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

Article Article scientifique Article Health systems governance, shocks and resilience: a scoping review of key concepts and theories eng 2025-06-19 2025-06 author Belloni Giulia 0000-0002-9159-0354 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland giulia.belloni@unisante.ch. author Monod Stefanie 0009-0001-8318-5789 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland. 101412 author Poroes Camille 0009-0007-3274-7749 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland. author Buhler Nolwenn 0000-0003-2941-8032 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland. 510852 author Avendano Mauricio 0000-0002-7295-2911 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA. author Wernli Didier 0000-0002-1751-1961 Global Studies Institute, University of Geneva, Geneva, Switzerland.,Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland. 525223 Département d'informatique (DINFO) e017358 10.1136/bmjgh-2024-017358 40541279 2059-7908 https://gh.bmj.com/lookup/doi/10.1136/bmjgh-2024-017358 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. Decision Making Health policies and all other topics Health policy Health systems Health systems evaluation Dewey 320 Mauricio Avendano and Nolwenn Bühler are funded by the Swiss National science Foundation programme (PNR80). 210142 24 Global Studies Institute 0DJ false BMJ global health 10 6 1ccb36fe-aa75-47b2-b5c0-e765d13a63e3 Article (Published version) Public e017358.full.pdf 909192 application/pdf b3c724178b2b72e91b9f35c8f873232be02db45947bf171a734070e032cdc85a openAccess Centres et instituts / Global Studies Institute

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Health systems governance, shocks and resilience: a scoping review of key concepts and theories	BMJ global health			2025	60	186

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