Collaboration Between local health authorities and community leaders in health emergency response in low- and middle-income countries: a scoping review of evidence from the COVID-19 era

Abstract

BACKGROUND: Collaboration between local health authorities and community actors is widely recognised as central to effective emergency preparedness and response, particularly in low- and middle-income countries (LMICs), where health systems face persistent resource and governance constraints. However, empirical evidence on how such collaboration is conceptualised, operationalised, and evaluated remains fragmented. This scoping review mapped and synthesised available evidence on collaboration between local health authorities and community leaders (including community-facing actors) during health emergencies, using the COVID-19 pandemic as an illustrative context to inform further research. METHODS: A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar for studies published between January 2020 and October 2025. Eligible studies were primary empirical research conducted in LMICs that examined collaboration between local health authorities and community-facing actors involved in emergency responses. Data were extracted using a structured charting tool and synthesised using descriptive and narrative approaches. RESULTS: Three qualitative studies from Bangladesh and the Philippines met the inclusion criteria. Collaboration involved partnerships between local health authorities and non-governmental organisations, universities, and community-based actors, often formalised through coordination mechanisms. Reported strategies included joint planning, co-implementation of services, resource and workforce sharing, capacity building, and community outreach. These approaches were associated with enhanced surge capacity, continuity of essential services, strengthened system resilience, and improved access and community engagement. However, community leadership roles were rarely explicitly defined, with leadership functions often embedded within community-facing or intermediary actors. CONCLUSION: The evidence base on collaboration during health emergencies in LMICs remains limited and conceptually underdeveloped. Available studies suggest that collaboration between local health authorities and community-facing actors may support coordinated and resilient responses. However, important gaps persist in how community leadership is conceptualised, operationalised, and evaluated. Future research should more explicitly define and examine community leadership roles, alongside strengthening institutionalised and sustainable collaborative mechanisms for emergency preparedness and response. TRIAL REGISTRATION: Not applicable. This scoping review does not involve a healthcare intervention or human participant enrolment. The review protocol has been published previously and is publicly accessible.