Pathways of resilience: A fuzzy-set qualitative comparative analysis of healthcare systems resilience to extreme weather events

This paper examines how healthcare systems respond to extreme weather events (EWEs) and identifies pathways through which resilience is achieved in practice. The authors analysed 18 validated case studies from diverse global contexts, including Colombia, England, India, Malawi, the Philippines, Tanzania, Uganda and Vietnam, covering floods, cyclones, landslides, extreme heat and other weather-related hazards. 

Using a fuzzy-set Qualitative Comparative Analysis (fsQCA), the study examined how EWEs affected four interrelated system levels: healthcare facilities, local health systems, communities and interconnected infrastructures. It assessed configurations of vulnerability, adaptive capacity and external support associated with two outcomes: service continuity and healthcare facility recovery. The authors conclude that health system resilience to EWEs is a multi-scalar process and highlight the importance of cross-system coordination, planning for capacity limits and investing in the health workforce as a central component of response and recovery.