The Global Centre for Risk and Innovation (GCRI)
A health system keeps working through a shock when its staff, power, water, medicines, data and referral routes hold together long enough for essential care to continue. Continuity fails at the weakest of these dependencies, often far from the hazard itself. This page sets out how disruption develops and propagates through services, how continuity is measured, and what the evidence serves for the institutions that must keep care running.
Health system continuity is the ability of a health system to keep essential care running through a shock, which holds only while staff, power, water, medicines, data and referral routes hold together. Continuity fails at the weakest dependency, often far from the hazard, and the indirect toll of missed care can exceed the direct one.
The working screen behind this subject: its structure, terms and states. Names are placeholders and values illustrative.
Hospitals, staff, power and essential services. The dossier below sets out how the risk develops, what is measured, where the data come from, how it is modelled and who decides.
A facility depends on grid power, piped water, medical oxygen, fuel, communications and supply deliveries. Losing one rarely stops care at once: generators, stored water and buffer stock buy time, and the binding constraint is whichever buffer runs out first.
Staff absorb surges through overtime, redeployment and task shifting, but illness, displacement, caring duties and unpaid salaries erode that capacity. A system that loses staff loses services even when its buildings and supplies are intact.
During an epidemic or disaster, routine immunisation, maternal care, chronic disease management and mental health services are deferred or abandoned. The indirect harm from interrupted care appears later than the direct harm of the shock and is counted less often.
A system still recovering from one event meets the next with depleted staff, stock and finance. Heat during an outbreak, or conflict during a flood, stacks the pressures, and recovery lengthens with each overlapping shock.
Each term as this page uses it. Where a standard-setting body defines the term, the wording follows that body.
| Term | Definition |
|---|---|
| Essential health services | The services a health system must sustain during an emergency, such as emergency care, maternal and child health, and treatment for chronic conditions. |
| Surge capacity | A health system's ability to expand care quickly beyond normal capacity in staff, space, supplies and systems. |
| Tracer medicine | A medicine whose availability is tracked as a signal of the wider supply of essential medicines in a facility. |
Each indicator carries its unit, its cadence, the kind of source behind it and the evidence label a value would carry. No values are shown: a programme supplies them under its own authority.
| Indicator | Unit | Cadence | Source type | Label |
|---|---|---|---|---|
| Essential health service disruption | percent of tracer services reported disrupted | per survey round | Key informant national and facility surveys | REPORTED |
| Routine service volume against expected | ratio of observed to expected visits | monthly | Routine health information systems such as DHIS2 | ESTIMATED |
| Facilities with reliable electricity and water | percent of facilities | per assessment | Facility surveys such as SARA and SPA | OBSERVED |
| Backup power and water endurance | hours of autonomous operation | per facility | Facility asset registers | OFFICIAL |
| Health worker density | doctors, nurses and midwives per ten thousand population | annual | National health workforce accounts | OFFICIAL |
| Unfilled shifts | percent of rostered shifts unfilled | weekly | Hospital human resources records | OBSERVED |
| Tracer medicine stock-out | percent of facilities reporting a stock-out | monthly | Logistics management information systems | REPORTED |
| Bed occupancy and surge capacity | percent occupied; additional beds deployable | daily | Hospital bed management systems | OBSERVED |
The topic as a computational graph: named sources feed the methods, an evidence review gates the outputs, and the decisions stay with the authorities that hold them.
Fig. 02Nodes carry their type, two metric rows and a state; connectors show what feeds what; dashed frames name the owners; the timeline is the cadence. Design of the pipeline, not a record of a run.
Named public datasets and institutional records, each with its licence class. Sources by agreement are used only under their terms and never republished.
| Source | What it gives | Licence class |
|---|---|---|
| WHO pulse surveys on continuity of essential health services | National reports of service disruption, its causes and mitigation across tracer services | Published records, WHO terms of use |
| DHIS2 national health information systems | Routine facility reporting of service volumes, stock and workforce | By agreement with each ministry of health |
| WHO SARA and DHS Service Provision Assessment surveys | Facility readiness: power, water, equipment, staff, diagnostics and medicines | Terms per survey programme |
| WHO National Health Workforce Accounts | Health workforce stock, distribution and flows by cadre | Open, attribution, WHO terms of use |
| WHO HeRAMS | Functionality, accessibility and service availability of facilities in emergencies | By agreement; public summaries |
| WHO Global Health Expenditure Database | Health spending by source of financing and function | Open, attribution, WHO terms of use |
Health Nexus prepares evidence. The decisions below are taken by the authorities named, under their own rules, and never by the platform.
| Who decides | The question | Evidence this page serves |
|---|---|---|
| Ministries of health | Which essential services must be protected first in a shock, and with what reserve capacity | Tracer-service disruption patterns; dependency maps; workforce and stock buffers by district |
| Hospital boards and managers | Where to invest first: backup power, water storage, oxygen supply or surge staffing | Endurance hours by dependency; stress tests by facility and scenario |
| Finance ministries and development partners | How much contingency financing keeps services running, and how fast it must flow | Continuity scenarios with service losses stated apart from the direct impacts of the shock |
| WHO regional offices and national public health institutes | Where to deploy surge teams and supplies when several countries are affected at once | Comparable continuity evidence across countries, with reporting completeness labelled |
Continuity starts from services, not buildings.
Hospitals are designed with redundancy, but redundancy is usually sized for single failures of limited duration. Extended or compound events, such as a regional outage during a heatwave, can exhaust backup fuel, overheat equipment and wards, and coincide with a surge in patients. Small dependencies with no substitute, such as a single medical gas supplier or a laboratory information system, can halt whole departments.
Workforce is often the binding constraint. Staff are themselves affected by the event, may be unable to travel, and fatigue quickly under surge conditions. Continuity also degrades gradually rather than failing outright: elective activity is cancelled first, then standards of care are adjusted, and harm accumulates among patients whose treatment is delayed.
| Method or data | What it shows | Limits |
|---|---|---|
| Facility dependency mapping | Which services rely on which utilities, suppliers and systems | Depends on accurate internal data that facilities may not hold or share |
| Business impact and maximum tolerable outage analysis | How long each service can be interrupted | Tolerances are judgements and vary with case mix |
| Exercises and after-action reviews | How plans perform with real people | Exercises rarely test long or compound disruptions |
| Discrete-event and agent-based simulation | Queues, bed occupancy and staff load under surge | Results are sensitive to behavioural assumptions |
| Routine activity and outcome data | Deferred care and excess harm after events | Attribution to the disruption needs careful causal design |
The current service level is R0: information and enquiries. An enquiry receives a reference and names the next step; applications, payments, compute allocations and registrations open only when their team, terms and review capacity exist.