TY - JOUR T1 - Shocks, stress and everyday health system resilience: experiences from the Kenyan coast JF - Health Policy Plan Y1 - 2020 A1 - Kagwanja, Nancy A1 - Waithaka, Dennis A1 - Nzinga, Jacinta A1 - Tsofa, Benjamin A1 - Boga, Mwanamvua A1 - Leli, Hassan A1 - Mataza, Christine A1 - Gilson, Lucy A1 - Molyneux, Sassy A1 - Barasa, Edwine KW - Delivery of Health Care KW - Government Programs KW - Health Planning Organizations KW - Health Resources KW - Hospital Administration KW - Humans KW - kenya KW - Politics KW - Workforce AB - Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an 'everyday resilience' lens. We focussed on chronic stressors, rather than acute shocks in examining the responses and organizational capacities underpinning those responses, with a view to contributing to the understanding of health system resilience. We drew on learning and experiences gained through working with managers using a learning site approach over the years. We also collected in-depth qualitative data through informal observations, reflective meetings and in-depth interviews with middle-level managers (sub-county and hospital) and peripheral facility managers (nā€‰=ā€‰29). We analysed the data using a framework approach. Health managers reported a wide range of health system stressors related to resource scarcity, lack of clarity in roles and political interference, reduced autonomy and human resource management. The health managers adopted absorptive, adaptive and transformative strategies but with mixed effects on system functioning. Everyday resilience seemed to emerge from strategies enacted by managers drawing on a varying combination of organizational capacities depending on the stressor and context. VL - 35 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/32101609?dopt=Abstract ER -