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Etienne calls for increased investments, new research on how to make health systems effective, universal, and able to respond to epidemics and other threats

Washington, D.C., 16 November 2016 (PAHO/WHO) - One of the most critical lessons of the recent Ebola epidemic in West Africa was that weak health systems-those that cannot meet people's health needs in normal times-cannot cope effectively with epidemics or other health emergencies, said the Director of Director of the Pan American Health Organization (PAHO), Dr. Carissa F. Etienne, at the 4th Global Symposium on Health Systems Research, in Vancouver, Canada.

To ensure that health systems can respond to future health emergencies, absorb shocks, and adapt to changing demands, countries need to take action and make the necessary investments to make their health systems strong and resilient.

Photo: PAHO/WHO, A. Silva. Dr. Carissa F. Etienne, PAHO Director, speaking at the 4th Global Symposium on Health Systems Research, in Vancouver, Canada.

"Preparedness requires more than emergency plans and simulation exercises," said Etienne. "It means strengthening core aspects of health systems, from human resources and access to medicines, to health information systems and even legal measures to support public health action."

Etienne's remarks were made before an audience of more than 2,000experts on health policy and health systems at the 4th Global Symposium on Health Systems Research, taking place this week in Vancouver. The symposium is cosponsored by Health Systems Global, PAHO, the World Health Organization, the Alliance for Health Policy and Systems Research, the Canadian Society for International Health, Canada's International Development Research Centre, and the Canadian Institutes of Health Research.

Investing in health systems resilience is "considerably more cost-effective" than financing emergency response and is likely to better protect people's health and well-being in both emergencies and normal times, said Etienne.

"Fragile health systems increase the vulnerability of populations to external risks that impact health and well-being, health protection, and ultimately social and economic development," she said. "Again and again we see this, through epidemics of H1N1 influenza, chikungunya and Zika virus; through earthquakes in Chile and Ecuador; hurricanes in Haiti and the Bahamas; and through the effects of climate change on health."

In September, health leaders from PAHO member countries endorsed a new framework for efforts to ensure that health systems are more resilient in future health emergencies. The "Resilient Health Systems" framework notes that more than 98 million people in the Americas were affected by disasters between 2004 and 2014, that the recent chikungunya epidemic sickened more than 1.6 million people, and the Zika epidemic had such a serious health impact that the World Health Organization declared it a "public health emergency of international concern." 

To ensure that health systems are prepared for such emergencies, the framework calls for integrated action and increased investments in disaster preparedness, risk reduction, and response; disease surveillance and outbreak management; and health system strengthening and universal health.

"We know that a fragmented approach is not enough," said Etienne during a panel discussion on resilient health systems. "We need to address both traditional disaster and disease risks as well as longer-term internal and external risks that affect the ability of health systems to respond well in both normal times and during health emergencies."

Research on strong health systems

To be effective, efforts to build strong, resilient health systems must be based on evidence from research in a range of areas. "Evidence generated must ensure that healthcare delivery systems of the future are of better quality, are universally accessible, and are more transparent, democratic, and responsive," said Etienne.

A central goal of this research should be to identify what are the characteristics of resilience in health systems. The results could lead to the development of "stress tests" that can assess health systems' response capacity and identify weaknesses that need to be addressed.

Getting started on this kind of research is especially urgent because the process of building resilient health systems will take time.

"Building health systems with the right attributes does not happen overnight. It requires long-term political, social, and economic stability and a broad commitment from countries to invest in health and development," said Etienne. "We must work together to find solutions."

PAHO, founded in 1902, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO.


- 4th Global Symposium on Health Systems Research
- Countries of the Americas seek stronger, more resilient health systems to cope with epidemics and other health emergencies
- PAHO "Resilient Health Systems" framework