# Healthcare system research shows key trends across countries

Global insights on building sustainability and resilience amid multiple crisesExploring evidence-based insights and recommendations on healthcare systems across seven key domains: financing, governance, workforce, medicines and technology, service delivery, population health, and environmental sustainability

COVID-19 exposed vulnerabilities in health systems worldwide. Despite the experience gained, the investments made, and the countermeasures now in place, many health systems are now in a much more perilous state than they were before the pandemic began. Without corrective action we risk our health systems entering a protracted process of decline, leaving them less able to meet populations’ needs, and more vulnerable to future crises. We cannot afford to delay the action needed to strengthen them. Research from the Partnership for Health System Sustainability and Resilience (PHSSR) highlights the need for a dual focus, emphasizing both resilience, and sustainability. We define these as: Health system sustainability: Sustainable health systems improve population health by continually delivering the key functions of providing services, generating resources, financing and stewardship, incorporating principles of financial fairness, equity in access, responsiveness and efficiency of care, and do so in an environmentally sustainable manner.Health system resilience: Resilient health systems are able to prevent, respond to, manage health system impact of, and recover and learn from, acute and chronic crises (including, but not limited to, pandemic threats, climate change and economic and technological shocks), minimising their short- and long-term impacts on health, social and economic wellbeing. On behalf of the PHSSR, leading country-based researchers studied healthcare systems in 18 countries* using a framework developed by the London School of Economics. This framework spans seven key domains; financing, governance, workforce, medicines and technology, service delivery, population health, and environmental sustainability. This framework helps to identify strengths, potential weaknesses, opportunities and risks for healthcare systems. In each country, the reports describe key recommendations that will inform sustained engagement with policymakers and health system stakeholders.Global research findingsThe PHSSR’s 2023 Summary Report synthesises the findings from the 18 countries to explores current challenges facing health services around the world, actionable recommendations and best practices across countries. Overall, the report’s findings underscore the need for both system resilience in the face of shocks and stresses, and sustainability amid longer-term demographic, social, technological, economic and environmental changes. Below are a few insight highlights from the report across some of the domains:  Financing: Financing healthcare is of paramount importance to ensure the resilience and sustainability of health systems, shaping systems’ abilities to sustainably provide comprehensive, quality care, provide financial protection and demonstrate resilience in the face of health crises and changing population needs. Financing mechanisms should provide universal coverage, protecting populations from the financial risks of ill health while ensuring that scarce resources are deployed equitably and to best effect, and that provider incentives are aligned with health system goals. From a resiliency perspective, defined systems for emergency financing are needed to provide confidence that health systems will be adequately resourced to respond to future crises.Workforce: In the long-term, the sustainability of the healthcare workforce is dependent on careful planning strategies which account for future needs and risks to supply of staff. Establishing data-informed national-level health workforce planning and coordination organizations will be key. Adequate incentives are needed to attract and retain staff and ensure their wellbeing. Expanding and optimising scopes of practice through policy and regulatory changes that enable task-shifting, and investing in the development of new healthcare roles, can shore-up healthcare systems long-term, and increase system resilience to crises.Service delivery: To improve citizen access and experiences, health services need to work together and have a strong emphasis on preventive care and primary care, rather than relying on expensive hospital-based care. Resilient service delivery models will require a higher degree of coordination to manage peaks in demand and have the system flexibility for increasing critical care capacity. Some of the priority recommendations from the Summary Report include: Adopt long-term health system budget planning that addresses social, economic and environmental factors and workforce needs Execute integrated non-communicable disease strategies that prioritise prevention and early detection  Improve working conditions, and expand training to ensure ‘skill-mixes’ are incorporated in the delivery of care   Utilise new technologies to reduce hospitalisations and improve access to high quality, innovative care Reduce socioeconomic inequalities through a "Health in all policies" approach  Download the full report The Summary Report offers a comprehensive analysis organised into chapters by domain, with each chapter first reviewing challenges identified in the 18 country reports, before moving onto strategies and recommendations for strengthening sustainability and resilience. Recognising the interconnected nature of the domains, we emphasise the importance of a holistic approach to health system strengthening. Tackling challenges in one domain often impacts the others and coordinated action across all domains is crucial for building resilient and sustainable health systems. Thus, common themes, such as the need to make better use of data, foster inter-sectoral collaboration, and strengthen prevention, are identified across multiple domains.  Finally, it is vital to recognise that health system reform is only one part of the puzzle. Healthcare is part of a spectrum of social and environmental protections that are needed for healthy populations, societies and economies. Nonetheless, we hope that these findings can contribute to collaborative learning processes to help inform policy and decision-making, allowing for more effective and efficient strategies for health system strengthening. In doing so, PHSSR aims to contribute to a healthier, more resilient, and prosperous future for all.  *Countries studied include Belgium, Brazil, Canada, England, France, Germany, India, Ireland, Italy, Greece, Japan, the Netherlands, Poland, Portugal, Saudi Arabia, Spain Switzerland, and Vietnam


### PHSSR Summary Report

[Download full report](https://www3.weforum.org/docs/WEF_PHSSR_Building_Sustainable_and_Resilient_Health_Systems_2023.pdf)


## PHSSR Summary Report Webinar Recording17 May 2023