Systems thinking for strengthening health systems in LMICs: need for a paradigm shift

Adam, Taghreed; Savigny, Don de

doi:10.1093/heapol/czs084

Cited by 233 publications

(215 citation statements)

References 5 publications

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“…This finding is confirmed by recent studies that found very few practical experiences from LMICs (3,11,12). The Alliance for Health Policy and Systems Research has been supporting various activities to build capacity to apply ST concepts and tools, with the objective of promoting wider use of the available methods that are applicable in LMICs (3,31). Furthermore, few respondents seemed to have a good grasp of what ST means and what the related concepts and tools are.…”

Section: Discussionmentioning

confidence: 53%

“…While previous studies demonstrated the comparability of phone interviews to face-to-face interviews (25,43) and the comparability of self-administered surveys with interviews (27,28); using different modes of data collection could create a potential bias regarding the nature of the responses obtained (31). However, self-administered questionnaires represented only 24% of the responses and we did not notice any major discrepancies between the responses provided by any group.…”

Section: Limitationsmentioning

confidence: 60%

“…Perhaps a factor that should not be underestimated is the language barrier, where the relevant literature and media for exchanging information are mostly available in English. Creating opportunities to sensitize health systems stakeholders about what ST is and how it can contribute to strengthening health systems, in appropriate language and format is, therefore, an essential step towards its wider adoption and use, as suggested in this study and as highlighted on several occasions (1,5,12,(31)(32)(33). At the same time, findings showed that there exists willingness among policy-makers, researchers, and other stakeholders to support novel approaches to strengthening health systems, including the application of ST principles and approaches.…”

Section: Discussionmentioning

confidence: 93%

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Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries

El‐Jardali

Adam

Ataya

et al. 2014

Int J Health Policy Manag

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Background: Systems Thinking (ST) has recently been promoted as an important approach to health systems strengthening. However, ST is not common practice, particularly in Low-and Middle-Income Countries (LMICs). This paper seeks to explore the barriers that may hinder its application in the Eastern Mediterranean Region (EMR) and possible strategies to mitigate them. Methods: A survey consisting of open-ended questions was conducted with a purposive sample of health policymakers such as senior officials from the Ministry of Health (MoH), researchers, and other stakeholders such as civil society groups and professional associations from ten countries in the region. A total of 62 respondents participated in the study. Thematic analysis was conducted. Results: There was strong recognition of the relevance and usefulness of ST to health systems policy-making and research, although misconceptions about what ST means were also identified. Experience with applying ST was very limited. Approaches to designing health policies in the EMR were perceived as reactive and fragmented (66%). Commonly perceived constraints to application of ST were: a perceived notion of its costliness combined with lack of the necessary funding to operationalize it (53%), competing political interests and lack of government accountability (50%), lack of awareness about relevance and value (47%), limited capacity to apply it (45%), and difficulty in coordinating and managing stakeholders (39%). Conclusion: While several strategies have been proposed to mitigate most of these constraints, they emphasized the importance of political endorsement and adoption of ST at the leadership level, together with building the necessary capacity to apply it and apply the learning in research and practice.

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Section: Discussionmentioning

confidence: 53%

Section: Limitationsmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 93%

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Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries

El‐Jardali

Adam

Ataya

et al. 2014

Int J Health Policy Manag

View full text Add to dashboard Cite

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“…We harnessed our mentors from in-service and through on-job training. The model we used is centered on existing health-system structures and policies, which make it easier to integrate into district health systems [20]. In contrast, the Rwandan model recruited and trained mentors earlier by decentralising pre-service training, which they were able to influence and tailor to meet the mentorship requirements [11].…”

Section: Discussionmentioning

confidence: 99%

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Ajeani

Ayiasi

Tetui

et al. 2017

Global Health Action

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Background: There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. Objectives: This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model. Methods: The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors. Results: Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better. Conclusions: The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved capacity among local mentors to provide mentorship among local district staff.

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“…2,[5][6][7][8][9] This paper describes health systems as CASs, discusses why some STHM practices might lead to unintended consequences, and proposes a way forward that could lead to increased local innovation and long-term capacity in health. While the concepts outlined in this paper could (and many argue should [10][11][12][13][14] ) be applied by larger global health organizations and initiatives, in this paper we focus on their specific application to STHMs.…”

Section: Introductionmentioning

confidence: 99%

Systems Thinking in Short-term Health Missions: A Conceptual Introduction and Consideration of Implications for Practice

Swanson

Thacker

2015

han-j-cjgh

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A strong tradition of short-term health missions (STHMs) exists around the world. STHMs have positive and negative effects on local health systems, and these consequences are often unanticipated and unintended. Conceptualizing local health systems as complex adaptive systems (CASs) may help global health actors approach global health activities, including health missions with a greater appreciation for local cultural and environmental context, leading to increased local capacity and impact while minimizing unintended negative consequences. For some, this might entail a shift in practice as it relates to short-term humanitarian work. In this paper, we introduce readers to health as a complex adaptive system (CAS). We then consider implications for practice, including adopting a "learning health system approach," that engages local stakeholders in an ongoing, iterative process of mutual learning and self-organization.

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Systems thinking for strengthening health systems in LMICs: need for a paradigm shift

Cited by 233 publications

References 5 publications

Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries

Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Systems Thinking in Short-term Health Missions: A Conceptual Introduction and Consideration of Implications for Practice

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