Health Systems Thinking Lecture by Atupele Chisiza - University of Zambia - Health Systems Management_unza

Introduction to Health Systems Thinking Presented by: Atupele Chisiza Course: HSM4325 University of Zambia Session Objectives Understand health system development and the forces that shape it Explore models for strengthening health systems Introduce key health system and conceptual frameworks Discuss the role of political economy in health system development Engage in applied examples and exercises Health System Development Health systems change over time, what we see today didn't always exist. Economic growth:As a country gets richer, it can spend more on health infrastructure, salaries, and medicines. Population needs: As the population grows or ages, the health needs change—e.g. more maternity services, or more chronic care for older adults. Technological advances:New medical technologies or IT systems (like digital records) can change how health systems operate Policy and governance reforms:Health systems change when governments change their strategy, e.g., Zambia’s shift to decentralization. Example: Zambia’s transition from mission hospitals to decentralized district health services Models for Health Systems Strengthening Vertical Programs: Target specific diseases (e.g. malaria control) Horizontal Approaches: Strengthen all aspects of the system (e.g. primary health care) Diagonal Approach: Uses targeted programs to also strengthen system-wide functions Example: PEPFAR HIV funding supporting labs and supply chains for other services Exercise 1 - Which Model? Question: A donor provides funding for maternal health and uses the opportunity to train general nurses and improve transport and logistics. What approach is this? Answer to Exercise 1 - Diagonal Approach: Targeted focus (maternal health) used to improve overall health system (training + transport) Health System Frameworks WHO Building Blocks Framework Health Systems Dynamics Framework Expands the WHO model to include: Context (social, political, economic) Population health needs and values Interactions between components Emphasizes system feedback and adaptation Systems Thinking Framework Focuses on: Relationships, interdependence, and feedback loops Non-linear behavior and unintended consequences Encourages understanding the “whole” system, not just parts What happens to service delivery if the workforce is underfunded?” Why they matter? Frameworks help organize thinking and provide a structure for understanding how different health system components interact. Conceptual Frameworks These help break complex ideas into understandable pieces. Determinants of Health Identifies the multiple factors influencing health: Social (education, income, housing) Behavioral (smoking, exercise) Environmental (clean air/water, climate) Health care access and quality Often visualized as a layered model or web of causation Logic models A tool for project design and evaluation: Inputs: Resources used (staff, funds, supplies) Activities/Processes: Actions taken (trainings, outreach) Outputs: Direct results (number trained) Outcomes: Short-to-medium term changes (e.g. improved knowledge) Impact: Long-term goals (e.g. reduced disease burden) Frameworks are tools, not perfect, but they help simplify planning and analysis. Exercise 2 - Build a Logic Model Task: Given this scenario, sketch a simple logic model: "A nutrition program trains community health workers, distributes supplements, and aims to reduce under-5 stunting." Answer to Exercise 2 Inputs: Funding, training, supplements Processes: Train CHWs, distribute supplements Outputs: Number of CHWs trained, supplements delivered Outcomes: Improved child nutrition Impact: Reduced under-5 stunting Political Economy in Health Systems Refers to how political forces, institutions, and economic systems shape health policy and system development. Health systems are shaped by politics and money. Key Concepts: Power and decision-making:Some stakeholders (e.g., ministers) have more say. Funding priorities: Often reflect politics (e.g., more clinics during election years). Stakeholder interests: NGOs, donors, communities, all have different priorities. Example: Debate over national health insurance in Zambia. Political and economic interests were at play. Exercise 3 - Political Economy in Action Scenario: The government shifts funding from hospitals to community health programs after an election. What political economy factors may have influenced this decision? Answer to Exercise 3 Political promises to increase community access Donor influence on policy direction Public pressure on underserved areas New leadership's priorities Summary - Health systems are shaped by multiple forces, not just health needs - Strengthening models vary: vertical, horizontal, diagonal - Frameworks simplify complex systems for planning and action - Political economy shapes what is prioritized in a health system Final Reflections & Q&A - What did you find most interesting? - Any questions before we wrap up? Thank You