1、Making Healthcare Systems Resilient in collaboration with An action plan for the next decade Ideation Center Insight The World Government Summit is a global platform dedicated to shaping the future of governments worldwide. Each year, the Summit sets the agenda for the next generation of governments

2、, with a focus on how they can harness innovation and technology to solve universal challenges facing humanity. The World Government Summit is a knowledge exchange center at the intersection of government, futurism, technology, and innovation. It functions as a thought leadership platform and networ

3、king hub for policymakers, experts and pioneers in human development. The Summit is a gateway to the future as it functions as the stage for analysis of future trends, concerns, and opportunities facing humanity. It is also an arena to showcase innovations, best practice, and smart solutions to insp

4、ire creativity to tackle future challenges. Answering Tomorrows Questions, Today Table of Contents 33 34 43 01 Executive Summary 05 The Imperative of Healthcare Resilience 19 A Plan for Action 23 Case Study: Reshoring Pharmaceutical Production in France 27 Case Study: Regional Disaster Health Respon

5、se in the United States 31 Case Study: National University Cancer Institute, Singapore Conclusion Appendix: Indicators in the Composite Healthcare Resilience Framework 46 Contacts Endnotes 03 Understanding Healthcare Resilience 09 A Framework for Assessing Healthcare Resilience Exposure to Hazards H

6、ealthcare System Vulnerabilities Response Capacities 11 13 15 Executive Summary 1 It has become all too apparent that healthcare systems around the world are poorly prepared to meet the demands of the populations they serve. The COVID-19 pandemic has underscored this harsh truth: In everything from

7、public health capacity to the simple availability of personal protective equipment, governments and healthcare providers everywhere have struggled to cope with the spread and impact of this virus. The failures highlighted by the COVID-19 pandemic have not been the only sign that current healthcare s

8、ystems are struggling to protect local populations.Major public health threats arising from both natural and human causes have been exposing the weaknesses of healthcare systems that, in most cases, were designed for more stable and predictable circumstances. Today, just as the business sector has r

9、ecognized the need to adapt to a world of volatility, uncertainty, and complexity, the healthcare sector must take urgent steps to build its resilience. Governments, regulators, and healthcare providers must work to make systems more robust over the next decade. 2 Under- standing Healthcare Resilien

10、ce 3 Healthcare resilience can be defined in different ways. It has been described as “a health care systems ability to adjust its functioning prior to, during, or following changes and disturbances, so that it can sustain required performance under both expected and unexpected conditions”1; or as “

11、the capacity to adapt to challenges and changes at different system levels, to maintain high quality care.”2 Strategy sources include World Resources Institute, Food and Agriculture Organization of the United Nations 12 indicators spanning 6 key dimensions, sources include World Economic Forum, Euro

12、pean Union, Vision of Humanity 5 indicators spanning 2 key dimensions 39 indicators spanning 10 key dimensions Assessment of 202 KPIs, Normalizing governance fi nancing; information management resources; infrastructure; health workforce; medical products, vaccines, and technology; health information

13、; health fi nancing; and service delivery 4. Build their surveillance capacity through real- time and comprehensive disease testing, risk-based veterinary supervision, predictive analytics, data monitoring, and international cooperation 5. Build their emergency response capacity through adaptation s

14、trategies, anticipatory and fl exible laws, agile governance structures and decision making, publicprivate partnerships and risk sharing models, contingency funding, and available fi nancial resources 6. Build their recovery capacity through disaster recovery strategies, investments in technology- e

15、nabled systems, and localization of supply chains Governments can deliver on their health resilience only through coordinated action. Health resilience, even in the most developed countries, requires such action throughout the entire government and healthcare systems by the three core stakeholders.

16、These are the central government (acting internally and in cross-government eforts), healthcare regulators, and healthcare providers (see Exhibit 4). These three core stakeholders will each take action in multiple areas, including strategies, plans, and regulations; governance and partnerships; fi n

17、ancing; information management; resources; infrastructure; and medicines, vaccines, and technology. Each core stakeholder will need to identify priorities so that eforts to build healthcare resilience are efective and protect the system when an unanticipated event occurs. The Roles of the Three Stak

18、eholders Each of the three stakeholders plays a diferent role, and the roles are complementary. Central Government/Cross-Government The central government must provide the legal basis and budget for preparedness activities, drafting the master emergency communications plan (including coordination wi

19、th international actors) and leading regular operational readiness testing exercises (see Exhibit 5). Source: Strategy multifaceted infection control measures; redesignation and prioritization of essential hospital resources; and adaptable workfl ows that related to Singapores Disease Outbreak Respo

20、nse System Condition (DORSCON) risk levels and the hospitals policies.44 The institutes strategy incorporated lessons from the 2003 SARS epidemic, after which Singapores DORSCON was established. The two main pillars for clinical care were a segregated-team workfl ow and measures to allocate and cons

21、erve resources: Segregated-team Workfl ow. To minimize the loss of workforce from potential COVID-19 infection, all institute staff, clinical and non-clinical, were segregated into two teams. This ensured that entire departments would not have to be quarantined in the event of an infection. Other me

22、asures included the cancellation of physicians leave, and confi ning physician sub-teams to specifi c ward, outpatient, and offi ce areas to minimize exposure and cross-contamination. Each outpatient sector had its own registration counter, rooms, and lavatories to facilitate contact tracing. Face-t

23、o-face meetings were canceled, and all department meetings were conducted on a secure videoconferencing platform. Resource Allocation and Conservation. Reducing patient volume was necessary to make the segregated-team model sustainable. This was accomplished by various means, including curtailing ou

24、tpatient referrals and appointments (e.g. appointments for cancer surveillance were deferred); encouraging telemedicine consults, home delivery of medications, and online payment; postponing all non-cancer surgeries for three months; conserving blood stocks for cancer patients for emergency surgerie

25、s, active bleeding, and semi-elective cancer surgeries; and limiting per-patient red cell and platelet transfusion and accepting lower hemoglobin levels for asymptomatic patients.45 32 Whereas previous health emergencies have highlighted hazards and vulnerabilities, and healthcare systems limited re

26、sponse capacities at smaller, national or regional scales, the current COVID-19 pandemic has fully exposed the catastrophic reality of a large-scale global healthcare crisis. The pandemics implications reach far beyond healthcare systems, drastically afecting the global economy and livelihoods. Gove

27、rnments therefore have an opportunity to draw appropriate lessons on how to make healthcare systems more resilient and responsive. This paper has laid out a framework with which to assess and strengthen health system resilience holistically. It stresses the importance of all stakeholders coordinatin

28、g their respective actions. Government actors at all levels need to defi ne the overall national and multinational strategies, which healthcare regulators need to then refi ne into more detailed action plans and initiatives.The initiatives themselves concern all actors in a healthcare system, includ

29、ing pharmaceutical and life sciences, healthcare payors (those entities that pay for care), providers, and others. In the past, the focus may have been too much on making healthcare systems more efcient, often in cost terms, and on tackling widely prevalent non-communicable diseases. This focus came

30、 at the expense of reserve capacity and the ability to respond quickly to other hazards and shocks to systems. Taking actions now to strengthen resilience will thus require redirecting funding or increasing it for better preparedness related to pandemic situations or natural catastrophes. Making app

31、ropriate choices in balancing these diferent priorities will be key to achieving greater resilience, an enhanced capacity to respond, and sustainability for the future. Conclusion 3333 Table 1: Indicators for Hazards Appendix: Indicators in the Composite Healthcare Resilience Framework SECTIONCATEGO

32、RYKEY DIMENSIONINDICATOR 1. HazardsNaturalDroughtsDrought intensity EarthquakesGlobal seismic hazard Extreme Weather Incidence Change in temperature compared with the average in the last 30 years or the moving average of the last 30 years (1990-2020) compared with the average of the 30 year span a d

33、ecade earlier (1980-2010) Celsius Floods Global fl ood map Insect InfestationDesert locust risk maps Pandemics Vol. 2, No. 4, pp. 24-30 (https:/www.ncbi.nlm.nih.gov/ pmc/articles/PMC3729067/). 12. Shunichi Koshimura and Nobuo Shuto, “Response to the 2011 Great East Japan Earthquake and Tsunami Disas

34、ter,” Philosophical Transactions of the Royal Society A, 2015; Vol. 373, No. 2053 (https:/royalsocietypublishing.org/ doi/10.1098/rsta.2014.0373). 13. John Sparrow, “Japan: Red Cross intervenes as healthcare breakdown threatens tsunami survivors,” International Federation of Red Cross, May 11, 2011

35、(https:/www. ifrc.org/en/news-and-media/news-stories/asia-pacifi c/ japan/japan-red-cross-intervenes-as-healthcare- breakdown-threatens-tsunami-survivors/). 14. Ibid. 15. “2014-2016 Ebola Outbreak in West Africa,” Centers for Disease Control and Prevention, last reviewed March 8, 2019 (https:/www.cd

36、c.gov/vhf/ebola/history/2014- 2016-outbreak/index.html). 16. Sylla Thiam et al., “Challenges in controlling the Ebola outbreak in two prefectures in Guinea: Why did communities continue to resist?” Pan African Medical Journal, 2015 (https:/pubmed.ncbi.nlm.nih. gov/26740850/). 17. “The Organisation o

37、f Resilient Health and Social Care Following the COVID-19 Pandemic,” Publications Ofce of the European Union, April 2020 (https:/ec.europa.eu/ health/sites/health/fi les/expert_panel/docs/026_health_ socialcare_covid19_en.pdf); Sriram Shamasunder et al., “COVID-19 reveals weak health systems by desi

38、gn: Why we must re-make global health in this historic moment,” Global Public Health, July 2020; Vol. 15, No. 7, pp. 1083- 1089 (https:/ 441692.2020.1760915). 18. “Global Health Security Index: Building Collective Action and Accountability,” Johns Hopkins Bloomberg School of Public Health, October 2

39、019 (https:/www.ghsindex. org/wp-content/uploads/2019/10/2019-Global-Health- Security-Index.pdf). 19. Strategy Laura Dyrda, “The 5 most signifi cant cyberattacks in healthcare for 2020,” Beckers Health IT, December 14, 2020 (https:/ most-signifi cant-cyberattacks-in-healthcare-for-2020. html); Jessi

40、ca Davis, “UPDATE: The 10 Biggest Healthcare Data Breaches of 2020,” Health IT Security, accessed January 27, 2021 (https:/ the-10-biggest-healthcare-data-breaches-of-2020). 27. T.A. Kakyo and L.D. Xiao, “Challenges faced in rural hospitals: The experiences of nurse managers in Uganda,” Internationa

41、l Nursing Review, April 19, 2018 (https:/ 28. James I. Price and Alok K. Bohara, “Maternal health care amid political unrest: The efect of armed confl ict on antenatal care utilization in Nepal,” Health Policy and Planning, Vol. 28, No. 3, pp. 309-319, May 2013 (https:/ doi.org/10.1093/heapol/czs062

42、). 29. “Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016,” The Lancet, Vol. 391, 2018 (https:/ action/showPdf?pii=S0140-6736%2818%2930994-2). 30. “

43、Diabetes,” World Health Organization fact sheet, accessed January 27, 2021 (https:/www.who.int/news- room/fact-sheets/detail/diabetes). 31. “Mongolias Air Pollution Crisis: A call to action to protect childrens health,” UNICEF, February 2018, page 15 (https:/reliefweb.int/sites/reliefweb.int/fi les/

44、resources/ Mongolia_air_pollution_crisis_ENG.pdf). 32. “Asthma Disparities in America,” Asthma and Allergy Foundation of America, accessed January 27, 2021 (https:/www.aafa.org/asthma-disparities-burden-on- minorities.aspx). 33. “Diabetes Rates by Country 2021,” World Population Review, accessed Jun

45、e 9, 2021 (https:/ rates-by-country). 34. “Strengthening health-system emergency preparedness: Toolkit for assessing health-system capacity for crisis management,” World Health Organization Europe, 2012, Part 1 (https:/reliefweb.int/sites/reliefweb.int/fi les/ resources/Full%20Report_683.pdf); Part

46、2 (https:/www. euro.who.int/_data/assets/pdf_fi le/0010/157888/e96188. pdf). 35. P. Nsubuga, M.E. White, S.B. Thacker, et al., “Public Health Surveillance: A Tool for Targeting and Monitoring Interventions,” in D.T. Jamison, J.G. Breman, A.R. Measham, et al., editors, Disease Control Priorities in D

47、eveloping Countries, 2nd Ed., The International Bank for Reconstruction and Development/The World Bank, Oxford University Press, Chapter 53, 2006 (https:/www.ncbi. nlm.nih.gov/books/NBK11770/). 36. “Project Defend: New approach to national security aims to diversify supply and reshore manufacture,”

48、Institute of Export House of Commons, Business, Energy and Industrial Strategy Committee, “The impact of Brexit on the pharmaceutical sector: Ninth Report of Session 2017-19,” 2018 (https:/ publications.parliament.uk/pa/cm201719/cmselect/ cmbeis/382/382.pdf). 37. Leila Abboud and Michael Peel, “Covi

49、d-19 hastens French push to bring home medicines manufacture,” 44 Financial Times, July 29, 2020 (https:/ content/80a4836b-ca25-48e0-996d-458186e968dc); Carlo Martuscelli and Giorgio Leali, “Can the coronavirus bring back Europes pharmaceutical factories?” Politico, October 12, 2020 (https:/www.politico.eu/article/can- the-coronavirus-bring-back-europe-pharmaceutical- factories/). 38. “The U.S. Needs a Disaster Health Response System to Save Lives After an Emergency,” American Hospital Association, May 10, 2018 (https:/www.aha.org/news/ insights-and-analysis/2018-05-10-us-needs-disaster- he