Strengthening health systems through the Partnership for Health System Sustainability and Resilience (PHSSR)

Using the PHSSR research framework the Indian health system was analysed across seven domains: governance, financing, workforce, medicines and technology, service delivery, population health, and environmental sustainability, the PHSSR and local research team contributed insights to help build a more resilient future for India’s health system and pave the way to universal health coverage.

The PHSSR country report stressed the importance of integrated infrastructure for e-health records. As a result, Japan included the development of a digital platform for collecting and sharing medical information in the ‘Honebuto’ – the set of guidelines used to inform Japan’s economic and fiscal policy. This digital platform will support making guideline-based therapeutic decisions and detecting patients at early stages of their diseases.

With Malaysia predicted to transition from middle-income to high-income status in the next ten years, it is critical to further strengthen the health system, so that it is equipped to go beyond meeting basic health needs to also deliver holistic and preventive healthcare.

The PHSSR Malaysia report policy recommendations include:

• Expanding and financing the structures which support civil society and non-governmental organisations, to help promote healthy lifestyles, fill workforce gaps, and deliver care at the community level
• Investing in and developing the workforce, using technology to mobilise volunteers and social workers
• Leveraging the full potential of data and technology in healthcare delivery, decision-making and ensuring interoperability
• Integrating disease burden projections into health budgeting and operational planning to prepare for future shocks and challenges

With high National Health Insurance coverage, a robust workforce and a community-based, integrated care system, overall, South Korea is widely considered to deliver positive population health outcomes and high life expectancy. However, its rapidly super-aging society poses challenges and there are critical areas for improvement.

The PHSSR South Korea report offers actionable, evidence-based policy recommendations to address several areas, including:

• Workforce deficiencies in primary care – changes are needed to support the aging population and tackle the rise in chronic diseases
• Low birth rates
• Assigning a higher weighted value to professional medical advice in decision-making
• Establishing a legal framework and guidelines for telemedicine solutions

Following the PHSSR policy recommendations on driving sustainability, health equity, and efficiency across Taiwan’s health system, the Taiwan Alliance of Patients’ Organizations and Global View Magazines held an expert forum in Taipei on Taiwan’s healthcare system resilience leveraging the PHSSR framework.

The event shone a spotlight on how Taiwan’s health system is addressing various challenges, including an aging population, the rise in chronic diseases, population health, and sustainable health system financing.

In Vietnam, the PHSSR recommendations led to the signing of a Memorandum of Understanding (MoU) with the government to support fiscal sustainability for the Vietnamese health system. Under the MoU, Health Technology Assessment (HTA) training workshops and policy dialogues have been set up with key stakeholders to build HTA capacity and capability in the health system.

Brazil’s unified health system (Sistema Único de Saúde, or SUS) is one of the largest and most comprehensive public health systems in the world. But there are challenges within such a large system: achieving health equity across Brazil’s large and diverse population, leveraging public health data more widely and ensuring the system is capable of withstanding future crises.

The PHSSR Brazil report outlines research and evidence-informed policy recommendations to tackle these challenges.

Canada's health system, though seemingly resilient in a post-pandemic world, faces long standing and deep-rooted issues that demand attention. From workforce burnout to coverage reform, there's a pressing need to revitalise the health system for a sustainable future.

The PHSSR Canada report outlines policy recommendations to address key challenges:

• Workforce crisis marked by burnout, poor retention and geographic distribution challenges, threatening resilience to respond to future shocks
• Gaps in healthcare coverage, barriers to access to healthcare and coordination of care, contributing to health inequities
• Slow pace of change due to lack of alignment among key stakeholders in the health system.

With non-communicable diseases (NCDs) accounting for 90% of deaths in the EU, it is vital that prevention and early detection are placed at the heart of EU health policies.

The EU PHSSR Expert Advisory Group formulated recommendations for EU institutions in its first policy report, focused on how best to support the efficiency of health systems and improve patient outcomes.

Belgium’s health system has many strengths, and the local population reports being generally satisfied with the system and the quality of care it provides. However, there remain weaknesses and challenges to address, and several reforms aimed at improving the health system’s sustainability and resilience are already ongoing.

The PHSSR Belgium report provides 70 evidence-informed policy recommendations designed to deliver better population health outcomes by addressing key issues:

• Fragmentated health policies and ambiguous value criteria leading to inefficiencies and inconsistent resource allocation
• Low wellbeing of healthcare professionals causing burnout and high turnover rates
• Challenges in balancing the integration of advanced technological solutions versus maintaining the essential human connections necessary for healthcare delivery

The UK experienced one of the highest death rates attributable to COVID-19 globally and understanding lessons for the future sustainability and resilience of the National Health Service (NHS) is vital.

The PHSSR England report makes 21 recommendations across five key domains from the PHSSR research framework: governance, health system financing, workforce, medicines and technology, service delivery, to strengthen the NHS. Recommendations include:

• Clarifying and strengthening mechanisms for coordination of preparedness
• Taking a more long-term perspective, to avoid the unintended consequences of targeting short-term efficiency gains
• Protecting physical and mental wellbeing of health and social care staff
• Increasing investment in diagnostic infrastructure and the workforce

The PHSSR undertook a rapid review of the French health system to support health system strengthening. One of the key learnings is the opportunity to transform health care by maximising the full potential of early diagnosis and intervention – to prevent non-communicable diseases (NCDs) from progressing, keep patients out of hospitals, improve access to innovation and to reduce the carbon footprint of the health sector.

The PHSSR analysed the German health network to identify key factors impacting sustainability and resilience (during the COVID-19 pandemic), focused on five key domains in the PHSSR research framework: governance, financing, workforce, medicines and technology and service delivery.

A key finding from the PHSSR Germany report was the need for robust data and quantifiable goals to create more sustainable and resilient health systems. Based on this recommendation, the Sustainability Index was developed, including 267 quantitative indicators, to assess the sustainability of the German healthcare system. The Index is updated every year to show progress and support local policy shaping.

In Greece, the government is acting on the PHSSR policy recommendations to expand screening for chronic kidney disease (CKD) and lung cancer, amongst other disease areas, by establishing a pilot lung cancer screening programme and new e-health system functionalities to allow for earlier detection of CKD. This will help to manage the burden of chronic disease, improving the sustainability and resilience of the Greek health system.

The PRESTO report was a unique collaboration between the RESTORE project and the PHSSR. Unlike other countries, this project produced an Irish case study conducted with no funding from private sector sources, drawing on in-depth and independent Irish analysis related to health system resilience.

The PHSSR Italy report calls for improved chronic disease management, which has led to the launch of a public-private collaboration to evaluate patient pathways for diseases such as diabetes, Chronic Obstructive Pulmonary Disorder (COPD) and severe asthma, with the ultimate goal being to ensure strategic investments deliver the greatest value for patients and the health system

In the Netherlands, the Ministry of Health has leveraged the PHSSR to determine the policy direction for the government. The PHSSR has also brought together healthcare policy makers on several occasions to discuss ways to strengthen the healthcare system. Pressing issues such as the financial stability of the Dutch health system, mechanisms to sustainably finance care and cure, and the growing workforce shortages underline the critical need for a robust and adaptable health system.

After two years of the COVID-19 pandemic, the Portuguese National Health Service (NHS) was on the brink of collapse. Drawing on recent health policy-related data, the PHSSR network presented 40 recommendations to help prepare the country for future crises, focused on the seven domains outlined in the PHSSR research framework: governance, financing, workforce, medicines and technology, service delivery, population health and social determinants, and environmental sustainability. Some of the evidence-based policy recommendations include:

• Adopting multi-annual budgets
• Investing in population-based screening and early diagnosis
• Investing in health promotion
• Supporting medical device reprocessing

The Swiss health system experienced the strongest shock in the last 100 years due to the COVID-19 pandemic. Attention shifted from a previous focus on increasing healthcare costs to a focus on ICU capacities, vaccine availability, an overburdened workforce and responsibility for overseeing the pandemic response.

As the pandemic faded out, new crises have arisen. The PHSSR Switzerland report reflects on the overall sustainability and resilience of the health system and presents 26 recommendations. Several projects are currently underway to implement the report’s findings.

Spain experienced one of the highest death rates attributable to COVID-19, and understanding the factors that led to this and learning the lessons from the policy failures is crucial for the future sustainability and resilience of the Spanish health system (Sistema Nacional de Salud, SNS).

The PHSSR Spain report looks at key determinants of sustainability and resilience across five of the domains outlined in the PHSSR research framework: governance, health system financing, workforce, medicines and technology, and service delivery.

Following the publication of the PHSSR Poland report, the Polish Ministry of Health applied the PHSSR research framework, to evaluate its long-term health strategies. Poland was one of the eight pilot countries where health system resilience was assessed in five key domains: governance, health system financing, workforce, medicines and technology and service delivery.

The PHSSR Egypt report was launched during the Global Congress on Population Health and Development in Cairo, highlighting the key strengths and weaknesses of Egypt's health system.

Some of the key policy recommendations outlined in the report include:

• Building on existing political support and the focus on healthcare outlined in Egypt Vision 2030, to provide universal coverage, leveraging the new Universal Health Insurance system
• Utilising Egypt’s strong partnerships with international health organisations, to strengthen environment and health policies
• Accelerating digitisation and data analytics sharing

Abu Dhabi is a leading example of the rapidly evolving healthcare landscape in the Middle East. The Emirate’s commitment to innovation is demonstrated by the notable expansion of the health sector, which provides a comprehensive suite of modern healthcare services, as well as universal health coverage for all residents. Local healthcare regulators and stakeholders are proactively expanding the adoption and accessibility of digital solutions, health services and innovative technologies, such as AI.

The PHSSR Abu Dhabi report was developed in close collaboration with the Department of Health Abu Dhabi (DOH) and provides insights into the local health system, including recommendations on how to strengthen its sustainability and resilience.

The PHSSR Pacific Island report looks at the strengths and weaknesses of health systems across Pacific Islands, focusing on the Marshall Islands, Tonga, and Vanuatu.

Health system challenges in the Pacific Islands are connected to broader regional challenges around governance and financing. Achieving sustainability and resilience in the region depends on national, regional, and global commitments across health, economic, and ecological systems.