Valery Ridde, Mrittika Barua, Emmanuel Bonnet , Alain Casseus , Lucie Clech , Manuela De Allegri, Mollah M. Shamsul Kabir , Jean-Marc Goudet, Daniel Henrys, Muhammed Nazmul Islam, Yunona L’Heureux , Camille Masselot, Dominique Mathon, Sofia Meistre, Malabika Sarker

The analysis of health system resilience has progressed significantly, yet there remains a wide diversity in the conceptual frameworks used. The ClimHB conceptual framework, developed in 2019, integrates two influential models: the Levesque model of healthcare access and DFID's resilience framework. Designed to study health system resilience in response to climate-induced events, the ClimHB framework uniquely positions the population as an active participant on the demand side, complementing the supply side of health services and providers. Characterised by three core dimensions – exposure, sensitivity, and adaptive capacity – this dual focus on demand and supply, and their interactions emphasises the dynamic interplay between both sides in shaping health system resilience.
A workshop utilising framework analysis, and the World Café method refined the ClimHB framework by integrating empirical evidence from Haiti and Bangladesh, alongside insights from a literature review. The revised framework presents a dynamic understanding of interrelated resilience, aimed at informing decision-making across all levels of healthcare. It emphasises the importance of contextual factors, strengthens outcome linkages, and incorporates socio-economic and ecological considerations. Governance, professional awareness, and supply-side feedback loops were also emphasised.
Site studies demonstrated the framework’s adaptability and ability to foster synergy between theory and implementation. However, challenges persist in operationalising the framework, particularly for policymakers, emphasising the need for validation, standardised measures, and a deeper understanding of resilience interplays. Future research should explore the framework’s implications for structural management, training, and resource allocation, addressing critical gaps in resilience research.