From Clech, L., Meister, S., Belloiseau, M. et al. Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19): an interdisciplinary mixed method research protocol. BMC Health Serv Res 22, 340 (2022). https://doi.org/10.1186/s12913-021-07294-3

Contemporary pandemics, mobilities and climate change have highlighted more than ever the need to develop an empirical, integrative, applied approach for documenting the resilience of healthcare systems beyond concepts in global health [1]. This situation is all the more dramatic for low and middle-income countries (LMIC) as the costs of these shocks and future, unforeseen emergencies will drain already scarce resources and accentuate existing inequities. Based on conceptual analysis and other empirical papers [2, 3], we define health systems resilience as: the constituents’ abilities of a health system facing destabilising experiences, events or shocks (contingent or expected, sudden or insidious, internal or external) to adapt and transform in order to maintain and/or improve access (for all) to comprehensive, relevant and quality healthcare and services without pushing patients into poverty.

Health systems resilience (HSR) is at the core of current preoccupations. The 2020 Lancet Countdown report on health and climate changes recommend to integrate climate change and the COVID-19 crisis responses, in a way that addresses inequality directly [4]. Globally, 400 million people have no access to essential health services [5]. Achieving universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all is part of the sustainable Development Goal (SDG) 3.8 for 2030. “For all” is essential in this declaration, as a significant proportion of the population, such as migrants, do face distinctive vulnerabilities to poor health [6] and poor healthcare access [7].

Various kind of emergencies are expected to continue happening, but a more resilient and robust healthcare system can minimize their impacts, which is within reach of all countries, even the poorest [8]. Because low- and middle-income countries (LMIC) and their populations face numerous social vulnerabilities and are already fragile in terms of health coverage and health structures; the necessity to document the resilience of national healthcare systems is even more compelling. There is an urgent need to build empirical evidence on the resilience of health systems and the strategies stakeholders organize to respond to these crises in order to thoroughly inform decision-makers to better anticipate.

Despite health system resilience being a widely researched topic, this concept lacks of conceptual maturity, needs clarification and empirical validation [2]. In this context, we present the design of an interdisciplinary research project (ClimHB project) focusing on health systems resilience through the example of vulnerable localities in Haiti and Bangladesh. These two countries are highly sensitive to climate change and other global and local risks. These changes and risks are pushing out people from their communities, or trapping them when unable to move away [9] thus influencing populations mobility and immobility. Both countries are experiencing global changes through the exacerbation of disruptions caused by climate-related events, (im)mobility and the Covid-19 pandemic. In order to understand how local contexts, influence and interact with patterns of resilience and population health, we use a multi-sites approach, to integrate a variety of local contexts and vulnerabilities, because context matters [10,11,12]. This project aims to answer two interrelated questions in the context of climate-induced environmental change (CIEC), population (im)mobilities, Covid-19 pandemic and other possible changes, events and risks affecting the population and the healthcare systems:

1. What is the relative resilience of local health service providers in various settings vulnerable to climate change and (im)mobility in Haiti and Bangladesh?

2. What are the patterns and distribution of health status and access to healthcare services of the (im)mobile populations in these various settings in Bangladesh and Haiti?