Background and Objective:
The COVID-19 pandemic posed an unprecedented challenge which caught many health systems worldwide widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience in the context of infectious diseases.

Methods:
The analytical framework was developed based on a two-tiered approach. First, a comprehensive review of the existing literature was conducted to identify relevant frameworks on health system resilience. Second, input was gathered in several rounds of internal and external consultations with designated field experts and stakeholders, drawing on their experiences from the pandemic.

Results:
The framework distinguishes between prerequisites of health system resilience, which address precautions to be taken in ‘normal’ times, and response strategies in the face of shocks (e.g., pandemics). Both sections are further divided into six building blocks that were adapted from the WHO health system framework: governance and leadership, information and research, financing, physical resources, human resources, service delivery. A comprehensive understanding of health systems is applied, as resilience is addressed in the action areas of public health, primary care, secondary care and long-term care. An overarching component on contextual factors – including, e.g., social cohesion, trust, international connectedness and health literacy – represents a distinctive feature of the framework and an important addition to the existing spectrum of resilience frameworks.

Conclusion:
In order to be better prepared for future health crises, the foundations for a resilient health system must already be laid in ‘normal’ times and in all areas of the health system. In the face of an imminent shock, adequate response strategies need to be developed. An essential learning from the COVID-19 crisis has been that contextual factors of societies and sub-groups play a major role in the ability of health systems to overcome a shock.