High Health System Performance, Low Health System Resilience: Navigating Vulnerability – an illustrative example using Small and Island States

While health system vulnerability and resilience are gaining traction among even the best-performing health systems in high-income countries, low-income countries have been concerned with such issues for some time. Small and island states grapple with substantial challenges, including being uniquely vulnerable to exogeneous shocks including climate disasters and economic shocks, which impact health system functionality and population health. As shocks are increasing in frequency and severity, S&IS may provide lessons applicable to high-income health systems.

We investigate health system performance and resilience in fourteen African small and island states. Acknowledging the distinction between health system performance and resilience, we assess whether these states experience greater vulnerabilities compared to other African countries. We then examine if this heightened vulnerability has led these states to prioritise strengthening their health system resilience.

We undertake a quantitative cross-country analysis of health system vulnerabilities and resilience. We explore the bivariate correlations between measures of country-level vulnerability, various measures of health system performance and health system resilience.

While African S&IS exhibit strong health system performance, they are disproportionately exposed to exogeneous shocks. Despite this, African S&IS have less resilient health systems compared to their larger, less vulnerable counterparts. This underscores the importance of distinguishing between health system performance and resilience.

This suggests a potential policy failure if African S&IS are unaware of their level of risk exposure or have not enacted appropriate policies to counter these risks. Many health system vulnerabilities are dynamic, in the face of growing vulnerabilities, policy-makers must actively build health system resilience.