Executive Summary:         
COVID-19 has created huge challenges. The lessons it has generated on preparing for future pandemics are clear but they are by no means the only learning. All health systems are vulnerable and there are practical steps that all countries can take, not simply to increase the resources available, but to ensure the capacity to mobilize, adapt and use those resources in different shock scenarios. The Health systems resilience during  COVID-19: Lessons for building back better study gathers the evidence of how countries have managed  (or not managed) to re-engineer what they do, who does what and how, and draws out the implications for future resilience. The study understands resilience as the ability of the health system to prepare for, manage and learn from a sudden and extreme disturbance. It is about maintaining the performance of core health system functions. While the focus here is on responding to shock, it is increasingly evident that the ability to transform and evolve will also be critical in meeting long-term structural challenges to health systems. The evidence the study assembles is rooted in what has happened and what policy makers need to know for the future. It builds on the core health system functions of governance, financing, resource generation, and service delivery and organizes its findings around a set of strategies that policymakers can use to strengthen the resilience of their health systems. These strategies and corresponding examples largely draw on the Health System Response Monitor (HSRM), a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, and benefit from the timeliness and accuracy of the content it collected. The examples used to illustrate each strategy offer ways to achieve the strategic objective but are by no means exhaustive. The different strategies described in this volume do not sit and should not be viewed in isolation from each other – they are complementary and linked, highlighting the interdependency of the health system functions. Each strategy works best when developed in light of the interactions with other health system elements and of national context. It is essential that these interactions are effective if health system functions are to operate in harmony with each other, as a system.