In August of 2012, 22 health leaders from 16 countries met in Bellagio, Italy to discuss the advantages of approaching health systems strengthening and capacity building efforts in Low- and Middle-Income Countries (LMICs) through a “complex, adaptive systems” (CAS) lens. Such a lens – already applied successfully to a variety of disciplines and sectors ranging from physics to business – provides the theory, language, and methods to describe and understand diverse and dynamic social systems like health. The meeting was sponsored by the Rockefeller Foundation and was titled “Strengthening Health System Capacities through Institutional Development: Enhancing Collaboration between Donors and Organizations in Low-Income Countries”.
Representatives from global health organizations such as the World Health Organization (WHO), The United States Agency for International Development (USAID), The Doris Duke Charitable Foundation (DDCF), the Norwegian Agency for Development and Cooperation (NORAD), Enhancing Support for Strengthening the Effectiveness of National Capacity Efforts (ESSENCE), and other organizations attended. These stakeholders from diverse perspectives allowed for an in-depth and interdisciplinary analysis of health systems and the interactions between organizations and actors at the ground level.
The three-day meeting featured discussion and presentation of best practices in health systems strengthening, specifically as it relates to capacity development. As a group, we agreed upon several consensus points:
- Health Systems are complex, adaptive social systems that are impacted by sectors often considered “outside” of health, such as education, business, and social networks.
- Context is key. Flexibility in the ability to learn, adapt and optimize health goals and practices must be enhanced.
- The reductionist paradigm that has dominated health for the past century must shift to allow for long-term, locally driven efforts to emerge.
- Systems Thinking – a discipline that considers the dynamic interactions of actors in complex, adaptive social systems like health – provides unique and promising insights, approaches, tools, and methods that are underutilized in health.
Moving forward, we are grateful that the DDCF will be supporting post-Bellagio activities such as: writing and submitting academic papers for publication; generating awareness through this blog (ghsia.wordpress.com) and twitter (CASforHealthCapacity); writing and distributing “white papers” that clarify these ideas; and organizing and supporting a “community of practice” for joint learning. Please consider spreading the word and joining us! If interested, comment below, or email us at cas4capacity(at)gmail.com.
