Introduction to Health Systems

Introduction to Systems

• Systems are complex entities
• Multiple interacting parts affect health systems
• Components include: physical bodies, behaviors, workplaces, schools, faith institutions, environment, regulations, policies, socioeconomic conditions, and culture
• Effective health systems require understanding components & their interaction
• A systems approach considers complex system characteristics, multiple stakeholders, and diverse perspectives & incentives
• Balancing conflicts in complex systems, like healthcare professional education (HPE), involves considering varied perspectives and making trade-offs
• A system is a complex whole, where functioning depends on parts and interactions between them

Definition of a System

• A system is a complex whole whose functioning depends on its parts and the interactions between those parts

The Health System (WHO)

• The WHO framework highlights key components (service delivery, health workforce, information, medical products, vaccines & technologies, financing, leadership/governance) for building a health system
• The key outcomes of a health system are improved health (level and equity), responsiveness, social and financial risk protection, improved efficiency, and safety.
• Access and quality are critical aspects.

General Systems Theory

• Introduced by Ludwig von Bertalanffy (Biologist)
• Argues organisms should be studied as complex wholes
• Includes a distinction between open and closed systems
• Focuses on hierarchical (nested) open systems, identifying systems boundary, level of organization, components, in and output.

Cybernetics

• Cybernetics is the science of control and communication in animals and machines, crucial for understanding control
• Negative feedback is a key concept in cybernetics
• Negative feedback counteracts deviations from a goal
• Positive feedback amplifies deviations from a goal.

Systems Approach to Management and Organizational Development

• Systems approach implies decisions and actions in one area impact others
• Example—purchasing impacts production
• All organizations are dependent on external factors for inputs

Examples of Feedback Mechanisms

• Return to Service Agreement of UP Manila
• Oral Health Systems
• Phil Health Benefits: extraction cases vs. preventive services

How about Systems Containing Humans?

• Humans have their own purposes
• This can differ from organizational purposes

Types of Complex Systems

• Simple problems have simple causes and linear causality with standard solutions
• Complicated problems consist of sets of simple problems, compounded by scale and coordination problems
• Complex problems involve interactions between determinants of sub-problems, nonlinear causal relationships, context sensitivity, and unpredictable outcomes

Complex Adaptive Systems

• Systems are made up of interacting parts/agents through relations
• Unpredictability is a key feature of complex adaptive systems.
• Interactions are crucial for understanding complex systems, with small inputs potentially leading to large effects
• Action results can depend on initial conditions
• Feedback mechanisms (positive and negative) contribute to emergent behavior
• Time delays in feedback loops are also relevant
• Path dependence and context sensitivity add to the challenge of studying and managing complex systems

Complexity of Health Interventions

• Interventions can vary in complexity
• Simple interventions target clearly defined problems for a targeted group and may have a single cause or mechanism
• More complex interventions may require negotiation, long implementation chains, and lessons learned from previous projects.