Abstract
<title>Abstract</title> <p>Background Health security policies and practices are increasingly embedded within domestic health system governance. Existing scholarship on global health norms has largely focused on how such norms are produced and disseminated through power and top-down expertise, with less attention to how domestic actors interpret and engage with them in practice. This study examines how actors within national health systems respond to and interact with health security policies, and the implications of these engagements for the reproduction of health security norms. Results Based on 53 realist interviews with policymakers, implementing partners, and health system actors in Nigeria and the Philippines, through iterative, theory-informed analysis, we developed a framework describing a spectrum of responses to health security governance, ranging from overt and quiet resistance to multiple forms of acceptance, including grudging, strategic, technical, and full acceptance. Our findings show that actors do not simply resist or accept health security agendas; rather, they navigate the space shaped by contextual factors such as institutional authority, resource dependence, and professional incentives. In many cases, actors expressed rhetorical resistance to the geopolitical or donor-driven aspects of health security while simultaneously engaging with its frameworks to secure resources, comply with technical requirements, or advance domestic priorities. Conclusion These findings illustrate how health security becomes embedded in domestic health governance through patterned and constrained forms of actor engagement in everyday institutional practice. Health security norms are reproduced through context-dependent ways in which domestic actors negotiate health security policies and practices, with implications for how global health agendas shape national priorities in practice.</p>