The need for a complex systems model of evidence for public health. Therefore, from a systems thinking perspective, systems consist of many interrelated feedback loops in which actions are just an attempt to alter the equilibrium of some of these loops. Health systems strengthening also health system strengthening, abbreviated hss is a term used in global health that roughly means to improve the health care system of a country. But poor implementation in countries hampers their effectiveness. Modules courses health policy and systems teaching. Systems thinking requires program planners and policymakers to look at the forest and the trees in any situation. Strengthening health systems to improve maternal, neonatal. As the global health community is pushing for ambitious goals of universal health coverage and health equity in the post2015 development era, there is an increasing interest worldwide to ensure evidenceinformed health policymaking as a means to improve health systems performance. The reaction of the other feedback loops to these actions is the principal.
Advancing the application of systems thinking in health health. Unicef has a long history of inputlevel support for. Healthy systems for universal health coverage a joint. Achieving ambitious health goalsfrom the every woman every child strategy to the health targets of the sustainable development goals to the renewed promise of almaata of health for allnecessitates strong, functional and inclusive health systems. The international health regulations ihr 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. Linear approaches to complex public health problems such as the obesity crisis are clearly useful, but cannot address the multiple dimensions of the real world and the many. Whether we understand the social world including health systems as operating through systems, or we take systems thinking simply as a useful mental construct to deal with the complexities of our social world, there is a growing attention to systems thinking in multiple fields of development practice and research, including global health. Systems thinking in public health and learning from isis. Obesity is a multifaceted problem that warrants complex thinking and a broad systems perspective to frame the problem, understand potential causes, identify critical leverage points of influence, and take effective action.
We dont want the nigeria example to just be a happy accident, we want the legacy of aid money spent on health to be a stronger, more flexible health system that will serve people on an ongoing. Reductionist approaches to improving health that emphasize shortterm goals have too often undermined local health systems by neglecting to strengthen local organizations. Bridging the worlds of research and policy alliance for health policy and systems research ahpsr established in 1999 with the goal. This study is a retrospective qualitative evaluation of the implementation experience and lessons learned from the district and provinciallevel health systems strengthening interventions in the five phit partnership projects in ghana, tanzania, rwanda, mozambique, and zambia table 1.
Equity and health systems health systems strengthening. The original course materials consist of two sets of. Download systems thinking for health systems strengtheningpdf. The aim of health systems strengthening is to incorporate this longterm building blocks strategy into health programmes even short term ones. Strengthening primary health care through community health workers.
Enhancing evidence informed policymaking in complex health. A howto manual was first published in 2007 and made possible through support provided by the u. Health systems require quality data from health information systems to plan for and ensure that. Systems thinking for health systems strengthening offers a practical approach to strengthening health systems through a systems thinking lens. Within this general definition, it can mean increasing funding for health infrastructure, improving health policy, trying to achieve universal healthcare, or any number of other health measures. Systems thinking for health systems strengthening pdf. Professor forrester recognized the need for a better way of testing new ideas about social systems, in the same way we can test ideas in engineering. Designed by unicef and the nossal institute for global health, this blended learning programme aims to build a critical mass of competent unicef staff who are equipped with timely and relevant knowledge and tools to support advocacy and programming related to national, regional, and. Decision support systems and intelligent systems pdf. Agency for international development usaid in cooperation with health systems 2020, the quality assurance project, and rpm plusmanagement.
Strengthening health systems to improve maternal, neonatal and child health outcomes. It is a perspective that deliberately goes beyond events, to look for patterns of behavior and the. Most of these studies discuss the concepts or make the case for the utility of systems thinking for health systems strengthening. Five ways to incorporate systems thinking into healthcare. For some, it is a top priority, while for others, it is not. With unprecedented mobility of people, products, and food, the myriad of. This video was produced by the alliance for health policy and systems research and was filmed during the launch of the alliances 2009 flagship report. While each building block of the who framework is important, quality and timely data from health information systems are the foundation of the health system and inform decision making in each of the other five building blocks of the health system. See interrelationships among systems rather than linear causeandeffect chains whenever events occur see processes of change among systems rather than discrete snapshots of change, whenever changes occur see the system in any situation, by identifying the inputs, processes. Systems thinking for health systems strengthening service. Open access protocol can action research strengthen. Good health, a state of complete physical, mental,and social wellbeing and not merely the absence of disease or infirmity, 1. Who systems thinking for health systems strengthening. Announcements, health systems research, publications, where we work leaders in low and middleincome countries lmics require timely and compelling evidence about how to strengthen their health systems to improve the health and wellbeing of their citizens.
Health systems in action management sciences for health. Published publication status show simple item record. Strengthening health systems in lowincome countries by. Health systems in kenya are constrained by insufficient financial resources, a shortage and poor. Usaids vision for health systems strengthening 20152019. Advancing the application of systems thinking in health. Accomplishing this will require a focus on health systems systemthinking, commonization of services and full integration of services with total dismantling of vertical programs across the world. Complex systems edson college of nursing and health. In the wake of a number of major international health crises, such as the 2014 ebola and 2016 zika outbreaks, and the findings of a number of. Create a culture of systems thinking to reap its benefits, systems thinking must become an integral part of the practices within a. This is the french translation of health policy and policy analysis the oldest of the open access courses in chepsaas portfolio the translation was produced by the consortium for mothers, children, adolescents and health policy and systems strengthening, with funding from the international development research centre idrc, canada. Pdf systems thinking for health systems strengthening. Public health framework for health systems strengthening. The centers for disease control and prevention cdc is committed to improving health outcomes around the world by helping countries establish core public health functions that strengthen health systems.
Moreover, health systems place different emphasis on the goal of equity. Strengthening global health security by embedding the. Equity is subjective, as it can mean different things to different people and different communities. Pdf systems thinking for strengthening health systems in lmics. Overview of systems thinking daniel aronson ystems thinking has its foundation in the field of system dynamics, founded in 1956 by mit professor jay forrester.
Systems thinking for strengthening health systems in lmics. Flagship report series the alliance for health policy and systems research the alliance is an. Failing to take this complexity into account will continue to hinder efforts to achieve better and more equitable. 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. Each of the five phit projects implemented interventions in one or more districts, with catchment areas. Guidance note on gavis approach to hss and the application process for 2014. Acf health system strengthening approach rationale 5 focused on practical action the step by step approach promotes a comprehensive process focusing on practical actions.
Systems science and systems thinking for public health. Systems thinking for health systems strengtheningpdf. I just found the learning activity health systems strengthening learning programme. The current interest in health systems strengthening hss provides an opportunity for the global health community to focus on building organizational capacity by improving institutions in lowincome countries. Despite the promise that systems approaches hold for improved understanding of the complex factors that contribute to health and disease, few systems initiatives have been developed at one of the premier u. In 2007, who introduced a model of six interdependent hs building blocks including hrs and the need for integrated strategic responses to challenges.
A framework 1 introduction there is global agreement that wellfunctioning health systems are needed to reduce maternal, newborn and child mortality and to increase health mcdonagh and goodburn, 2001. Improving community health by strengthening community investment roles for hospitals and health systems robin hacke, executive director, center for community investment katie grace deane, assistant director, initiative for responsible investment preface by donald schwarz, md, mph, mba, vice president, program, robert wood johnson foundation. Systems thinking for health systems strengthening world health. Health systems limitations like these are binding constraints to further progress in global health. In the global development literature, one may argue. Each health care system must decide upon its own equity objective and how to put it into operation. Improving and sustaining community health is integral to overall health systems strengthening efforts. Much of our health is the responsibility of families and individuals. Use of evidence in health systems strengthening and policymaking plays an essential. Summary of health systems strengthening learning programme. The tools include an overview of the oca approach, a facilitator guide, a series of capacity development resource guides, and a capacity indicators catalog. Too often assessments are performed without any planning of response analysis and translation of the finding into concrete actions. Additionally it shows how better evaluations of health system strengthening initiatives can.