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

Swanson Chad,Thacker Brian

doi:10.15566/cjgh.v2i1.50

Abstract

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.

Highlights

Short-term health missions (STHMs) to low- and middle-income countries (LMICs) have become a popular global health activity for many health care providers and public health professionals
While we are not aware of any consensus on the definition of short-term health missions (STHMs), we have modified the definition that Martinuik et al applied to short term health missions:[1] an STHM refers to a short trip of 1 day to 2 years by a health professional to an LMIC to provide direct medical care or a public health intervention to the population
This paper describes health systems as complex adaptive systems (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

Summary

Introduction

Short-term health missions (STHMs) to low- and middle-income countries (LMICs) have become a popular global health activity for many health care providers and public health professionals. Households and communities learn about the outputs of programs and interventions that the managers and providers implement They might be more aware of unintended consequences as they become more aware of local attitudes, beliefs, and practices, as well as the decisions being made by policymakers and planners. “Soft” capabilities such as navigating complexity, learning collaboratively, engaging politically, and being self-reflective are at least as important as the technical capabilities, though they are too often not adequately considered in health planning.[21] This learning organization approach can enhance the impact and efficacy of global health interventions, like STHMs, by preventing unintended consequences that invariably result when communities and households are disregarded in the learning process

A Complex Systems Paradigm Shift

Conclusion