Systems Thinking for Capacity in Health
We believe that systems thinking and complexity science can be transformational in global health by increasing local capacity and shared learning, and minimizing unintended consequences.
Sign onto the Call for GHSIAs
To sign onto this call, comment below with the following: Your name, affiliation, and location. If you have questions or comments, email ghsias@gmail.com. You can see the Lancet article here, or the body of the article here.
Call to Action
Those engaged in global health should hold governments and other affiliated organisations accountable for the effect of global health activities on existing health systems
WHO should:
• take the lead in development and dissemination of HSIAs that can be used by all groups associated with global health, and
• include prominent section for development and dissemination of HSIAs on their website
All donors, led by major donors such as the Bill & Melinda Gates Foundation, the US President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank should:
• require that all global health initiatives and programmes that they fund take into account the effect on the existing health system, and
• fund activities to develop and implement effective evidence-based HSIAs
Government leaders and ministry of health personnel, particularly in developing countries, should assess and document effect of global health initiatives and programmes on their existing health system, irrespective of who funds the programme
Academic institutions and researchers should prioritise research for development of HSIAs that are evidence-based and take into account local realities
Non-governmental organisations and staff who participate in humanitarian work should:
• participate in development of and sign onto codes of conduct, such as the NGO Code of Conduct
• take into account effect of their programmes on existing health system, and
• work with academic and other institutions to develop HSIAs that are appropriate to their specific situation
The Alliance for Health Policy and Systems Research, the Health Systems Action Network, the Countdown Working Group on Health Policy and Health Systems, the International Health Impact Assessment Consortium, the Institute for Health Metrics and Evaluation, and others involved in health systems advocacy and research should:
• support development of HSIAs and indicators that are evidence-based, easy to use, and appropriate to the implementing organisation’s capacity and situation
• Collaborate to establish a website where methods and expertise in the conduct of HSIAs are displayed
Signed:
R. Chad Swanson, DO, Johns Hopkins School of Public Health
Baltimore, MD, USA
Henry Mosley, MD, MPH, Johns Hopkins School of Public Health
Baltimore, MD, USA
David Sanders, MBChB, University of Western Cape
Bellville, Western Cape, South Africa
David Egilman, MD, MPH, Brown University
Providence, RI, USA
Jan De Maeseneer, MD, PhD, Ghent University
Ghent, Belgium
Mushtaque Chowdhury, PhD, BRAC University
Dhaka, Bangladesh
Claudio F. Lanata, MD, MPH, Nutritional Research Institute
Lima, Peru
Kirk Dearden, PhD, Boston University
Boston, MA, USA
Malcolm Bryant, MBBS., MPH, Innovative Development Expertise and Advisory Services, Inc
Boston, MA, USA
WHY GHSIA?
The idea behind Global Health Systems Impact Assessments is actually quite simple: all global health activities should consider the impact that they have on the underlying health system before their activity begins. The need for these assessments stems from three facts:
1. Millions suffer and die needlessly around the world, mostly in developing countries. This blog will assume that there is agreement on this point. (If needed, however, see here, here, here, here, or here)
2. Functional, vibrant health systems are needed to ensure health. This blog will discuss some of the evidence and rational behind that claim. However, much information can be found on the “Health Systems Links” on the right side of this blog’s home page.
3. Targeted health programs have significant impacts on the underlying health systems, both positively and negatively, sometimes with disastrous consequences. While this blog will likely discuss examples of such programs, documentation can also be found here, here, and here.
We request, then, that all global health program planners in all organizations – from multimillion dollar donors like the global fund and the Gates foundation to district health leaders in Africa – consider the impact that their respective activities will have on health systems building blocks like service delivery mechanisms, the health workforce, and health technologies. This planning, we predict, will lead to systems in developing countries that are less dependent on developed countries’ funds and technical support, and better prepared to respond to future health challenges.
For more on the need for GHSIAs, see here.
Systems Thinking for Capacity in Health 
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I fully support this initiative. we need to redefine health systems strengthening within the context of emerging financing and delivery of health services.
Join me in this call. This might be helpful to bring good change in our health systems.
Zaheen Fatima
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“A stitch in time”
University of California San Diego
San Diego, California
I support this very relevant initiative. SAKHO
The Mali Health Organizing Project strongly supports this call.
Innovative Development Expertise & Advisory Services, Inc (IDEAS)
16 Depot Road
Boxford, MA 01921
With rare exceptions, experience demonstrates that the gains of vertical programs will only be sustained, if health systems are strengthened to routinely provide the required services.
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I strongly support this call to action.
Innovative Development Expertise & Advisory Services, Inc (IDEAS)
thank yioun for including my name in your mailing list
WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
We fully support this call.
I totally agree with your call. It will be crucial to reach an agreement asap on a common assessment framework. This should adopt a modular approach (i.e. by levels of complexity building on the same framework) to allow for the great variety of project/programmes, including the availability of funds for the assessment. I also suggest to use the WHO HS framework (identifying 6 system functions), as it already widely used.
I am working as Health System Strengthening project coordinator. I totally support the call.
We support your call also as Osservatorio Italiano sulla Salute Globale (Italian Global Health Watch), see http://www.saluteglobale.it/ (only in Italian, unfortunately). I am the current president of this association.
I support this timely initiative given the levels of funding now going into health systems strengthening
I would like to add my support to this timely initiative given the increased funding mainly from Global Health Initiatives that is now going into supporting health systems strengthening in developing countries.
I agree completely with this need for a Call to Action
Thank you all on this issue of global concern. I am a specialist in Health Policy, Planning and Management (HPPM) and would want to contribute specifically on innovative financial mechanisms that will foster the public-private partnership in health services delivery using the government tools. Alternatively is on Human resources for health in community based programs using the VHT or CHW, an area i have researched and done some work on.
I agree with the Call to Action. I believe that a health system is the most important integral part of a nation’s development and determines how much the people are healthy and happy. The horizons of a health system are very broad and its time to think Health in all Policies!
Amit Samarth, MBBS, MHA
MPH Student at JHSPH
A very welcomed development which I hope will
yield the desired outcome.
I work in Kenya and I totally agree with this call to action.Our health systems need to be defined and then strengtthened accordingly
The initiative is timely. The Department of Public Health, Univ. of The Gambia is willing to collaborate with colleagues and partners in this endeavour.
A timely initiative. The Dept. of Public Health, School of Medicine, University of The Gambia is willing to collaborate with colleagues in this endeavour.
This is a wonderful initative
I would like to join it too
S.K. CHATURVEDI
This is wonderful !
Please add my name also .
This is a movement to believe in. Thanks for all involved!
I fully support this very constructing initiative.
I completely agree with this call.
I hope the people at the right positions will listen to this and take the needed action!
I strongly support your call for GHSIAs for this will not only provide a baseine on which to measure progress, it will also provide a forum for sharing of best practices and help in continuous assessment of alignment to commitments and overall Health Systems Strengthening goals (directly or indirectly) especially if areas of weakness, strengths & opportunities for HSS are jointly agreed and a set of critical & locally relevant indicators is adopted and measured every so often. The culture of ’embracing error’ and ‘learning from our results’ needs to be deliberately emphasised by those in charge of our health systems in order not to loose focus of the cumulative effetc of our choices of courses of actions (at all levels) on the well being of the overall health system. The perspectives of those providing and accessing health services from the peri-urban and the remotest peripheries also needs to be continously sought.
I fully agree with the mission. As a faculty of health management in India, I support the initiative of GHSIA…
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The Assessment is long overdue. The European Commission has provided guidelines to ensure that innovations and policies do not negatively affect the common values such as equity and social protection that health systems serve to underpin in Europe.
This is a Sustainable Healthcare Initiative that we must all embrace!
I join you in this call. Great scientific framework, and great values for impact on real-world issues. I am Assistant Professor in Complex Systems (Human-Natural Systems Lab) at Virginia Tech.
As a professional who has suffered the brunt of non-functional systems & desirous of pursuing a grand career in development of the same – I totally support this initiative and wish to be more involved with it sooner than later
Dear Jyoti,
Thanks for your comment. Please join the conversation on FB, twitter, and this blog. Email us with specific suggestions, comments, etc. We look forward to collaborating!
Best,
Chad
Equidad significa: para todos lo mejor, y no simplemente lo mejor para unos pocos. esto implica transformar el contexto socio político de toma de decisiones y la cultura sanitaria, donde nosotros los ciudadanos no deleguemos la salud en aparatos burocráticos, que terminan controlando y manipulando no solo el dinero sino la forma de vivir de las poblaciones.
Our health our future
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