ArticleBMJ global health2017
Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa.
Article in BMJ global health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 129 papers, 4 of them syntheses that pooled it.
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Who cites it
129 citing papers in PubMed, 4 syntheses or guidelines pooled it, 254 citations in OpenAlex.
- Leadership practices and maternal and child health outcomes in Sub-Saharan Africa: a systematic review.BMC health services research · 2026Pooled it
- Hospitals during economic crisis: a systematic review based on resilience system capacities framework.BMC health services research · 2022Pooled it
- Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis.BMC public health · 2022Pooled it
- What Is Resilience and How Can It Be Nurtured? A Systematic Review of Empirical Literature on Organizational Resilience.International journal of health policy and management · 2018Pooled it
- Strategic health policy and health system resilience in protracted crisis settings: policymaker perspectives from Yemen.Global health action · 2026Article
- Leading Learning Health Systems in the Asia Pacific: A Mixed-Method Evaluation of Health Professionals' Experiences in a Longitudinal Leadership Program.Learning health systems · 2026Article
- Developing a framework for primary health care resilience in pandemic conditions for Iran.Journal of health, population, and nutrition · 2026Article
- Advancing justice and sustainability through health system resilience under economic sanctions.Health policy and planning · 2026Article
- When formal governance persists but resilience does not: health system governance and resilience in Yemen across a decade of conflict and crisis (2014-2025).BMC health services research · 2026Article
- Understanding the role of 'software' in health system capacity for non-communicable disease response: hypertension care in rural Coastal Kenya.Health policy and planning · 2026Article
- Addressing priority gaps in access and quality of NCD services in primary care settings in Rural Kenya: a participatory approach to intervention development.BMC primary care · 2026Article
- Organisation of health services for the delivery of primary health care in the WHO African region: a future perspective.The Lancet. Primary care · 2026Review
- Time for change in implementation research and practice.BMC medicine · 2026Article
- A framework and practical approach to identify and address ethical issues arising in interventional health systems research.International journal of nursing studies · 2026Review
- From inherent capacities to resilient systems: a multi-dimensional framework for assessing health system resilience.BMC health services research · 2026Article
- Support for the wellbeing of frontline healthcare workers should be incorporated in health emergency preparedness planning.Communications medicine · 2026Review
- Resilience as recovery: stakeholder perspectives on Uganda's health system response to infectious disease shocks.Frontiers in health services · 2026Article
- Resilience of health systems in Africa to infectious disease shocks: A qualitative evidence synthesis.PLOS global public health · 2026Article
- Strengthening health system resilience during COVID-19: a qualitative study of national-level decision-makers in Guinea and Sierra Leone.BMJ global health · 2025Article
- Barriers to health care access for sanitation workers in five municipalities of Bangladesh: an evaluation of Shasthya Nirapotta Scheme using multinomial logistic regression approach.International journal for equity in health · 2025Article
69 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Recent global crises have brought into sharp relief the absolute necessity of resilient health systems that can recognise and react to societal crises. While such crises focus the global mind, the real work lies, however, in being resilient in the face of routine, multiple challenges. But what are these challenges and what is the work of nurturing everyday resilience in health systems? This paper considers these questions, drawing on long-term, primarily qualitative research conducted in three different district health system settings in Kenya and South Africa, and adopting principles from case study research methodology and meta-synthesis in its analytic approach. The paper presents evidence of the instability and daily disruptions managed at the front lines of the district health system. These include patient complaints, unpredictable staff, compliance demands, organisational instability linked to decentralisation processes and frequently changing, and sometimes unclear, policy imperatives. The paper also identifies managerial responses to these challenges and assesses whether or not they indicate everyday resilience, using two conceptual lenses. From this analysis, we suggest that such resilience seems to arise from the leadership offered by multiple managers, through a combination of strategies that become embedded in relationships and managerial routines, drawing on wider organisational capacities and resources. While stable governance structures and adequate resources do influence everyday resilience, they are not enough to sustain it. Instead, it appears important to nurture the power of leaders across every system to reframe challenges, strengthen their routine practices in ways that encourage mindful staff engagement, and develop social networks within and outside organisations. Further research can build on these insights to deepen understanding.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.