The health systems resilience: notes for a research agenda for the SUS

ABSTRACT The COVID-19 pandemic highlighted the resilience of health systems. In this paper, we seek to explore elements to support a research agenda on resilience for the Unified Health System (SUS). First, based on a scoping review, we analyzed the conceptual and methodological development of resilience applied to health systems research both at international and national levels, identifying who the formulating groups are and what they propose as analytical frameworks. Then, we propose an analytical framework adapted for the Brazilian health system features. The framework underpinned the pointing out of critical issues to be investigated in research on SUS resilience, based on four dimensions: governance and leadership, financing, resources (workforce, infrastructure, medicines, and technologies), and service provision. Finally, we discuss opportunities and challenges for implementing a research agenda on resilience for the SUS.

摘要 新型冠状病毒肺炎（COVID-19）大流行凸显了卫生系统韧性（resilience）。本研究旨在探索可支撑统一卫生系统（Unified Health System，SUS）韧性研究议程的相关要素。首先，本研究基于范围综述（scoping review），分析了韧性在国际及国家层面卫生系统研究中的概念与方法学发展历程，明确了相关研究的制定主体及其提出的分析框架。随后，本研究结合巴西卫生系统的实际特点，提出了适配的分析框架。该框架基于四大维度明确了SUS韧性研究中亟待探索的关键议题：治理与领导力、筹资、资源（人力资源、基础设施、药品与技术）以及服务提供。最后，本研究就推进SUS韧性研究议程的机遇与挑战展开了讨论。