Health System Resilience Strengthening Processes in natural disaster-prone Insular Countries: Cases of Saint Lucia, Dominica, and Haiti

Abstract

Abstract Health systems resilience (HSR) refers to "the ability of health sector actors, institutions and communities to effectively withstand crises, maintain their essential functions in such circumstances and, learning from experience, reorganise accordingly". In the Caribbean, the need for resilient health systems has never been more critical. To withstand the acute or chronic shocks constantly experienced (natural disasters, staff shortages), these systems need to build or strengthen their capacity. However, despite the general recognition of HSR's key role, research on the subject remains limited in this region and a further understanding of its construction in such contexts remains necessary. This study aims to explore, analyse, and understand the mechanisms of health systems resilience (HSR) development in natural disaster-prone Caribbean countries. It involves a multiple case study covering three countries in the Caribbean region: St Lucia, Dominica, and Haiti. The study intends to be exploratory and explanatory, and it adopts a mixed quantitative and qualitative methodology. It is articulated in two sections, with respectively a theoretical and an empirical emphasis. Drawing on the conceptual frameworks provided by Kruk & al, 2017; Grimm & al, 2021 and Thomas, S & al, 2020 the first section involves a literature review supplemented by structured interviews, focus groups and a quantitative questionnaire to assess each country's HSR status. The triangulation of the collected information will serve to develop a conceptual framework adapted to these contexts. The second, empirical section will consist of a realist evaluation of selected HSR projects carried out within the respective countries. Building on the results from the first section, the focus lies on identifying Context-Mechanism-Effect (CME), semi-regularities consistent with the realist evaluation approach. Once collected, the relevant information will be analysed in order to select the CME patterns which can be extended to similar contexts as well as to derive conclusions for the construction of the cases and the attainment of the overall research objective. This study aspires to enrich the understanding and materialisation of HSR in these specific contexts and to contribute to the scientific literature devoted to this subject across the region.