Healthcare access at the heart of system resilience
by Lorna Rothery · Open Access GovernmentZisis Kozlakidis and Cyrine Badji from the World Health Organization’s International Agency for Research on Cancer explore how health system resilience depends on equitable access to care, examining how geographic, socioeconomic and institutional barriers affect services
Health system resilience is often viewed as a necessity for low-income settings, where health services must continue functioning despite recurrent shortages, instability and long-term institutional pressures. In these contexts, resilience is commonly associated with the ability to maintain care despite limited fiscal, workforce, infrastructural and supply-chain capacity. However, this framing can create the impression that resilience is mainly a concern for countries with fewer financial resources. In reality, high-income health systems can also be vulnerable, especially when they depend on complex technologies, specialised workers, imported products, digital systems and highly interconnected institutions.
Financial resources may increase what a health system can potentially do, but they do not automatically prove that the system can continue providing safe and equitable access to healthcare services. Here, we explore the inter-relationship between health system resilience and healthcare access, highlighting key elements at the intersection of the two, with examples from the field of cancer.
The synergistic impact of barriers
According to the World Health Organization, health system resilience is ‘the ability of a health system exposed to a shock to resist, absorb, accommodate and recover from the effects of the shock in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management’. (1) Therefore, a genuinely resilient health system should be assessed not only by whether hospitals remain physically open during instability, but by whether people have access and can continue to receive the care they require over time. Rural residence, long travel distances, limited transport and the uneven distribution of specialist services can create significant barriers, particularly where health infrastructure is already constrained. Geography, however, rarely operates independently. It typically compounds socioeconomic disadvantage, lower health literacy, limited access to primary care and other structural factors, contributing to differences in cancer risk, screening participation, stage at diagnosis and survival.
Emerging evidence from global health research points to the importance of understanding these inequalities as ‘place-based and interconnected’. (2) Thus, for example, communities experiencing both socioeconomic deprivation and geographical isolation may have, as a result, greater exposure to certain cancer risk factors while having fewer opportunities to benefit from prevention and early detection. At the same time, this synergistic view explains why single changes or innovations are unlikely to provide a paradigm shift, but rather a point solution that would subsequently need to be connected to several other solutions to be as impactful as possible. Addressing these disparities as part of resilience research, therefore, requires consideration not only of whether services exist, but also whether they are accessible, affordable, acceptable and appropriate for the populations they are intended to serve.
Rebuilding confidence
The complexity of the barriers affecting healthcare access is likely to shape perceptions of limited progress and, therefore, maintain limited trust in the healthcare system. This latter element, trust, is especially important in communities affected by weak infrastructure or previous negative experiences with healthcare systems. Low access to healthcare services should not necessarily be viewed simply as a lack of awareness. It may reflect concerns about safety, confidentiality, affordability, discrimination or the perceived quality and reliability of the services themselves. Rebuilding confidence in a similar way requires collaboration among many stakeholders and engagement with communities and trusted local organisations, along with clear, culturally appropriate communication.
For example, local healthcare workers and community organisations also play an important role in rebuilding confidence in healthcare access because they know patient needs, transport barriers, local languages, and available resources. They may maintain referrals, deliver medicines, identify high-risk patients and support outreach when formal services are interrupted. Additionally, professional networks and informal systems, such as personal contacts, can also contribute to continuity. These systems are flexible, making them useful especially when formal procedures are delayed, but they may also be inconsistent or unequal. Therefore, effective informal practices should be assessed and formalised where appropriate and where possible. (3) The recent addition of mobile and outreach services, community-based prevention, self-sampling and appropriately designed digital approaches in several healthcare systems has extended access where conventional healthcare infrastructure is limited.
Overall, health system resilience in high-income settings should be reframed as the demonstrated ability to convert financial, technological and institutional resources into safe, equitable and continuous healthcare during instability. Wealth and advanced infrastructure in particular are enabling resources, but they are not proof of resilience by themselves. In less-affluent settings, digitalisation may underpin many solutions that increase access and, eventually, resilience. However, the broader objective is to develop health systems in which geographical location and socioeconomic circumstances have less influence on cancer outcomes. This requires approaches that combine prevention and early detection with accessible, timely and high-quality treatment, while creating healthcare environments that are trusted and responsive to local needs. Such approaches can improve cancer outcomes while also strengthening health systems and supporting broader population health and wellbeing.
References
- World Health Organization. “Health Systems Resilience.” WHO Regional Office for the Eastern Mediterranean, 2019. Accessed 8 August 2026.
- McGowan, Victoria J., et al. “Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review.” BMC Public Health 21.1 (2021): 1888.
- Barasa, Edwine, et al. “What Is Resilience and How Can It Be Nurtured? A Systematic Review of Empirical Literature on Organizational Resilience.” International Journal of Health Policy and Management, vol. 7, no. 6, 6 Feb. 2018, pp. 491–503, https://doi.org/10.15171/ijhpm.2018.06.