Availability and utility of tools to evaluate resilience of public health emergency preparedness and response in LMICs: a systematic review protocol

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BACKGROUND: Low- and middle-income countries (LMICs) experience recurrent public health emergencies, including infectious disease outbreaks, climate-related shocks and humanitarian crises, which expose persistent weaknesses in health system preparedness and response. Although resilience-defined as the capacity of health systems to anticipate, absorb, adapt to and recover from shocks-has gained increasing attention, there is no comprehensive synthesis of tools specifically designed to evaluate the resilience of public health emergency preparedness and response (PHEPR), particularly in LMICs contexts. OBJECTIVE: 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 LMICs health systems. METHODS: This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 statement and will follow the PRISMA 2020 reporting guideline. A comprehensive search will be conducted in PubMed, Scopus, Web of Science, WHO Institutional Repository for Information Sharing (IRIS), Africa Centres for Disease Control and Prevention repositories and relevant governmental and organisational platforms. Eligible sources will include peer-reviewed and grey literature published in English between 2005 and 2025 that describe, develop, validate or apply PHEPR resilience assessment tools. Two reviewers will independently undertake screening, full-text review and data extraction using a piloted 24-item extraction form. Methodological quality of empirical studies will be appraised using appropriate Joanna Briggs Institute critical appraisal tools, while resilience assessment instruments will be evaluated using structured qualitative criteria examining their conceptual foundations, development methods, validation evidence and implementation characteristics ETHICS AND DISSEMINATION: Ethical approval was not required because this review 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. PROSPERO REGISTRATION NUMBER: CRD420251243633.

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