Supporting a resilient health workforce: Lessons from health systems experiencing shocks

Resilient health systems depend on a resilient health workforce, especially in low- and middle-income countries (LMICs) experiencing shocks. However, there are gaps in evidence on how to support such a workforce. The aim of this paper is to draw together lessons on how the health system has supported health workforce resilience in LMIC settings experiencing shocks. This is a qualitative synthesis of eight studies that explored health systems responses to shocks. We re-analysed the data and identified health system responses to support the health workforce, categorising them as absorption, adaptation, transformation and maladaptation within a health systems resilience framework. We then identified the broader capacities that enabled deployment of these approaches. Most responses are absorptive and adaptive, focusing on rapid deployment of staff, training, and community, peer and supervisor support. Transformative responses were rare. There were several underlying health system capacities that enabled these responses. These included making best use of social networks and collaboration, distributed leadership, learning from previous shocks, robust and timely information systems providing data on health workforce and population needs, and health workforce governance structures and systems. This paper presents empirical examples of health system responses aimed at supporting health workers across a variety of LMIC contexts exposed to diverse shocks. Our analysis highlights a reinforcing dynamic: a resilient health workforce enhances the resilience of the overall health system, while a resilient health system, in turn, strengthens and sustains workforce resilience during periods of crisis. Establishing systemic mechanisms to protect and empower the health workforce is essential for advancing overall health system resilience.