‘We have a plan for that’: a qualitative study of health system resilience through the perspective of health workers managing antenatal and childbirth services during floods in Cambodia

ObjectiveHealth system resilience can increase a system’s ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding about what generates and influences resilience. This study aimed to generate empirical knowledge on health system resilience by exploring how public antenatal and childbirth health services in Cambodia have absorbed, adapted or transformed in response to seasonal and occasional floods.DesignA qualitative study using semi-structured interviews and thematic analysis and informed by the Dimensions of Resilience Governance framework.SettingPublic sector healthcare facilities and health departments in two districts exposed to flooding.ParticipantsTwenty-three public sector health professionals with experience providing or managing antenatal and birth services during recent flooding.ResultsThe theme ‘Collaboration across the system creates adaptability in the response’ reflects how collaboration and social relationships among providers, staff and the community have delineated boundaries for actions and decisions for services during floods. Floods were perceived as having a modest impact on health services. Knowing the boundaries on decision-making and having preparation and response plans let staff prepare and respond in a flexible yet stable way. The theme was derived from ideas of (1) seasonal floods as a minor strain on the system compared with persistent, system-wide organisational stresses the system already experiences, (2) the ability of the health services to adjust and adapt flood plans, (3) a shared purpose and working process during floods, (4) engagement at the local level to fulfil a professional duty to the community, and (5) creating relationships between health system levels and the community to enable flood response.ConclusionThe capacity to absorb and adapt to floods was seen among the public sector services. Strategies that enhance stability and flexibility may foster the capacity for health system resilience.

Risk-Based Criticality Assessment for Smart Critical Infrastructures

Today, critical infrastructure is more interconnected, which allows more vulnerabilities in the case of disasters. In addition, the effect of one infrastructure can lead to one or more cascading failures in another infrastructure due to the dependency complexity between them. This article introduces a holistic approach using network indicators and machine learning to better understand the geographical representation of critical infrastructure. Previous work on a similar model was based on a single measure; such as in fashion, this paper introduces four measures utilized to identify the most vital geographic zone in the city. The model aims to increase resilience, focusing on the preparedness phase by assessing the essential nodes of infrastructure, which allows more space to adopt risk mitigation strategies before any disturbance event. Holding in-depth knowledge of the vital zones of small scales and accordingly ranking them will positively improve the overall system resilience.

Spatio-Temporal Pattern and Influence Mechanism of Cultivated Land System Resilience: Case from China

The study of cultivated land systems from the perspective of resilience is of great significance for the innovation of the research paradigm of cultivated land use and the rational utilization and protection of cultivated land. This study aims to explain the theoretical connotations of cultivated land system resilience (CLSR), construct an evaluation system and zoning rules for CLSR, and take 30 provinces of China as case study areas to explore the influencing factors of CLSR, so as to provide a reliable governance plan for the sustainable development of cultivated land. The results show that: (1) CLSR refers to a sustainable development ability that CLS—by adjusting the structure and scale of internal elements—absorbs and adapts to internal and external disturbances and shocks to the maximum possible extent, abandons the original inapplicable state, creates a new recovery path, achieves a new balance, and avoids system recession. (2) The overall CLSR of the 30 provinces showed an upward trend, and the degree of polarization of the distribution pattern was gradually intensified and experienced a transition process from “leading by resource and ecological resilience—equilibrium of each resilience—leading by production and scale structural resilience”. (3) In the north, east, and south coastal areas of China, CLSR mainly consists of the major evolution areas and the stable development areas; the potential excitation areas of CLSR are mainly concentrated in the central and western regions of China; the CLSR-sensitive lag areas and degraded vulnerable areas are mainly distributed in the northwest and southwest of China. (4) Water resource endowment has a strong influence on CLSR, while social economy mainly influences CLSR through ‘economic foundation-superstructures’ and ‘economic development-factor agglomeration’. (5) According to the different CLSR zones, CLSR was strengthened mainly from the aspects of driving factor agglomeration, building factor free-flow systems, and multi-means support.