Table 3 Framework for evaluating the legitimacy of health systems in fragmented conflict zones

Views of legality

Whether the authority gets and exercises political power in accordance with citizens’ views on laws, rules, and norms [67]

1- Coordination and cooperation among responding agencies [68, 69]

Constitutive

2- Cooperation of responding bodies with local authorities [70]

Constitutive

3- Involvement of the local community in the decision-making process [71, 72]

Constitutive

4- Community accountability [73, 74]

Constitutive

5- The legal foundation of the responding bodies [75]

Constitutive

6- Ability to coordinate with international donors and to secure services and support from them [76]

Constitutive

views of justification

Agreement with shared principles, beliefs, values and ideas [67]

1- Transparency [73, 77, 78]

Constitutive

2- Equity [9, 35, 79, 80]

Constitutive

3- Incorruptness [35, 81]

Constitutive

4- Understanding people’s needs [82]

Constitutive

5- Impartiality [81, 83]

Constitutive

6- Respect for community customs and traditions [84]

Constitutive

acts of consent

When someone gives permission for something to be done or acknowledges the authority of someone or an entity [85]

1- People’s compliance with health advice and instructions issued by responding agencies [81]

Constitutive

2- Delegation of the local community to the responding bodies to represent community health interests and provide services [86]

Constitutive

Views of performance (Instrumental legitimacy)

Assessing an organisation’s capability to achieve its objectives effectively and efficiently while considering aligning its actions with societal expectations [35, 78, 87,88,89]

1- Rapid response [90]

Substitutive

2- Quality of health services [91]

Substitutive

3- Availability of health services [92]

Substitutive

4- Effective health services (reliability) [35, 91]

Substitutive