Health systems provide essential resources to optimize, maintain, or restore the health of populations. The extent to which a health system can meet the needs of a local community can be considered the system’s “capacity”; however, it is unclear what this constitutes. We conducted a standardized rapid review to understand how health system capacity has been conceptualized in academic and grey literature. We conducted duplicate screening and data extraction. We summarized document characteristics descriptively and definitions/frameworks narratively. We identified 22 relevant documents; three (14%) provided a definition and 20 (91%) provided a framework. Each definition provided was unique. We synthesized reported frameworks into 11 key elements of health system capacity. We identified an infrequent and inconsistent conceptualization of health system capacity in published literature; however, this review may be used as a starting point for defining and describing key elements of capacity.
Get full access to this article
View all access options for this article.
References
1.
KrukMEGageADArsenaultC, et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196-e1252. doi:10.1016/S2214-109X(18)30386-3
2.
OrganizationWH. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. In: Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes: Who’s Framework for Action; 2007. https://iris.who.int/handle/10665/43918. Accessed 31 October 2025.
3.
MurrayCJFrenkJ. A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78(6):717-731.
4.
MannsBJHastingsSMarchildonGNoseworthyT. Health system structure and its influence on outcomes: the Canadian experience. Healthc Manage Forum. 2024;37(5):340-350. doi:10.1177/08404704241248559
ColesEAndersonJMaxwellM, et al.The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Syst Rev. 2020;9(1):94. doi:10.1186/s13643-020-01344-3
7.
WilliamsIBrownHHealyP. Contextual factors influencing cost and quality decisions in health and care: a structured evidence review and narrative synthesis. Int J Health Pol Manag. 2018;7(8):683-695. doi:10.15171/ijhpm.2018.09
MirzoevTNGreenAT. Planning, for public health policy. In: QuahSR, ed. International Encyclopedia of Public Health. 2nd ed.Academic Press; 2017:489-499. doi:10.1016/B978-0-12-803678-5.00333-7
Home. Niagara Ontario Health Team - Équipe Santé Ontario Niagara; 2025. https://noht-eson.ca/. Accessed October 31, 2025.
12.
DobbinsM. Rapid Review Guidebook. The National Collaborating Centre for Method and Tools; 2017:13.
13.
MunnZPetersMDJSternCTufanaruCMcArthurAAromatarisE. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. doi:10.1186/s12874-018-0611-x
14.
O’GradyHTsangJ. Defining health system capacity: a rapid review. 2025. Published online May 8. https://osf.io/49d2r. Accessed November 3, 2025.
15.
PetersMDJMarnieCTriccoAC, et al.Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-2126. doi:10.11124/JBIES-20-00167
16.
BogaleBScamblerSMohd KhairuddinANGallagherJE. Health system strengthening in fragile and conflict-affected states: a review of systematic reviews. PLoS One. 2024;19(6):e0305234. doi:10.1371/journal.pone.0305234
17.
ZhaoJHaoXSunXDuYZhangMWangQ. Including health system capacities into the assessment framework of a temperature-resilience health system. Risk Manag Healthc Policy. 2024;17:3085-3098. doi:10.2147/RMHP.S494486
18.
Canadian Institute for Health Information. Health System Capacity: Measures to Support System-Level Monitoring in Canada. CIHI; 2022.
KrukMEMyersMVarpilahSTDahnBT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910-1912. doi:10.1016/S0140-6736(15)60755-3
21.
KajiAKoenigKLBeyT. Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 2006;13(11):1157-1159. doi:10.1197/j.aem.2006.06.032
22.
CookeJ. A framework to evaluate research capacity building in health care. BMC Fam Pract. 2005;6(1):44. doi:10.1186/1471-2296-6-44
23.
BlanchetKNamSLRamalingamBPozo-MartinF. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Pol Manag. 2017;6(8):431-435. doi:10.15171/ijhpm.2017.36
24.
NickersonJWAdamsOAttaranAHatcher-RobertsJTugwellP. Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools. Health Policy Plan. 2015;30(5):675-686. doi:10.1093/heapol/czu043
TravagliaJDebonoDDebonoG. Capacity Building and Intellectual Disability Health Services: An Evidence Check Rapid Review Brokered by the Sax Institute for the NSW. Ministry of Health; 2018.
27.
PalagyiAMaraisBJAbimbolaSToppSMMcBrydeESNeginJ. Health system preparedness for emerging infectious diseases: a synthesis of the literature. Glob Public Health. 2019;14(12):1847-1868. doi:10.1080/17441692.2019.1614645
28.
Belghiti AlaouiADe BrouwereVMeessenBBigdeliM. Decision-making and health system strengthening: bringing time frames into perspective. Health Policy Plan. 2020;35(9):1254-1261. doi:10.1093/heapol/czaa086
29.
ClearyS. Economic evaluation and health systems strengthening: a review of the literature. Health Policy Plan. 2021;35(10):1413-1423. doi:10.1093/heapol/czaa116
30.
The Republic of Uganda Ministry of Health. Baseline Assessment of District Health Systems Capacity: Use of the DHSS Progression Model; 2020.
31.
ThomasSSaganALarkinJCylusJFiguerasJKaranikolosM. Strengthening Health Systems Resilience: Key Concepts and Strategies; 2020. https://www.ncbi.nlm.nih.gov/books/NBK559803/. Accessed November 3, 2025.
32.
AkinyemiOOPopoolaOAFowotadeAAdekanmbiOCadmusEOAdebayoA. Qualitative exploration of health system response to COVID-19 pandemic applying the WHO health systems framework: case study of a Nigerian state. Sci Afr. 2021;13:e00945. doi:10.1016/j.sciaf.2021.e00945
33.
BastolaADhitalRShahR, et al.Experiences of COVID-19 patients admitted in a government infectious disease hospital in Nepal and its implications for health system strengthening: a qualitative study. PLoS One. 2021;16(12):e0261524. doi:10.1371/journal.pone.0261524
34.
Cordova-PozoKLKorziliusHPLMRouwetteEAJA, et al.Using systems dynamics for capturing the multicausality of factors affecting health system capacity in Latin America while responding to the COVID-19 pandemic. Int J Environ Res Publ Health. 2021;18(19):10002. doi:10.3390/ijerph181910002
35.
KaramagiHCTumusiimePTiti-OfeiR, et al.Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19. BMJ Glob Health. 2021;6(3):e004618. doi:10.1136/bmjgh-2020-004618
36.
BrownGWBridgeGMartiniJ, et al.The role of health systems for health security: a scoping review revealing the need for improved conceptual and practical linkages. Glob Health. 2022;18(1):51. doi:10.1186/s12992-022-00840-6
37.
KabirAKarimMNBillahB. Health system challenges and opportunities in organizing non-communicable diseases services delivery at primary healthcare level in Bangladesh: a qualitative study. Front Public Health. 2022;10:1015245. doi:10.3389/fpubh.2022.1015245
38.
LeeJMJansenRSandersonKE, et al.What is the current state of public health system preparedness for infectious disease emergencies? A scoping review. medRxiv. 2022. doi:10.1101/2022.10.25.22281308. Preprint posted online October 26, 2022.
39.
RendellNSheelM. Expert perspectives on priorities for supporting health security in the Pacific region through health systems strengthening. PLOS Glob Public Health. 2022;2(9):e0000529. doi:10.1371/journal.pgph.0000529
40.
World Health Organization. Toolkit for Assessing Health-System Capacity for Crisis Management: Strengthening Health-System Emergency Preparedness. 2: Assessment Form. World Health Organization, Regional Office for Europe; 2022.
World Health Organization. Refugee and Migrant Health System Review: Challenges and Opportunities for Long-Term Health System Strengthening in Uganda; 2024. https://www.who.int/publications/i/item/9789240098824. Accessed November 3, 2025.
