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首页> 美国卫生研究院文献>International Journal of Health Policy and Management >Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries
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Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries

机译：在卫生系统中应用系统思维概念的限制：来自东地中海国家的利益相关者调查的区域视角

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>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.
机译：>背景：系统思维（ST）最近被推广为加强卫生系统的重要方法。但是，ST并不常见，特别是在中低收入国家（LMIC）中。本文旨在探讨可能阻碍其在东地中海地区（EMR）中应用的障碍以及减轻这些障碍的可能策略。 >方法：进行了一个由开放性问题组成的调查，目的是针对卫生政策制定者的有意样本，例如卫生部高级官员，研究人员以及民间社会等其他利益相关者来自该地区十个国家的团体和专业协会。共有62位受访者参加了这项研究。进行了主题分析。 >结果：尽管人们也发现了对ST手段的误解，但人们强烈认识到ST在卫生系统的决策和研究中的相关性和实用性。应用ST的经验非常有限。在EMR中设计卫生政策的方法被认为是被动的和零散的（66％）。人们普遍认为，使用ST的限制因素是：其成本高昂的观念，加上缺乏必要的资金来实施它（53％），竞争的政治利益和政府问责制（50％），缺乏对相关性和价值的认识（47％），应用此功能的能力有限（45％），以及协调和管理利益相关者的难度（39％）。 >结论：尽管已提出了缓解大多数此类限制的几种策略，但它们都强调了政治支持和领导层采用ST的重要性，以及建立必要的能力来应用和应用ST在研究和实践中学习。

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