Enhancing Global Health System Resilience and Sustainability Post-COVID-19: A Grounded Theory Approach

Darmadi Darmadi, Zhanna R. Gardanova, Maria V. Mikhailova, Zahraa H. Al-Qaim, Evgeniy V. Kostyrin, Mikhail E. Kosov, Marina V. Vasiljeva


Based on a grounded theory approach to healthcare professionals’ experience, this study conducted a qualitative assessment of new opportunities and provided a conceptual justification of forward-looking trends of global health system efficiency improvement and resilience toward universal health in the post-COVID-19 era. The data were collected through semi-structured interviews, while theoretical saturation was reached after 20 interviews with international experts in Global Health System Resilience (psychologists, nurses, and community health consultants). The data were analyzed using four coding stages: initial, focused, axial, and theoretical. The results showed that to achieve global health system resilience toward universal health and safety coverage in the post-COVID-19 era, it is required to develop a strategy including the support of healthcare professionals, which allows coping with the emotional and psychological impact of the pandemic. Moreover, opportunities for professional development and collaboration can enhance their resilience and adaptability during and after crises. The findings suggest factors of global health system resilience ranked using the AHP method. The present research provides a valuable insight into the significance of telemedicine, remote care, and ensuring the safety of the healthcare industry and patients as the most crucial factors for enhancing health system sustainability. This article provides new policy recommendations to ensure the long-term effectiveness and sustainability of health systems.


Doi: 10.28991/ESJ-2023-07-06-011

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Global Health System Resilience; Health System Sustainability; Public Health; Post-COVID-19 Era; Health Management Efficiency; Healthcare Technology; Grounded Theory Approach.


W.H.O. (2021). Building Health Systems Resilience for Universal Health Coverage and Health Security during the COVID-19 Pandemic and Beyond: A Brief on the WHO Position. World Health Organization (WHO), Geneva, Switzerland. Available online: https://www.who.int/publications/i/item/WHO-UHL-PHC-SP-2021.01 (accessed on November 2023).

W.H.O. (2020). Glossary of Health Emergency and Disaster Risk Management Terminology. World Health Organization (WHO), Geneva, Switzerland. Available online: https://www.who.int/publications/i/item/9789240003699 (accessed on November 2023).

Preston, S. H., & Bank, W. (1994). World Development Report 1993: Investing in Health. Population and Development Review, 20(2), 464. doi:10.2307/2137529.

W.H.O. (2005). International Health Regulations (3rd Ed.). World Health Organization (WHO), Geneva, Switzerland. Available online: https://www.who.int/publications/i/item/9789241580496 (accessed on November 2023).

Wenham, C., Katz, R., Birungi, C., Boden, L., Eccleston-Turner, M., Gostin, L., Guinto, R., Hellowell, M., Onarheim, K. H., Hutton, J., Kapilashrami, A., Mendenhall, E., Phelan, A., Tichenor, M., & Sridhar, D. (2019). Global health security and universal health coverage: From a marriage of convenience to a strategic, effective partnership. BMJ Global Health, 4(1), 1145. doi:10.1136/bmjgh-2018-001145.

OECD. (2023). Ready for the Next Crisis? Investing in Health System Resilience. Organisation for Economic Cooperation and Development, OECD Publishing, Paris, France. doi:10.1787/1e53cf80-en.

Donskikh, O. A. (2021). Moral and Ideological Consequences of Pandemic. The Beacon: Journal for Studying Ideologies and Mental Dimensions, 3(2), 020510125. doi:10.55269/thebeacon.3.020510125.

Sokolov, E. V., & Kostyrin, E. V. (2022). Social Financial Technologies for the Development of Large-Scale Healthcare Systems and the Russian Economy. 2022 15th International Conference Management of Large-Scale System Development (MLSD). doi:10.1109/mlsd55143.2022.9934748.

Greenberg, N., Brooks, S. K., Wessely, S., & Tracy, D. K. (2020). How might the NHS protect the mental health of health-care workers after the COVID-19 crisis? The Lancet Psychiatry, 7(9), 733–734. doi:10.1016/S2215-0366(20)30224-8.

Kathirvel, N. (2020). Post COVID-19 pandemic mental health challenges. Asian Journal of Psychiatry, 53, 102430. doi:10.1016/j.ajp.2020.102430.

Banerjee, D., Vaishnav, M., Sathyanarayana Rao, T. S., Raju, M. S. V. K., Dalal, P. K., Javed, A., Saha, G., Mishra, K. K., Kumar, V., & Jagiwala, M. P. (2020). Impact of the COVID-19 pandemic on psychosocial health and well-being in South-Asian (World Psychiatric Association zone 16) countries: A systematic and advocacy review from the Indian Psychiatric Society. Indian Journal of Psychiatry, 62(9), S343–S353. doi:10.4103/psychiatry.IndianJPsychiatry_1002_20.

Wang, X., Wong, Y. D., & Yuen, K. F. (2021). Rise of ‘lonely’ consumers in the post-covid-19 era: A synthesised review on psychological, commercial and social implications. International Journal of Environmental Research and Public Health, 18(2). doi:10.3390/ijerph18020404.

Filindassi, V., Pedrini, C., Sabadini, C., Duradoni, M., & Guazzini, A. (2022). Impact of COVID-19 First Wave on Psychological and Psychosocial Dimensions: A Systematic Review. Covid, 2(3), 273–340. doi:10.3390/covid2030022.

Sohn, J. N. (2021). Impact of Covid-19 Pandemic on Mental Health and Associated Risk Factors. Journal of Southwest Jiaotong University, 56(5), 213–224. doi:10.35741/issn.0258-2724.56.5.20.

Moskovkin, V. M. (2020). Do We Need a Great Reset? COVID-19, Black Revolution, Inequality and Common Good. The Beacon: Journal for Studying Ideologies and Mental Dimensions, 3(1), 011310115. doi:10.55269/thebeacon.3.011310115.

Mamelund, S. E., & Dimka, J. (2021). Not the great equalizers: Covid-19, 1918–20 influenza, and the need for a paradigm shift in pandemic preparedness. Population Studies, 75(S1), 179–199. doi:10.1080/00324728.2021.1959630.

Rao, G., Singh, A., Gandhotra, P., Meraj, P., Jauhar, S., Kuvin, J., Epstein, L., Naidu, S., Arora, R., Kaplan, B., & Jauhar, R. (2021). Paradigm Shifts in Cardiac Care: Lessons Learned From COVID-19 at a Large New York Health System. Current Problems in Cardiology, 46(3), 100675. doi:10.1016/j.cpcardiol.2020.100675.

Danne, T., Limbert, C., Puig Domingo, M., Del Prato, S., Renard, E., Choudhary, P., & Seibold, A. (2021). Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future. Diabetes Therapy, 12(9), 2289–2310. doi:10.1007/s13300-021-01114-x.

Guzoňová, V., & Bočková, K. (2022). Color Preferences for Morning and Evening Chronotypes. Emerging Science Journal, 6(4), 798-816. doi:10.28991/ESJ-2022-06-04-010.

Tatarkanov, A. A. B., Alexandrov, I. A., & Olejnik, A. V. (2020). Evaluation of the contact surface parameters at knurling finned heat-exchanging surface by knurls at ring blanks. Periodico Tche Quimica, 17(36), 372–389.

Oleinik, A., Kapitanov, A., Alexandrov, I., & Tatarkanov, A. (2020). Calculation methodology for geometrical characteristics of the forming tool for rib cold rolling. Journal of Applied Engineering Science, 18(2), 292–300. doi:10.5937/jaes18-25211.

Kartashova, E. A., & Sarvilina, I. V. (2019). About the prognostic role of fibulin-5 protein in the progression of pathological vascular remodeling in patients with isolated sistolic arterial hypertension. Advances in Gerontology, 32(6), 1003–1010.

Kartashova, E. A., & Sarvilina, I. V. (2018). The influence of cytoflavin on molecular mechanisms of myocardial and vascular wall remodeling in patients with sistolic arterial hypertension. Cardiology and Cardiovascular Surgery, 11(5), 40–46. doi:10.17116/kardio20181105140.

Reyes, J. A., Bates, A., & Gadaleta, D. (2021). Raising the Standard: Extending Patient-centered Care via Digital Healthcare. Bariatric Times, 18(5), 14–15

Moosavi, S., Namdar, P., Moghaddam Zeabadi, S., Akbari Shahrestanaki, Y., Ghalenoei, M., Amerzadeh, M., & Kalhor, R. (2023). Healthcare workers exposure risk assessment in the context of the COVID-19: a survey among frontline workers in Qazvin, Iran. BMC Health Services Research, 23(1), 155. doi:10.1186/s12913-023-09160-w.

Ashinyo, M. E., Dubik, S. D., Duti, V., Amegah, K. E., Ashinyo, A., Larsen-Reindorf, R., Kaba Akoriyea, S., & Kuma-Aboagye, P. (2020). Healthcare Workers Exposure Risk Assessment: A Survey among Frontline Workers in Designated COVID-19 Treatment Centers in Ghana. Journal of Primary Care & Community Health, 11. doi:10.1177/2150132720969483.

Wang, J., Zhou, M., & Liu, F. (2020). Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. Journal of Hospital Infection, 105(1), 100–101. doi:10.1016/j.jhin.2020.03.002.

Talaee, N., Varahram, M., Jamaati, H., Salimi, A., Attarchi, M., Kazempour dizaji, M., Sadr, M., Hassani, S., Farzanegan, B., Monjazebi, F., & Seyedmehdi, S. M. (2022). Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire. Journal of Public Health (Germany), 30(3), 531–536. doi:10.1007/s10389-020-01313-z.

Ambrose, J., Catchpole, K., Evans, H., Nemeth, L., Layne, D., & Michelle, N. (2023). Healthcare Team Resilience During COVID-19: A Qualitative Study. doi:10.21203/rs.3.rs-2626478/v1.

Rajapaksha, R. M. N. U., Khatri, R. B., Abeysena, C., Wijesinghe, M. S. D., Endalamaw, A., Thomas, T. K., Perera, N., Rambukwella, R., De Silva, G., Fernando, M., & Alemu, Y. A. (2022). Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol. BMJ Open, 12(11), e067829. doi:10.1136/bmjopen-2022-067829.

Vigoda-Gadot, E., Cohen, N., & Mizrahi, S. (2022). Battling COVID-19: Public Personnel Management, Trust, and Social Resilience During a Global Crisis. Review of Public Personnel Administration, 43(3), 583–613. doi:10.1177/0734371x221111479.

Lee, B. W. (2020). A study on the awareness of community public health project among the employees in the public health center. Medico-Legal Update, 20(1), 1614–1620. doi:10.37506/v20/i1/2020/mlu/194533.

Lee, B. W. (2023). A Study to Establish Local Healthcare Projects in the with-COVID-19 Age: Based on Health Recognition of Local Residents in the Korea. Journal of Survey in Fisheries Sciences, 10(4S), 472-483. doi:10.17762/sfs.v10i4S.740.

Walters, J. K., Sharma, A., & Harrison, R. (2023). Efficiency Improvement Strategies for Public Health Systems: Developing and Evaluating a Taxonomy in the Australian Healthcare System. Healthcare (Switzerland), 11(15), 2177. doi:10.3390/healthcare11152177.

Vasiljeva, M., Neskorodieva, I., Ponkratov, V., Kuznetsov, N., Ivlev, V., Ivleva, M., Maramygin, M., & Zekiy, A. (2020). A predictive model for assessing the impact of the COVID-19 pandemic on the economies of some Eastern European Countries. Journal of Open Innovation: Technology, Market, and Complexity, 6(3), 92. doi:10.3390/JOITMC6030092.

Vankar, P. (2023). Health and health systems ranking of countries worldwide in 2023, by health index score, Statista. Available online: https://rb.gy/jf6h0 (accessed on May 2023).

Hummel, S., Oetjen, N., Du, J., Posenato, E., Resende de Almeida, R. M., Losada, R., Ribeiro, O., Frisardi, V., Hopper, L., Rashid, A., Nasser, H., König, A., Rudofsky, G., Weidt, S., Zafar, A., Gronewold, N., Mayer, G., & Schultz, J.-H. (2021). Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study. Journal of Medical Internet Research, 23(1), e24983. doi:10.2196/24983.

Hernández-Torrano, D., Ibrayeva, L., Sparks, J., Lim, N., Clementi, A., Almukhambetova, A., Nurtayev, Y., & Muratkyzy, A. (2020). Mental Health and Well-Being of University Students: A Bibliometric Mapping of the Literature. Frontiers in Psychology, 11, 1226. doi:10.3389/fpsyg.2020.01226.

Zhou, T., Xu, C., Wang, C., Sha, S., Wang, Z., Zhou, Y., Zhang, X., Hu, D., Liu, Y., Tian, T., Liang, S., Zhou, L., & Wang, Q. (2022). Burnout and well-being of healthcare workers in the post-pandemic period of COVID-19: a perspective from the job demands-resources model. BMC Health Services Research, 22(1), 284. doi:10.1186/s12913-022-07608-z.

Ualiyeva, R. (2023). Functional Role of Vitelline Glands and Mehlis Gland in the Process of Resistant Egg Shell Formation in Trematodes. OnLine Journal of Biological Sciences, 23(2), 124–132. doi:10.3844/ojbsci.2023.124.132.

Ellison, M. L., Belanger, L. K., Niles, B. L., Evans, L. C., & Bauer, M. S. (2018). Explication and Definition of Mental Health Recovery: A Systematic Review. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 91–102. doi:10.1007/s10488-016-0767-9.

Dhar, G., & Dash, S. P. (2022). A Systematic Literature Review on the Impact of Open Spaces on Human Physiological and Mental Well-Being in Post-Pandemic Housing in Urban Context. ECS Transactions, 107(1), 7723–7747. doi:10.1149/10701.7723ecst.

Bostock, S., Crosswell, A. D., Prather, A. A., & Steptoe, A. (2019). Mindfulness on-the-go: Effects of a mindfulness meditation app on work stress and well-being. Journal of Occupational Health Psychology, 24(1), 127–138. doi:10.1037/ocp0000118.

Kubzansky, L. D., Huffman, J. C., Boehm, J. K., Hernandez, R., Kim, E. S., Koga, H. K., Feig, E. H., Lloyd-Jones, D. M., Seligman, M. E. P., & Labarthe, D. R. (2018). Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series. Journal of the American College of Cardiology, 72(12), 1382–1396. doi:10.1016/j.jacc.2018.07.042.

Vera San Juan, N., Aceituno, D., Djellouli, N., Sumray, K., Regenold, N., Syversen, A., Mulcahy Symmons, S., Dowrick, A., Mitchinson, L., Singleton, G., & Vindrola-Padros, C. (2021). Mental health and well-being of healthcare workers during the COVID-19 pandemic in the UK: contrasting guidelines with experiences in practice. BJPsych Open, 7(1), 15. doi:10.1192/bjo.2020.148.

Makhbul, Z. K. M., & Rawshdeh, Z. A. (2021). Mental stress post-COVID-19. International Journal of Public Health Science, 10(1), 194–201. doi:10.11591/ijphs.v10i1.20497.

Billings, J., Ching, B. C. F., Gkofa, V., Greene, T., & Bloomfield, M. (2021). Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis. BMC Health Services Research, 21(1), 923. doi:10.1186/s12913-021-06917-z.

Sinsky, C., & Linzer, M. (2020). Practice and policy reset post-covid-19: Reversion, transition, or transformation? Health Affairs, 39(8), 1405–1411. doi:10.1377/hlthaff.2020.00612.

Park, B., Steckler, N., Ey, S., Wiser, A. L., & DeVoe, J. E. (2020). Co-creating a thriving human-centered health system in the post-COVID-19 era. NEJM Catalyst Innovations in Care Delivery, 1(3), 1-9. doi:10.1056/CAT.20.0247.

Talmage, C. A., Allgood, B., Ashdown, B. K., Brennan, A., Hill, S., Trevan, E., & Waugh, J. (2022). Tethering Natural Capital and Cultural Capital for a More Sustainable Post-COVID-19 World. International Journal of Community Well-Being, 5(3), 657–678. doi:10.1007/s42413-021-00151-5.

Ibarra, F., Baez, M., Cernuzzi, L., & Casati, F. (2020). A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness. Journal of Healthcare Engineering, 2020, 2036842. doi:10.1155/2020/2036842.

van Zyl, L. E. (2021). Social Study Resources and Social Wellbeing Before and During the Intelligent COVID-19 Lockdown in The Netherlands. Social Indicators Research, 157(1), 393–415. doi:10.1007/s11205-021-02654-2.

Charmaz, K. (2014). Constructing grounded theory. SAGE Publication, Newcastle upon Tyne, United Kingdom.

Glaser, B. G. (2007). Constructivist grounded theory?. Historical Social Research. Supplement, 93-105.

Ishizaka, A., & Labib, A. (2011). Review of the main developments in the analytic hierarchy process. Expert Systems with Applications, 38(11), 14336–14345. doi:10.1016/j.eswa.2011.04.143.

Dyer, R. F., & Forman, E. H. (1992). Group decision support with the Analytic Hierarchy Process. Decision Support Systems, 8(2), 99–124. doi:10.1016/0167-9236(92)90003-8.

Wallenius, J., Dyer, J. S., Fishburn, P. C., Steuer, R. E., Zionts, S., & Deb, K. (2008). Multiple criteria decision making, multiattribute utility theory: Recent accomplishments and what lies ahead. Management Science, 54(7), 1336–1349. doi:10.1287/mnsc.1070.0838.

Wang, G. Y. (2022). Churn Prediction for High-Value Players in Freemium Mobile Games: Using Random Under-Sampling. Statistika, 102(4), 443–453. doi:10.54694/STAT.2022.18.

Fridell, M., Edwin, S., von Schreeb, J., & Saulnier, D. D. (2019). Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords. International Journal of Health Policy and Management, 9(1), 6–16. doi:10.15171/ijhpm.2019.71.

Biddle, L., Wahedi, K., & Bozorgmehr, K. (2020). Health system resilience: A literature review of empirical research. Health Policy and Planning, 35(8), 1084–1109. doi:10.1093/heapol/czaa032.

Khayrutdinov, M. M., Golik, V. I., Aleksakhin, A. V., Trushina, E. V., Lazareva, N. V., & Aleksakhina, Y. V. (2022). Proposal of an Algorithm for Choice of a Development System for Operational and Environmental Safety in Mining. Resources, 11(10), 88. doi:10.3390/resources11100088.

Xiang, H., Lu, J., Kosov, M. E., Volkova, M. V., Ponkratov, V. V., Masterov, A. I., Elyakova, I. D., Popkov, S. Y., Taburov, D. Y., Lazareva, N. V., Muda, I., Vasiljeva, M. V., & Zekiy, A. O. (2023). Sustainable Development of Employee Lifecycle Management in the Age of Global Challenges: Evidence from China, Russia, and Indonesia. Sustainability (Switzerland), 15(6), 4987. doi:10.3390/su15064987.

Mukataeva, Z., Dinmukhamedova, A., Kabieva, S., Baidalinova, B., Khamzina, S., Zekenova, L., & Aizman, R. (2023). Comparative characteristics of developing morphofunctional features of schoolchildren from different climatic and geographical regions. Journal of Pediatric Endocrinology and Metabolism, 36(2), 158–166. doi:10.1515/jpem-2022-0474.

Davletova, A. H., Tolganbaiuly, T., Tazhigulova, A. I., Smagulova, L. A., Kasymova, A. H., & Baigozhanova, D. S. (2019). Project-oriented training experience in micro-robot programming in college and its features. Option: Journal of Human and Social Sciences, (22), 292-307.

Nurbekova, Z. K., Mukhamediyeva, K. M., Davletova, A. H., & Kasymova, A. H. (2018). Methodological system of educational robotics training: Systematic literature review. Espacios, 39(15), 28.

Findling, M. G., Blendon, R. J., & Benson, J. M. (2020). Delayed Care with Harmful Health Consequences - Reported Experiences from National Surveys during Coronavirus Disease 2019. JAMA Health Forum, 1(12), 201463. doi:10.1001/jamahealthforum.2020.1463.

de Joode, K., Dumoulin, D. W., Engelen, V., Bloemendal, H. J., Verheij, M., van Laarhoven, H. W. M., Dingemans, I. H., Dingemans, A. C., & van der Veldt, A. A. M. (2020). Impact of the coronavirus disease 2019 pandemic on cancer treatment: the patients’ perspective. European Journal of Cancer, 136, 132–139. doi:10.1016/j.ejca.2020.06.019.

Zainun, N. Y., Ajman, N. N., Sulaiman, N., & Khahro, S. H. (2022). Challenges Faced in Managing Covid-19 Pandemic Case Study: Malaysia. Advances in Engineering Research. doi:10.2991/aer.k.220131.043.

Adam, O., Sayibu, M., Oloji, S., Akintunde, I., & Yinka, T. (2022). Technology Infrastructure in Public Health System: Mediating Role of Public Trust in Government Disaster Preparedness. Public Policy and Administration Research, 12(5), 27–40. doi:10.7176/ppar/12-5-03.

Hincapié, M. A., Gallego, J. C., Gempeler, A., Piñeros, J. A., Nasner, D., & Escobar, M. F. (2020). Implementation and Usefulness of Telemedicine During the COVID-19 Pandemic: A Scoping Review. Journal of Primary Care and Community Health, 11. doi:10.1177/2150132720980612.

Odusola, F., Smith, J. L., Bisaga, A., Grbic, J. T., Fine, J. B., Granger, K. E., Hu, M. C., & Levin, F. R. (2020). Innovations in pre-doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder. Journal of Dental Education, 84(5), 578–585. doi:10.1002/jdd.12048.

Majnarić, L. T., Babič, F., O’Sullivan, S., & Holzinger, A. (2021). AI and Big Data in Healthcare: Towards a More Comprehensive Research Framework for Multimorbidity. Journal of Clinical Medicine, 10(4), 766. doi:10.3390/jcm10040766.

Kuhlmann, E., Brînzac, M. G., Burau, V., Correia, T., & Ungureanu, M. I. (2021). Health workforce protection and preparedness during the covid-19 pandemic: A tool for the rapid assessment of EU health systems. European Journal of Public Health, 31(Supplement_4), IV14–IV20. doi:10.1093/eurpub/ckab152.

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DOI: 10.28991/ESJ-2023-07-06-011


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Copyright (c) 2023 Darmadi Darmadi, Zhanna R. Gardanova, Maria V. Mikhailova, Zahraa Haleem Al-Qaim, Evgeniy V. Kostyrin, Mikhail E. Kosov, Marina V. Vasiljeva