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Can health system be resilient in a Failed State? Lessons from a scoping review in Haiti

par St Louis, Patricia ;Wautié, Alice ;Makali Lwamushi, Samuel;Radix, Carlene;Paul, Elisabeth
Référence Discover Health Systems, 4, 1
Publication Publié, 2025-06-18

Article révisé par les pairs

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Résumé :

Caribbean Small Island Developing States (SIDS) face many environmental, economic, political and social challenges. Alongside recurrent acute shocks, Haiti experiences various chronic shocks earning it the label of a ‘Failed State’. Against this background, the question arises as to whether and how the health system (HS) could be resilient. We aim to explore the extent to which Haiti exhibits features of health system resilience (HSR) and what interventions support this process. For this scoping review, articles were retrieved from PubMed, Scopus, ProQuest and the Virtual Health Library (VHL). Articles were independently screened and selected according to the Joanna Briggs Institute PRISMA-ScR extension guidelines for scoping review. The World Health Organization’s frameworks for HS strengthening and emergency preparedness were applied for thematic, deductive-inductive analysis. Most of the articles (57%) focused on acute shocks, while 13% described co-occurrence of chronic and acute shocks, termed “acute-over-chronic shocks” by some authors. Irrespective of shock type, Haiti’s HS greatest challenges include financial and human resource scarcity, compounded by governance shortcomings and burgeoning non-governmental organisations. These often undermine local leadership and further weaken the governance of the HS. Complementing several HSR features, the study identified a ‘continuum of shocks’, reflecting interconnectedness between differing shocks and subsequent adopted measures. Global health diplomacy has emerged as a promising strategy for improving health care accessibility and HSR. Without rethinking the overall mechanisms for HS financing, addressing power imbalances and donors’ lack of accountability, it is unlikely that Haiti, as a SIDS, will forge forward in strengthening its health system or resilience.