Health financing policy responses to economic crises in WANA countries: a systematic review (2008–2026)

Abstract Background The West Asian and North African (WANA) region has faced severe macroeconomic shocks over the past two decades, including sanctions, currency devaluation, and austerity measures, which critically threaten health system sustainability and equity. Objective This systematic review examines macro-level health financing policy responses (revenue raising, risk pooling, and strategic purchasing) to economic crises in WANA countries (2008–2026). Methods Six electronic databases (PubMed, Scopus, WoS, Embase, EconLit, PAIS) and four grey literature sources were searched up to April 29, 2026. Institutional alignment was analyzed using the ‘abc’ structural model, and study quality was appraised using JBI, MMAT, and AACODS tools. Results From 3,455 initial records, 27 studies were included (23 high quality, 4 moderate). Structural misalignment (ΔE > 0) between policy goals, institutional tasks, and organizational positions was identified in 89% of the included studies (24 of 27), regardless of their quality rating. Sanctions predominantly disrupted pharmaceutical supply chains, while currency collapses eroded the health sector’s revenue base. Fragmented risk pooling in Lebanon and Jordan exacerbated health poverty during crises. Conclusion Redesigning institutional tasks (M₂) and establishing automatic counter-cyclical financing mechanisms are essential to enhance health financing resilience in WANA. Policymakers must align macro-fiscal mandates with health sector positions to prevent systemic collapse during economic shocks.