An account of health systems resilience to emergencies in Africa

A scoping review

Bibliographic Data

ID19535084
AuthorsMartin Ankomah (0009-0003-7262-2327, University of Ghana), Gordon Abekah-Nkrumah (University of Ghana, corresponding author), Grace Adjei Okai (0000-0003-3731-8285, University of Ghana), Lily Yarney (0000-0003-3423-326X, University of Ghana), Anita Asiwome Adzo Baku (0000-0002-4741-592X, University of Ghana)
Year2026
Volume22
Issue1
Publication date2026-04-06
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueGlobalization and Health (JOURNAL)
Journal identifiersISSN: 1744-8603 • E-ISSN: 1744-8603
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/s12992-026-01209-9
PMID41943161
OpenAlexW7150873340
LanguageEN
References cited113

Healthcare systems across Africa continue to face a wide range of shocks. Using Ebola and COVID-19 as case studies, this study examines the various resilience strategies implemented in different countries and synthesises them in a way that can serve as a practical guide to make health systems in Africa more resilient for future emergencies. The study is a scoping review that synthesises evidence from peer-reviewed journal articles and grey literature, structured around a conceptual framework developed by the authors. We focused on various aspects of health system resilience during the Ebola outbreaks and the COVID-19 pandemic in Africa. This review identifies six key elements vital to health system resilience in Africa: strong leadership and governance, equitable social protection, digital health innovation, trusted community engagement, a sustainable and flexible workforce, and adaptable infrastructure. However, several gaps must be addressed to strengthen resilience against future health emergencies. While political commitment and coordination mechanisms improved integration and awareness, poor decentralisation, weak accountability, and fragmented governance undermined effectiveness. Social protection initiatives and digital tools enabled rapid responses but persistent inequities in access and data gaps hindered their reach. Telemedicine and workforce expansion showed adaptability but lacked sustainability. Community trust and local innovations supported resilience, yet their potential was curtailed by top-down strategies and insufficient institutional support. This review emphasises the need for equitable, inclusive, and coherent strategies to strengthen resilient health systems in Africa. It calls for a shift from reactive, fragmented approaches to a long-term system-wide transformation grounded in inclusive governance, equitable social protection, robust digital health systems, a sustainable workforce, integrated and trusted community engagement, and adaptive physical infrastructure. Importantly, the review affirms that addressing deep-seated political, structural, and social inequities is crucial to ensuring resilience does not become an empty concept. The framework developed from this review provides a roadmap for policymakers to embed resilience as a core, institutional principle of long-term health system transformation, rather than a temporary emergency measure

Health services research · Healthcare system · Psychological resilience · Public health · Resilience (materials science) · Social policy · Social system · Disaster Response and Management · Global Health and Surgery · Viral Infections and Outbreaks Research · Health Policy