Supporting health system resilience capacities in fragile and shock-prone settings: A qualitative synthesis of six years of learning from the ReBUILD consortium
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Conflicts, crises and chronic stressors such as climate change are growing threats to health systems, which has led to increased focus on the concept of resilience. However, while there is an expanding literature on resilience, it has largely focused on conceptualization and measurement, rather than on understanding how to support the development of resilience capacities.
During ReBUILD we focused on building empirical evidence on this topic in relation to fragile and shock-prone (FASP) settings, where this is most urgent, challenging and neglected. In this paper, we used qualitative thematic synthesis to bring together findings across the consortium’s work, taking our conceptual framework as an initial structure but adding themes inductively from the research, and revisiting our original hypotheses in light of findings.
We analysed 75 papers and briefs, presenting findings by health system resilience capacity domains and reflecting on cross-cutting themes and lessons. Limitations include the self-selected evidence base and mix of sources.
We found:
- resilience capacities were strongly interdependent,
- resilience was consistently relational as well as technical,
- connected systems were not peripheral influences but constitutive features of resilience in FASP settings,
- absorptive and adaptive responses were much more commonly observed than transformative ones. This reflects the resourcing and political constraints of the settings studied, and
- a recurring finding was the presence of maladaptive responses, including increased cost-shifting to households and greater dependence on unregulated providers.
This reinforces the importance of assessing resilience through the lenses of equity and justice.
Read this Social Science and Medicine – Health Systems paper here [opens new tab].
Suggested citation
Sophie Witter, Karin Diaconu, Augustus Osborne, Shophika Regmi, Rouham Yamout, Wesam Mansour, Maria Paola Bertone, Sally Theobald, Kyu Kyu Than, Jo Raven, Supporting health system resilience capacities in fragile and shock-prone settings: A qualitative synthesis of six years of learning from the ReBUILD consortium,
SSM – Health Systems, Volume 7,2026, doi.org/10.1016/j.ssmhs.2026.100334.