BACKGROUND:
Health misinformation and disinformation are increasingly recognized as major threats to population health. While digital platforms are often blamed for their spread, insufficient attention has been paid to how weaknesses within health systems themselves enable misinformation to emerge, persist, and cause harm, particularly in low-resource settings. This paper examines how structural and functional gaps within health systems contribute to health misinformation and disinformation, reframing misinformation as a symptom of systemic failure rather than solely a communication or behavioral problem.

METHODS:
A systems-based analytical approach was employed, integrating evidence from peer-reviewed literature with insights drawn from prior public health and health systems work in resource-constrained contexts. The analysis was guided by key health system building blocks, governance, health workforce, service delivery, health information systems, and community engagement, to identify critical points where misinformation is generated, amplified, or left unaddressed.

RESULTS:
The analysis reveals that misinformation thrives in settings characterized by weak institutional communication, limited health worker capacity in risk and crisis communication, fragmented health information systems, and low public trust in health authorities. Delayed, inconsistent, or absent messaging from official health system actors was found to significantly increase reliance on informal information sources. These gaps were particularly pronounced during periods of uncertainty, such as disease outbreaks and health emergencies, where system silence functioned as an accelerator of misinformation.

CONCLUSIONS:
Health misinformation should be addressed as a health systems strengthening priority rather than an isolated communication challenge. Strengthening governance, institutionalizing timely and transparent health communication, investing in workforce communication competencies, and embedding community engagement within health systems are critical for building resilience against misinformation. A systems-oriented response offers sustainable solutions that extend beyond digital regulation and episodic public awareness campaigns.