Last week over 200 people came together in Washington, D.C. to tackle the complex problem of understanding the role of communities in building resilient health systems.The format of Cracking the Nut events has been successful for the past five years in grappling with topics in the agriculture and finance sectors—all complicated, evolving issues that are tough to crack.

Resilient health systems are made of resilient individuals and organizations.

The prevailing framework for understanding resiliency in the context of health systems, Michael Meyers of the Rockefeller Foundation said during his opening remarks, is one derived from the 2015 Lancet article by Margaret E Kruk and others. It outlines the characteristics of a resilient health system within the context of the Ebola crisis: aware, adaptive, diverse, self-regulating, and integrated.Throughout the two days, we grappled with issues of scale, replicability, equity, sustainability, cost-effectiveness, evidence, and market dynamics. We delved into country-level initiatives, ranging from those in fragile states such as Liberia and Afghanistan to those in countries that are already benefiting from significant private-sector engagement, such as Ghana, Kenya, and Nigeria.There is no universal or simple solution, but as I discussed in my closing remarks at the event, there are five principles at the heart of all resilient health systems: 

1. Resilient health systems are made of resilient individuals and resilient organizations able to solve problems, make informed decisions, and have access to the tools and resources they need. This includes the health workers on the front lines of the Ebola crisis. The nursing student who had access to a loan to stay in school when her mother died. Or the tuberculosis program manager who better tracks cases using a new diagnostic tracking technology.
2. Building resiliency requires long-term systems development, but short-term wins are both possible and promising. These quick wins, which can lead to long-term commitments and investment, are most likely to happen where trust exists among diverse stakeholders, especially those most affected by an ongoing situation, and where all parties are willing to be flexible and adapt to changing realities.
3. The data revolution brings great promise for building resiliency—as well as the need to maximize the powerful potential of information. Who owns health sector-related data? Are stakeholders, especially at the community level, empowered to use data to inform meaningful action? In short, access to and use of information must be transparent, and both bottom-up and top-down.
4. Resilient health systems benefit from enhanced technological platforms that have advanced ecosystems based on community needs, rather than on the latest devices. The Principles for Digital Development serve as an essential and ethical set of guidelines for anyone engaged in introducing a technological tool. These nine principles grew out of a consultation with key global development partners and are endorsed by over a hundred agencies.
5. Resilient health systems are living, breathing organisms that change over time, responding to the environment in times of crisis as well as times of calm. We should see crises as an opportunity for learning, but also continue to prepare for the next crisis. Many of the sessions last week illustrated the importance of interconnectivity, breaking down silos and communication barriers, and recognizing that every community is its own evolving ecosystem.

Do these principles resonate with you? What else do we need to crack the nut of resilient health systems?