Building resilient health systems through learning sites in fragile and shock-prone settings: Insights from Lebanon, Nepal and Sierra Leone
Read this SSM-Health Systems paper here.
Health systems in fragile and shock-prone settings often face persistent challenges, including weak governance and accountability mechanisms, limited resources, and insufficient capacity. This paper presents findings from embedded learning sites established in Lebanon, Nepal and Sierra Leone, as part of a multi-country initiative to strengthen local health system resilience.
Using participatory action research, the learning sites aimed to build resilient health systems by supporting local actors to identify systemic gaps, co-create and implement adaptive, locally-led interventions and enable sustained improvements in health system functions.
A range of qualitative methods including key informant interviews, focus group discussions, co-creation workshops, power mapping, critical reflection meetings process documentation were employed to collect data. Analysis was conducted in two stages: first at the country level using the thematic framework approach and second through cross-country synthesis, guided by four key domains of interventions including governance, evidence-based planning, community engagement and multisectoral coordination.
Results showed that learning sites enabled more inclusive and evidence-informed decision-making, revitalised governance platforms, strengthened quality and use of local data, and created mechanisms for the inclusion of community voice in health planning. These efforts supported local actors to improve planning, coordination and supervision while enhancing health system’s ability to absorb and adapt to future shocks.
Despite operating in highly constrained contexts, the learning sites demonstrated that embedded, participatory approaches can facilitate meaningful systems change without creating parallel structures. The study offers critical lessons on the importance of trust, co-creation, capacity strengthening and institutionalization of learnings for equitable and responsive health systems.
Suggested citation
Regmi S, Witter W, Idriss A, Khalil J, Baral S, Rijal A, Dhungana A, Fouad F, Diaconu K, Yamout R, Gautam G, Arjyal A, Mansour W, Raven R, Building resilient health systems through learning sites in fragile and shock-prone settings: Insights from Lebanon, Nepal and Sierra Leone, SSM – Health Systems, Volume 7, 2026,
https://doi.org/10.1016/j.ssmhs.2026.100297.
Further information
More on the Nepal learning site projects:
- Understanding and strengthening local health governance and planning to build resilient local health systems that leave no one behind: Nepal
- Strengthen coordination mechanisms and improve health system resilience across local governments in Kapilvastu district, Nepal
More on the Lebanon learning site in Majdal Anjar:
More on the Sierra Leone learning sites:
Image: Female Community Health Volunteers meet at a learning site in Kapilvastu, Nepal