Shocks

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept.Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience.  Four  databases  and  gray  literature  were  searched  using  the  keywords  “health  system”  and  “resilience”  for  published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization  (WHO)  health  system  framework.  The  scoping  review  identified  eleven  sources  with  descriptions  and  24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience.Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience  primarily  focus  on  major  shocks.  Adjustments  to  long-term  changes  and  the  element  of  learning  should  be  considered  for  a  better  understating  of  health  system  resilience.

Food security is a dynamic concept, which has continuously integrated new dimensions and levels of analysis over the years; this reflects the wider recognition of its complexities in research and public policy issues. Food security is achieved when all people, at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life. Food insecurity occurs at individuals, households or nation level that has neither physical nor economical access to the nourishment they need. Food insecurity is an enduring, critical challenge in Ethiopia which is Africa's second populous country after Nigeria. The 2015 El Niño drought is one of the strongest droughts that have been recorded in Ethiopian history were more than 27 million people became food insecure and total population of 18.1 million people require food assistance in 2016. As indicated by Africa Food Security and Hunger Multiple Indicator Scorecard, Ethiopia ranked first in having the highest number of people in state of undernourishment which is 32.1 million people in 2014. World Food Program found long-term effects of chronic malnutrition cost Ethiopia approximately 16.5 percent of its GDP in each year. The number of food insecure people in the country increasing from time to time; which was estimated to 2.9 million in 2014 and 4.5 million in August, 2015 and by the end of the same year this figure had more than doubled to 10.2 million food insecure people. Drought and land degradation, population pressure, instability and armed conflict are major sources of food security problems in Ethiopia. To cope with these problems Ethiopian people use sale of livestock, agricultural employment, and migration to other areas, requesting grain loans, sales of wood or charcoal, small scale trading and limiting size and frequency of meal as major coping mechanisms.