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 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


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


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 herehereherehere, 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 herehere, 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.

41 comments on “Sign onto the Call for GHSIAs

  1. Pingback: Call to Action Published, and Sign-on Activated « Global Health Systems Impact Assessments

    • Dan Osei
      August 13, 2009

      I fully support this initiative. we need to redefine health systems strengthening within the context of emerging financing and delivery of health services.

    • Zaheen
      July 5, 2010

      Join me in this call. This might be helpful to bring good change in our health systems.

      Zaheen Fatima

  2. Pingback: Health Systems get-together, and HSIA sign-on activated « Utah Valley Global Health Group

  3. Dr. Uzodinma Adirieje
    July 3, 2009

    “A stitch in time”

  4. Ryan Lindsay
    July 3, 2009

    University of California San Diego
    San Diego, California

  5. I support this very relevant initiative. SAKHO

  6. Anna Ninan
    July 5, 2009

    The Mali Health Organizing Project strongly supports this call.

  7. Peter Cross
    July 8, 2009

    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.

  8. Pingback: Commission on Smart Global Health: A Unique, Historical Opportunity? « Global Health Systems Impact Assessments

  9. Christine Pilcavage
    August 5, 2009

    I strongly support this call to action.

    Innovative Development Expertise & Advisory Services, Inc (IDEAS)

    August 7, 2009

    thank yioun for including my name in your mailing list

  11. Adriano Cattaneo
    August 11, 2009

    WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
    We fully support this call.

  12. Giorgio Tamburlini MD PhD
    August 12, 2009

    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.

  13. Mohammed Ibrahim, MD
    August 12, 2009

    I am working as Health System Strengthening project coordinator. I totally support the call.

  14. Adriano Cattaneo
    August 12, 2009

    We support your call also as Osservatorio Italiano sulla Salute Globale (Italian Global Health Watch), see (only in Italian, unfortunately). I am the current president of this association.

  15. I support this timely initiative given the levels of funding now going into health systems strengthening

  16. 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.

  17. Adam Bracken
    August 15, 2009

    I agree completely with this need for a Call to Action

  18. Dr. Sampson Ezikeanyi, MD, DHSM, MPH
    August 23, 2009

    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.

  19. asamarth
    August 23, 2009

    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

  20. Gloria Abumere
    August 23, 2009

    A very welcomed development which I hope will
    yield the desired outcome.

  21. Dr. Mercy Nabwire Ouma
    August 23, 2009

    I work in Kenya and I totally agree with this call to action.Our health systems need to be defined and then strengtthened accordingly

  22. Hassan Njai, MPH, MA, M.SC., Dept. of Public Health, Sch. of Medicine, University of The Gambia.
    August 24, 2009

    The initiative is timely. The Department of Public Health, Univ. of The Gambia is willing to collaborate with colleagues and partners in this endeavour.

  23. Hassan Njai, MPH, MA, M.SC., Dept. of Public Health, Sch. of Medicine, University of The Gambia.
    August 24, 2009

    A timely initiative. The Dept. of Public Health, School of Medicine, University of The Gambia is willing to collaborate with colleagues in this endeavour.

    September 22, 2009

    This is a wonderful initative
    I would like to join it too


    September 22, 2009

    This is wonderful !
    Please add my name also .

  26. Michael D. Barnes, Ph.D., Brigham Young University Department of Health Science
    November 4, 2009

    This is a movement to believe in. Thanks for all involved!

  27. I fully support this very constructing initiative.

  28. Maaike Flinkenflögel, MD
    February 16, 2010

    I completely agree with this call.
    I hope the people at the right positions will listen to this and take the needed action!

  29. 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.

  30. Dr Sonu Goel
    September 18, 2011

    I fully agree with the mission. As a faculty of health management in India, I support the initiative of GHSIA…

  31. Pingback: International Health Policies in Lancet today – #23 – FR – 10 July 09 | Politiques Sanitaires Internationales

  32. Freddie Ssengooba,
    October 26, 2012

    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.

  33. Mike Omotosho, SHI
    December 30, 2012

    This is a Sustainable Healthcare Initiative that we must all embrace!

  34. Matteo Convertino
    July 10, 2013

    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.

  35. Jyoti
    July 21, 2013

    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

    • chads
      July 23, 2013

      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!



  36. alejandro baena giraldo
    March 7, 2014

    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.

  37. Eucabeth Kabwoya
    April 6, 2014

    Our health our future

  38. joitaabed
    January 13, 2016

    Please add me to your mailing list

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