Emergent metabolic parasitism driven by organelle sequestration.

The normal functioning of health systems can be disrupted by significant shocks, primarily due to the pressures they place on various components of the system []. Documented shocks that may affect health systems include infectious disease outbreaks, large-scale population displacements, civil unrest, and climate-related issues [–]. These shocks diminish a health system’s ability to provide high-quality routine healthcare and to respond effectively to emergencies. Disruptions within health facilities frequently occur due to the reallocation of resources, whether human, financial, or material, to crisis response efforts, thereby diverting resources from service delivery, logistics, or influencing community perceptions []. Subsequently, the health system is left overwhelmed and unable to function normally. On a larger scale, systemic issues, including governance deficiencies, insufficient financing, structural and resource limitations, and fragile information infrastructure, further intensify disruptions []. Such disruption may result in loss of life from other illnesses, economic downturns, social upheavals, and diminished access to quality services in specialized clinics (e.g., non-communicable diseases, reproductive health, and HIV), which are frequently deprioritized during outbreaks [,]. This inability of health systems to provide essential health services during response to shocks directly impacts universal health coverage []. The COVID-19 pandemic exposed the insufficiency of universal health coverage, which is defined as: 1) an adequate number of trained health professionals; 2) availability of medicines; 3) resilient health information systems, including surveillance mechanisms; 4) suitable infrastructure; 5) adequate public financing; and 6) a robust public sector capable of providing equitable and high-quality services [,]. The increasing frequency of outbreaks of emerging and re-emerging infectious diseases further undermines global health security and the attainment of universal health access. In low-resource settings, especially in Africa within the meningitis belt and arbovirus-endemic regions, outbreaks are frequent [,]. Since 2020, the African region has faced more than 100 major outbreaks annually. Uganda alone experienced over 800 disease outbreaks between 2000 and 2022 [,]. Notably, a 2025 review reported 85 outbreaks between 2017 and 2022, most of which were vaccine-preventable diseases (VPDs) and viral hemorrhagic fevers (VHFs) [–]. Health systems in Africa, however, continue to lack sufficient capacity to respond effectively to emergencies while maintaining routine operations and care [,]. Resilience is defined as “the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learned, reorganize if conditions require it” []. The concept gained prominence during the Ebola Virus Disease outbreak in West Africa during 2014–2016, when health systems lost the ability to ensure health for all and achieve good outcomes []. Similarly, the COVID-19 pandemic revealed extensive challenges in establishing resilient systems [–]. Resilience has often been narrowed to emergency response rather than the broader aspects that sustain essential services, including financing, human resources, and community engagement []. To establish resilient health systems globally, it is essential to contextualize the concept of resilience, as the current lack of a shared understanding hampers its effective operationalization for system strengthening. For Africa, this necessitates analyzing the concept through the perspectives of various local stakeholders. We conducted a qualitative evidence synthesis of published literature indexed in prominent databases and grey literature. Our primary objective was to examine evidence regarding health system resilience in African nations, with aims of synthesizing the interpretations of resilience and identifying characteristics of resilient systems in response to infectious disease shocks. Our evidence synthesis was ted in accordance with the PRISMA Reporting Guidelines [] ().