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

摘要

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 (de Savigny and Adam 2009; Sheikh et ah 2011). 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) (Senge 1994; Sterman 2006; Shiell et al. 2008; Paina and Peters 2012).