vaccination and health systems. Depending on the context, it may be possible to implement a policy that obliges vaccination, as in the previous COVID-19 policy that emphasizes individual responsibilities, 10. 10. Sometimes it is. If you can't achieve vaccination goals, how should the health system adapt? The strategy for adapting is not the system preference of the system, but to the residents' wishes (for example, expanding regular vaccination systems to a more convenient place for patients), and preparing for emergency situations. On the side, there are the areas of care quality, and so on. 49 In the future crisis, medical systems may need to reconsider their response strategies in order to create socially accepted solutions in light of the trust level of residents. When responding to COVID-19 and other crises, the health system may need to be adapted to low reliability, but the most effective and appropriate method is still unknown. 28, 49, 52, 67, for example, maximizing vaccination and inoculation rates is essential for preventing infection, but is greatly affected by residents' trust in vaccination and health systems. Depending on the context, it may be possible to implement a policy that obliges vaccination, as in the previous COVID-19 policy that emphasizes individual responsibilities, 10. 10. Sometimes it is. If you can't achieve vaccination goals, how should the health system adapt? The strategy for adapting is not the system preference of the system, but to the residents' wishes (for example, expanding regular vaccination systems to a more convenient place for patients), and preparing for emergency situations. On the side, there are the areas of care quality, and so on. 49 In the future crisis, medical systems may need to reconsider their response strategies in order to create socially accepted solutions in light of the trust level of residents.	An emerging idea from Covid-19 is the need to build the capacity of health workers and other health system actors to make decisions in response to shocks. This is not just about who can make what decisions, but how to build individual and collective capacity to act. 19, 26, 28 For example, health workers in care gained confidence in their leadership as the unique skills they developed during the pandemic, such as negotiating with local suppliers, were recognized and repeatedly used. 50 Supporting the capacity of health system actors to make and act on decisions is useful for their ability to adapt to future changes.	The health system needs to respond promptly and continuously to COVID-19. Shor t-term effects are also formed due to changes, such as the need to deal with the daily health services after the suspension of daily health services is delayed. It was more difficult to observe lon g-term systematic and contextual impacts. For example, the change in use patterns affected the income of medical providers who adopted the volume payment method. One of the 20 pandemic issues was that it was difficult to evaluate the results because it was necessary to act quickly in a rapidly changing situation, and there was little time to evaluate the potential impact. The government has forced the government to reorganize a hospital, which has forced the government to rely on the government's supply chain. As a result, care home supply chains became slower, more expensive and inefficient. 26	The health system needs to be able to monitor the risk of developing beyond the health system. The five pandemic brought many risks to the health systems in addition to the virus itself, as well as pandemic and the impact on social systems. COVID-19 was the main example of these risks. Due to the impact of pandemic on finance and food systems, malnutrition has been increased, and in 2020, children under 5 years old have lost 6 million or 7 million, and the child has also died due to poor nutrition. 87 is estimated to increase. At the same time, indispensable nutritional services such as regional screening and vitamins are interrupted or unusable in vulnerable countries. The 88 pandemic threatened the resources of health systems, including a decrease in funding due to the economic recession. (20) These risks are also recognized in the paper, but there are few discussions on how to monitor and detect them. < SPAN> Health systems need to respond quickly and continuously on COVID-19. Shor t-term effects are also formed due to changes, such as the need to deal with the daily health services after the suspension of daily health services is delayed. It was more difficult to observe lon g-term systematic and contextual impacts. For example, the change in use patterns affected the income of medical providers who adopted the volume payment method. One of the 20 pandemic issues was that it was difficult to evaluate the results because it was necessary to act quickly in a rapidly changing situation, and there was little time to evaluate the potential impact. The government has forced the government to reorganize a hospital, which has forced the government to rely on the government's supply chain. As a result, care home supply chains became slower, more expensive and inefficient. 26
The health system needs to be able to monitor the risk of developing beyond the health system. The five pandemic brought many risks to the health systems in addition to the virus itself, as well as pandemic and the impact on social systems. COVID-19 was the main example of these risks. Due to the impact of pandemic on finance and food systems, malnutrition has been increased, and in 2020, children under 5 years old have lost 6 million or 7 million, and the child has also died due to poor nutrition. 87 is estimated to increase. At the same time, indispensable nutritional services such as regional screening and vitamins are interrupted or unusable in vulnerable countries. The 88 pandemic threatened the resources of health systems, including a decrease in funding due to the economic recession. (20) These risks are also recognized in the paper, but there are few discussions on how to monitor and detect them. The health system needs to respond promptly and continuously to COVID-19. Shor t-term effects are also formed due to changes, such as the need to deal with the daily health services after the suspension of daily health services is delayed. It was more difficult to observe lon g-term systematic and contextual impacts. For example, the change in use patterns affected the income of medical providers who adopted the volume payment method. One of the 20 pandemic issues was that it was difficult to evaluate the results because it was necessary to act quickly in a rapidly changing situation, and there was little time to evaluate the potential impact. The government has forced the government to reorganize a hospital, which has forced the government to rely on the government's supply chain. As a result, care home supply chains became slower, more expensive and inefficient. 26	The health system needs to be able to monitor the risk of developing beyond the health system. The five pandemic brought many risks to the health systems in addition to the virus itself, as well as pandemic and the impact on social systems. COVID-19 was the main example of these risks. Due to the impact of pandemic on finance and food systems, malnutrition has been increased, and in 2020, children under 5 years old have lost 6 million or 7 million, and the child has also died due to poor nutrition. 87 is estimated to increase. At the same time, indispensable nutritional services such as regional screening and vitamins are interrupted or unusable in vulnerable countries. The 88 pandemic threatened the resources of health systems, including a decrease in funding due to the economic recession. (20) These risks are also recognized in the paper, but there are few discussions on how to monitor and detect them.	It is often explained that in connection with pandemic, it is necessary to have cros s-sector, domestic and international mutual dependence for resilience (recovery). The vertical health systems are not the same. Medical systems are interchangeable not only with scale and su b-systems, but also with other systems, which are fundamentally reflected in our consequences and uncertainties. The relationship between effective teamwork, medical system orthodox, and vertical mutual dependence is recognized (described in more detail in "What is missing in frameworks"). However, it has not been examined about the scales of different medical systems, the causes of failure on the su b-systems, or how to strengthen vertical interactions.	We have identified the six major areas leaking from the resilience framework, which was an important factor during pandemic. In other words, teamwork, actor's legitimacy, influential values, fairness and justice, associations between medical systems resilience and social resilience, and governance in the private sector. It is often explained that in connection with the < SPAN> pandemic, it is necessary to have cros s-sectional, domestic and international mutual dependence for resilience (recovery). The vertical health systems are not the same. Medical systems are interchangeable not only with scale and su b-systems, but also with other systems, which are fundamentally reflected in our consequences and uncertainties. The relationship between effective teamwork, medical system orthodox, and vertical mutual dependence is recognized (described in more detail in "What is missing in frameworks"). However, it has not been examined about the scales of different medical systems, the causes of failure on the su b-systems, or how to strengthen vertical interactions.
We have identified the six major areas leaking from the resilience framework, which was an important factor during pandemic. In other words, teamwork, actor's legitimacy, influential values, fairness and justice, associations between medical systems resilience and social resilience, and governance in the private sector. It is often explained that in connection with pandemic, it is necessary to have cros s-sector, domestic and international mutual dependence for resilience (recovery). The vertical health systems are not the same. Medical systems are interchangeable not only with scale and su b-systems, but also with other systems, which are fundamentally reflected in our consequences and uncertainties. The relationship between effective teamwork, medical system orthodox, and vertical mutual dependence is recognized (described in more detail in "What is missing in frameworks"). However, it has not been examined about the scales of different medical systems, the causes of failure on the su b-systems, or how to strengthen vertical interactions.	The health system needs to be able to monitor the risk of developing beyond the health system. The five pandemic brought many risks to the health systems in addition to the virus itself, as well as pandemic and the impact on social systems. COVID-19 was the main example of these risks. Due to the impact of pandemic on finance and food systems, malnutrition has been increased, and in 2020, children under 5 years old have lost 6 million or 7 million, and the child has also died due to poor nutrition. 87 is estimated to increase. At the same time, indispensable nutritional services such as regional screening and vitamins are interrupted or unusable in vulnerable countries. The 88 pandemic threatened the resources of health systems, including a decrease in funding due to the economic recession. (20) These risks are also recognized in the paper, but there are few discussions on how to monitor and detect them.	Team pandemic indicates that information flow, decisio n-making, and interaction between systems levels are affected by the quality of teamwork between actors and medical system teams. 16, 18, 24, 26, 55, 56, 65, 69, 76 The ability to work well as a colleague and a medical professional is a trusting relationship, power dynamics, groups and processes and memberships. Based on. According to evidence obtained from multiple countries, medical professionals need more than funds, gavanans, and wel l-organized services. 18, 65 teams and team members, and lack of trus t-building mechanisms such as tools that draw internal accusations and feedback, leading to abnormal reliability levels between medical workers themselves and other stakeholders. I am. 16 The lack of mechanisms was particularly noticeable in the to p-down approach, which seemed to reduce the collective trust of medical professionals on the ability of local and national governments. 16, 26, 76 Low energy in medical workers, such as primary care staff, < Span> Team Pandemic is the interaction between actors and medical system teams between the flow of information, decision making, and the level of the system. It indicates that it is affected by the quality of teamwork. 16, 18, 24, 26, 55, 56, 65, 69, 76 The ability to work well as a colleague and a medical professional is a trusting relationship, power dynamics, groups and processes and memberships. Based on. According to evidence obtained from multiple countries, medical professionals need more than funds, gavanans, and wel l-organized services. 18, 65 teams and team members, and lack of trus t-building mechanisms such as tools that draw internal accusations and feedback, leading to abnormal reliability levels between medical workers themselves and other stakeholders. I am. 16 The lack of mechanisms was particularly noticeable in the to p-down approach, which seemed to reduce the collective trust of medical professionals on the ability of local and national governments. 16, 26, 76 Low energy team pandemic in healthcare professionals, such as primary care staff, has a teamwork between actors and medical system teams, interaction between information, decisio n-making, and system levels. It indicates that it is influenced by the quality of. 16, 18, 24, 26, 55, 56, 65, 69, 76 The ability to work well as a colleague and a medical professional is a trusting relationship, power dynamics, groups and processes and memberships. Based on. According to evidence obtained from multiple countries, medical professionals need more than funds, gavanans, and wel l-organized services. 18, 65 teams and team members, and lack of trus t-building mechanisms such as tools that draw internal accusations and feedback, leading to abnormal reliability levels between medical workers themselves and other stakeholders. I am. 16 The lack of mechanisms was particularly noticeable in the to p-down approach, which seemed to reduce the collective trust of medical professionals on the ability of local and national governments. 16, 26, 76 Low energy in medical workers, such as primary care staff	Legitimacy of the health system: In addition to community legitimacy, actors within the system must also perceive the system as legitimate. Perceptions of the health system’s governance mechanisms influence their behavior in implementing and committing to health system actions (e. g., following guidelines). 16, 18, 26, 41, 47, 55, 69, 76 Legitimacy extends to government institutions as well as non-governmental sectors and actors, such as professional unions, non-governmental organizations and agencies that protect the rights of health workers, non-governmental organizations and agencies, and the private sector. Groups that were often excluded from decision-making and information flows, such as health workers, nurses, primary care providers, and public health workers, had to adapt on their own. This led to resentment, reduced trust, and a reduced willingness to engage with local authorities and commit to central strategies, especially among groups that had no mechanisms to disagree with more powerful actors. 16, 26, 47, 76 Other pre-existing problems, such as a hostile work environment for health workers, existed before the pandemic, but exacerbated distrust of health workers after the pandemic.
Values have formed a lot of decision-making, organizational and social values that were made to support COVID-19, and the goals of response and reconstruction. 16, 19, 35, 48, 67, 69, 76, 79, 89 Pandemic had a significant uncertainty, so the results and forms were often unknown at the time the decision was made. An ethical dilemma occurred among the decisio n-makers. 48, 79, for example, there may be a lack of guidelines and ethics frameworks, and may be confronted with community, group, individual status, available resources, values. 16, 76, 79 The act of prioritizing services for various groups is a technical decision and a values -based decision. Giving priority to both the creation of evidence and the resource allocation is not only during the shock, but also in the subsystems and fields that have been neglected before the shock emerge as a weak connection in response, and to the next crisis. Created a risk. 69, 79 Personal, organized, and social values may have influenced the response of the health system in other ways. < SPAN> Value has formed a lot of decision-making and corresponding and reconstruction goals for personal, organizational, and social values that were made to support COVID-19. 16, 19, 35, 48, 67, 69, 76, 79, 89 Pandemic had a significant uncertainty, so the results and forms were often unknown at the time the decision was made. An ethical dilemma occurred among the decisio n-makers. 48, 79, for example, there may be a lack of guidelines and ethics frameworks, and may be confronted with community, group, individual status, available resources, values. 16, 76, 79 The act of prioritizing services for various groups is a technical decision and a values -based decision. Giving priority to both the creation of evidence and the resource allocation is not only during the shock, but also in the subsystems and fields that have been neglected before the shock emerge as a weak connection in response, and to the next crisis. Created a risk. 69, 79 Personal, organized, and social values may have influenced the response of the health system in other ways. Values have formed a lot of decision-making, organizational and social values that were made to support COVID-19, and the goals of response and reconstruction. 16, 19, 35, 48, 67, 69, 76, 79, 89 Pandemic had a significant uncertainty, so the results and forms were often unknown at the time the decision was made. An ethical dilemma occurred among the decisio n-makers. 48, 79, for example, there may be a lack of guidelines and ethics frameworks, and may be confronted with community, group, individual status, available resources, values. 16, 76, 79 The act of prioritizing services for various groups is a technical decision and a values -based decision. Giving priority to both the creation of evidence and the resource allocation is not only during the shock, but also in the subsystems and fields that have been neglected before the shock emerge as a weak connection in response, and to the next crisis. Created a risk. 69, 79 Personal, organized, and social values may have influenced the response of the health system in other ways.	The health system needs to be able to monitor the risk of developing beyond the health system. The five pandemic brought many risks to the health systems in addition to the virus itself, as well as pandemic and the impact on social systems. COVID-19 was the main example of these risks. Due to the impact of pandemic on finance and food systems, malnutrition has been increased, and in 2020, children under 5 years old have lost 6 million or 7 million, and the child has also died due to poor nutrition. 87 is estimated to increase. At the same time, indispensable nutritional services such as regional screening and vitamins are interrupted or unusable in vulnerable countries. The 88 pandemic threatened the resources of health systems, including a decrease in funding due to the economic recession. (20) These risks are also recognized in the paper, but there are few discussions on how to monitor and detect them.	Fairness is associated with all dimensions in the resilience framework. As with the focus so far, trust 97, if the system is mainly focused on Cavid 19 Care 9, 14, 58, individuals and groups access high quality care and pay for it. Is affected by whether you can receive it. Sharing knowledge is useful for identifying vulnerable group 15. COVID-19 noted that the resilience could only be managed to a level with a medical system or a specific group, and that it has permanent the difference in fairness. For example, health systems may be able to manage resilience in urban areas, but in rural areas that can secure resources and provide services to more blessed people, may not be able to absorb, adapt, and change resilience. Not 12. 12 This raises a problem over whether the weight of each dimension at various levels and the weight of each dimension that contributes to resilience abilities is equal.	Crossing of fields: Covid-19 is called a synchronization interaction between the COVID-19 and the social, economic, and environmental factors that have disadvantaged consequences. There is. Facts such as poverty and social and gender inequality have created COVID-19 inequality and setbacks for vulnerable and disadvantageous groups. In order for everyone to receive hig h-quality medical services without experiencing financial difficulties, the universal insurance is the key, but the responsibility for social care and protection is not the authority of the medical system. be. However, these factors have greatly contributed to the results that the medical system should be responsible for. 1, 34, 99, 100 < SPAN> Fairness is associated with all dimensions in resilience frameworks. As with the focus so far, trust 97, if the system is mainly focused on Cavid 19 Care 9, 14, 58, individuals and groups access high quality care and pay for it. Is affected by whether you can receive it. Sharing knowledge is useful for identifying vulnerable group 15. COVID-19 noted that the resilience could only be managed to a level with a medical system or a specific group, and that it has permanent the difference in fairness. For example, health systems may be able to manage resilience in urban areas, but in rural areas that can secure resources and provide services to more blessed people, may not be able to absorb, adapt, and change resilience. Not 12. 12 This raises a problem over whether the weight of each dimension at various levels and the weight of each dimension that contributes to resilience abilities is equal.
Crossing of fields: Covid-19 is called a synchronization interaction between the COVID-19 and the social, economic, and environmental factors that have disadvantaged consequences. There is. Facts such as poverty and social and gender inequality have created COVID-19 inequality and setbacks for vulnerable and disadvantageous groups. In order for everyone to receive hig h-quality medical services without experiencing financial difficulties, the universal insurance is the key, but the responsibility for social care and protection is not the authority of the medical system. be. However, these factors have greatly contributed to the results that the medical system should be responsible for. 1, 34, 99, 100 fairness is associated with all dimensions in the resilience framework. As with the focus so far, trust 97, if the system is mainly focused on Cavid 19 Care 9, 14, 58, individuals and groups access high quality care and pay for it. Is affected by whether you can receive it. Sharing knowledge is useful for identifying vulnerable group 15. COVID-19 noted that the resilience could only be managed to a level with a medical system or a specific group, and that it has permanent the difference in fairness. For example, health systems may be able to manage resilience in urban areas, but in rural areas that can secure resources and provide services to more blessed people, may not be able to absorb, adapt, and change resilience. Not 12. 12 This raises a problem over whether the weight of each dimension at various levels and the weight of each dimension that contributes to resilience abilities is equal.	Crossing of fields: Covid-19 is called a synchronization interaction between the COVID-19 and the social, economic, and environmental factors that have disadvantaged consequences. There is. Facts such as poverty and social and gender inequality have created COVID-19 inequality and setbacks for vulnerable and disadvantageous groups. In order for everyone to receive hig h-quality medical services without experiencing financial difficulties, the universal insurance is the key, but the responsibility for social care and protection is not the authority of the medical system. be. However, these factors have greatly contributed to the results that the medical system should be responsible for. 1, 34, 99, 100	Private sector: In order for the public and private sector to complement, the governance of a powerful private sector is required. At 58, 64 COVID-19 Pandemic, private sector played an important role in adjusting the response of multiple health systems and maintaining daily health. Private sector also affected the amount of financial resources assigned to public sector and the speed that the public health system could handle pandemic. 10, 12, 13, 30, 39, 59, 64 However, it is the public sector that most countries manage COVID-19. 29 Some public sectors are weakened due to the decrease in investment in governmen t-operated systems that invested national expenses, inadequate services, low trust in the entire health system, and among categories. The cooperation is insufficient. 13, 29, 39, 58 For example, in India, if the public sector could not accommodate patients, the private sector could fill the gap between clinical tests and COVID-19 care. Since the use of private medical providers, the social and economic low levels had an unprecedented economic impact, which had a negative effect on health outcomes and systems. 13, 58 cases require a powerful monitoring of the private sector, for example, a	How should the private sector be managed and regulated to promote resilience? In general, the role and position of the private health sector in the system-wide capacity to respond to current and future shocks has not been studied much. The resilience framework does not distinguish between private and public sector governance as the four dimensions relate to the system-wide resilience capacity. However, similar to equity, resilience capacity may also vary significantly between the public and private sectors. In turn, this is likely to affect the four dimensions and the system's ability to manage resilience. Distinguishing between health system levels and sector governance may help to further explain resilience capacity.
The table summarizes the 63 papers included in the review.	Crossing of fields: Covid-19 is called a synchronization interaction between the COVID-19 and the social, economic, and environmental factors that have disadvantaged consequences. There is. Facts such as poverty and social and gender inequality have created COVID-19 inequality and setbacks for vulnerable and disadvantageous groups. In order for everyone to receive hig h-quality medical services without experiencing financial difficulties, the universal insurance is the key, but the responsibility for social care and protection is not the authority of the medical system. be. However, these factors have greatly contributed to the results that the medical system should be responsible for. 1, 34, 99, 100	First author	Publication date
Objectives	Crossing of fields: Covid-19 is called a synchronization interaction between the COVID-19 and the social, economic, and environmental factors that have disadvantaged consequences. There is. Facts such as poverty and social and gender inequality have created COVID-19 inequality and setbacks for vulnerable and disadvantageous groups. In order for everyone to receive hig h-quality medical services without experiencing financial difficulties, the universal insurance is the key, but the responsibility for social care and protection is not the authority of the medical system. be. However, these factors have greatly contributed to the results that the medical system should be responsible for. 1, 34, 99, 100	Regido-Quigley 64	March 2020
To describe the resilience of the Spanish health system during Covid-19 using the components of the health system.	Long-term medical shortages weakened health services, and financial resources were forced to support local responses. Coordination between levels and public compliance was good but needed to be strengthened over time.	Gopichandran 29	April 2020
Based on the response to Covid-19, discuss factors to increase the resilience of the Indian health system.	Long-term medical shortages weakened health services, and financial resources were forced to support local responses. Coordination between levels and public compliance was good but needed to be strengthened over time.	Hsieh 5o	April 2020
Describe the resilience of Taiwan's health system during Covid-19.	Long-term medical shortages weakened health services, and financial resources were forced to support local responses. Coordination between levels and public compliance was good but needed to be strengthened over time.	Kirchhoff 63	May 2020
Comparing responses to the Covid-19 pandemic in the UK and Germany.	Long-term medical shortages weakened health services, and financial resources were forced to support local responses. Coordination between levels and public compliance was good but needed to be strengthened over time.	Regid y-Quigley 8	May 2020
During the COVID-19 period, explain the main aspects of Hong Kong, Singapore and Japan's three resilient health systems.	Long-term medical shortages weakened health services, and financial resources were forced to support local responses. Coordination between levels and public compliance was good but needed to be strengthened over time.	PEIFFER-SMADJA 31	June 2020
Explain the major elements of French hospitals on COVID-19.	In the hospital, all medical departments needed to deal with the indirect impact of fashion, secure dedicated and effective leadership, support medical workers, and organize communication with the general public.	Huntte 30	June 2020
It describes the recovery and response of Trinidad Tobago's medical system in response to COVID-19.	In the hospital, all medical departments needed to deal with the indirect impact of fashion, secure dedicated and effective leadership, support medical workers, and organize communication with the general public.	Garcia Elorio 68	June 2020
Discuss the strategy of PHE, focusing on redesign and strengthening healthcare systems.	Current COVID-19 Pandemic provides opportunities to adopt integrated approaches to the quality of medical care integrated with improvement of quality planning, quality management, and quality guarantee to achieve sustainable and large-scale introductions. do. When the medical system starts to adopt such a method or continues to recruit, it is important that its effectiveness is strictly valued with appropriate management, accountability, governance system and structure. It is.	Dasugupta 58	July 2020
Survey the impact of COVID-19 on sexual / reproxy health and rights through a cross-sector lens.	Current COVID-19 Pandemic provides opportunities to adopt integrated approaches to the quality of medical care integrated with improvement of quality planning, quality management, and quality guarantee to achieve sustainable and large-scale introductions. do. When the medical system starts to adopt such a method or continues to recruit, it is important that its effectiveness is strictly valued with appropriate management, accountability, governance system and structure. It is.	De Seewake Rail 39	July 2020
Learning from the country's response to COVID-19 so far.	The integrated services, the health system and the trust of the government seem to be useful for resilience. Insufficient investment and privatization in the public health system have hindered cooperation, providing services and systems.	Seahan 9	July 2020
Identify lessons from COVID-19 to improve public health system preparedness for climate-related emergencies.	Cross-sectoral responsibilities need to be clarified. Health information systems need to respond quickly and update frequently. Strengthening community engagement is beneficial for preparedness. Health must be linked to economic and social development. Leadership needs adaptive capacity and integration into programs.	Mazingi 32	August 2020
Exploring surgical system vulnerabilities from past outbreaks and COVID-19.	Cross-sectoral responsibilities need to be clarified. Health information systems need to respond quickly and update frequently. Strengthening community engagement is beneficial for preparedness. Health must be linked to economic and social development. Leadership needs adaptive capacity and integration into programs.	O'Sullivan 12	August 2020
Provide comments on the rural primary health care sector during the Covid-19 pandemic.	Pandemic preparedness and communication need to be adapted to rural risks and environments. Primary health care is a key component of rural care and has benefited from the response through adaptability, flexibility, local decision-making, resource management and regional collaboration. Covid-19 related responses such as telemedicine will strengthen rural care in the wake of irrational events.	Gupta 13	August 2020
Better understand the extent of resilience in the Indian health system.	Pandemic preparedness and communication need to be adapted to rural risks and environments. Primary health care is a key component of rural care and has benefited from the response through adaptability, flexibility, local decision-making, resource management and regional collaboration. Covid-19 related responses such as telemedicine will strengthen rural care in the wake of irrational events.	Etienne 40	August 2020
Learning lessons from COVID-19, identify transformational changes in current approaches to health systems and development.	Health must be linked to economic and social development and driven by integrated policies and planning. Health systems should focus on equitable access to health services such as primary care and strengthen public health capabilities.	Costafont 59	August 2020
Identify which characteristics of managed competition make a difference in managing the pandemic.	Health must be linked to economic and social development and driven by integrated policies and planning. Health systems should focus on equitable access to health services such as primary care and strengthen public health capabilities.	Meyer 11	September 2020
Explain the importance of investments like telehealth in local healthcare to support resilience during Covid-19.	COVID-19 has seen policies and services adapt quickly to enable telecare, but policy reforms are needed to address persistent challenges such as access to and affordability of care.	Chua 10	September 2020
Illustrate Singapore's response to COVID-19 using two theories of health system resilience.	COVID-19 has seen policies and services adapt quickly to enable telecare, but policy reforms are needed to address persistent challenges such as access to and affordability of care.	Collins 14	October 2020
Identify key areas for government priority efforts in strengthening the government's capacity to effectively prevent, warn, and respond to emergencies, and improve population health outcomes to increase resilience to health hazards.	COVID-19 has seen policies and services adapt quickly to enable telecare, but policy reforms are needed to address persistent challenges such as access to and affordability of care.	15	Oct 2020
Assess lessons learned from the development of health information systems in COVID-19 and EBOLA focus groups to optimize preparedness and response activities.	Strengthen governance and coordination and align with the global health agenda. Health system infrastructure and resources need to be built and integrated into primary care. Community engagement can help improve accuracy and reliability of information and prevent misinformation.	Cuschieri 27	Nov 2020
Summary of pandemic preparedness in Malta and its impact on routine practice.	Strengthen governance and coordination and align with the global health agenda. Health system infrastructure and resources need to be built and integrated into primary care. Community engagement can help improve accuracy and reliability of information and prevent misinformation.	Haldane 90	Dec 2020
Supporting transformative resilience following Covid-19.	Strengthen governance and coordination and align with the global health agenda. Health system infrastructure and resources need to be built and integrated into primary care. Community engagement can help improve accuracy and reliability of information and prevent misinformation.	Lal 89	December 2020
Understand how health systems with strong GHS and UHC policies have moved forward during Covid-19.	Strengthen governance and coordination and align with the global health agenda. Health system infrastructure and resources need to be built and integrated into primary care. Community engagement can help improve accuracy and reliability of information and prevent misinformation.	DASZAK 46	February 2021
Examine the US approach to preparing for pandemic and its impact on COVID-19.	Strengthen governance and coordination and align with the global health agenda. Health system infrastructure and resources need to be built and integrated into primary care. Community engagement can help improve accuracy and reliability of information and prevent misinformation.	Marshall	February 2021
We will examine the response of home care for COVID-19 while considering the position in the medical system.	Centralized response has led to a decrease in resource restrictions, additional work, and the ability to make local decisions in care homes. Resilience (resilience) was the result of the ability to build a network for staff and teams to respond to the issues brought to centralized.	Ahan Hanzo 34	March 2021
Investigate whether African countries use lessons from past infectious diseases in order to build a correspondence strategy with resilience.	Centralized response has led to a decrease in resource restrictions, additional work, and the ability to make local decisions in care homes. Resilience (resilience) was the result of the ability to build a network for staff and teams to respond to the issues brought to centralized.	Narwar 66	March 2021
The patient's safety issues in India's COVID-19 bring out lessons on resilience.	Insufficient investment in public health systems for many years, lack of reliable data, lack of resources and infrastructure caused by restrictions affected patient safety. Expanding investment in the public sector may minimize future risks.	Hamade 17	April 2021
It describes the current recovery mechanism of Lebanon's public primary healthcare system.	Insufficient investment in public health systems for many years, lack of reliable data, lack of resources and infrastructure caused by restrictions affected patient safety. Expanding investment in the public sector may minimize future risks.	Piribari 43	April 2021
The Iranian medical system focuses on what roles the resilience plays due to the stress factor of Cavid-19.	Insufficient investment in public health systems for many years, lack of reliable data, lack of resources and infrastructure caused by restrictions affected patient safety. Expanding investment in the public sector may minimize future risks.	Rome	April 2021
Comparing the recovery of two different health systems in Italy in COVID-19.	Insufficient investment in public health systems for many years, lack of reliable data, lack of resources and infrastructure caused by restrictions affected patient safety. Expanding investment in the public sector may minimize future risks.	Arami 16	June 2021
Evaluate system preparation and resilience for emerging infectious diseases based on the Palagei framework.	The appropriate ability to respond to resilience and systemic and global crisis depends on the existing characteristics and abilities of both the system level, the state government level, and the federal level.	Geburemeskel 47	June 2021
Explore the role of regional health initiatives in the resilience of health systems in African countries.	The appropriate ability to respond to resilience and systemic and global crisis depends on the existing characteristics and abilities of both the system level, the state government level, and the federal level.	Hassan 18	June 2021
In LMIC's COVID-19, we summarize evidence about integrated health services.	The appropriate ability to respond to resilience and systemic and global crisis depends on the existing characteristics and abilities of both the system level, the state government level, and the federal level.	Bassier 41	June 2021
Based on better governance and the need for a stronger and stronger health system, we present views and expectations for changes expected in the future of public health in the world, region, and national level.	The appropriate ability to respond to resilience and systemic and global crisis depends on the existing characteristics and abilities of both the system level, the state government level, and the federal level.	Harden 28	June 2021
Review COVID-19 in 28 countries using the resilience framework in the medical system.	The resilient health system is a comprehensive response that integrates health and social and economic considerations, inner and outside the health system to maintain the adaptation ability inside and outside the health system to meet the needs of the local community, maintaining pandemic and other care. It was thought to have sustainable functions and resources, reducing vulnerabilities in catastrophic losses in the local community, continuous learning and adaptation.	Kwon 20	July 2021
Provides an approach to enhance health and resilience based on the effects of COVID-19 in the Asia-Pacific region.	The resilient health system is a comprehensive response that integrates health and social and economic considerations, inner and outside the health system to maintain the adaptation ability inside and outside the health system to meet the needs of the local community, maintaining pandemic and other care. It was thought to have sustainable functions and resources, reducing vulnerabilities in catastrophic losses in the local community, continuous learning and adaptation.	Smuggling 38	July 2021
Explore how the government's actions in Australia's New Southwales and Canadian state are related to the rarity of the health systems.	The resilient health system is a comprehensive response that integrates health and social and economic considerations, inner and outside the health system to maintain the adaptation ability inside and outside the health system to meet the needs of the local community, maintaining pandemic and other care. It was thought to have sustainable functions and resources, reducing vulnerabilities in catastrophic losses in the local community, continuous learning and adaptation.	Philips 48	August 2021
Explore the asymmetry of information in COVID-19 and how it had affected British government decisions.	In the era of uncertainty, officials in various levels and departments tried to get new information to minimize mistakes in making decisions. Most innovations occurred in management and organizations, not rapid innovation.	Fisk 79	August 2021
We discuss important ethical concerns in COVID-19 pandemic in relation to the construction of a resignment health system.	In the era of uncertainty, officials in various levels and departments tried to get new information to minimize mistakes in making decisions. Most innovations occurred in management and organizations, not rapid innovation.	Amulios 35	August 2021
Discuss the major policy response to the COVID-19 approach to Southeast Asian countries, including resilience.	In the era of uncertainty, officials in various levels and departments tried to get new information to minimize mistakes in making decisions. Most innovations occurred in management and organizations, not rapid innovation.	BALQIS-ALI 56	August 2021
Explore the viewpoint of general citizens on the response of health systems against COVID-19, identify the gap to strengthen the health system based on the WHO's health system construction block.	In the era of uncertainty, officials in various levels and departments tried to get new information to minimize mistakes in making decisions. Most innovations occurred in management and organizations, not rapid innovation.	Hodgins	September 2021
Evaluate the innovation and changes created between COVID-19 in Australian pediatric health services.	The values of the medical system of fairness, comprehensive, and labor support have formed a response. No n-layered rule structure, response, and clear vision supported innovation and change.	Bark 25	September 2021
Verify whether the Irish government's response to Pandemic has contributed to reform and resilience reform and resilience.	The values of the medical system of fairness, comprehensive, and labor support have formed a response. No n-layered rule structure, response, and clear vision supported innovation and change.	Plug 91	September 2021
Explains the regional difference between COVID-19, which is in Lombarddia and Veneto in Italy.	The values of the medical system of fairness, comprehensive, and labor support have formed a response. No n-layered rule structure, response, and clear vision supported innovation and change.	Sundalaman 36	September 2021
What is a wel l-prepared medical system with resilient?	Recognizes the organization of primary healthcare services, planned growth ability, strong surveillance integrated with health management information system, ability to increase production in internal, and adaptable health systems The five design features of the government create resilience abilities.	Hari 65	October 2021
Working on resilience between professionals at every level of medical care and clarifying guidelines to support it.	Recognizes the organization of primary healthcare services, planned growth ability, strong surveillance integrated with health management information system, ability to increase production in internal, and adaptable health systems The five design features of the government create resilience abilities.	Larson 67	October 2021
Explain the lessons of COVID-19 regarding the enhancement of the vaccination program.	Recognizes the organization of primary healthcare services, planned growth ability, strong surveillance integrated with health management information system, ability to increase production in internal, and adaptable health systems The five design features of the government create resilience abilities.	Tokalic 81	October 2021
Exploring how Croatia and Bosnia and Herzegovina have engaged with Covid-19 in terms of health system resilience after recent wars and natural disasters.	Recognizes the organization of primary healthcare services, planned growth ability, strong surveillance integrated with health management information system, ability to increase production in internal, and adaptable health systems The five design features of the government create resilience abilities.	Martin 76	November 2021
Exploring the impact of health system governance on community care staff during Covid-19 in England.	Centralized control of resources and priorities limits control of resources, restricts decision-making, and lacks voice for local staff transitioning into a crisis. A collective belief in individual and organizational capabilities can support the transition.	Leslie 55	November 2021
Consider competing responses focused on resilience in Covid-19 in Canada.	Centralized control of resources and priorities limits control of resources, restricts decision-making, and lacks voice for local staff transitioning into a crisis. A collective belief in individual and organizational capabilities can support the transition.	Orhan	November 2021
Consider ways to mitigate the impact of NCDSON health systems in the EU in light of COVID-19.	Centralized control of resources and priorities limits control of resources, restricts decision-making, and lacks voice for local staff transitioning into a crisis. A collective belief in individual and organizational capabilities can support the transition.	Riccardo 52	November 2021

Examine the COVID-19 monitoring tool implemented in Italy and its direct and indirect effects.

Discussion and Conclusion

The tool was able to detect cases and rapidly intensify preventive measures to mitigate Covid-19 exposure, but faced public criticism for being too sensitive. A public forum and question-and-answer session organized by the government helped to reduce the criticism.

Alistair 54

January 2022

Review policies, regulatory frameworks and laws on health emergency management at European and global levels.

The crisis highlights existing gaps in the horizontal and vertical level of cooperation and coordination, and regulations.

Shin 23

January 2022

Ethical issues

Competing interests

Record the reaction of the members of the WHO Southeast Asian Regional Secretariat regarding the lessons learned from the pandemic.

Authors’ contributions

The most important lesson learned during pandemics was 16 theme fields. The importance of lon g-term thinking by policy proprietors was emphasized as the basis of a powerful health system.

Elim Poon - Journalist, Creative Writer

Last modified: 27.08.2024

Resilience: Now What?; Comment on “Re-evaluating Our Knowledge of Health System Resilience During COVID Lessons From the First Two Years. Teamwork, actor legitimacy, values, inclusivity, trans-sectoral resilience, and the role of the private sector are identified as lessons from. We argue that in practice health system resilience is hindered by path dependencies of national health systems and, owed to the crisis, interim.

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