تفکر سیستمی برای تقویت سیستم‌های بهداشتی

Many developing countries are looking to scale-up what works through major systems strengthening investments. With leadership, conviction and commitment, systems thinking can facilitate and accelerate the strengthening of systems to more effectively deliver interventions to those in need and be better able to improve health in an equitable way. Systems thinking is not a panacea. Its application does not mean that resolving problems and weaknesses will come easily or naturally or without overcoming the inertia of the established way of doing things. But it will identify, with more precision, where some of the true blockages and challenges lie. It will help to: 1) explore these problems from a systems perspective; 2) show potentials of solutions that work across sub-systems; 3) promote dynamic networks of diverse stakeholders; 4) inspire learning; and 5) foster more system-wide planning, evaluation and research. And it will increase the likelihood that health system strengthening investments and interventions will be effective. The more often and more comprehensively the actors and components of the system can talk to each other from within a common framework –-communicating, sharing, problem-solving -- the better chance any initiative to strengthen health systems has. Real progress will undoubtedly require time, significant change, and momentum to build capacity across the system. However, the change is necessary -- and needed now. This report therefore speaks to health system stewards, researchers and funders and maps out a set of strategies and activities to harness these approaches, to link them to these emerging opportunities and to assist systems thinking to become the norm in design and evaluation of interventions in health systems. But, the final message is to the funders of health system strengthening and health systems research who will need to recognize the potential in these opportunities, be prepared to take risks in investing in such innovations, and play an active role in both driving and following this agenda towards more systemic and evidence-informed health development. Contents......Page 5 Acknowledgments......Page 11 Preface......Page 15 Executive Summary......Page 19 Acronyms......Page 25 1 Systems thinking for health systems strengthening: An introduction......Page 29 Introduction to the Report......Page 31 Key terms and terminology ......Page 32 Overview of the Report......Page 37 2 Systems thinking: What it is and what it means for health systems......Page 39 Systems thinking......Page 41 Bringing the system into focus with a systems thinking lens......Page 42 Systems thinking – a paradigm shift......Page 45 System stakeholder networks......Page 46 Another view of interventions......Page 47 Implications of systems thinking for designing and evaluating health interventions ......Page 49 3 Systems thinking: Applying a systems perspective to design and evaluate health systems interventions......Page 51 Systems thinking: A case illustration......Page 53 Ten Steps to Systems Thinking......Page 56 Part I: The Intervention Design......Page 57 Part II: The evaluation design......Page 62 Conclusion......Page 73 4 Systems thinking for health systems: Challenges and opportunities in real-world settings......Page 75 Part I: Select challenges in applying a systems perspective......Page 77 Part II: Innovative approaches to applying the systems perspective ......Page 84 Conclusion......Page 88 5 Systems thinking for health systems strengthening: Moving forward......Page 89 The growing focus on health systems......Page 91 Schools of thought and experience......Page 92 Moving forward......Page 94 Wrapping up......Page 96 Reference List......Page 97 Alliance Scientific and Technical Advisory Committee members......Page 107 Makes The Case For Systems Thinking In An Easily Accessible Form For A Broad Interdisciplinary Audience, Including Health System Stewards, Programme Implementers, Researchers, Evaluators, And Funding Partners. Systems Thinking For Health Systems Strengthening: An Introduction -- Systems Thinking: What It Is And What It Means For Health Systems -- Systems Thinking: Applying A Systems Perspective To Design And Evaluate Health Systems Interventions -- Systems Thinking For Health Systems: Challenges And Opportunities In Real-world Settings -- Systems Thinking For Health Systems Strengthening: Moving Forward. [edited By Don De Savigny And Taghreed Adam]. November 2009--preface. Includes Bibliographic References (p. 97-104). Also Available Via World Wide Web