Shiraz, October 5 — A new review of health system responses to economic crises in the West Asia and North Africa region reveals a persistent mismatch between stated goals and actual capabilities during times of stress. The systematic review, published in BMC Health Services Research by researchers at Shiraz University of Medical Sciences, analyzed 27 studies covering the period from 2008 to 2026. Researchers screened 3,455 records from six major databases and four grey literature sources before selecting the final set of studies.
Each study was evaluated using design-appropriate tools: the Joanna Briggs Institute checklist, the Mixed Methods Appraisal Tool, and the AACODS checklist for grey literature. The search strategy underwent peer review against the PRESS standard, and the review was registered in line with PRISMA 2020 guidelines.
Of the 27 included studies, 23 were rated high quality and four moderate quality. Applying the ‘abc’ structural model, which measures alignment between policy goals, institutional tasks, and organizational positions, the review found that 89 percent — 24 out of 27 studies — documented structural misalignment, indicated by a delta-E value greater than zero. This pattern held across study quality ratings, showing that in nearly every crisis examined, government-stated health system goals were not matched by the actual capabilities of institutional tasks, which lacked adequate organizational mandates and resources.
The review identified two primary shock mechanisms: international sanctions disrupted pharmaceutical supply chains through banking restrictions, import controls, and supplier withdrawal due to compliance risk; currency collapses eroded government revenue, reducing purchasing power for hard-currency-priced imports like drugs and vaccines while diminishing the real value of health workers’ wages. These supply-side and revenue erosion effects interacted to compound system strain.
Fragmented risk pooling — observed in Lebanon and Jordan, where multiple small, poorly coordinated insurance schemes covered separate population segments — worsened health poverty during crises by limiting reserves and bargaining power, pushing households toward out-of-pocket payments strongly linked to catastrophic health expenditure.
The authors concluded that the architecture of risk pooling, not just funding levels, determines whether a health system bends or breaks under macroeconomic pressure, and recommended two structural reforms to improve resilience, though specific reform details were not included in the provided source text. Consult your doctor for medical advice.
