Low- and middle-income countries (LMICs) routinely confront public health emergencies, including infectious disease outbreaks, climate-related shocks and humanitarian crises. These recurrent events expose persistent weaknesses in health system preparedness and response. The concept of resilience—the capacity of health systems to anticipate, absorb, adapt to and recover from shocks—has gained attention as a priority attribute for systems that face such threats. Despite this interest, there is no comprehensive synthesis of tools specifically developed to evaluate resilience of public health emergency preparedness and response (PHEPR), particularly within LMIC contexts.
A focused review of available instruments and frameworks is needed to inform policy and practice: to understand what tools exist, how robust their development and validation are, how accessible they are, and whether they are applicable to the structural and operational realities of LMIC health systems.
The objective of this systematic review is to identify, describe and critically appraise existing tools and frameworks used to evaluate PHEPR resilience, and to assess their methodological robustness, availability and applicability to LMIC health systems.
The review will include both peer-reviewed and grey literature that describe, develop, validate or apply instruments or frameworks for assessing resilience in PHEPR. Sources must be published in English and dated between 2005 and 2025. Eligible materials are those that provide sufficient detail on the tool or framework to allow description and appraisal, including conceptual basis, development methods, validation evidence or implementation experiences. The focus is explicitly on tools relevant to public health emergency preparedness and response and on their utility in LMIC settings.
A comprehensive literature search will be conducted across multiple databases and repositories to capture both academic and organisational outputs. Sources listed for searching include PubMed, Scopus and Web of Science, together with institutional platforms such as the WHO Institutional Repository for Information Sharing (IRIS), Africa Centres for Disease Control and Prevention repositories, and other relevant governmental and organisational platforms. The strategy is intended to identify peer-reviewed studies and grey literature that meet the inclusion criteria for tool description, development or application.
Two reviewers will independently undertake the screening process. This comprises initial title and abstract screening followed by full-text review for records that appear to meet inclusion criteria. Independent dual review aims to reduce bias and improve reliability of inclusion decisions. Discrepancies between reviewers will be resolved according to the protocol’s procedures (details of resolution processes were not reported in the source). The time frame for included publications is 2005–2025 and only English-language materials will be considered.
Data extraction will be performed independently by two reviewers using a piloted 24-item extraction form. The extraction form is designed to systematically capture key attributes of identified tools and studies, including descriptive information, conceptual foundations, development methods, evidence of validation or testing, implementation characteristics and any reported outcomes or lessons learned. The piloting of the extraction form aims to ensure consistency and completeness in data capture across reviewers.
Where empirical studies are included, their methodological quality will be appraised using appropriate Joanna Briggs Institute (JBI) critical appraisal tools. The use of JBI instruments indicates a structured approach to assessing risk of bias and methodological rigour in included empirical research. Specific JBI checklists to be applied were not specified in the source.
Beyond study-level quality appraisal, the protocol specifies structured qualitative criteria to evaluate the resilience assessment instruments themselves. These criteria will examine the tools’ conceptual foundations, how they were developed, the extent and quality of validation evidence and their implementation characteristics such as accessibility, feasibility and contextual adaptability. This approach aims to assess not only whether tools exist but also whether they are methodologically robust and practically applicable for assessing PHEPR resilience in LMICs.
Ethical approval was not required for this review because it will use publicly available literature. Findings will be disseminated through peer-reviewed publication, conference presentations and policy briefs to inform future development and implementation of resilience assessment tools for public health emergency preparedness and response in LMICs. The review is registered in PROSPERO with registration number CRD420251243633.