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Resilience for Social Systems-Health: An Innovative Approach to Analyze Resilience of Health Systems

Updated: Feb 12

MSD Hub editor's note (Michael Field, Senior Systems Specialist, Vikāra Institute):

This blog provides an overview of GOAL’s Resilience for Social Systems (R4S) framework. Similar to other MSR frameworks, the R4S framework uses systems lenses to gain a better understanding of how risks are identified, prioritized and managed. Through the use of their R4S, GOAL can work with communities on practical ways to improve their capacity to manage risks related to known and knowable shocks and stresses that are more proactive. What is interesting about GOAL’s approach is their recognition that all human systems, including market systems have a social element, which is an important influencer on how risks related to shocks and stresses are managed.


Daniel Muhungura, Roving Health Advisor, GOAL Programme Technical Team (PTT) along with colleagues Katende Robert, Systems Analysis and Design Advisor, GOAL Global Partnership Centre and Fiona Mitchell, Markets Advisor, GOAL PTT, attended the Markets Systems Symposium (MSS) in Cape Town, South Africa from 14th – 16th November 2023. The annual MSS brings industry leaders, experts, and visionaries together to exchange ideas, foster collaboration, and shape the future of market systems and this year the Symposium prioritised three key themes; Climate Change & Adaptation, Conflict-Affected Contexts and Food Security and Food Systems. Daniel presented on ‘Resilience for Social Systems-Health: An Innovative Approach to Analyze Health Systems Resilience in Fragile and Conflict-Affected Settings (South Sudan)’ at the Symposium.

In the following sections, we will delve deeper into the concept of Resilience for Social Systems (R4S) as presented by Daniel. Our exploration aims to shed light on the significance of this innovative approach and its role in advancing our understanding of health systems in challenging environments.

What is R4S?

R4S is a practical step-by-step method to analyse the resilience of socio-economic systems and how these systems react to shocks and stresses. Societies are comprised of various socio-economic systems, including health systems, which serve a population's needs. Communities living in fragile and conflict-affected areas tend to be served by systems that are highly susceptible to shocks and stresses.

Building resilient health systems requires a systemic approach

R4S helps us to understand how different system components interact and assesses their impact on the resilience of communities against shocks and stresses.

The R4S approach includes a risk analysis feature that helps communities anticipate how hazards may cause shocks. It equips them to prepare for these shocks, mitigate their adverse effects, and maintain their essential functions.

Applying R4S facilitates the creation of innovative interventions that strengthen system resilience by addressing root causes, leading to improved community well-being in the face of shocks and stresses. As a result, communities become more resilient and inclusive.

The R4S approach is structured into five key components:

  1. Identification and selection of the social and economic system

  2. Mapping the current system

  3. Identification of risk scenarios

  4. Resilience analysis and synthesis of the system considering the six determinant factors of resilience (DFR)

  5. Participatory monitoring, evaluation, and learning – including program design for interventions to build resilient systems. Finally, feedback loops are built to ensure programs are adaptively managed.

Source: GOAL’s R4S manual

R4S Mapping Tool

One of the key innovations in R4S is its mapping tool, which aims to enhance the comprehension of complex socio-economic systems. This tool facilitates the analysis of healthcare delivery systems beyond the outcomes and supply chain, providing a more holistic understanding. The mapping shows the key actors supporting and regulating the system’s core functions. It shows how various systems, including water, transport, communication, financial, etc., interact with the health system to ensure it is robust and resilient.

R4S Risk Analyses

R4S provides guidance on analysing risk scenarios that affect communities and socioeconomic systems. The framework identifies six determinant factors of resilience (DFR): governance, diversity, redundancy, connectivity, learning, and participation. DFR allows for a deeper understanding of the resilience of various aspects of the health delivery system. Once the risk scenarios and DRF analysis are mapped, they show how the system is vulnerable to different shocks and stresses, making it a powerful tool. Another advantage of this mapping is the visualisation of how actors’ actions, or absence of them, affect the system's ability to withstand hazards – underpinning the level of its vulnerability.

During the visioning process, an ideal map is created to depict where the systems should be in the future. This acts as a guide for project identification and management.

The R4S framework, as presented by Roving Health Advisor Daniel Muhungura, offers a practical and systematic method for assessing socio-economic systems' resilience to shocks and stresses. The five key components of R4S, including mapping tools and risk scenario analysis, provide a holistic understanding of healthcare delivery systems. The framework's unique features, such as the six determinant factors of resilience, enable visualisations of vulnerabilities and support adaptive management. R4S emerges as a powerful tool, equipping communities to strengthen resilience and contribute to more inclusive and resilient societies. GOAL's commitment to comprehensive solutions for complex healthcare challenges is evident in the structured approach and mapping tool integrated into the R4S framework.

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