Public health systems analysis - where the River Kabul meets the River Indus

Abstract

In this paper we review two recent paradigmatic shifts and consider how a two-way flow in innovation has been critical to the emergence of new thinking and new practices. The first area relates to our understanding of the nature of public health systems and the shift from a medical paradigm to a more holistic paradigm which emphasises the social, economic and environmental origins of ill-health and looks to these as key arenas in which to tackle persistent inequalities in populations’ health experiences. In respect of this paradigmatic shift, it is argued, developing countries were in advance of their more developed counterparts. Specifically, the Alma Ata Declaration and the Primary Health Care Approach which was central to its implementation pre-figured elements of what was to be called in developed countries The New Public Health such as the need for greater community involvement and recognition of the importance of other sectors in determining health outcomes. But this paradigmatic shift added a new complexity to our understanding which made the identification of appropriate policy responses increasingly difficult. However, a parallel shift was taking place in the cognate field of operational research/systems analysis (OR/SA) which was adding greatly to our ability to analyse and to identify key points of intervention in complex systems. This led to the emergence of new techniques for problem structuring which overcame many of the limitations of formal mathematical models which characterised the old paradigm. In this paradigmatic shift developed countries have led the way, specifically in the new fields of Community Operational Research and Operational Research for Development, but only by drawing strongly on the experience and philosophies to be found in developing countries.

How can health systems be strengthened to control and prevent an Ebola outbreak? A narrative review

“…At the broader level, an holistic approach is clearly needed, ‘understanding […] the nature of public health systems and the shifts from a medical paradigm to a more holistic paradigm’ ( 50 ), encompassing human ecology, socio-economic, political, environmental and policy agendas, with appropriate division of responsibilities locally, nationally, and globally through interdisciplinary collaboration ( 2 , 51 ). Kim-Farley ( 52 ) argues that ‘only through worldwide concerted action will the effort to control infectious disease be effective’.…”

“…Recent experiences confirmed by the available literature inform us that trust is a critical factor in ensuring an effective community-level response. This is itself predicated on a genuine two-way dialogue which generates understanding – practitioner understanding of community knowledge, beliefs and views, and community understanding of the rationale for measures being implemented ( 50 ). In the context within which there is a strong motivation for family members to hide incidences, community knowledge is vital.…”

Beyond bridging the know-do gap: a qualitative study of systemic interaction to foster knowledge exchange in the public health sector in The Netherlands

“…Therefore, knowledge can never be offered in a fixed format [ 38 ] but has inherently dynamic properties since it is shaped in interactions [ 37 , 45 ]. In order to enable such interactions, more attention should be paid to shaping such multi-actor networks, which may be small at the local level, for example by involving consultants, practitioners, policymakers, and citizens, or large when they deal with overarching issues relevant for whole sectors [ 26 , 46 ]. Such multi-actor networks also imply more diversity in the nature of roles as all actors may assume different roles (producer, user, intermediary, preconditional) at the same time or may assume different roles on different occasions.…”

“…Within this study, the public health sector and its knowledge exchange processes are seen as an innovation system in which innovations are generated and implemented, i.e., diffused and disseminated, through the interaction of multiple stakeholders. Although bringing new products, processes, and forms of organisation into economic use may not be the foremost goal of public health, as it mostly caters for public goods such as disease prevention and health promotion, it has been recognised that public health systems can be seen as sectorial innovation systems [ 21 , 25 , 26 ]. However, the perspective of innovation systems has not yet been used as an analytical tool for investigating the know-do gap.…”

Community Operational Research: Innovations, internationalization and agenda-setting applications

“…Britain for several decades before a parallel movement, with a different branding (Community-Based Operations Research), emerged in the USA (Johnson and Smilowitz, 2007;Johnson, 2012). It was only towards the end of the 20 th Century, and early in the 21 st , that applications outside the UK and USA, often in developing countries, started to appear regularly (e.g., Rosenhead, 1993;Ochoa-Arias, 1994Waltner-Toews et al, 2004;Foote et al, 2007;Midgley et al, 2007;Shen and Midgley, 2007;White, Smith & Curry, 2011;Thunhurst, 2013;Barros-Castro et al, 2015;Sova et al, 2015;Tirivanhu et al, 2016;Velez-Castiblanco et al, 2016). Even as late as 2004, Midgley and Ochoa-Arias were able to make the claim that international development was a new application area for Community OR practitioners, with a relatively small number of people involved at that time.…”