“Wood Already Touched by Fire is not Hard to Set Alight”; Comment on “Constraints to Applying Systems Thinking Concepts in Health Systems: A Regional Perspective from Surveying Stakeholders in Eastern Mediterranean Countries”

Document Type : Commentary


Health Policy, Planning and Management Department, School of Public Health, University of Ghana, Accra, Ghana; Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands


A major constraint to the application of any form of knowledge and principles is the awareness, understanding and acceptance of the knowledge and principles. Systems Thinking (ST) is a way of understanding and thinking about the nature of  health systems and how to make and implement decisions within health systems to maximize desired and minimize undesired effects. A major constraint to applying ST within health systems in Low- and Middle-Income Countries (LMICs) would appear to be an awareness and understanding of ST and how to apply it. This is a fundamental constraint and in the increasing desire to enable the application of ST concepts in health systems in LMIC and understand and evaluate the effects; an essential first step is going to be enabling of a wide spread as well as deeper understanding of ST and how to apply this understanding.


Main Subjects

  1. Paina L, Peters DH. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan 2012; 27: 365-73.
  2. Senge P. The Fifth Discipline. The Art and Practice of the Learning Organization. New York: Crown Publishing Group; 1990.
  3. Agyepong IA, Kodua A, Adjei S, Adam T. When ‘solutions of yesterday become problems of today’: crisis-ridden decision making in a complex adaptive system (CAS)—the Additional Duty Hours Allowance in Ghana. Health Policy Plan 2012; 27 Suppl 4: iv20-31. doi: 10.1093/heapol/czs083
  4. Adam T. Editorial Advancing the application of systems thinking in health. Health Res Policy Syst 2014; 12: 50. doi: 10.1186/1478-4505-12-50
  5. Alliance for Health Policy and Systems Research, World Health Organization. Systems Thinking for Health Systems Strengthening. Geneva, Switzerland: WHO: 2009
  6. El-Jardali F, Adam T, Ataya N, Jamal D, Jaafer M. Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries. Int J Health Policy Manag 2014; 3: 399-407. doi: 10.15171/ijhpm.2014.124
  7. Yehezkel Dror. Public Policy-making re-examined. New York: Leonard Hil Books; 1968
  8. Charles E. Lindblom and David Braybrooke: A Strategy of Decision. New York: The Free Press; 1970
  9. Herbert A. Simon: Administrative Behavior: As study of Decision making processes in Administrative Organization. 3rd edition. New York: The Free Press; 1976.
  10. Appiah P. Appiah KA, Agyeman-Duah I. Bu me Bε. Proverbs of the Akans. Oxfordshire, UK: Ayebia Clarke Ltd; 2007.