Health systems governance, shocks and resilience: a scoping review of key concepts and theories

• الحاوية / القاعدة: BMJ Global Health
• المؤلفون الرئيسيون: Mauricio Avendano, Didier Wernli, Stéfanie Monod, Camille Poroes, Giulia Belloni, Nolwenn Bühler
• التنسيق: مقال
• اللغة: الإنجليزية
• منشور في: BMJ Publishing Group 2025-06-01
• الوصول للمادة أونلاين: https://gh.bmj.com/content/10/6/e017358.full

Introduction It is often argued that health system resilience to shocks is influenced by governance. Multiple theoretical perspectives seemed to have emerged in the literature, but there has been limited analysis of their foundation and implications so far. To address this gap, the aim of this paper is to carry out a scoping review of conceptualisation and theories on the definition and relationship between governance and health system resilience in the context of shocks.Methods Six electronic databases were searched using the following keywords: resilience, health system, framework and governance. 835 abstracts were screened, and 47 full texts were extracted and analysed in MAXQDA using inductively generated codes. We analysed the conceptualisation of health system resilience, governance and shock and theories on the relationship between them.Results Although there are no collectively agreed definitions, health system resilience is typically defined as the capacity of a system to continue to perform its fundamental functions in the setting of acute disruptive events (shocks). Existing conceptualisations and theories focus on normative descriptions of the ‘capacities’ that should be developed to promote health system resilience. They usually emphasise the bidirectional relationship between governance and health system resilience, but underlying mechanisms remain undertheorised. While many authors stress the value of a forward-looking approach that anticipates scenarios to build resilience, there is no consensus on whether a centralised ‘top-down’ is more effective than a decentralised ‘bottom-up’ approach to respond to shocks.Conclusions Overall, the literature suggests that governance is critical to understanding health system resilience in response to shocks, yet these relationships are considered complex and potentially bidirectional and remain undertheorised. Future research should develop more nuanced theories that capture the dynamics of these relationships and consider how the health system relates to broader (non-health) systems that have the potential to foster health system resilience.