The health systems resilience: notes for a research agenda for the SUS

Paschoalotto, Marco Antonio Catussi; Lazzari, Eduardo Alves; Castro, Marcia C.; Rocha, Rudi; Massuda, Adriano

doi:10.1590/0103-11042022E812I

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Brasil

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ESSAY • Saúde debate 46 (spe8) • Dec 2022 • https://doi.org/10.1590/0103-11042022E812I copy

The health systems resilience: notes for a research agenda for the SUS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The COVID-19 pandemic highlighted the resilience of health systems. In this paper, we seek to explore elements to support a research agenda on resilience for the Unified Health System (SUS). First, based on a scoping review, we analyzed the conceptual and methodological development of resilience applied to health systems research both at international and national levels, identifying who the formulating groups are and what they propose as analytical frameworks. Then, we propose an analytical framework adapted for the Brazilian health system features. The framework underpinned the pointing out of critical issues to be investigated in research on SUS resilience, based on four dimensions: governance and leadership, financing, resources (workforce, infrastructure, medicines, and technologies), and service provision. Finally, we discuss opportunities and challenges for implementing a research agenda on resilience for the SUS.

KEYWORDS
Health system research; Health system resilience; Resilience; Unified Health System

Opportunities

Different international initiatives are seeking to expand the scope of analysis of studies on resilience of health systems in different countries

International collaboration for the development of studies that explore the resilience of health systems in the context of countries with socioeconomic inequalities and health systems with great fragmentation, as is the case in Brazil

Contributions from the Brazilian academy in the development of analysis models using references from collective health, particularly from the social and political sciences, and health management planning developed in the process of Brazilian health reform and the construction of the SUS

International collaborations can be of great value to update and strengthen national SUS evaluation initiatives

Challenges

Lack of international studies on the resilience of health systems with realities similar to the Brazilian one, such as Turkey, Mexico and South Africa

Complexity of the conformation of the Brazilian health system, which, despite having universality and comprehensiveness as principles of the SUS, coexists with chronic low funding, fragile regional organization and the presence of a strong private subsystem that competes with the public system

There is still no national consensus on the importance of studies on the resilience of health systems, in comparison with studies already developed on health systems.

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