Realizing their potential to become learning organizations to foster health system resilience: opportunities and challenges for health ministries in low- and middle-income countries.

The burgeoning literature on resilient health systems in low- and middle-income countries (LMICs) provides limited insights into the practice of resilience-building. To address this operational shortcoming, we explore the potential of health ministries to become 'learning organizations' to help foster resilience. We adopted a multi-stage, iterative methodology comprising multiple purposive literature searches, the selection and application of a conceptual framework from the 'learning organizations' literature, and expert opinion to expand on the framework with illustrative examples from LMICs. The principal finding of our prospecting assessment and appraisal is that many LMIC health ministries possess assets necessary for mounting a structured learning process for fostering increasingly resilient health systems. These assets include learning management strengths in systematic problem-solving, experimentation, self-analysis, learning from others and knowledge transfer. In addition, recent methodological advances in measuring progress towards becoming a learning organization enhance resilience-building potential. All health ministries, however, face substantial challenges in trying to realize their learning potential. They have to recognize the value of their learning assets and harness them in the service of a resilience-promoting learning agenda. Learning management and measurement skills must be complemented by supportive environments, sound leadership, and incentives that reinforce learning. The absence of models of sustained learning organizations in health sectors in LMICs and other countries hinders progress. Furthermore, our understanding of the dynamics of effective learning as well as the relationship between a learning organization and resilience is at a nascent stage. Increased attention to the role of adaptive capacity in fostering resilience may lead to more investment in systematic research on learning organizations and their effects on health system performance in LMICs.