PRESERVE: A Value-Based Resilience Framework for Health Planning in Remote and Geographically Dispersed Regions, with an Illustrative Application in Jazan, Saudi Arabia.

Background: Saudi Arabia’s Health Sector Transformation Program (HSTP) is moving the Ministry of Health from direct provision towards regulation and strategic planning, with value-based care and fiscal sustainability as explicit goals. Remote and geographically dispersed regions such as Jazan, with mountain, coastal and island settings, face planning problems that national templates do not capture: dispersed populations, difficulty retaining staff and higher unit costs. Existing health-system resilience frameworks say little about cost, value or the work of a regional planning department. Methods: We developed the framework between January and March 2024 within the Department of Planning, MOH Jazan Branch, using a document-based design in four stages: gap analysis of established resilience frameworks, thematic synthesis, alignment with Vision 2030 and HSTP, and operationalisation against planning functions. We then built a transparent scenario model of one time-critical pathway (suspected ST-elevation myocardial infarction in a mountain governorate) with a sensitivity analysis. Results: PRESERVE has eight components (Place-based planning, Resilience, Equity, Sustainability, Efficiency, Resource optimisation, Value-based care and Excellence), supported by four enablers (governance, data intelligence, workforce and e-health) and coordinated by the Department of Planning. It is operationalised through a three-phase roadmap for 2024–2030, a provisional alignment matrix linking planning functions to Vision 2030 objectives, and a set of indicators for each component. In the scenario model, a tele-cardiology-supported pharmaco-invasive pathway lowered the planning estimate of episode cost from 15,000 to 4,500 SAR (70%; 1.05 million SAR a year at 100 episodes) before programme costs and started reperfusion about five hours earlier. The saving stayed positive in every combination tested (10–85%). These are scenario estimates, not observed outcomes. Conclusions: PRESERVE gives regional planners a structured route from historical budgeting to value-based planning, and a testable set of indicators. Empirical validation by Delphi consensus and a pilot in Al-Dair, Fifa and Farasan is the next step. Keywords: Health system resilience; Value-based care; Rural and remote health; Place-based planning; Health planning; Saudi Vision 2030; Jazan; Telehealth.