Session 2

Session 2: Using appropriate methodologies and metrics to assess vulnerability & health system resilience and support equitable public health policies

This session was moderated by Dr. Ivalda Macicame, Director of Survey and Observation in Health, INS Mozambique.

Measurement approach to health systems resilience for public health

Dr. Sohel Saikat, Senior Advisor, Primary Health Care and Lead, Health Systems Resilience and EPHFs, WHO

Dr. Saikat reflected on how COVID-19 exposed deep weaknesses in global public health systems, especially for vulnerable populations.

Currently, monitoring of health systems for Universal Health Coverage, health security and wider public health is fragmented while capacity requirement for them are interdependent. WHO, in collaboration with partners like the Public Health Agency of Canada, reviewed prevailing monitoring tools from global to country levels and developed scope for integration, as well as dedicated package of indicators which member states and partners can adapt and apply to measure resilience in health systems from a public health perspective.

A new framework under WHO’s next program will emphasize multisector coordination, inclusion of public health in essential services, and workforce development across sectors to ensure long-term health system strength.

Sohel Saikat’s presentation (PDF)

Experiences of Mozambique in addressing appropriate metrics to assess the Vulnerability and Adaptation for the Health sector to Climate

Dr. Tatiana Marrufo, Program Lead of Environmental health, including the Occupational health, Instituto Nacional de Saúde, Mozambique

Dr. Marrufo explained that Mozambique has experienced significant natural disasters in the past 47 years, affecting its health system. That is why, in 2019, it was conducted the first Assessment of the Vulnerability and Adaptation of the Health Sector to the Climate Change (V&A). A methodology proposed by the WHO and IPCC was employed, utilizing historical climate, epidemiological, and socio-economic data (1979-2016) at the district level (162 districts) to determine the Health Vulnerability Index (HVI), resulting in a combination of selected and available indicators categorized in exposure, sensitivity and adaptive capacity components. The findings showed the country’s high vulnerability to climate change, and clearly a great urban/rural inequality that make it necessary for the health sector to be prepared to deal with this scenario, in the context of a changing climate.

Moving forward, Mozambique aims to expand assessments to health facilities and communities, train health professionals on climate risks, and support the integration of climate adaptation into national health plans, contributing to a more resilient and informed health system.

Tatiana Marrufo’s presentation (PDF)

Panel and engaging the audience: Using different methodologies and metrics to support and influence public health policies: country experiences

Dr. Carlos Hernandez Avila, Head of the governance and knowledge management unit at El Salvador’s National Institute of Public Health

Dr. Hernandez shared their experience with a multicentric project aiming at promoting social technologies. They became involved in it following the Petropolis workshop, Rio de Janeiro Brazil 2023. In particular, the project promotes participatory rapid diagnosis (PRA) and participatory mapping (PC), taking advantage of the presence of the figure of the health promoter in El Salvador. A first effort was made with the support and accompaniment of the Forum Itaborai /FIOCRUZ, during the year 2024, 17 health promoters were trained in these methodologies together with community leaders in a rural area near the capital of El Salvador, after which the initiative was presented to the Minister of Health with the aim of extending it to the whole country. As of April 2025, 83 health resources have been trained in primary health care, who are applying the methodology in one of the 17 organizational health structures (SIBASI SUR) that are responsible for a population of 135,000 people. These technologies make it possible to identify the social determinants of health, promoting community.

Carlos Hernandez Avila’s presentation (PDF)

Dr. Henk Hilderink, Top expert Public Health Foresight at RIVM (Netherlands National Institute for Public Health and the Environment)

Dr. Hilderink explained strategic foresight as being a proactive, systematic way of exploring multiple possible futures, including their uncertainties, challenges, and opportunities. Rather than predicting one outcome, it examines various societal, technological, environmental, geopolitical, and economic scenarios to help guide policy and build resilience. RIVM has been conducting public health foresight for over 30 years, producing long-term (25-year) outlooks to inform present-day decisions. Their approach blends methods like scenario building and modeling with extensive stakeholder engagement, involving not only researchers and policymakers but also communities and interest groups. Despite public health foresight still lagging behind sectors like climate and economics, RIVM’s work serves as a key foundation for evidence-based, foresight-informed policy that addresses complex, long-term health challenges.

Henk Hilderink’s presentation (PDF)

Dr. Mesay Hailu Dangisso, Director General of the Ethiopian Public Health Institute (EPHI)

Dr. Dangisso highlighted the central role the institute plays in Ethiopia’s public health emergency management, research, laboratory systems, and national data analytics. They support the Ministry of Health by generating evidence through research, surveillance, and analytics to inform policies and interventions. Its core mandates include public health research, emergency preparedness and response, lab capacity building, and national data management. The institute coordinates both national and sub-national emergency operations, conducts disease surveillance, and strengthens laboratory infrastructure for pathogen monitoring, genomics, and biosecurity. A key initiative is its national data management and analytics program, which produces high-quality data for decision-making and supports health sector strategies, including the Health Sector Transformation Plan and National Insurance Package.

Mesay Hailu Dangisso’s presentation (PDF)

Prof. Vernon Lee, Chief Executive Officer of Singapore Communicable Diseases Agency

, introduced the newly created agency. It brings together policy, research, operations, and clinical oversight under one roof to protect the population from infectious diseases. The agency focuses on preparedness, prevention, surveillance, and swift response, using a range of tools including mandatory notifications, syndromic and lab surveillance, genomic sequencing, and newer technologies like wastewater testing. One example is their comprehensive dengue control program. Despite a low mosquito index, dengue remains endemic, so the agency integrates surveillance with targeted interventions. This includes early clinical management to reduce hospitalizations and mortality, public engagement, and an innovative Project Wolbachia, where male mosquitoes infected with Wolbachia bacteria are released to suppress mosquito populations. A randomized trial showed this led to a 75% drop in dengue cases in targeted areas. With this success, releases have been scaled up nationally, and Singapore continues to combine vector control, community action, and surveillance to work toward potentially eliminating dengue in the future.

Vernon Lee’s presentation (PDF)

The session ended with a fruitful discussion with the audience.