Developing an Original Theoretical Framework for Community Resilience and Health System Strengthening in Post-Conflict Northern Nigeria

Health system strengthening in post-conflict settings requires theoretical frameworks that move beyond conventional health systems building block models to incorporate community agency, adaptive capacity, and the unique recovery dynamics of conflict-affected populations. This study developed an original theoretical framework for community resilience and health system strengthening in post-conflict northern Nigeria, drawing on evidence from Borno and Yobe States. A multi-stage theory-building methodology was employed: systematic review of resilience theory, post-conflict health systems, and community health literature (78 publications from 2015 to 2024); qualitative grounded theory fieldwork with 56 participants including community leaders, healthcare workers, local government health officers, and displaced persons across six communities in Maiduguri and Damaturu; and expert validation through a two-round Delphi consultation with 22 community health and health systems specialists. The systematic review identified critical gaps in existing frameworks, including inadequate theorisation of informal health systems that operate during formal system disruption, community social capital as a health system input, and the non-linear recovery trajectories of conflict-affected PHC services. Grounded theory analysis generated six original theoretical constructs: informal health system bridging, conflict-adaptive community health agency, social cohesion as health infrastructure, displacement-reintegration health transition, religious institution health system substitution, and post-conflict trust restoration dynamics. The resulting Post-Conflict Community Health Resilience Framework integrates these constructs into a processual model. Expert validation confirmed theoretical novelty and practical applicability across the North East zone. The framework constitutes an original contribution to post-conflict health systems science with applicability beyond Nigeria.