ABSTRACT Health systems in low and middle‐income countries face a fundamental puzzle: some severely resource‐constrained systems demonstrate unexpected adaptive capabilities when tested by repeated crises while others with comparable resource levels collapse. Existing theories cannot explain this variation. Resource availability approaches predict failure under extreme limitation but cannot account for adaptation despite deficits. Resilience frameworks describe desired outcomes without specifying pathways when baseline capacity is absent. Crisis management models outline learning stages but provide limited evidence on whether learning occurs in low‐resource settings. This paper develops the Crisis‐Induced Adaptive Capacity (CIAC) framework, a middle‐range theoretical synthesis of dynamic capabilities theory, high‐reliability organization principles, and crisis management scholarship. CIAC explains how adaptive capacity emerges through three mechanisms grounded in crisis responses across sub‐Saharan Africa and South Asia: dynamic reconfiguration of organizational capabilities, cultivation of reliability‐seeking behaviors, and institutionalization of crisis‐derived learning. The framework demonstrates that adaptive capacity develops through deliberate organizational processes rather than automatically from crisis exposure. CIAC generates eight testable propositions, specifies measurable indicators for investigation, and provides methodological guidance for testing mechanisms across contexts. The framework offers researchers analytical tools for longitudinal case studies and policymakers guidance for strengthening health systems when substantial resource increases remain unlikely.
Ayotunde Giwa (2026) studied this question.