Health Systems Thinking


Dr Katie Reed worked in Sub Saharan Africa for 9 years mainly involved in malaria control. She was the programme director for the distance learning Masters in Public Health at Manchester for 8 years until August 2014 and continues to teach ‘Health system challenges’ on the course

Here Dr Reed provides a brief outline of health systems and provides some excellent resources around health systems.

All countries in the world have a health system, though all are different. Some are more formalised than others and, as we have seen in the current West African Ebola epidemic, some are more resilient than others.

All health systems deliver health services, though these might in a few cases be delivered entirely by a state provider. It is more usual now to find a wide range of public, private and not for profit organisations delivering health services throughout any country. All health systems are populated by human resources; nurses, doctors, microbiologists, managers and other related staff. All systems have information and decision making functions, and all use medical technologies, products and vaccines. All have some governance, regulatory and leadership functions and all rely on financing of some sort. If you are not familiar with these terms stop for a moment and think about how health care happens in your own country or one that you are familiar with. Then see if you can populate each of the six headings with 2 or 3 organisation, bodies etc. that are important to delivering health in your country.

The WHO has been promoting health systems thinking for some years, and the following short video (6 minutes)  helps explain the concept: Systems thinking for Health Systems Strengthening

However, strengthening health systems has proved to be very challenging and even after considerable investment the gains have been less than had been hoped for. One lesson that has emerged is the importance of considering the consequences of any planned action on all parts of the health system. Too often well intended vertical programmes, often delivering health services for single diseases, have in retrospect weakened other parts of the system by recruiting staff away from key areas, diverting funds and stepping outside the local decision making systems.

But health systems are also weakened by poverty, war and political instability. In retrospect it has been easy to see why the Ebola epidemic was able to take such a hold in West Africa when one looks at the state of the health systems in the countries before the first case emerged (see ‘Beyond Ebola: A New Agenda for Resilient Health Systems‘).


Dr Katie Reed

If you are interested in learning more about Health System Thinking in global health, the following paper would be a good place to start: Rifat Atun, Health systems, systems thinking and innovation (2012).

Additionally, Dr Reed teaches on the ‘Health system challenges, low and middle income countriesPGT unit at the University of Manchester which can be taken as a standalone unit or as part of a Master of Public health programme.

We'd love to hear what you think! Comment below to join the conversation!