The role of diaspora in supporting health system resilience in fragile and shock-prone settings: A scoping review

Fragile and shock-prone (FASP) settings face severe health system challenges that diminish the capacity to respond and adapt in crisis. Diaspora play a significant role in supporting health systems globally, yet their contributions to the resilience of health systems in FASP settings remain underexplored. This review aims to examine the literature on diaspora contributions to health systems resilience in FASP settings.

A scoping review of literature across academic databases and grey literature sources was conducted. Studies reporting diaspora contributions to health systems and communities across FASP settings between 2006 and 2025 were included. Data was extracted and summarised to present key diaspora capital forms, contributions, engagement models, and associated factors.

A total of 61 publications across 26 fragile settings were included, with a predominance of grey literature. Social capital was the most reported form of diaspora capital, often combined with financial and human capital. Five engagement models were identified, with diaspora-local actor engagement most reported. Diaspora contributions supported multiple health system resilience capacities, including improved service delivery, physical and human resource availability, adaptive governance, information systems, and community resilience capacities. Network power emerged as a critical enabling factor, in addition to trust, technology, and digital platforms. The scale and impact of contributions were influenced by diaspora characteristics, host and home country environments, and the crisis context. Unintended consequences included increased inequity, sustainability challenges, and health system fragmentation.

Our findings demonstrate that diaspora capital represents a critical health system resilience capability in FASP settings. Diaspora draw on combined financial, human and social capital through multiple pathways to contribute to multiple health system resilience capacities. However, empirical research remains limited. Future research examining the roles and contributions of diaspora in supporting resilience of health systems in FASP settings is needed.