Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 13 1 2024 12 01 Learning From Countries on Measuring and Defining Community-Based Resilience in Health Systems: Voices From Nepal, Sierra Leone, Liberia, and Ethiopia 1 12 4629 10.34172/ijhpm.7996 EN Angeli Rawat School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada 0000-0002-1313-2796 Katrina Hsu Faculty of Medicine, University of Alberta, Edmonton, AB, Canada 0000-0002-8380-5415 Agazi Ameha UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia 0000-0002-5796-0972 Asha Pun UNICEF Nepal Country Office, Kathmandu, Nepal 0000-0002-0257-0205 Kebir Hassen UNICEF Yemen Country office, Sana’a, Yemen 0009-0008-6820-5762 Aline Simen-Kapeu The World Bank Group, Abidjan, Ivory Coast 0000-0003-2259-1027 Nuzhat Rafique UNICEF Field office Benghazi, Benghazi, Libya 0000-0002-5926-9704 Macoura Oulare UNICEF Regional Office West and Central Africa, Dakar, Senegal 0000-0002-5220-4393 Jonas Karlstrom SingHealth Duke-NUS Global Health Institute, Singapore, Singapore 0000-0002-7279-428X Sameera Hussain University of Ottawa, Ottawa, ON, Canada Kumanan Rasanathan UNICEF, New York City, NY, USA 0000-0001-9347-1765 Journal Article 2023 02 28 Background  The best approach for defining and measuring community healthcare (CHC) resilience in times of crisis remains elusive. We aimed to synthesise definitions and indicators of resilience from countries who had recently undergone shocks (ie, outbreaks and natural disasters). Methods  We purposively selected four countries that had recently or were currently experiencing a shock: Nepal, Ethiopia, Sierra Leone, and Liberia. Focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with participants at the community, facility, district, sub-national, national, and international levels. Interviews and discussions were translated and transcribed verbatim. Data were open coded in ATLAS.ti using a grounded theory approach and were thematically collated to a pre-specified framework. Results  A total of 486 people participated in the study (n = 378 community members, n = 108 non-community members). Emergent themes defining CHC resilience included: the importance of communities, health system characteristics, learning from shocks, preventing and preparing for shocks, and considerations for sustainability and intersectoral engagement. Participants identified 193 potential indicators for measuring resilience, which fell into the domains of: (1) preparedness, (2) response and recovery, (3) communities, (4) health systems, and (5) intersectoral engagement.  Conclusion  Despite varying definitions and understanding of the concept of resilience, community-centred responses to shocks were key in building resilience. Further insight is needed into how the definitions and indicators identified in this study compare to other shocks and contexts and can be used to further our understanding of health system resilience. Metrics and definitions could assist policy-makers, researchers, and practitioners in evaluating the readiness of systems to respond to shocks and to allow comparability across health systems. We must build health systems that can continue to function and ensure quality, equity, community-focused care, and engagement, regardless of the pressures put upon them and ensure they are linked to strong primary healthcare. https://www.ijhpm.com/article_4629_bd5c5e1c04111451ed8b63079ea181e7.pdf