Resilience in Times of Health Crises: An Analytical Model to Better Understand the Complexity in Fragile States
The case of the first Ebola virus disease epidemic in Guinea, between 2013 and 2016, revealed the organizational failures of Guinean institutions in crisis management and the dependence on international technical and financial partners. Many researchers have blamed the deficits in terms of resilience to explain the difficulties in managing the crisis. This article aims to explore how to improve the resilience to strengthen the management of health crises in Fragile States. Data collection for this qualitative study was carried out in the post-Ebola period in 2017, through semi-structured interviews, observation of crisis management or post-crisis recovery events, and an in-depth literature review. In this paper, we present the best practices to strengthen health crisis management in Fragile States and discuss our three-dimensional model to improve resilient health crisis management in Fragile States. This model highlights that the management of epidemics is based on an initial state and a specific context; but also on intra-organizational and inter-organizational dimensions since several organizations must collaborate. The last dimension of the model makes it possible to assess health resilience according to the 5 characteristics of Kruk et al. (2015), or awareness, diversity, self-regulation, integration and adaptability.