Developing a process-based conceptual model for optimizing health system responsiveness as a reflection of people-centeredness during crisis and recovery periods

Health system responsiveness is a key dimension of efficiency and people-centeredness, particularly during periods of crisis and recovery, including the ongoing wartime context in Ukraine. Such crisis periods include pandemics, economic instability, and, notably, the full-scale war in Ukraine, which has profoundly affected the functioning of the health sector and highlighted the need for new approaches to management and responsiveness. Enhancing the health system’s capacity to respond to population needs requires implementing a process-based approach that aligns structural, procedural, and outcome components and supports system resilience under crisis conditions. To substantiate a conceptual framework for optimizing the responsiveness of the territorial health system based on the process-oriented approach, drawing on the analysis of healthcare professionals’ suggestions and using the organization of rehabilitation services for military personnel as a practical implementation example. The study employed a cross-sectional analytical design using a one-time sociological survey of 57 key healthcare professionals. A self-developed questionnaire, based on the WHO responsiveness assessment framework with additional items on system feedback improvement, was applied. Methods included systems analysis, comparative and schematic modeling, and a process-based approach. Statistical analysis was performed in R Commander (v.4.2.1). The average responsiveness score was 6.3 points (95% CI: 5.6-7.0), more than one-third below the maximum possible level. The largest gaps between importance and actual provision were found in dignity, communication, timeliness, living conditions, and access to social support. The main barriers were financial, organizational, and legal constraints. The proposed process-based conceptual model could, according to expert evaluation, increase responsiveness to 8.9 points (95% CI: 8.7–9.5) and improve overall system outcomes. Optimizing responsiveness requires strengthening regulatory, financial, resource, and organizational-communication mechanisms within the healthcare system. The proposed process-oriented model provides a foundation for enhancing people-centeredness, accountability, and resilience of health systems in crisis and post-crisis contexts.