Resilient Health Systems Appraisal Measure (ReHSAM) Data Collection Tool

Turning the concept of health system resilience into action means embedding it in the health system operations and daily decisions. To this end, the authors proposed 69 resilience standards in a prior study and subsequently translated those standards into a decision support tool, presented in this document: The Resilient Health System Appraisal Measure (ReHSAM). ReHSAM was developed through a sequential, three-phase approach. First, scoping review synthesized evidence from 2014-2024 on measuring health system performance and resilience in fragile, low-income contexts. Second, a best-fit framework approach synthesized these findings with evidence from existing policy frameworks and measurement practices. Through an iterative inductive deductive process, emerging concepts were analyzed to develop a conceptual framework, the Resilient Health System Appraisal Model. Third, the framework was translated into a measurement tool that integrates principles from performance management and implementation science.

ReHSAM indicators are scored on a four-level scale: Level 1 (score 1) represents nascent resilience capacities, while Level 4 (score 4) indicates mature capacities. Level 0 (score zero) is assigned when no data is available. The measurement tool, ReHSAM, was subsequently applied in 2025 to assess the resilience of health system in Sudan at two timepoints. Findings are reported by indicator and resilience standard.
ReHSAM is designed to assess health system resilience through a whole-of-system approach, rather than evaluating isolated building blocks. It is equally important to note that ReHSAM is designed for formal state health systems where governance structures exist or are recognized as necessary. As such, the tool doesn’t capture the resilience of a informal system operating outside the formal state apparatus.