Table 1 Sustainability and resilience—summary of key findings by PHSSR domains presented in [33]
Domain (key references) | Sustainability | Resilience | ||
|---|---|---|---|---|
| Â | Strengths | Weaknesses | Strengths | Weaknesses |
Clear governance enables decision-making | Low accountability Underdeveloped policy evaluation Fragmented information systems | A command-and-control system enabling rapid decision-making, and inter-sectoral cooperation through the pandemic | Political resoluteness Often reactive rather than proactive pandemic responses Weak contingent planning | |
Risk pooling and universal coverage | Excessive out-of-pocket Systematic budget deficits driving retrospective financing | New financial policy measures were adopted to address the pandemic | Reactive spending under the pandemic Lack of needs consideration for financial reforms | |
Strengthening of human resources after the pandemic | Lack of financial incentives and pay Low professional satisfaction No strategic planning High shortage of doctors in some medical specialities | High adaptability during the pandemic Redeployment and sharing of human resources | Unsustainable extra costs during the pandemic Mental health issues | |
Effective cost containment measures on pharmaceutical expenditure Established HTA | Delays in access to therapeutic innovation Low level of R&D Low evaluation of technologies Financial pressure from hospital medicines | Adaptability and increase in telemedicine use Effective COVID-19 vaccination strategy and delivery based on telephone consultations | Financial risk related to health technology innovation Most telemedicine is based on telephone consultations | |
Extensive primary care network Emergence of more integrated delivery models | Hospital-centric response to inadequacies in primary care Geographic inequities in healthcare Low focus on health promotion and prevention | A sharp increase in telehealth consultations during the pandemic Flexible private supply complementary to the NHS | Heavy decline in consultations during the pandemic Increase in surgical waiting times | |
| Â | Sustainability and resilience | |
|---|---|---|
Strengths | Weaknesses | |
Good performance regarding infant mortality and preventable and treatable mortality Low barriers to healthcare Widespread health programmes in schools Overall high immunization in the population | High burden of disease and low quality of life among older people High inequalities and inequities in health determinants Low health in lifestyle-related indicators | |
Ongoing initiatives and legal framework supporting environmental sustainability Some initiatives for environmental sustainability led by the Ministry of Health in hospitals reaching maturity | Environmental sustainability measures are most centred in hospitals and focused on energy, water and waste Lack of policy actions Lack of assessment of policy benefits and costs | |