Can innovation strengthen resilient, just and sustainable health systems in disaster-prone settings? Insights from HSR2024.

Health systems in disaster-prone settings face recurrent shocks that expose and often deepen existing inequities. Increasingly, innovation, particularly digital technologies and artificial intelligence (AI), is positioned as a pathway to strengthen resilience, responsiveness, and accountability. Drawing on insights from innovation-focused sessions at the 8th Global Symposium on Health Systems Research, this commentary examines whether and under what conditions innovation can contribute to resilient, just and sustainable health systems. We define disaster-prone settings as contexts repeatedly exposed to acute shocks and chronic stressors, such as climate events, outbreaks, and displacement, where service delivery is periodically disrupted and recovery shapes long-term system trajectories. Across diverse examples, including digital dashboards, interoperable data systems, AI-supported decision tools, and community-driven innovations, the symposium highlighted how innovations can improve detection, coordination, and service continuity, particularly during crisis conditions. These approaches can make populations previously invisible to the health system visible, strengthen real-time decision-making, and support anticipatory action. However, the analysis shows that innovation does not inherently produce equitable outcomes. Digital and AI-enabled tools may reproduce or even intensify existing exclusions if they rely on unrepresentative data, lack interoperability, or operate without transparent governance and accountability. Many technologies remain at an early stage, with evolving evidence on effectiveness and equity impacts, placing policymakers in a position of making decisions in uncertainty. In disaster contexts, where rapid decisions and weakened oversight are common, these risks are amplified. We argue that innovation strengthens resilience and justice primarily when accompanied by institutional readiness and governance capacity. This includes clear mandates, regulatory frameworks, ethical safeguards, and mechanisms for iterative learning that translate evidence into practice. Equally important are participatory approaches that ensure communities shape design and decision-making, rather than being passive data sources.