The COVID-19 pandemic proved to be the greatest health crisis in a century. It highlighted how health systems are not resilient to shocks, with consequent impact on the global economy and global community. Even the most advanced health systems in the world were not resilient enough.

It is not known what the next crisis has in store for humanity – however, it is critical to make health systems ready for future shocks. There is urgency in ensuring that health systems can withstand current and future challenges.

This report recommends policy areas and investments to improve the resilience of health systems into the future, drawing on analyses of three major vulnerabilities health systems faced during the pandemic:

  • Health systems were underprepared. Pre-existing inequity and chronic diseases made the outcomes of the pandemic worse. Despite rhetoric of spending on health being an investment, not a cost, approaches had not changed significantly before the crisis. Health systems spent less than 3% of total health expenditure on prevention, leaving too many in the population vulnerable.

  • Health systems were understaffed. This constrained effective responses to the pandemic and continues to do so. A sufficient and well-trained workforce in health care and long-term care is necessary to promote agility in times of crisis, as well as to address the care backlog and meet the substantial increase in mental health needs.

  • Health systems suffered from underinvestment. Boosting the resilience of health systems requires investments and improved co-ordination and co-operation. This report recommends an annual targeted investment of 1.4% of GDP across OECD countries relative to expenditure in 2019, on health workforce, prevention and key infrastructure.

Beyond this investment, this report makes six recommendations to improve health systems resilience and to reduce the impact of future shocks:

  • Promote population health: vulnerable populations make for vulnerable health systems

  • Promote workforce retention and recruitment: people are the key to making systems resilient

  • Promote data collection and use: without the right data, decision makers are flying blind

  • Promote international co-operation: responses are better together than alone

  • Promote supply chain resilience: getting products and services when and where they are needed

  • Promote governance and trust: without trust, whole-of-society responses are less effective.

The pandemic proved that there are significant social and economic dividends from promoting health system resilience. Investing in resilience will give people better access to health services that they need, promoting their health and well-being and fostering their full participation in society.

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