{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:07:24Z","timestamp":1790186844127,"version":"4.1.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Health system resilience is essential for effective pandemic response and health security, yet existing assessments often lack actionable guidance for policymakers. This study develops a data-driven framework to identify key resilience contributors and country capability profiles using the complete 2021 Global Health Security Index (GHSI) dataset for 195 countries. Through a multi-method analytical approach, we derive a composite resilience measure that captures 70.6% of shared variance across six GHSI domains. After accounting for inter-domain correlations, Detection, Health Capacity, and Prevention show the strongest independent associations with overall resilience (ridge coefficients of 0.242, 0.228, and 0.219, respectively), with Detection contributing most. Cluster analysis reveals two distinct country typologies: a high-performing, balanced-capability group (33% of countries) spanning both high-income and several upper-middle-income countries, and a larger group (67%) with lower and more structurally uneven capabilities, particularly in Prevention and Health Capacity. These profiles suggest different strategic pathways for system strengthening\u2014from sustaining advanced capacities in high-performing countries to targeted investments in detection and core health functions in settings with more fragmented capabilities. Our findings provide an essential framework for comparing resilience across countries and prioritising investments where they matter most, offering practical guidance for national and global health security planning.<\/jats:p>","DOI":"10.1371\/journal.pone.0340560","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:31:20Z","timestamp":1790184680000},"page":"e0340560","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants and typologies of health system resilience: A data-driven framework for prioritising investment"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5209-4219","authenticated-orcid":true,"given":"Richmond","family":"Balinia Adda","sequence":"first","affiliation":[{"name":"University of Technology and Applied Sciences","place":["Navrongo, Ghana"],"department":["Department of Biometry, School of Mathematical Sciences"]},{"name":"University of Technology and Applied Sciences","place":["Navrongo, Ghana"],"department":["Department of Epidemiology and Biostatistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Pwayirane","sequence":"additional","affiliation":[{"name":"University of Technology and Applied Sciences","place":["Navrongo, Ghana"],"department":["Department of Biometry, School of Mathematical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"6","key":"pone.0340560.ref001","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1038\/s41591-021-01381-y","article-title":"Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries","volume":"27","author":"V Haldane","year":"2021","journal-title":"Nat Med"},{"key":"pone.0340560.ref002","article-title":"Building resilient health systems: a proposal for a resilience index","volume":"357","author":"ME Kruk","year":"2017","journal-title":"BMJ"},{"issue":"9","key":"pone.0340560.ref003","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(23)00279-6","article-title":"Health system resilience: a critical review and reconceptualisation","volume":"11","author":"S Witter","year":"2023","journal-title":"Lancet Glob Health"},{"key":"pone.0340560.ref004","volume-title":"Health systems resilience during COVID-19: Lessons for building back better","author":"A Sagan","year":"2021"},{"key":"pone.0340560.ref005","volume-title":"Fourth round of the global pulse survey on continuity of essential health services during the COVID-19 pandemic: November 2022\u2013January 2023","author":"World Health Organization","year":"2023"},{"key":"pone.0340560.ref006","volume-title":"Global Health Security Index 2021","author":"Nuclear Threat Initiative, Johns Hopkins Center for Health Security, Economist Impact","year":"2021"},{"key":"pone.0340560.ref007","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ijmedinf.2017.01.019","article-title":"Digital disease detection: A systematic review of event-based internet biosurveillance systems","volume":"101","author":"J O\u2019Shea","year":"2017","journal-title":"Int J Med Inform"},{"issue":"3","key":"pone.0340560.ref008","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/heapol\/czx183","article-title":"Towards an understanding of resilience: responding to health systems shocks","volume":"33","author":"J Hanefeld","year":"2018","journal-title":"Health Policy Plan"},{"issue":"3","key":"pone.0340560.ref009","doi-asserted-by":"crossref","DOI":"10.5751\/ES-08748-210341","article-title":"Social-ecological resilience and biosphere-based sustainability science","volume":"21","author":"C Folke","year":"2016","journal-title":"E&S"},{"issue":"6","key":"pone.0340560.ref010","doi-asserted-by":"crossref","first-page":"491","DOI":"10.15171\/ijhpm.2018.06","article-title":"What is resilience and how can it be nurtured? 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