Systems Thinking
We live in an interconnected world. Everything affects everything; nothing stands alone. At MEASURE Evaluation, we worked from this premise—called systems thinking. A system is composed of many interrelated actors and parts. To improve any component of a country’s health system, we need to consider how the actors and parts all affect each other, and how the larger context shapes the interactions. The context may lead us to address some factor that wasn’t obvious initially, but actually plays a big role in enabling change further downstream. Failure to address such a factor can fatally undermine attempts to bring improvement.
An example of systems thinking is achieving change by collaborating with country partners. By working alongside country partners from the beginning, they see why and how changes are made, and they have a vested interest in seeing the changes succeed and be sustained. Often, collaboration is not the fastest way to get things done. But without the buy-in of the people who will be maintaining the systems in the long-term, their lack of understanding of the system or—even worse—their distrust of it, can result in resistance to its implementation.
Systems thinking for health systems strengthening can be challenging because it may lead to a set of actions that seems unfocused to some. But to achieve substantial and sustained improvements, there is no alternative. This approach takes into account that as health information system components are strengthened and better managed, better quality data will be generated and capacity to use those data by decision makers at every level of the health system will be improved. That will lead to increased understanding about where programs are in greatest need, and yield better decisions on budgeting, properly locating health interventions, and devising more appropriate and effective interventions. Those decisions, in turn, will improve program impact, accountability, and sustainability.
MEASURE Evaluation had a long history of using a systems approach, and developed resources and provided technical assistance to help others engage in systems thinking.
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