RESUMO
Health system resilience is a prerequisite for effectively managing cataclysmic events adversely affecting health outcomes. The COVID-19 pandemic reasserted the importance of having resilient health systems and called for a relook at the existing framework that measures health system resilience. Mixed methods were used in this study. The review started with the measurement of health systems resilience and its context. Ebola epidemic triggered the importance, hence our search focused on published literature from 2014 to 2021. Based on the review, a semi-structured tool was developed for key in-depth interviews of seven experts from different countries. The frameworks focused on climate change, disaster management, health systems, city-specific resilience, and e-resilience were reviewed. In-depth interviews highlighted that resilient health systems need to engage the private sector, priority areas like leadership and governance, health resources, and a unified agenda for global collaboration. From experts' point of view, the inherent nature of health systems to respond to shock was clearly defined as the resilient health system. Health systems resilience definition needs to be defined, based on which assessment indicators will be identified. Indicators need to evolve continuously and be able to measure resilience at sub-national, national, regional, and global levels.
RESUMO
BACKGROUND: Many countries, including India, seek locally constructed disease burden estimates comprising mortality and loss of health to aid priority setting for the prevention and treatment of diseases. We created the National Burden Estimates (NBE) to provide transparent and understandable disease burdens at the national and subnational levels, and to identify gaps in knowledge. METHODS: To calculate the NBE for India, we combined 2017 UN death totals with national and subnational mortality rates for 2010-17 and causes of death from 211â166 verbal autopsy interviews in the Indian Million Death Study for 2010-14. We calculated years of life lost (YLLs) and years lived with disability (YLDs) for 2017 using published YLD-YLL ratios from WHO Global Health Estimates. We grouped causes of death into 45 groups, including ill-defined deaths, and summed YLLs and YLDs to calculate disability-adjusted life-years (DALYs) for these causes in eight age groups covering rural and urban areas and 21 major states of India. FINDINGS: In 2017, there were about 9·7 million deaths and 486 million DALYs in India. About three quarters of deaths and DALYs occurred in rural areas. More than a third of national DALYs arose from communicable, maternal, perinatal, and nutritional disorders. DALY rates in rural areas were at least twice those of urban areas for perinatal and nutritional conditions, chronic respiratory diseases, diarrhoea, and fever of unknown origin. DALY rates for ischaemic heart disease were greater in urban areas. Injuries caused 11·4% of DALYs nationally. The top 15 conditions that accounted for the most DALYs were mostly those causing mortality (ischaemic heart disease, perinatal conditions, chronic respiratory diseases, diarrhoea, respiratory infections, cancer, stroke, road traffic accidents, tuberculosis, and liver and alcohol-related conditions), with disability mostly due to a few conditions (nutritional deficiencies, neuropsychiatric conditions, vision and other sensory loss, musculoskeletal disorders, and genitourinary diseases). Every condition that was common in one part of India was uncommon elsewhere, suggesting state-specific priorities for disease control. INTERPRETATION: The NBE method quantifies disease burden using transparent, intuitive, and reproducible methods. It provides a simple, locally operable tool to aid policy makers in priority setting in India and other low-income and middle-income countries. The NBE underlines the need for many more countries to collect nationally representative cause of death data, paired with focused surveys of disability. FUNDING: Ministry of Health and Family Welfare, Government of India.