Factors of Power and Equity: Enhancing Our Health System Resilience Research Frameworks Comment on "Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic"

The concept of health system resilience has gained prominence in global health discourse, especially in response to the Ebola and COVID-19 pandemics. This commentary responds to Saulnier and colleagues’ 2022 review, which used the Dimensions of Resilience Governance framework to synthesize of COVID-19 related health system resilience research and explore possible conceptual gaps. The review’s findings reveal elements missing from the original framework which underscore the social nature of health systems. This commentary links the review’s empirical findings to nascent theorization of health systems resilience to develop an adapted Framework for Exploratory Research on Health Systems Resilience. A key contribution of the adapted framework is to make explicit the role of actor power and highlight more clearly the distinctions between: (i) research focused on identifying the capacities needed to enable adaptation; (ii) research focused on the actors whose interests and choices determine which adaptive strategies are used, and (iii) research that assess the outcomes of such strategies.