Annex 4 - compilation of approaches

Systems thinking for health

Systems thinking has its origins in the early 20th century in fields as diverse as engineering, economics and ecology. With the increasing emergence of complexity, these and other non-health disciplines developed systems thinking to understand and appreciate the relationships within any given system, and in designing and evaluating system-level interventions.

Systems Thinking for Health Systems Strengthening offers a practical approach to improving health systems through a systems thinking lens. It works to reveal the underlying characteristics and relationships of systems, which are described as dynamic architectures of interactions and synergies. Such systems typically exhibit non-linear and unpredictable behaviour, are resistant to change, and provide a challenge where seemingly obvious solutions can worsen a problem.

The framework describes 10 practical steps in a two-stage conceptual process that can be adapted to many different situations. Intervention design includes convening stakeholders, brainstorming, predicting performance, and adaptation and redesign. Evaluation design includes identification of indicators, choice of methods, selection of design, planning, budgeting and funding.

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