Health system response to health emergencies in low- and middle-income countries: a systematic review protocol

Health emergencies continue to stimulate greater interest in health systems and services, particularly their ability to respond to such shock. While studies have been done on health system response to health emergencies, there has been no attempt to synthesise this body of evidence to inform future emergency preparedness and response plan, particularly in low- and middle-income countries (LMICs) where health systems are deemed to be weak. This paper aims to provide a systematic review protocol for synthesising evidence on health system response to health emergencies in LMICs. The WHO building blocks of health system functioning will be used as a conceptual framework for the review. The review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Nine electronic databases will be searched: Medline, Embase, Ovid Emcare, Scopus, ScienceDirect, Academic Search Complete, HINARI, CINAHL and African Index Medicus. The search will be supplemented by citation searching, searching reference lists of included articles, search for grey literature in Google Scholar and relevant websites. Studies focusing on health system response to health emergencies in LMICs, published in English and between 2007 and 2025, will be eligible for inclusion. A narrative synthesis will be performed on all the included studies. Studies will be mapped and categorised into the WHO six building blocks of health system functioning, exploring relationships between and within studies, identifying the response mechanisms of the health system during health emergencies and their barriers and facilitators. The data to be used do not include individual patient data, so ethical approval is not required. The results of the systematic review will be disseminated through a peer-reviewed journal publication, presentations at conferences and seminars. CRD42024556271.