Systems Thinking for Health Systems Strengthening

Systems thinking and health reforms in Latin America - November 2013

Meeting participants, November 2013
©WHO/Santiago Aguirre

Dr Taghreed Adam from the Alliance Secretariat was invited to participate in a meeting organized by IDRC, Canada, and hosted by the Ministry of Health in Colombia on “Systems thinking and health sector reform in Latin America”. The meeting was held at the Ministry of Health in Bogota on 25 to 27 November 2013.
Dr Adam was invited as an expert in the field of systems thinking and complex adaptive systems concepts and methodologies to discuss and share ideas on how these concepts can be used to understand, redesign and evaluate health sector reform initiatives in Latin America. Policy-makers and researchers from 8 countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico and Peru) attended the meeting, as well as the the Vice Ministers of Colombia and Costa Rica.

The meeting focused on the recent health sector reforms since most health systems in Latin American countries were transformed by the effects of deep structural reforms in the last 20 years. Furthermore, reforms offer a privileged experimental opportunity since their consequences are varied and complex - influencing governance, financing, human resources and services delivery among others.
By the end of the meeting, participants were very enthusiastic about using systems thinking concepts to address health systems problems. Both policy-makers and researchers expressed their intention to pursue this thinking in future policy development and research in the region.

Among the topics that participants were particularly interested to pursue are:

  • Understanding why primary health care services are still inadequate in achieving their goals and how can they be strengthened from a systems thinking perspective—for example, the reasons for (and how to improve) the low quality of services at this level and the lack of coordination of the continuum of care between primary, secondary and tertiary levels (which would involve among others a stakeholders network analysis to understand their characteristics, role, power and drivers ).
  • How primary care staff can be motivated in an effective and sustainable manner to improve quality of care, overall responsiveness and patient satisfaction.
  • Why there is a gap between formal (rules and guidelines) and actual practices at all levels of the health care delivery system. How can these be anticipated and mitigated.
  • Understanding the particular challenges of providing adequate health services within the context of decentralization.
  • Questions related to universal coverage, e.g., how to improve rational use of medicines using a systems thinking approach; how to ensure equitable access to health services for indigenous population; optimization of care at the different levels in a way that ensures equitable access and efficiency.
  • Given the high proportion of indigenous population in many Latin American countries and the complexities involved, e.g., racisms, discrimination, understand why services do not reach them and what are the possible solutions to improve access and coverage in an equitable way, using a systems thinking lens.

The meeting concluded with a series of commitments among both policy-makers and researchers focusing around the importance of building the capacity in the Latin American region to use and apply systems thinking in research and practice.
These included activities such as: developing and sharing curricula to teach systems thinking as part of pre-service and post-graduate training; publishing and sharing experiences in using systems thinking and complexity science to understand and evaluate health systems problems; searching for financial support to carry out empirical research to advance this knowledge; and promoting the relevance of systems thinking approaches both in academic and policy-making environments.