دانشگاه اصفهان مطالعات وقف و امور خیریه 3115-7475 4 2 2026 09 23 The Role of Health NGOs in the Resilience and Sustainability of Health System Governance During Crises نقش سازمان‌های مردم‌نهاد سلامت در تاب‌آوری و پایداری حکمرانی نظام سلامت در شرایط بحران 117 142 30778 10.22108/ecs.2026.149903.1212 FA محمدعلی کیانی دکتری، گروه جغرافیای سیاسی، دانشکدۀ جغرافیا، دانشگاه تهران، تهران، ایران افسانه دهقان‌پور فراشاه استادیار، گروه حکمرانی فرهنگی و اجتماعی، دانشکدۀ حکمرانی، دانشکدگان مدیریت، دانشگاه تهران، تهران، ایران ثمانه یزدانی استادیار، گروه مدیریت و حسابداری، دانشکدۀ علوم انسانی و هنر، دانشگاه ملی مهارت، تهران، ایران 0009-0001-8709-2969 Journal Article 2026 07 23 Introduction In recent years, health systems have increasingly confronted complex and unpredictable crises, rendering sole reliance on formal and bureaucratic structures inadequate for an effective response (Kuhlmann et al., 2024). In such contexts, health non-governmental organizations (NGOs) possess substantial capacity to intervene, compensate for systemic shortcomings, and enhance health system governance. Nevertheless, a review of the existing literature reveals that most studies have approached the role of these organizations from a fragmented, case-specific, and crisis-centric perspective, often reducing them to “reactive and relief actors” (Schwartz, 2016; Yasobant et al., 2024). The extant literature suffers from a significant gap regarding a comprehensive framework capable of holistically elucidating the deeper functions of health NGOs, such as participation in policymaking, advocacy, trust-building, and health equity, across the entire crisis management cycle (from preparedness to post-crisis learning). Accordingly, the central problem of the present study is the absence of a comprehensive and contextualized model for the integrated understanding of the multilevel functions of health NGOs during crises. Addressing this gap, the primary research question is: “What are the key functions and roles of health NGOs in the resilience and sustainability of health system governance during crises?” Methodology This study was conducted using a qualitative and inductive approach. Data were collected through purposive sampling via in-depth, semi-structured interviews with 18 key informants (including health system policymakers, senior managers, and active members of health NGOs). Interviews continued until theoretical saturation was achieved. The data were subsequently analyzed using the thematic analysis framework proposed by Braun and Clarke (2006) across three levels: basic, organizing, and overarching themes. To evaluate the quality and ensure the trustworthiness of the findings, Lincoln and Guba’s (1985) four criteria—credibility, confirmability, dependability, and transferability—were rigorously applied. Furthermore, inter-coder reliability was calculated using Holsti’s coefficient of agreement (1969), yielding a value of 0.82, which indicates a highly desirable level of coding consistency. Findings The thematic analysis of the data resulted in the extraction of 130 basic themes, 32 organizing (sub) themes, and 9 overarching (main) themes regarding the functions of health NGOs in crises. The findings demonstrate that the role of NGOs encompasses a continuous spectrum, ranging from preventive measures to emergency interventions and post-crisis rehabilitation. The overarching themes are as follows: Pre-crisis preparedness and risk reduction: including health-oriented community preparedness, identification of local health vulnerabilities and hazards, and community-based monitoring and early health warnings; Health-oriented community empowerment: comprising the organization and empowerment of health volunteers, mobilization of social capital and health-oriented local participation, and localization of health interventions based on the local context; Health-oriented response, care, and support: encompassing the provision of urgent health services, continuation of essential care, referral of affected individuals to formal services, logistical support and operational coordination, psychological first aid, psychosocial interventions, and the identification, referral, and follow-up of cases requiring specialized mental health services; Institutional collaboration in health: which involves executive partnerships with formal health institutions, institutional coordination, division of labor, and information exchange; Participation in health policymaking: including the generation of field evidence, social representation and health-oriented advocacy, and involvement in the design and reform of health policies; Equity and advocacy in health: comprising the identification of and active outreach to high-risk groups, defending the rights of patients and vulnerable populations, and reducing inequalities in access to health services; Health awareness, trust-building, and accountability: encompassing prompt, reliable, and comprehensible communication, dispelling rumors and correcting health misinformation, building social trust, monitoring the performance of formal health institutions, and demanding transparency and accountability; Organizational resilience and learning: including the continuity of service delivery and organizational flexibility, management of resources, networks, and human capacities, as well as institutional learning and the redesign of health-oriented interventions; Post-crisis rehabilitation and care: involving the follow-up of the health status of affected individuals, reintegration of patients into the care and treatment cycle, and the health-oriented return of vulnerable groups to normal life. Discussion and Conclusion The findings of this study indicate that health NGOs are not merely “relief charities” intended to temporarily fill government gaps during emergencies; rather, they steer a “complete resilience ecosystem.” The most prominent distinguishing feature of the current research compared to the existing literature is the analytical elucidation of the transition of NGOs’ roles from “reactive rescuers” to “participants in policymaking,” “reproducers of institutional trust,” and “defenders of equity.” By localizing interventions, actively tracking marginalized groups, and generating objective field evidence, they act as strategic partners in health system governance. Consequently, shifting away from a competitive and bureaucratic mindset and embracing NGOs as active policy actors—through the establishment of structured collaborative platforms and advisory seats—is imperative for realizing sustainable health governance. Acknowledgments We hereby sincerely express our gratitude to all participants whose provision of invaluable insights and experiences through in-depth interviews made this research possible. بحران‌های پیچیده محدودیت‌های ساختارهای رسمی و بوروکراتیک را آشکار و نقش سازمان‌های مردم‌نهاد سلامت (سمن‌های سلامت) را به ‌منزلۀ نهادهای مکمل در بهبود حکمرانی نظام سلامت برجسته می‌کنند. این پژوهش کیفی با هدف واکاوی نقش سمن‌های سلامت در ارتقای تاب‌آوری و پایداری حکمرانی نظام سلامت در شرایط بحران انجام شد. داده‌ها از طریق مصاحبه‌های نیمه‌ساختاریافته با ۱۸ خبره گردآوری شدند. مشارکت‌کنندگان با نمونه‌گیری هدفمند انتخاب و داده‌ها با روش تحلیل مضمون تحلیل شدند. تحلیل داده‌ها به استخراج ۹ مضمون فراگیر، ۳۲ مضمون سازمان‌دهنده و ۱۳۰ مضمون پایه در چرخۀ مدیریت بحران منجر شد. مضامین فراگیر عبارت‌اند از: ۱) آمادگی و کاهش خطر پیش از بحران؛ ۲) توانمندسازی سلامت‌محور جامعه؛ ۳) پاسخ، مراقبت و حمایت سلامت‌محور؛ ۴) همکاری نهادی سلامت؛ ۵) مشارکت در خط‌مشی‌گذاری سلامت؛ ۶) عدالت و حمایت در سلامت؛ ۷) آگاهی‌بخشی، اعتماد و پاسخ‌گویی سلامت؛ ۸) تاب‌آوری و یادگیری سازمانی؛ و ۹) بازتوانی و مراقبت پسابحران. نتایج نشان داد کارکرد سمن‌های سلامت در چرخۀ مدیریت بحران، از آمادگی و توانمندسازی جامعه تا پاسخ، همکاری نهادی، مشارکت در خط‌مشی‌گذاری، عدالت‌خواهی، اعتمادسازی، یادگیری سازمانی و بازتوانی پسابحران امتداد دارد؛ از این ‌رو، این سمن‌ها فراتر از بازیگران امدادگر و واکنشی، به‌ مثابۀ شرکای راهبردی حکمرانی نظام سلامت نقش‌آفرینی می‌کنند.

https://ecs.ui.ac.ir/article_30778_49ead76c6fb9b3952c2dfe73ae51d563.pdf