Author: Ashenafi Woyessa
Woyessa, Ashenafi, 2025 Exploring Health Emergency Preparedness from a System Perspective: Implications for Resource-poor Health System Resilience, Flinders University, College of Nursing and Health Sciences
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Background: The rising incidence of health emergencies poses significant challenges for health systems worldwide, particularly in resource-constrained settings. Despite the burdens of epidemiological, environmental, and security-related emergencies, the Ethiopian health system lacks optimal preparedness. The absence of evidence supporting policy interventions worsens the country’s preparedness deficit in its health system. In Ethiopia, previous research has overlooked system-level preparedness, leaving gaps in understanding progress, current readiness, and the factors that enable or hinder system-level health emergency preparedness. Notably, the interactions among the influencing factors and the system-wide impacts of these interactions remain opaque. Given these gaps, the present research explored health emergency preparedness in Ethiopia, a country with a resource-poor health system.
Aim: This research aimed to explore health emergency preparedness within the Ethiopian health system, focusing on investigating the system’s preparedness progress, current readiness, factors that enable or limit this preparedness, the interplay among these factors, and their system-wide influence.
Methods: The research adopted a constructivist grounded theory approach, with data collection and analysis conducted iteratively. Data were gathered through three rounds of in-depth interviews with healthcare managers in the Ethiopian health system and its key partner organisations. The analysis involved three stages of coding, with constant comparative analysis and memoing throughout. Initial coding helped break transcripts into excerpts. Focused coding aided in reintegrating these excerpts into coherent concepts, which later developed into categories. Theoretical coding helped connect the main categories and consolidate them into core categories, leading to the emerging theory. Ultimately, the emerging theory informed the creation of an explanatory conceptual framework, outlining key strategies to improve health emergency preparedness.
Findings: Data analysis revealed eight main categories that capture the key findings. The first category, “Inadequate readiness despite positive progress”, highlights that overall readiness remains insufficient despite ongoing initiatives. The subsequent categories, “Embracing emerging opportunities” and “Harnessing local adaptive mechanisms”, encapsulate the key enablers of preparedness. The remaining categories—“Weak coordination and poor collaboration”, “System instability and change”, “Constraints on healthcare resources”, “Learning and education gaps”, and “Low adoption of recommended approaches”—collectively present the key barriers to preparedness. These eight categories were consolidated into two core categories, culminating in the “Optimisation of health emergency preparedness in resource-poor health systems” theory. The theory suggests that integrating optimised approaches involving attitude shifts, local adaptations, leveraging global opportunities, and addressing persistent barriers will enhance preparedness. The interactions among the elements of the theory further contributed to the development of an enablers-and-barriers-informed conceptual framework to enhance health system disaster preparedness.
Conclusion and implications: This research concludes that the Ethiopian health system's emergency preparedness can be enhanced by building on existing initiatives, leveraging identified enablers, and addressing barriers. An important insight for similar resource-poor health systems is the need to overcome the tendency to use resource limitations to justify inadequate preparedness. Another key takeaway is the necessity of shifting from the “no resources, no preparedness mentality” to prioritising available opportunities and leveraging an integrative strategy. Utilising a framework from this research will support this integrative approach.
Keywords: Barriers, Enablers, Health Emergencies, Health System, Preparedness, Readiness, Resource-poor
Subject: Nursing thesis
Thesis type: Doctor of Philosophy
Completed: 2025
School: College of Nursing and Health Sciences
Supervisor: Professor Paul Arbon