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Systems thinking analyses for health policy and systems development: a Malaysian case study
Health and development are inextricably linked. Countries require
robust health systems to enable the delivery of quality health
services and to ensure access to health as a public good while
both balancing national budgets and providing protection against
individual catastrophic spending on healthcare. Getting this
balance right remains a problem for most countries, particularly
in resource-constrained settings. Training resources available to
address the development of health systems often take a narrow,
singular, linear approach which fails to engage with the
intersections and interactions of health with a multitude of
systems and determinants. Although there is general guidance and
technical support for countries from multilateral agencies like the
World Health Organization and the World Bank, the importance
of local contexts in building and strengthening health systems adds
a layer of complexity to the task.The publications by de Savigny
and colleagues on systems thinking for health systems
strengthening and applied systems thinking for health systems
research (de Savigny and Taghreed, 2009; de Savigny, Blanchet
and Taghreed, 2017) provide the analytical approach and the
tools to use systems thinking to understand the multiplicity of
factors involved. However, texts seldom demonstrate how the
systems thinking approach has been applied across an entire
health system.
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