The world is seeing an increased incidence of shocks –whether from natural hazards, epidemics like COVID-19, or conflict. Shocks are often responded to through humanitarian systems that run parallel to national public service delivery systems. This approach misses opportunities to strengthen national systems to manage future shocks, and is increasingly viewed as being unsustainable. Under the Maintaining Essential Services After Natural Disasters (Maintains) programme, the authors are undertaking operational research across six countries (Pakistan, Bangladesh, Ethiopia, Kenya, Uganda, and Sierra Leone) that seeks to understand how national systems can be more responsive to shocks – scaling up to address needs that arise due to the shock, whilst maintaining routine service delivery and avoiding indirect effects from service disruption.
In this working paper, the authors set out a model of shock-responsiveness in health systems. This builds upon an evidence review (Witter and Russell, 2019) and background paper (Witter, 2019) prepared for Maintains by Professor Sophie Witter, and an initial conceptual model developed by the Centre for Humanitarian Change for their work under Maintains in Kenya and Uganda.