Building resilience into our public health system

THE EDITOR, Madam:

In the aftermath of the devastation caused by hurricane Melissa, there are many emotions that have been expressed, ranging from grief, hope and faith, to gratefulness for life and community. However, resilience, although expected on a personal level, is not automatic and might not be inherited. It must be built into the systems that we have.

Among the inescapable realities associated with health systems that must be taken into consideration are: (a) The cultural context in which the health systems were developed; (b) The history that informed their development; (c) The political system that informs or drives them; and (d) The economic structure, including funding and resources, that supports them. For health systems to be successful, they must be accessible, affordable and provide high quality clinical care, patient-centred focus, efficient in operations, effective in preventive care, have a strong workforce management, robust data analysis, and coordinated care across different providers. Further, they must have embedded a commitment to continuous improvement while considering unique needs of the populations being served, and while addressing the various determinants of health.

The Sendai Framework (UN Office for Disaster Risk Reduction) defines resilience as “ the ability of a system, community or society exposed to hazards to resist, absorb, accommodate, adapt to, transform and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management.” Equally crucial are non-technical inputs—community trust, leadership adaptability, risk communication, and social cohesion – that determine how well populations buy into and support interventions. Without these, even the most well-stocked facility or system can fail under stress.

Some ‘structural deficits’ in the local health system that can hinder the effective diagnosis and surveillance of emerging and re-emerging diseases might be rooted in aspects of governance and financing issues, human resource challenges, limited infrastructure, and data management weaknesses. Two aspects of the national surveillance system come to mind. The first is the apparent incomplete reporting from healthcare providers that might affect the ability of the National Surveillance Unit to know the true scope of health problems. One can only wonder why leptospirosis, an endemic disease in Jamaica that has caused several outbreaks in the past, and is now topical post-Melissa, is not a reportable disease included in the information shared in the Weekly Epidemiology Bulletin. Perhaps, even more quizzical, is the inclusion of yellow fever. The second is the absence of the Veterinary Service Division (Ministry of Agriculture, Fisheries and Mining) and The University of the West Indies in discussions about leptospirosis, two entities that have been pivotal in diagnosis and research on the disease, since it was first reported in Jamaica in 1953. It is time for a multi-pronged approach to infuse resilience.

PAUL D. BROWN, JP, PhD

pdbrownjm@gmail.com