The pandemic has exposed the inequalities and weaknesses within some of the world’s finest healthcare systems. An initiative to ensure healthcare systems develop the resilience and sustainability they need has begun.


Millions of patients have suffered as a direct consequence of contracting COVID-19, but billions will suffer indirectly because of the impact on the delivery of routine care. Years of progress in cancer care was undone by just months of the pandemic. The previously already long waiting lists for elective surgery are now unachievable, and maternity care standards have fallen.

Driven by a commitment to improving healthcare delivery and global health the World Economic Forum, the London School of Economics and AstraZeneca have formed the Partnership for Health System Sustainability and Resilience (PHSSR).

“From new models of care, to innovative financing mechanisms and breakthrough technologies, PHSSR aims to make change happen, by identifying transferable solutions with the greatest potential, and supporting their adoption to deliver better health and better care for all.”

The first stage of this initiative was to pilot a framework designed to analyze the sustainability and resilience of health care systems. In late March a global summit was held, where the results of the eight pilot countries were presented. Leading experts from these countries, the Organization for Economic Co-operation and Development, and the World Health Organization joined to discuss the results, their implications and the future of health care.


The PHSSR framework has been developed to enable a rapid assessment of health system sustainability and resilience. The members of PHSSR agreed on definitions for both health system sustainability and resilience, see below.

A country’s health system sustainability and resilience are assessed through the following five domains:

  • Health system governance
  • Health system financing
  • Health system workforce
  • Medicines and technology
  • Health service delivery

A set of qualitative indicators and questions relating to aspects of each domain which are considered as important contributors to sustainability and resilience of healthcare systems were developed by the team. Using the example of financing, particularly universal coverage and fair financing of health systems, examples of indicators of health system sustainability and resilience include:- universal coverage for essential health services, needs based access (rather than ability to pay), and low out of pocket payments.

Applying this new framework allows for a quick yet thorough judgement of a country’s position regarding the goal to build a sustainable and resilient health systems in a post-pandemic world.

Sustainability within a health system, a definition:A health system’s ability to continually deliver the key health system functions of providing services, generating resources, financing and stewardship, incorporating principles of fair financing equity in access and efficiency of care in pursuit of its goals of improving population health and responsiveness to the needs of the population it serves.”

Resilience within a health system, a definition:A health system’s ability to absorb, adapt to, learn and recover from crisis born of short term shocks and accumulated stresses, in order to minimize their negative impact on population health and disruption caused to health services.”

The PHSSR summit presented not only the country specific findings but also drew upon the overarching findings, such as improving the effectiveness of care delivery and optimization of care delivery with digitalization. Thus, helping to ensure resilience and sustainability within health systems.


A big topic for the PHSSR summit was the consequence of the COVID-19 pandemic on the detection of non-communicable diseases (NCDs) i.e. those which are not passed from human to human. As previously mentioned, one of the major consequences of the pandemic has been, and remains, the effects on healthcare provision particularly NCDs, with cancer detection as an example.

One of the Sustainable Development Goals is to reduce premature deaths due to NCDs by one third by 2030. Currently one in three deaths caused by NCDs affects people between the age of 30-69. NCDs are the most common cause of premature death in Switzerland, examples being heart failure, cancer and kidney disease. Early detection of disease is often crucial to five-year survival rates and quality of life. Thorough screening processes can have a dramatic impact. To tackle the impact of NCDs on society strategic responses to ensure timely treatment are needed. The summit reported the need to maximize common efforts to deliver affordable, people-centered and integrated responses to co-morbidities, and to include disease prevention, early diagnosis, screening and appropriate treatment in public health services. Taking cardiovascular disease as an example, this could include; health taxes on tobacco, alcohol and sweetened beverages, population-wide campaigns and widely supporting NCD prevention by building healthy cities with infrastructures that support physical activity.


The pandemic has, much like the impact of war on surgery, fueled an incredible progression of digitalization in healthcare including a rapid acceleration in the use, and acceptance, of telemedicine, as discussed by EY’s Global Health leader, Aloha McBride (Has COVID-19 triggered a sprint toward smarter health care | EY – Global). The PHSSR summit emphasized that this is but a start, and great transformations placing digital at their heart are required. Enabling digital technologies will help to improve access to care, decrease costs and improve outcomes, but clear reimbursement pathways are very much needed.


The COVID-19 pandemic has been a universal threat to our health and wellbeing. It has highlighted the deficiencies and flaws in health systems across the globe. Diseases have not stopped for the pandemic, cancers continue to grow, and chronic illnesses persist.  Only 1% of the world bank bailout would be required to improve health care across the world. Growing and nurturing resilience and sustainability in our health systems is needed, and we do not have the freedom not to invest in health.

Through our global brand, client network, and experience, EY has a lot to offer, be it in helping to build a more resilient health care supply chain, developing financial sustainability, business transformation and tools for evaluating efficacy of change.

The partnership, focusing on ensuring resilience and sustainability in healthcare, is inviting expressions of interest, further collaboration and expansions to ensure global reach. For those wishing to learn more and/or are interested in contributing to PHSSR’s mission please visit, and indeed do please join the this years’ FutureHealth Basel conference which focuses on; digitalization of healthcare, sustainable business models and leadership.