BRHI Building Resilience in Health Infrastructure: An indicator-based framework to assess overall hospital resilience

Health infrastructure plays a pivotal role during and after crises, providing life-saving care and supporting community recovery. To fulfill this critical function, health facilities must remain resilient, and capable of adapting and maintaining services despite challenges. This document introduces a comprehensive framework for assessing the resilience of health infrastructure. It is designed to guide humanitarian organisations, local authorities, and health stakeholders in understanding and enhancing the capacity of health systems to withstand and recover from disruptive events. Developed under the Humanitarian Action Challenge (HAC) research program on “Building Resilience in Health Infrastructure” , a collaboration between ETH Zurich and the International Committee of the Red Cross (ICRC), the framework offers a structured approach to resilience assessment. It integrates system representation, service measures, resilience indicators, and resilience estimation, enabling informed decision-making to prioritize interventions. System Representation: The framework maps key components influencing resilience—such as human resources, supply chains, the built environment, and organizational structures—and identifies critical factors, like staff-to-patient ratios and backup power capacity. Service Measures: Defines measurable outcomes reflecting the health facility's performance post-crisis, such as patient survival rates and service recovery time. Resilience Indicators: Links facility performance to resilience, using baseline scenarios to gauge the impact of changes in infrastructure or operations. Resilience Estimation: Simulates the effects of specific disruptive events on service delivery, highlighting areas for improvement. This framework is tailored to humanitarian settings, ensuring relevance in contexts of conflict and protracted crises. It serves as a decision-support tool, empowering stakeholders to address vulnerabilities and strengthen the resilience of health systems holistically. The framework is expected to provide a clear structured high-level overview of the resilience of hospital systems and facilitate decision-making as to which actions should be taken to improve resilience.