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

Abstract

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. (Excerpts)