Health Systems Preparedness for Outbreak Response: A Systematic Review

Background: Outbreak response depends on health-system capacities that extend beyond formal planning, including surveillance, coordination, staff readiness, supplies and community trust. Evidence about measured preparedness and real-world response is dispersed across different designs. Objective: To evaluate reported health-system preparedness for infectious-disease outbreaks, identify recurrent operational gaps and assess whether preparedness scores correspond with response performance. Methods: We screened a bounded, fully enumerated set of openly accessible publisher, PubMed and PubMed Central records for primary studies published between 1 January 2000–13 August 2026. Source verification was completed on 14 August 2026. One reviewer inspected accessible original reports, extracted source-located findings and assessed design limitations. Findings were grouped thematically without statistical pooling. Results: The verifiable record set contained 30 accessed record entries, including 7 secondary publication-metadata records. After duplicate removal, 23 unique reports were screened; 2 were excluded initially and 3 after full-text assessment. Eighteen studies were included. Facility studies identified gaps in budgets, personal protective equipment, training and simulation. Surveillance rebuilding improved reporting coverage, although some response timeliness indicators declined. Country-level preparedness scores did not reliably predict observed outbreak response or COVID-19 burden; higher scores were associated with greater reported case/death data completeness in one ecological study. Conclusions: Preparedness appears multidimensional, context dependent and imperfectly captured by national indices. The evidence supports operational assessment, practical drills, integrated surveillance and coordinated response planning, but largely observational designs do not establish causal effects. The open-source verification set is not a complete export of all relevant bibliographic databases.