Published: 2020-05-27 12:10 | Updated: 2020-05-27 13:05

Maintaining health services during challenges requires collaboration, flexibility and clear decision-making

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Key factors for health systems to maintain health services when faced with challenges are collaboration, clear decision-making for health system workers as well as flexible response plans, according to a new doctoral thesis from Karolinska Institutet.

Dell Saulnier, PhD student
Dell Saulnier, PhD student, Department of Global Public Health. Photo: Dell Saulnier

“My thesis looked at flooding in Cambodia to understand how floods change health needs and the health system’s capacity to manage those needs. We know that extreme weather events are expected to become more frequent as climate change continues. They can harm human health and shock health systems, challenging the system’s ability keep delivering health services. Resilient health systems have the capacity to continue providing health services to meet a diverse range of new and routine health needs following a shock, yet we are still discovering what it is that helps health systems be resilient,” says Dell Saulnier, at the Department of Global Public Health and author of the doctoral thesis. 

What are the most important findings? 

“We saw that floods can have a prolonged effect and increase both new and routine health needs, in the short-term and for up to two years. The health system in Cambodia appeared to have the capacity to absorb and adapt to manage these health needs but were helped by the local communities’ own abilities to take care of their needs.  

From our findings, we identified four ways that might help health systems be resilient: collaborating across health system levels and with other sectors and organizations; having clear relationships between system actors that create boundaries to the decisions they are allowed to take in their roles; having plans in place for responding to extreme weather events but letting those plans be flexible; and involving the community in decision-making in the health system to a greater degree.” 

Could the findings in your study be useful in other extreme events, such as the current COVID-19 pandemic? 

“We need to be prepared to address the collateral effects of the pandemic on healthcare utilization. I think there are a few straight-forward principles of resilience that health systems can adhere to, that will help them adapt to this ever-changing and prolonged situation; set clear roles and responsibilities for their workers – from clinicians to public health staff – that allows them to be flexible and confident in their decision-making; work closely with other sectors like education and with the local population when planning the health response, and; encourage clear, open, two-way communication with communities and between all levels of the system, from administrators and technicians to department heads and policy makers. 

How can this knowledge contribute to improving people’s health? 

“If we can help health systems finds ways to maintain health services for all kinds of health needs after extreme weather events, we will go a long way towards keeping people healthy following these events. Since we expect extreme weather events to become more frequent in the future, this type of knowledge could have far reaching impacts into the future.” 

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Dell Saulnier Affiliated to teaching/tutoring