This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. A common thread is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. They each address problems of complexity, which is a frequent challenge in global health. The different methods and tools are suited to different types of inquiry and involve both qualitative and quantitative techniques. The paper concludes by emphasizing that explicit models used in systems thinking provide new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to improve people’s health.

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The application of systems thinking in health: why use systems thinking?

Implementation research: new imperatives and opportunities in global health.

Gender equality in science, medicine, and global health: where are we at and why does it matter?

Objectives: This paper reports on findings from a systematic review designed to investigate the state of systems science research in public health. The objectives were to: (1) explore how systems methodologies are being applied within public health and (2) identify fruitful areas of activity. Design: A systematic review was conducted from existing literature that draws on or uses systems science (in its various forms) and relates to key public health areas of action and concern, including tobacco, alcohol, obesity and the social determinants of health. Data analysis: 117 articles were included in the review. An inductive qualitative content analysis was used for data extraction. The following were systematically extracted from the articles: approach, methodology, transparency, strengths and weaknesses. These were then organised according to theme (ie, commonalities between studies within each category), in order to provide an overview of the state of the field as a whole. The assessment of data quality was intrinsic to the goals of the review itself, and therefore, was carried out as part of the analysis. Results: 4 categories of research were identified from the review, ranging from editorial and commentary pieces to complex system dynamic modelling. Our analysis of each of these categories of research highlighted areas of potential for systems science to strengthen public health efforts, while also revealing a number of limitations in the dynamic systems modelling being carried out in public health. Conclusions: There is a great deal of interest in how the application of systems concepts and approach might aid public health. Our analysis suggests that soft systems modelling techniques are likely to be the most useful addition to public health, and align well with current debate around knowledge transfer and policy. However, the full range of systems methodologies is yet to be engaged with by public health researchers.

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Systems science and systems thinking for public health: a systematic review of the field.

Malaria eradication within a generation: ambitious, achievable, and necessary

Background: New forms of leadership are required to bring about the fundamental health system changes demanded by primary health care (PHC) Using theory about complex adaptive systems and policy implementation, this paper considers how actors’ sensemaking and the exercise of discretionary power currently combine to challenge PHC re-orientation in the South African health system; and provides examples of leadership practices that promote sensemaking and power use in support of PHC Methods: The paper draws on observational, interview, and reflective data collected as part of the District Innovation and Action Learning for Health Systems Development (DIALHS) project being implemented in Cape Town, South Africa Undertaken collaboratively between health managers and researchers, the project is implemented through cycles of action-learning, including systematic reflection and synthesis It includes a particular focus on how local health managers can better support front line facility managers in strengthening PHC Results: The results illuminate how the collective understandings of staff working at the primary level - of their working environment and changes within it – act as a barrier to centrally-led initiatives to strengthen PHC Staff often fail to take ownership of such initiatives and experience them as disempowering Local area managers, located between the centre and the service frontline, have a vital role to play in providing a leadership of sensemaking to mediate these challenges Founded on personal values, such leadership entails, for example, efforts to nurture PHC-aligned values and mind-sets among staff; build relationships and support the development of shared meanings about change; instil a culture of collective inquiry and mutual accountability; and role-model management practices, including using language to signal meaning Conclusions: PHC will only become a lived reality within the South African health system when frontline staff are able to make sense of policy intentions and incorporate them into their everyday routines and practices This requires a leadership of sensemaking that enables front line staff to exercise their collective discretionary power in strengthening PHC We hope this theoretically-framed analysis of one set of experiences stimulates wider thinking about the leadership needed to sustain primary health care in other settings

/pdf/advancing-the-application-of-systems-thinking-in-health-4q5tr2xw27.pdf

Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care

Districts and sub-districts are crucial to the functioning of the district health system and the successful implementation of health sector reforms, which have been at the centre of public debate in the past few years. While policy intentions and service challenges are much debated, little systematic discussion is held about the internal operations and functioning of sub-districts and districts. These dynamics will strongly influence the implementation of the reforms proposed.This chapter discusses the complexities and challenges of managing a sub-district, using as a case study the Cape Town sub-district of Mitchell's Plain. Drawing on debates in systems thinking and management theory the role of districts and sub-districts at the interface between strategic policy direction and operational service implementation is discussed. The chapter uses experience from an action learning project in Mitchell's Plain to present examples of innovation aimed at strengthening leadership and routine management functions. We argue that routine management in an environment of stress, constraints and uncertainty requires that managers be resilient, reflective, and continuously able to learn, analyse and adapt. Management and leadership development programmes should focus on developing these capabilities (within and beyond the classroom), in addition to developing technical skills and capacities.

Crises, routines and innovations : the complexities and possibilities of sub-district management

http://reference.sabinet.co.za/webx/access/electronic_journals/healthr/healthr_2012_2013_a15.pdf

Soraya Elloker

Papers

Implementation research: new imperatives and opportunities in global health.

Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care

Crises, routines and innovations : the complexities and possibilities of sub-district management

Crises, Routines and Innovations:complexities and possibilities