Building resilient health systems: lessons from international, national and local emergency responses to the Ebola epidemic in Sierra Leone. (360G-Wellcome-205326_Z_16_Z)

The response to the Ebola epidemic has challenged the dominant paradigm of gradual health systems strengthening, led by national governments and supported by international actors. It poses difficult questions about what kind of responses are helpful in situations when sudden shocks appear to overwhelm already fragile health systems and deplete limited resources. Over the last 12 months, the Ebola epidemic has revealed a lack of resilience in the health systems of affected countries, demonstrating an inability to recover from shocks and mount effective responses. We ask: In what ways has the international Ebola-response affected Sierra Leone's health system and its ability to withstand future shocks? How can international, national and local emergency response mechanisms be utilised to build a resilient health system in Sierra Leone, and what lessons emerge? Our findings will offer the potential to promote a major shift in the global health systems debate, from one narrowly focused on health system strengthening, to a focus on building health systems that are strong as well as resilient. The study will explore what needs to happen at each systems level, what capacities need to be created at local, district and national level, and what role international actors should play. To address these questions, we bring together a multidisciplinary team with extensive expertise in a range of highly relevant, but currently largely separate, bodies of scientific scholarship: health systems/health systems strengthening; policy and implementation science; disaster risk reduction/emergency preparedness; and the anthropology of global health and medical humanitarianism. Explicitly bringing together these often separate bodies of learning will enable us to more fully and effectively answer our principal research questions, identify transferable lessons and contribute to generating substantive health systems research evidence relating to what promotes resilient health systems.