# Re-evaluating the Conceptual Framework of Health System Resilience: Insights From Economic Sanctions: Comment on "Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic"

## TL;DR

This paper examines how the concept of health system resilience applies under economic sanctions and during the pandemic, suggesting ways to improve the framework.

## Contribution

The paper identifies gaps in the current health system resilience framework related to equity and monitoring under economic sanctions.

## Key findings

- The CFHSR domains cover most strategies from economic sanctions and pandemic responses.
- Equity and teamwork aspects are missing from the current resilience framework.
- Monitoring consequences is absent in both ES and pandemic experiences.

## Abstract

Health system resilience in the context of economic sanctions (ES) is an underexplored area. We used data from recent studies on the impact of ES on the health systems to cross-reference and assess the applicability of the conceptual framework of health system resilience (CFHSR). Reviewing the interventions implemented under ES and aligning them with the CFHSR and COVID-19 responses, we found that the CFHSR domains encompass most strategies from the ES and COVID-19 studies. However, CFHSR does not cover several strategies related to equity and teamwork. Additionally, monitoring the consequences is missing from the experiences of COVID-19 and ES. The CFHSR appears to be reasonably effective in categorizing strategies for both COVID-19 and ES. Nonetheless, its domains can be further refined. Specifically, incorporating an intersectional equity lens could enhance this conceptual framework. The next step is to develop a practical guide to apply CFHSR to strengthen health system resilience.