Strengthening Health Systems

Complexity, Complexity, Complexity

chads — Fri, 14 Oct 2011 15:48:13 +0000

This blog post, podcast, and publication by David Peters and others at Future Health Systems provides a very good introduction to health as a complex, adaptive system.

Conference Call on Systems Sciences and Health Systems Strengthening

chads — Mon, 19 Sep 2011 18:00:34 +0000

I will be moderating a conference call sponsored by the APHA on Systems Sciences and Health Systems Strengthening. on October 18. See here for details.

Bellagio Conference on Institutional Capacity Building, and Health Systems Strengthening

chads — Mon, 19 Sep 2011 17:58:16 +0000

I will be participating in a Bellagio Conference on “Strengthening Health System Capacities through Institutional Development: Enhancing Collaboration between Donors and Institutions in Low- Income Countries” next August 27-31 at the Rockefeller’s Bellagio Center in Italy. The conference will be highly selective, and nearly all attendees have been chosen. However, we are interested in pre-conference collaborations.

Here is a summary of the proposal:

There is a growing consensus around the need for strong health systems to improve health long-term globally, and institutions play a crucial and central role in HSS by supporting and performing research, analyzing health policy, organizing social mobilization movements, and training health professionals. Our objective in organizing this conference at the Rockefeller Foundation’s Bellagio Center is to highlight the important role that institutions play in health systems, and outline concrete steps that donors can take to support the development of institutions in low income countries capable of adapting and responding effectively to ever-changing challenges. We will connect a unique mix of southern educators, researchers, and practitioners with on the ground institutional capacity building experience from the public sector as well as civil society, and link them with international donors that support innovative approaches. We aim to accomplish the following objectives: perform background research and develop relationships with donors and institutions before the conference starts; consider a web-based communication hub for future collaborations and learning; propose indicators for measuring the strength of institutions; draft a document of understanding between donors and institutions; publish our findings in a peer-reviewed academic journal; and propose an on-going, evolving mechanism to regularly evaluate the extent to which institutional capacity building programs are successful.

We will be doing a substantial amount of pre-conference research and other preparatory activities. Let me know if you and/or your institutions are interested in collaborating.

Systems Thinking and the Future of Public Health

chads — Mon, 28 Mar 2011 09:38:21 +0000

Two prominent publications highlight the central importance of systems thinking concepts to the future of public health:

Health professionals for a new century: transforming education to strengthen health systems in an interdependent world is a report authored by 20 professionals from around the world (joint first authors are Julio Frenk and Lincoln Chen) that considers the future challenges facing health education, and makes recommendations moving forward. It’s long (36 pages), and I found this podcast and this discussion (with part 2 here, and the accompanying power point here) very helpful.

The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015 is a Lancet-commissioned report (also long, 33 pages) that considers the next global health agenda, after the MDGs. The report highlights principles such as holism, sustainability, equity, and ownership.

Systems Sciences and Health

chads — Sun, 13 Mar 2011 04:50:26 +0000

I am becoming more and more convinced that the health systems strengthening movement could learn much from the so-called “systems sciences.” Below are some resources that I have found helpful.

General Systems Thinking

Systems Thinking: Creative Holism for Managers is the best summary (that I am aware of) of the various systems thinking approaches and methods. Jackson considers ten: hard systems thinking, system dynamics, organizational cybernetics, complexity theory, strategic assumption surfacing and testing, interactive planning, soft systems methodology, critical systems heuristics, team syntegrity, and postmodern systems thinking.

Thinking in Systems: A Primer is an excellent, easy to read introduction to systems thinking.

Peter Senge’s The Fifth Discipline: The Art & Practice of the Learning Organization is a classic, best seller that outlines the five disciplines that are needed to form a successful organization in this age of complexity and rapid change: “personal mastery,” “mental models,” “shared vision,” “team learning,” and “systems thinking.” While the examples and explanations are primarily from a business perspective, the principles apply to all organizations.

Here is a brief blog post that summarizes the evolution of systems thinking.

I have found this lecture series on complexity by Scott Page very helpful.

Finally, this blog post lists the top 15 systems thinking books, and this blog lists their 10 favorite systems thinking books in the last decade.

Health-Related Systems Thinking Resources

Here is a brief systems thinking introduction provided by the Association of Schools of Public Health.

This 2007 Symposium on the Systems Sciences sponsored by the NIH provides great introductory lectures to 3 methodologies: systems dynamics, agent-based modeling, and systems network analysis.

And this is a brief (10 pages or so) introduction to systems thinking from a US healthcare reform perspective, an appendix to the IOM’s document “Crossing the Quality Chasm.”

This is an excellent consideration of healthcare as a complex, adaptive system by William Rouse from a US health system perspective.

This document (about 100 pages) approaches health systems strengthening from a systems thinking perspective. It is published by the WHO’s Alliance for Health Policy and Systems Research. Here is a 6 min summary video.

The following audio and power point lectures (just over 1.5 hours total; I think that they are outstanding) from Henry Mosley approach global health from a systems thinking perspective:

Mental Models
The Health Production System
Leadership and Learning Organizations

There have also been a number of excellent articles on complexity and health care by Paul Plsek. See here, for example.

Allan Best has also published extensively on the subject. See here, for example.

Are there any other systems thinking resources that you have found helpful?

Health Systems Strengthening Guiding Principles Published

chads — Wed, 22 Dec 2010 18:14:19 +0000

“Toward a Consensus on Guiding Principles for Health Systems Strengthening” was published in PLoS Medicine. It is open access, available to all. I have reproduced a summary list of the principles below. In the coming weeks, I will be posting on next steps: advocacy, application, education, research, etc.

Ten Health Systems Strengthening Guiding Principles

1. HOLISM
* Consider all systems components, processes, and relationships simultaneously.
* Include all health systems strengthening principles listed below.
2. CONTEXT
* Consider global, national, regional, and local culture and politics.
3. SOCIAL MOBILIZATION
* Mobilize and advocate for social and political change to strengthen health systems and address the social determinants of health.
4. COLLABORATION
* Develop long-term, equal, and respectful partnerships between donors and recipients within the health sector and among other sectors.
* Develop and commit to a shared vision among partners by challenging underlying beliefs and assumptions.
* Ensure frequent communication among actors.
5. CAPACITY ENHANCEMENT
* Enhance capacity and ownership at all levels, from individuals and households to ministries of health, including leadership, management, institutional strengthening, and problem solving.
6. EFFICIENCY
* Train and supervise the most appropriate personnel to meet health needs.
* Utilize appropriate technology.
* Coordinate external aid and activities.
* Minimize waste.
* Allocate funds where they are needed most.
7. EVIDENCE-INFORMED ACTION
* Strengthen structure, systems, and processes to gather, analyze, and apply data locally.
* Make decisions, whenever possible, based on evidence.
* Monitor progress of programs, and adjust accordingly.
* Ensure transparency and accountability.
8. EQUITY
* Target those who are disenfranchised.
* Plan for equity by empowering the disenfranchised, with a particular emphasis on gender.
* Disaggregate indicators to track disenfranchised groups.
9. FINANCIAL PROTECTION
* Ensure that funding streams are predictable.
* Consider insurance schemes to protect from financial catastrophes.
10. SATISFACTION
* Respond to needs and concerns of all stakeholders.
* Demonstrate accountability to constituents.
* Implement and respond to feedback mechanisms measuring quality and provider/client relationships.

Enjoying the live webcast of the Global Sysmposium on Health System Research

chads — Tue, 16 Nov 2010 15:37:32 +0000

Almost like being in Montreux.

Consensus Statement Highlighted in Lancet

chads — Tue, 07 Sep 2010 12:40:37 +0000

Our consensus statement on guiding principles for health systems strengthening has been highlighted in this recent Lancet comment.

We have finalized our list of principles, and are in the process of submitting it for publication. As soon as we hear more, we will update this site.

Update on HSS Guiding Principles

chads — Mon, 19 Apr 2010 08:53:23 +0000

1. Systems Principles: Health systems stewards apply systems principles. Health systems are holistic, interdependent, constantly changing, and counter-intuitive; they are more than the sum of their parts . As such, global health planners should consider the impact that their activities will have on all of the major components, processes, and relationships in the health system when attempting to strengthen (or minimize the negative impacts on) it. Just because an intervention strengthens one component (or even several components) of the health system (such as service delivery) does not necessarily mean that it strengthens the entire system. Indeed, it may even weaken the overall system while strengthening one component. As such, all of the principles listed below must be considered; neglecting even one could lead to systems weakening. It seems like we should focus on these three systems principles (see Systems Thinking for HSS, p. 40):
• Holism: “no individual agent or element determines the nature of the system”
• Leverage: “seeing where actions and changes in structure can lead to significant, enduring improvements” (P. Senge’s “The Fifth Discipline,” p. 114).
• Counter-intuitive: highlights the need for broad and continuous monitoring.

2. Effectiveness and Efficiency: Strong health systems improve and maintain health in the most efficient manner possible.
a. Allocative Efficiency: The global health funding focus should match the current and anticipated future need of the population.
b. Structural Efficiency: The structure of health systems should match the population’s need. Duplication and disruption of partner countries’ health activities should be avoided.
c. Technical Efficiency

3. Capacity Enhancement: HSS activities develop human and institutional capacity long-term.
a. New public health challenges are most efficiently addressed by trained locals.
b. Behavior change and institutional development takes many years. Programs should consider this when planning time-lines.
c. Development and maintenance of effective leaders and management plans is crucial.
d. Quality assurance is a cyclic, iterative, gradual process that must be planned for.
e. Recipient collaborators should be allowed the development of “ownership” of programs, data, and research capabilities, and be accountable for their results.

4. Social Mobilization and Change: Recognizes that ill health is at least as much a social problem as it is a biomedical one.
a. Public health successes depend on social change.
b. Health systems should be structured and develop incentives to adequately impact the social determinates of health.

5. Equity:
a. Performance indicators should be disaggregated to reveal inequity in disenfranchised populations.
b. Service delivery approaches should target those that need them most.
c. Those with the poorest health should be empowered by inclusion in health planning and implementation, and frequent consultations with them.

6. Customer Satisfaction:

7. Financial Protection:

8. Intersectoral Collaboration: The importance of the social determinates of health require that health systems actors be leading advocates in issues such as education, gender equality, and poverty reduction. They must develop relationships with leaders in those fields, be effective communicators, and be active and political and advocacy activities.

9. Local Context: All of the principles and guidelines above, and the process of deciding how much to consider each one, are context specific. Local communities and nations will need to decide how to measure health status and customer satisfaction, for example.

First Global Symposium on Health Systems Research Registration Open

chads — Mon, 05 Apr 2010 11:01:12 +0000

Registration is now open!

Click here to register now!

www.hsr-symposium.org/index.php/registration

16-19 November 2010: Researchers, policy-makers, representatives of donor and multinational organizations, and other stakeholders representing diverse constituencies will gather in Montreux, Switzerland to share evidence, identify significant knowledge gaps, and set a research agenda aimed at accelerating universal health coverage. Visit http://www.hsr-symposium.org/

Registration to the Symposium is limited, so register early to ensure your participation!

For information on registration fees and conditions click here.

http://www.hsr-symposium.org/index.php/registration

Application is now open for the following:

- Young Researcher Programme – http://www.hsr-symposium.org/index.php/young-researchers-call

- Scholarships – http://www.hsr-symposium.org/index.php/scholarships

- Satellite sessions – http://www.hsr-symposium.org/index.php/satellite-meetings

- Marketplace stalls – http://www.hsr-symposium.org/index.php/marketplace

 The Call for Abstracts closes on April 30, 2010 – Submit your abstract soon !!

We look forward to seeing you in Montreux!

Symposium Secretariat
www.hsr-symposium.org/