Constraints to applying systems thinking concepts in health
systems: A regional perspective from surveying stakeholders
in Eastern Mediterranean countries
Background:
Systems Thinking (ST) has recently been promoted as an important approach to health systems
strengthening. However, ST is not common practice, particularly in Low- and Middle-Income Countries (LMICs).
This paper seeks to explore the barriers that may hinder its application in the Eastern Mediterranean Region (EMR)
and possible strategies to mitigate them.
Methods:
A survey consisting of open-ended questions was conducted with a purposive sample of health policy-
makers such as senior officials from the Ministry of Health (MoH), researchers, and other stakeholders such as civil
society groups and professional associations from ten countries in the region. A total of 62 respondents participated in
the study. Thematic analysis was conducted.
Results:
There was strong recognition of the relevance and usefulness of ST to health systems policy-making and
research, although misconceptions about what ST means were also identified. Experience with applying ST was
very limited. Approaches to designing health policies in the EMR were perceived as reactive and fragmented (66%).
Commonly perceived constraints to application of ST were: a perceived notion of its costliness combined with lack of
the necessary funding to operationalize it (53%), competing political interests and lack of government accountability
(50%), lack of awareness about relevance and value (47%), limited capacity to apply it (45%), and difficulty in
coordinating and managing stakeholders (39%).
Conclusion:
While several strategies have been proposed to mitigate most of these constraints, they emphasized the
importance of political endorsement and adoption of ST at the leadership level, together with building the necessary
capacity to apply it and apply the learning in research and practice
