📖 ABSTRACT/OVERVIEW
Background: Health system resilience describes the capacity of health systems to absorb, adapt to, and transform under shock conditions. The North East geopolitical zone of Nigeria, affected by prolonged armed conflict, provides a critical natural experiment for studying primary healthcare resilience. This study analyses mechanisms of primary healthcare resilience and adaptation in conflict-affected Northeast Nigeria. Methodology: A multi-site comparative case study was conducted across six local government areas in Adamawa, Yobe, and Borno States with varying levels of conflict exposure and healthcare system disruption. Mixed-methods data collection included facility assessments, 72 in-depth interviews with healthcare workers, managers, and community leaders, and documentary analysis of humanitarian health programme reports. Results: Three resilience archetypes emerged: adaptive absorbers, community-anchored continuers, and collapsed systems. Community trust relationships and flexible task-sharing were the core mechanisms sustaining healthcare delivery in functional systems. Humanitarian actor integration improved supply continuity but sometimes disrupted long-term health system ownership. Conclusion: This study provides an original multi-site theoretical contribution to health system resilience theory grounded in the Northeast Nigerian conflict context. Family medicine practice models adapted to conflict settings must prioritise community trust building and task-shifting flexibility as foundational resilience strategies. Keywords: health system resilience, conflict, Northeast Nigeria, primary healthcare, humanitarian
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