Evidence map›Paper›PMID 40541279›Full record

ArticleBMJ global health2025

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

Giulia Belloni, Stefanie Monod, Camille Poroes, Nolwenn Bühler, Mauricio Avendano, Didier Wernli

Abstract readScoping Review
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. Observational
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
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  9. Public Health System Credibility and Firm-Level Financial Risk: A Panel Data Analysis.Inquiry : a journal of medical care organization, provision and financing
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Giulia BelloniCenter for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland giulia.belloni@unisante.ch.ORCID http://orcid.org/0000-0002-9159-0354
Stefanie MonodCenter for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.ORCID http://orcid.org/0009-0001-8318-5789
Camille PoroesCenter for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.ORCID http://orcid.org/0009-0007-3274-7749
Nolwenn BühlerCenter for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.ORCID http://orcid.org/0000-0003-2941-8032
Mauricio AvendanoCenter for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.ORCID http://orcid.org/0000-0002-7295-2911
Didier WernliGlobal Studies Institute, University of Geneva, Geneva, Switzerland.ORCID http://orcid.org/0000-0002-1751-1961

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIt 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.

methodsSix 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.

resultsAlthough 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.

conclusionsOverall, 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.

Indexed as

Delivery of Health CareHumansDecision MakingHealth policies and all other topicsHealth policyHealth systemsHealth systems evaluation

Identifiers

PMID40541279
PMCPMC12181996

What OpenQuestion holds

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Registered trials

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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.