Systems thinking: strengthening health systems in practice

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Background

As health systems all over the world not only recover from COVID-19, but learn to adapt to contexts of increasing uncertainty amidst persistent challenges, it is clear that systems thinking has never been needed more. Systems thinking is an approach to problem-solving that views problems as part of a wider dynamic system. It recognizes and prioritizes the understanding of linkages, relationships, interactions and interdependencies among the components of a system that give rise to the system’s observed behaviour. Systems thinking is a philosophical frame, and it can also be considered a method with its own tools. Identifying ways in the short and long-term which strengthen health systems is critical and applied systems thinking offers opportunities to do this. Systems thinking is often considered to be a field, a discipline, a philosophical approach and a set of tools and methods and can be defined as a way to understand and improve complex issues and situations. Despite broad consensus that systems thinking is important in health systems strengthening, it remains underutilized by researchers, public health practitioners and health decision makers. Further, a gap remains in the translation from concept to policy.

There is limited evidence to date showing how systems thinking has been applied to solve real-world health system challenges, including building system resilience and the subsequent development of health policies. While the health policy and systems research literature is full of calls for more systems thinking, it is clear that empirical examples of applied systems thinking is lacking. Studies on this are much needed in order to overcome perceptions that systems thinking is too conceptual to be policy relevant and not practicable for designing or evaluating health system interventions, especially in low resource settings. In fact, the minimal advances in applied systems thinking in health systems strengthening over the past decade is the impetus for broadening the evidence base now. Applied systems thinking is well positioned to address the complexities of current policy, practice and research questions implicated in health system strengthening across global contexts of growing insecurity, resource constraints and social and political pressures.

The aim of this Research Topic is to gather empirical evidence as well as decision maker viewpoints on how systems thinking tools and methodologies (i.e., process mapping, social network analysis, systems dynamics modelling, causal loop diagrams, etc), and/or systems theory is being applied to health system challenges. In particular, we welcome original manuscripts and policymaker viewpoints or commentaries exploring how applied systems thinking is used to improve health systems adaptivity and resilience. This can include primary health care, universal health coverage, multi sectorality, equity, urban health, non-communicable diseases, health emergencies (including COVID-19) amongst others. In addition, requests for evaluations of systems-driven interventions will be valuable. Submissions from researchers, policymakers, and practitioners working at all levels of the health system, especially in low-resource and emergency/fragile settings are encouraged.

Keywords: Health systems strengthening, systems thinking, resilience, health emergencies, universal health coverage, primary health care

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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