Resilient Facilities & Services

Community engagement Community engagement is the inclusion of local health system users and community members in all aspects of health planning, provision, and governance. It is a central component of ensuring that the services delivered are tailored to population needs, priorities and values, which can be achieved through the involvement of communities in the design, financing, governance, and implementation of PHC. To ensure that the needs of all community members are met, it is important that community engagement efforts include representation from diverse members of the community. This may require multiple mediums for engagement, to best capture the needs and opinions of traditionally underrepresented community members.  is an important aspect of preparedness, response, recovery, and resilience. ⁶¹⁴ Primary care Primary care is “a key process in the health system that supports first-contact, accessible, continuous, comprehensive, and coordinated patient-focused care.” providers and staff can help increase patient and community trust in health services both before and during crises through thoughtful engagement. ⁴ Community and stakeholder engagements should occur throughout planning, risk assessment, implementation, review, and ongoing preparedness activities, which include facility emergency planning, facility surveys, and seeking input and funding. ⁶

Key activities

National and sub-national levels

• Ensure engagement with a broad cross-section of the population and particularly with vulnerable communities. Emergencies, disasters, and shocks can disproportionately affect more vulnerable populations including women, children, immigrants and refugees, elderly people, people with mental or physical disabilities, people with chronic diseases, and other individuals and communities with higher levels of risk. Planning and work should include perspectives and input from people in these populations to increase the likelihood of appropriately identifying and increasing the capacity to face s and vulnerabilities. ⁶
• Invest in institutionalised mechanisms for whole-of-government and whole-of-society engagement. Review existing mechanisms for whole-of-society action including expanding multisectoral approaches to health systems strengthening and management, community engagement and empowerment, and multi-stakeholder and participatory governance. Develop policy, legislative, and regulatory instruments to employ whole-of-government and whole-of-society (including private sector such as private health care providers) resources to support public health emergency preparedness, response, and efforts, including capacity-building for ongoing and future threats (see the policy & leadership module for more information). 

District &/or facility level

• Coordinate and build relationships with the sectors and actors who play a role in managing health risks of emergencies locally and nationally: technical experts such as urban planners, civil engineers, hazardous facilities operators, climate information providers, animal health professionals, critical infrastructure managers (including energy, water, and sanitation), telecommunications and transport providers, pharmaceutical companies, and emergency services. ⁶ This key activity supports effective risk management and helps enable health services to continue functioning effectively in emergency contexts.

Individual &/or community level

• Collaborate with at-risk populations as well as the organisations and actors who play a role in meeting the needs of vulnerable populations. Health service providers have an important role in minimising the negative health outcomes associated with emergencies. Collaboration is essential to managing health risks for these populations and to developing and maintaining plans for continuing essential services in emergencies. Relevant stakeholders may include: ⁶
  • community groups and members of vulnerable and at-risk populations; 
  • local, regional, and national government leaders and agencies; 
  • health system and services providers, including members of the ministry of health, representatives of health-related non-governmental organisations and private groups, primary care and other health care providers, and facility representatives; and 
  • other groups including academia and the research community, the media, the private sector, multinational companies, and international organisations

Related elements

• Policy & leadership 
• Population health management 
• Multi-sectoral approach 

Relevant tools & resources

• Karamagi et al., 2022: On the resilience of health systems: A methodological exploration across countries in the WHO African Region
• Mustafa et al., 2022: COVID-19 Preparedness “1. Activities and measures taken in advance to ensure effective response to the impact of hazards, including the issuance of timely and effective early warnings and the temporary evacuation of people and property from threatened locations (ISDR). 2. Pre-disaster activities, including an overall strategy, policies, and institutional and management structures that are geared to helping at-risk communities safeguard their lives and assets by being alert to hazards and taking appropriate action in the face of an imminent threat or the actual onset of a disaster (OCHA-WFP).” and Response Plans from 106 countries: a review from a health systems resilience perspective
• World Bank, 2022: ​​​​​Global Facility for Disaster   “A serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts.” Reduction and Recovery “The restoring or improving of livelihoods and health, as well as economic, physical, social, cultural and environmental assets, systems and activities, of a disaster-affected community or society, aligning with the principles of sustainable development and “build back better”, to avoid or reduce future disaster risk.” annual report

Assessments are important to understand current facility and service preparedness and to prioritise the necessary infrastructure and operations changes. Assessments are essential to identify needs that can be prioritised and take place progressively over time. The tools and metrics described below can help with prioritisation.

Key activities

National and sub-national levels

• Establish routine surveillance and monitoring of diseases.
• Establish communications protocols between higher and lower levels of authority within the health system.
• Ensure that human resources and financial resources are available and prepared to implement the recommended changes. ⁷⁸ These resources include financing for potentially considerable retrofitting of physical structures, maintenance and strengthening of critical systems and equipment, planning and conducting exercises, and revising emergency management plans based on training. Additionally, train and prepare the human resources who will staff the facilities.
• Address critical gaps in health system foundations. Use existing systems and processes to identify long-term health systems strengthening and emergency preparedness needs and inform resource allocation to address identified critical gaps. Similarly, leverage investments and attention on emergency preparedness and response to proliferating wider benefits to the health system through strengthened primary care and essential public health functions.
• Conduct routine surveillance activities, and use these learnings to facilitate recovery and strengthen future response efforts. Routinely reviewing health system operations through after-action reviews, operations reviews, routine disease surveillance, and health management information systems data collection can provide important information about system vulnerabilities, which can then be targeted for improvement prior to future shocks.
• Develop or strengthen national action plans for ; disaster risk reduction; emergency preparedness, response, and recovery; and incident management systems. If these plans and guidelines are already in place, ensure continuity between and accountability for plans across jurisdictions and the national/subnational level. Ideally, the plans should accommodate and complement one another. Additionally, emergency preparedness and response plans should be tested, reviewed, and revised as necessary on a regular basis. ³ 

District &/or facility level

• Use surveys to track service availability and facility amenities. Examples include the Service Availability and Readiness Assessment (SARA), Service Provision Assessments (SPA), or Service Delivery Indicators (SDI).
• Ensure risk assessments consider structural, non-structural, functionality, and preparedness of health care facilities on a routine basis.
• Conduct routine simulation exercises with community members to test the functionality of health facility structures, mechanisms, and functions for emergency management and service continuity under conditions.
• Conduct post-emergency reviews at the facility or subnational level to evaluate health facility and system performance in emergency management and service continuity under disaster conditions. Use the lessons learned to improve recovery and strengthen capacities for current and future risks.
• Conduct hospital and health centre safety evaluations at every health care facility, subnationally. Utilise data collection tools and metrics described below to inform these assessments. Use the findings of these assessments to improve the facility functions described in the Deep Dive section. 
• At the facility level, put in place mechanisms to ensure the continuity of service functions in times of crisis. These mechanisms can include flexible funding for PHC, telehealth, reliable logistics management information systems, and reliable supply chains. If these mechanisms are lacking, make certain facilities know where to turn for support for continued service delivery in an emergency. 

Related elements

• Policy & leadership 
• Physical infrastructure 
• Information & technology 
• Service availability & readiness 

Relevant tools & resources

• Assessment tool: Safe Hospitals Checklist 
  • Use the Safe Hospitals Checklist, which applies to health facilities and other levels of health care, to obtain a rating of the structural and nonstructural safety and the emergency and disaster management capacity of a health facility.
• Assessment tool: WHO Harmonised Health Facility Assessment
  • The Harmonised Health Facility Assessment (HHFA) is a comprehensive health facility survey tool for countries assessing the availability of health facility services as well as the capacities of facilities to provide services at required standards of quality.
• More details and downloadable guidance and tools for adapting, planning, and implementing a Harmonised Health Facility Assessment can be found in the Harmonised Health Facility Assessment resource package.

Ensuring effective planning and preparedness work takes place is a critical action to establishing a baseline level of emergency preparedness. Incorporating preparedness and resilience into existing systems and processes involves a range of stakeholders and actions at health system, district, and facility levels can ensure effective institutionalisation of this work.

Key activities

National and sub-national levels 

• Establish a systematic and multisectoral process for priority-setting that is participatory and inclusive.
• Translate priorities into strategic and operational plans for the health system. Include costing and budgeting, implementation, and ongoing monitoring and evaluation.
• Create a system-wide culture that supports continuous iteration and improvement backed by a high-level commitment to innovation and learning.
• Establish mechanisms to recognize, evaluate, and scale successful innovations beyond pilot testing, and systematically share learnings across stakeholders.
• Establish linkages between national health system strategic plans and national action plan for Seek synergies in activities, budgets, and monitoring and evaluation, and identify areas that require focused attention from the health security or health systems sides. Also, link the national health sector strategic plan and disease-specific plans such as HIV, tuberculosis, malaria, and those relating to specific population groups including ethnic minorities, women and children, elderly, refugees, and vulnerable and marginalised communities.
• Identify or establish a team or focal person for maintaining essential health services in incident management systems or emergency operating centres. 
• Establish or strengthen information systems and data sharing mechanisms within and across facilities and sectors at different levels. Ensure interoperability of information systems between clinical, public health, and veterinary sectors. 

District &/or facility level

• Define your health facility emergency management plan, including service continuity. Identify a source of funding or a budget line.
• Designate a team or focal person for emergency management and service continuity.
• Prioritise primary care services to be maintained during emergencies according to national protocols. 
• Create a system for maintaining essential medicines and supplies. 
• Strengthen supply chains through robust supply chain management and operational functions, such as appropriate financing, performance management, and risk management. Ensure supply chains, prepositioned stocks, and essential medical products to enable service delivery in various settings such as the community, at home, through digital platforms, and in facilities. 

Related elements

• Policy & leadership 
• Medicines & supplies 
• Adjustment to population health needs

Relevant tools & resources

• Mansour et al., 2022: Health systems resilience in fragile and shock-prone settings through the prism of gender equity and justice: implications for research, policy and practice
• WHO, 2021: Fostering resilience through integrated health system strengthening: technical meeting report
• WHO, 2021: Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond: WHO position paper

Developing protocols, and conducting training for staff, managers, providers, and the community will help ensure that people are more prepared to respond appropriately during an emergency, so facilities can continue providing services. 

Key activities 

National and sub-national levels 

• Implement policies and systems to recruit and equitably distribute health workers, particularly in rural or marginalised communities. Across all areas of service delivery, train the health workforce with a public health orientation.
• Enact policies, regulations, and strategies to retain skilled workers, such as supportive supervision, continuing professional development, and appropriate remuneration.
• Implement quality assurance and regulatory systems that ensure workers have the appropriate training and qualifications, that workforce records are maintained, and that appropriate measures are taken to ensure workers meet established standards.
• Develop a public health workforce capable of delivering context-specific essential public health functions (including all-hazards emergency management and International Health Regulations [2005]) alongside clinical and curative health services. 

District &/or facility level

• Ensure protocols for case management during priority health emergencies and disasters are up-to-date.
• Ensure staff are trained in and community members are aware of protocols for emergency and disaster risk management (including prevention, preparedness, response, and recovery) and service continuity.
• Ensure that emergency plans and protocols include coordination across different groups including women, children, immigrants and refugees, elderly, people with mental or physical disabilities, people with chronic diseases, and other individuals and communities with higher levels of risk. To the extent possible, create opportunities for cross-group engagement and coordination as part of ongoing training and work.
• Use training experiences and feedback to revise planning and protocols. Continue to practice and update plans and protocols periodically. 

Related elements

• Health workforce

Relevant tools & resources

• WHO, 2021. Health service continuity planning for public health emergencies: a handbook for health facilities. Interim version for field testing.  
• WHO, 2021. Health Systems Resilience “The ability of a system, community, or society exposed to hazards to resist, absorb, accommodate to, and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management.” Simulation Exercises.
   

Health facilities and the PHC services PHC services refer to any intervention, procedure, regimen, or process that providers use to respond to the needs and demands of their patient population at the primary care level. Because of PHC’s community-facing orientation, services can be provided virtually or face-to-face in homes, communities, or PHC centres. Depending on the context, services may be provided by public or private providers. they provide are of critical importance in a health system emergency. Resilient facilities and services should be able to maintain or quickly return to providing essential and routine health services and to help with recovery. The overall aim of resilient facilities and services is “protect[ing] human life and produc[ing] good health outcomes for all during a crisis and in its aftermath.” ¹⁰

Key activities

National and sub-national levels 

• Allocate funds to priority services and populations. Flexible health financing arrangements are critical for facilitating essential health services, especially during emergency situations. This flexibility ensures financial protection from catastrophic health expenditure for population members and mitigation of demand-side issues for services such as reduced uptake of essential health services due to affordability. It can also enable timely critical services such as surveillance, testing, contact tracing, prophylaxis, treatment, vaccination, and follow-up.
• Purchase services from providers who can deliver good quality at the right level of the system.
• Target vulnerable groups and fund health care and service coverage to expand access to care.
• Recognize and adopt innovations such as digital platforms and telehealth to maintain the provision of care when the health system is under stress. 
• Coordinate public and private providers to share resources, such as workers and supplies. 

District &/or facility level

• Ensure that essential features and utilities are available at facilities; see Deep Dive for more on these essential features.
• Implement standard safety equipment and safety procedures at facilities.
• Maintain continuity of services at the facility and community levels through task shifting and flexibility of services. 

Related elements

• Physical infrastructure 
• Purchasing & payment systems 

Relevant tools & resources

• OECD, 2021: Strengthening the frontline: How primary health care helps health systems adapt during the COVID 19 pandemic
• PHCPI, 2021: PHC COVID-19 guidance on maintaining access to routine and essential services and surveillance and response 

“Not all emergencies can be predicted, but they can be prepared for.” 
Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organisation ³

All countries are vulnerable to emergencies or shocks of one sort or another. The same health system emergency–such as an earthquake, disease outbreak, conflict, economic shock, climate change, or pandemic–can occur with the same intensity in two countries or two communities. However, the extent of the damage to individual health, infrastructure, or health services may vary greatly depending on the communities’ vulnerability, , and . ⁹ Resilient facilities and services refer to the existence of strong and sustainable linkages between and health system capabilities at the point of care.  

According to the USAID Blueprint for Global Health Resilience “The ability of a system, community, or society exposed to hazards to resist, absorb, accommodate to, and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management.” , “health resilience is necessary to mitigate against the country and global shocks and stressors (both health and non-health). A prerequisite for health resilience is accessible primary health care.” ⁵ PHC is a patient’s first point of contact with the health system and should lead to trusting, respectful relationships and services that meet local needs and expectations. PHC collects local data that provide essential surveillance knowledge to all levels of the system, making strong PHC a core input to resilient facilities and services across the system. ⁷

During times of crisis, resilient facilities and services are essential for directly responding to the crisis, maintaining routine and essential services, and reducing the burden on tertiary facilities. ²⁰ The COVID-19 pandemic has highlighted the importance of PHC for maintaining essential services during emergencies. Countries reported more than half of essential services were disrupted in 2020, on average, with ongoing disruptions continuing through 2021. ²¹

During emergencies, the ability of health services to continue functioning relies on key factors:

• That health services are housed in safe and secure facilities that are prepared for emergencies and capable of resisting exposures and forces from all types of s, 
• That medical equipment is protected from damage and in working order, 
• That community infrastructure and critical services, including water and power, continue to be available to support health services, and
• That health personnel can provide medical assistance in safe and secure settings when they are most needed. ⁹

Safe and secure facilities allow the maintenance of essential and routine health services in emergencies, supporting response and . ³

Resilient health facilities will be able to function in an emergency situation, providing essential health services to those in need. Considerations for resilient facilities’ functions include:

• Guidelines
  • Consideration(s)
    • There are standards and codes for existing and new health facilities.
    • Infection prevention and control (in health facilities, in other health-care settings, and for the health workforce) exists
  • Supporting resource(s)
    • WHO, 2015: Comprehensive safe hospital framework 
• Infrastructure
  • Consideration(s)
    • The system prioritises safe siting and construction, universal design (e.g. access for people with disabilities), and considerations for energy efficiency and reduced carbon footprint.
    • Existing structures are, or are being, updated to be capable of withstanding shocks and to be self-sufficient, including having reliable power and water systems.
    • There is a focus on health facility security.
  • Supporting resource(s)
    • PHCPI, 2022: Physical infrastructure module
    • WHO, 2022: Health systems for health security framework 
    • World Bank, 2021: Frontline: Preparing Healthcare Systems for Shocks from Disasters to Pandemics report
• Planning and training
  • Consideration(s)
    • and management–including emergency and response and health services continuity planning, training, and exercises–is ongoing.
    • There is surge capacity and supply chain planning and preparation (including staff, supplies, equipment, and lifelines).
    • Financial resources exist, including budgets for emergency and disaster risk management work to strengthen staff, activities, and services; health supplies; and infrastructure.
  • Supporting resource(s)
    • PHCPI, 2022: Health workforce and Purchasing & payment systems modules
    • WHO, 2021: Health service continuity planning for public health emergencies: a handbook for health facilities handbook
    • World Bank, 2021: Frontline: Preparing Healthcare Systems for Shocks from Disasters to Pandemics report
    • WHO, 2019: Health emergency and disaster risk management framework
• Capacity
  • Consideration(s)
    • There is sufficient equipment and devices (safety, security, maintenance) and maintain emergency stocks of essential medical supplies.
    • Patient isolation capacity exists.
    • There are decontamination protocols and capacity.
    • Lifelines and support services–including water, road or physical access, and staff welfare–are ensured.
  • Supporting resource(s)
    • PHCPI, 2022: Medicines & supplies and Information & technology modules

Resilient health facilities will be able to maintain or quickly resume the provision of essential and routine health services in an emergency situation. Considerations for functions of resilient services include: ⁴

• Staff capacity and staffing models are flexible (such as cross-training for comprehensive care) to enable rapid changes in deployment as health needs shift.
  • Supporting resource(s)
    • PHCPI, 2022: Management of services, Access, and Service availability & readiness modules
• Care is provided through a mix of home-, community-, and facility-based services and providers to maximise opportunities to interact with the population and enable flexible care delivery depending on the emergency.
  • Supporting resource(s)
    • PHCPI, 2022: Access & availability and Population health management modules
• Services are built on population health management strategies that leave no one behind. 
  • Supporting resource(s)
    • PHCPI, 2022: Population health management module
• Services are multidisciplinary and integrated across levels of care. 
  • Supporting resource(s)
    • PHCPI, 2022: Organisation of services and Primary care Primary care is “a key process in the health system that supports first-contact, accessible, continuous, comprehensive, and coordinated patient-focused care.” functions modules
• Quality of care delivery is prioritised in maintaining essential and routine health services.
  • Supporting resource(s)
    • PHCPI, 2022: Primary care Primary care is “a key process in the health system that supports first-contact, accessible, continuous, comprehensive, and coordinated patient-focused care.” functions module
    • WHO, 2021: Technical package on quality of care in fragile, conflict-affected, and vulnerable settings 
• Providers and organisations are able to adapt (e.g. through resource and task shifting to meet changing needs). There is local decision-making authority.
  • Supporting resource(s)
    • PHCPI, 2022: Management of services and Adjustment to population health needs modules
• Providers and organisations have built trust and confidence in the system through community engagement and other measures.
  • Supporting resource(s)
    • PHCPI, 2022: Population health management module
• Facility and health system operations have flexibility in funding and decision-making, led by competent local facility and organisational leadership.
  • Supporting resource(s)
    • PHCPI, 2022: Financing and Management of services modules

 A single emergency or shock can severely impede the progress of primary health care and other sectors. 3 Increasing the resilience of facilities and services involves building capacity at three different levels:

Absorptive capacity

• Absorptive capacity involves taking preventative measures where possible in order to avoid or minimise negative impacts from health system shocks, emergencies, or disasters. The goal of absorptive capacity is to maintain health system stability. ⁵
• Examples include:
  • Task-shifting or task-sharing in order to align health care workers with pressing needs. ⁵
  • Developing memoranda of understanding between health facilities for coordination during emergencies. ²⁵

Adaptive capacity

• Adaptive capacity involves developing approaches to respond to change. It is a health system’s (or health facility’s) ability to improve its overall performance while also being able to make ongoing adjustments. ⁵
• Examples include:
  • Innovating and using digital platforms and tools during COVID-19 to conduct training and supportive supervision.
  • Ensuring protected funding for facility improvements even (or especially) during times of calm.

Transformative capacity

• Transformative capacity involves building and leveraging an enabling environment that supports systemic change. This is a health system’s ability to address ongoing vulnerabilities or contextual factors that impact a system’s performance or a population’s health outcomes by making fundamental changes. ⁵
• Examples include:
  • Establishing or formalising arrangements such as memoranda of understanding between public and private providers to share resources such as workers and supplies in times of crisis. ⁵

Developing these capacities must be undertaken through stakeholder engagement and be based on data, steps which are explored in more detail in the take action section of the module.

• Disaster   “A serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts.” : “A serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts.” ²⁶
• Emergency “An extraordinary situation in which people are unable to meet their basic survival needs, or there are serious and immediate threats to human life and well-being. Emergency interventions are required to save and preserve human lives and/or the environment. An emergency situation may arise as a result of a disaster, a cumulative process of neglect or environmental degradation, or when a disaster threatens and emergency measures have to be taken to prevent or at least limit the effects of the eventual impact. (UNDP)” : “An extraordinary situation in which people are unable to meet their basic survival needs, or there are serious and immediate threats to human life and well-being. Emergency “An extraordinary situation in which people are unable to meet their basic survival needs, or there are serious and immediate threats to human life and well-being. Emergency interventions are required to save and preserve human lives and/or the environment. An emergency situation may arise as a result of a disaster, a cumulative process of neglect or environmental degradation, or when a disaster threatens and emergency measures have to be taken to prevent or at least limit the effects of the eventual impact. (UNDP)” interventions are required to save and preserve human lives and/or the environment. An emergency situation may arise as a result of a disaster, a cumulative process of neglect or environmental degradation, or when a disaster threatens and emergency measures have to be taken to prevent or at least limit the effects of the eventual impact. (UNDP)” ²⁷
• Hazard “A process, phenomenon or human activity that may cause loss of life, injury or other health impacts, property damage, social and economic disruption or environmental degradation.” : “A process, phenomenon or human activity that may cause loss of life, injury or other health impacts, property damage, social and economic disruption or environmental degradation.” ²⁶
• Health security “The activities required, both proactive and reactive, to minimise the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries.” : “The activities required, both proactive and reactive, to minimise the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries.” ²⁸
• Preparedness “1. Activities and measures taken in advance to ensure effective response to the impact of hazards, including the issuance of timely and effective early warnings and the temporary evacuation of people and property from threatened locations (ISDR). 2. Pre-disaster activities, including an overall strategy, policies, and institutional and management structures that are geared to helping at-risk communities safeguard their lives and assets by being alert to hazards and taking appropriate action in the face of an imminent threat or the actual onset of a disaster (OCHA-WFP).” : “1. Activities and measures taken in advance to ensure effective response to the impact of hazards, including the issuance of timely and effective early warnings and the temporary evacuation of people and property from threatened locations (ISDR). 2. Pre-disaster activities, including an overall strategy, policies, and institutional and management structures that are geared to helping at-risk communities safeguard their lives and assets by being alert to hazards and taking appropriate action in the face of an imminent threat or the actual onset of a disaster (OCHA-WFP).” ⁸
• Recovery “The restoring or improving of livelihoods and health, as well as economic, physical, social, cultural and environmental assets, systems and activities, of a disaster-affected community or society, aligning with the principles of sustainable development and “build back better”, to avoid or reduce future disaster risk.” : “The restoring or improving of livelihoods and health, as well as economic, physical, social, cultural and environmental assets, systems and activities, of a disaster-affected community or society, aligning with the principles of sustainable development and “build back better”, to avoid or reduce future disaster risk.” ²⁶
• Resilience “The ability of a system, community, or society exposed to hazards to resist, absorb, accommodate to, and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management.” : “The ability of a system, community, or society exposed to hazards to resist, absorb, accommodate to, and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management.” ²⁶