Systems thinking for health systems strengthening in low- and middle-income countries LMICs:
seizing the opportunity
Don de Savigny, Swiss Tropical and Public Health Institute and
Health, Policy and Planning - Volume 27 suppl 4 October 2012
Taghreed Adam andDon de Savigny
Systems thinking for strengthening health systems in LMICs: need for a paradigm shift
“…………We need new ways of thinking and of working in order to accommodate the complexity of the challenges in and urgent need for health system innovation and change.’ (Herbert and Best 2011)
Health systems are complex. Failing to take this complexity into account will continue to hinder efforts to achieve better and more equitable health outcomes. Understanding and working with complexity requires a paradigm shift from linear, reductionist approaches to dynamic and holistic approaches that appreciate the multifaceted and interconnected relationships among health system components, as well as the views, interests and power of its different actors and stakeholders.
Systems thinking helps to re-orient our perspectives by expanding our understanding of the characteristics of complex adaptive systems and identifying how this learning may be applied to system problems and the creation of potential solutions. Long used in other disciplines, systems thinking holds great yet largely untapped potential for health systems, particularly in low- and middle-income countries (LMICs).
Systems thinking is primarily a way of thinking in approaching problems and in designing solutions. It is an approach to problem solving that appreciates the very nature of complex systems as dynamic, constantly changing, governed by history and by feedback, where the role and influence of stakeholders and context is critical, and where new policies and actions (of different stakeholders) often generate counterintuitive and unpredictable effects, sometimes long after policies have been implemented.
Systems thinking can be applied regardless of the field of enquiry. It is a way to view the world using the general logic underlying the various systems … .”
Health systems, systems thinking and innovation
Taghreed Adam, Justine Hsu, Don de Savigny, John N Lavis, John-Arne Røttingen, and Sara Bennett
Evaluating health systems strengthening interventions in low-income and middle-income countries: are we asking the right questions?
Irene Akua Agyepong, Augustina Kodua, Sam Adjei, and Taghreed Adam
When ‘solutions of yesterday become problems of today’: crisis-ridden decision making in a complex adaptive system (CAS)—the Additional Duty Hours Allowance in
Don de Savigny, Jayne Webster, Irene Akua Agyepong, Alex Mwita, Constance Bart-Plange, Aba Baffoe-Wilmot, Hannah Koenker, Karen Kramer, Nick Brown, and Christian Lengeler
Introducing vouchers for malaria prevention in
David H Peters, Ligia Paina, and Sara Bennett
Expecting the unexpected: applying the Develop-Distort Dilemma to maximize positive market impacts in health
R Chad Swanson, Adriano Cattaneo, Elizabeth Bradley, Somsak Chunharas, Rifat Atun, Kaja M Abbas, Korina Katsaliaki, Navonil Mustafee, Benjamin Mason Meier, and Allan Best
Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change
Cameron D Willis, Barbara L Riley, Allan Best, and Pierre Ongolo-Zogo
Strengthening health systems through networks: the need for measurement and feedback
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