Identifying vulnerabilities in essential health services: Analysing the effects of system shocks on childhood vaccination delivery in Lebanon

Sharif A. Ismail, Andrada Tomoaia-Cotisel, Aya Noubani, Fouad M. Fouad, Robert Šakić Trogrlić, Sadie Bell, Karl Blanchet and Josephine Borghi

Social Science & Medicine, 2024, vol. 358, issue C

Abstract: Shocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined with existing vulnerabilities to produce effects on essential health services delivery, through the prism of a case study on childhood vaccination in Lebanon. Lebanon has experienced a series of shocks in recent years, including large-scale refugee arrivals from neighbouring Syria, the COVID-19 pandemic and a political-economic crisis. We developed a causal loop diagram (CLD) to explore the effects of each shock individually, and in combination. The CLD was developed and validated using qualitative data from interviews with 38 stakeholders working in Lebanon's vaccination delivery system, in roles ranging from national level policy to facility-level service delivery, conducted between February 2020 and January 2022.

Keywords: Vaccination; Humanitarian; Lebanon; Refugee; Systems; Complexity; Causal loop diagram; Resilience (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1016/j.socscimed.2024.117260

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