Introduction to Complex Health Systems
Participants’ course and assessment outline
This is a document developed by members of the CHEPSAA project.
CHEPSAA (Consortium for Health Policy and Systems Analysis in Africa) is a project funded by the
European Union which aims to extend sustainable African capacity to produce and use high quality
health policy and systems research by harnessing synergies among a Consortium of African and
European universities with relevant expertise.
This document is an output from a project funded by the European
Commission (EC) FP7-Africa (Grant no. 265482). The views
expressed are not necessarily those of the EC.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Introduction to the course
This document outlines the course content, in overview and session by session. It also
explains the assessments you will have to complete during the course (pages 14 – 20
below).
In order to understand the functioning of health systems, and act towards strengthening
them, it is necessary to grasp the notion of complexity and see how it plays out in the
system, through the behaviours, actions and relationships between people. The course
provides an opportunity to study and understand this important aspect of health
systems. It explores how the health system is a platform from which health services are
delivered, and how a well-functioning system is therefore necessary for the provision of
quality – effective and caring – services for the sick and vulnerable.
The Introduction to Complex Health Systems course is made up of ten sessions. Sessions
1 & 2 work together, introducing and discussing health systems; sessions 3 & 4 look at
and develop ideas around a particular example of health system functioning; sessions 57 together develop analysis of the roles and behaviour of people in the health system;
sessions 8 & 9 pull the strands of the course together through case studies; and finally
session 10 wraps up the course concepts.
Overview of the sessions
Session 1: What is a health system?
Session 2: Frameworks for describing and
analysing health systems
Session 3: Understanding the Thai experience of
health system development
Session 4: Whole system change – PHC and UHC
Session 5: Recognising agents in health systems
Session 6: Exploring power, agency and mindsets
Session 7: Managing change in health systems
Sessions 8 & 9: Intervening in health systems
(case studies)
Session 10: Health system complexity and change
What you will be expected to do
The course is designed to be taught in ten three-hour sessions, with self-study
preparation and exercises, and assignments done between the sessions. You will also be
expected to do varying amounts of reading in preparation for some of the sessions. The
sessions involve a variety of activities, including lectures, videos, group exercises,
discussions and teamwork tasks. The course takes an active-learning approach, and
sessions are therefore designed to be interactive and you are expected to engage with
and participate actively in the group tasks, discussions and other learning activities.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Course learning outcomes
These are what it is intended you will be able to do by the end of the course. While not
all sessions address all the outcomes, most of them weave through the majority of the
sessions.
By the end of this course you are expected to be able to:
1. Show understanding of the dynamic and complex nature of health systems by
reflecting on and describing their value bases and functioning, as well as the central
roles and behaviours of a range of agents.
2. Show understanding of health systems as social constructions, influenced by, and
influencing the agents within them, as well as influenced by broader political and
economic forces, generating public value and contributing to societal development.
3. Apply these understandings to assessment of own health system and comparison
between health systems.
4. Apply relevant analytical skills and an understanding of complex systems in order to
develop ideas about action to strengthen health systems.
5. Develop the personal communication, teamwork and leadership skills which are
important for supporting health system change.
6. Demonstrate understanding of and openness to different perspectives on the nature
of health systems, by expressing these in writing or orally.
THRESHOLD CONCEPTS
A foundation of the course design is the identification and introduction of threshold
concepts. These are the key ideas, set out below, underpinning the course content and
philosophical perspective, with which students should be familiar and conversant.
Threshold Concepts
A. People make sense of the system around them and act based on their understandings
and mind sets.
B. Health systems are socially constructed; they exist within contexts and histories.
C. Health systems are integrative by nature, and consist of complex inter-relationships; we
all have a role in the system.
D. Health systems consist of ‘hardware’ and ‘software’.
E. Health system effectiveness is a ‘whole system’ judgement rather than one based on the
effectiveness of specific interventions.
F. Power is everywhere: in agency, service delivery and decision-making.
G. Everyone has a part to play in the system, working towards shared goals.
H. The health system is knowable and changeable.
I. The health system is a complex adaptive system.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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SESSION GUIDES
Session 1
Introductions; What is a Health System?
This session aims to orientate you into the course, and provides an introduction to
thinking about health systems, how they are constructed and function in particular
contexts, their value bases and their place in history and society.
Topics and activities:
1. Introductions and course overview: Participatory activity
2. What is a health system and why is it important?: Group work
3. The ‘life’ and experience of a health system (with Nigeria as a particular
example), considering political economy: Lecture; Podcast on a Nigerian
example; ‘Gap-minder’ review and task
Resources you will need:
Handout 1 – Timeline of a country’s health system
Readings (see below)
Self- study
a. Readings on introduction to health systems. These readings will consolidate the
concepts introduced in this session, and prepare you for the next session:
Gilson, L., 2012. Health systems and institutions. In R. Smith & K. Hanson, eds. Health
systems in low- and middle-income countries: an economic and policy perspective.
Oxford: Oxford University Press.
Sheikh, K., et al. 2014. People-centred science: strengthening the practice of health policy
and systems research. Health research policy and systems. 12:19. url:
http://www.health-policy-systems.com/content/12/1/19.
Van Olmen, J. et al., 2012. The Health System Dynamics Framework: The introduction of an
analytical model for health system analysis and its application to two case-studies.
Health, Culture and Society, 2(1), pp.0–21. url:
http://hcs.pitt.edu/ojs/index.php/hcs/article/view/71/96
De Savigny, D. & Adam, T., 2009. Systems thinking for health systems strengthening. World
Health Organization. url:
http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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b. Task: Drawing a timeline of your own country health system.
Gather information on timelines of own countries’ health system development by
consulting others from same country and doing brief research, then draw a timeline of
the health system’s development – milestones, social/political/economic context,
drivers of change. Use the template in Handout 1 as a guide.
Session 2
Frameworks for describing and analysing health systems
This session fleshes out the discussion of what a health system is and why it is important in a
society. Concepts, measures and frameworks for thinking about systems are introduced and
the integrative nature of health systems is emphasised. You will then apply these to your
own country’s health system. The session also introduces and guides a reflection on
teamwork skills.
Topics and activities:
1. Discuss your own country’s health system history and make comparisons with other
countries: Group discussion and feedback;
2. Understanding systems: Flashmob Game
3. Ideas and frameworks for thinking about health systems and policy: Video and lecture;
group discussion.
4. Application of frameworks to specific country scenarios: Thinking pairs to prepare for
homework
5. What makes for effective group work? Readings and discussion
Resources you will need:
1. Handout 2 – Building successful group work
2. Assessment guide - for assignment tasks
3. Thai case study
4. Handout 3 – questions for the Thai case study and questions
Self-study and assignment task
1. Assignment
below):

1 – (to be handed in for assessment - see Assessment Guide, page 14
Draw a diagram of your own country’s health system, showing its’ key features and
their inter-relationships. Use one of the health systems frameworks introduced in
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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
this session to help you analyse and depict the health system.
Explain why you chose the framework you did –i.e. what about it did you find helpful
or particularly applicable?
2. Read the Thai case study, in Chapter 7 of Good Health at Low Cost (London School of
Hygiene and Tropical Medicine), which can be accessed at:
http://ghlc.lshtm.ac.uk/files/2011/10/GHLC-book-mono_Chapter-7.pdf
This case of health system improvement will be the focus of next session. To make the best
use of the session contact time, you need to read and have a good idea about the case study
before the session. The questions in Handout 3 will guide your reading; you should make
notes in response to the questions, for more participation in class discussions.
Reading tip: Before you start to read, do a quick survey of the chapter, to get a sense of its
structure, and of where you will need to look to find answers to each of the questions in your
handout. This will save you time, and make your reading more focused.
Session 3
Key issues in Health System Development: learning from the Thai experience
This session deepens the ideas about what health systems are, showing that they are
complex and integrative, and that health system development is a long-term task,
influenced by broader political, economic and social forces, and requiring persistence, vision
and adaptability. The session introduces the notion of system effectiveness, and relevant
indicators. It uses a case study of Thailand to develop ideas about understanding and
strengthening health systems, including the interactions between system hardware and
software.
Topics and activities :
1. Feedback on self-study
2. Thai case study as an example of health systems strengthening: Group and class
discussion.
3. Assessing health system performance and wrap-up of the Thai experience - Lecture.
4. Own learning style. – Individual reflection
Resources you will need:
Thai case study
Handout 3 - Thai case study questions.
Readings (see below)
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Self-study
a. Reflection on group work and own contribution – Refer back to the checklist
developed in Session 2 on Building successful group work (Handout 2).
o Which of the points on the checklist do you think are your strongest points,
based on your experience over the past 3 sessions?
o Which point/s do you think you personally need to improve on?
o What do you think has been your main contribution to group work so far?
b. Reading in preparation for session 4:
 WHO 2008 report: Primary Health Care: Now more than ever. Pages xi-xx:
Introduction and overview.
 WHO 2010 report: Health Systems financing: the path to universal coverage Pages ixxxii.
Note: In addition to the focus pages given above for the reports, try to scan the rest of
the contents of both reports.
Session 4
Whole system change – Towards Primary health Care (PHC) renewal and
Universal Health Coverage (UHC)
This session develops and consolidates ideas about what systems are and how to strengthen
them. It focuses on primary health care and universal health coverage as changes affecting
all aspects of the health system. It then asks students to apply lessons from the Thai case
study as well as UHC and PHC to think about and articulate concise ideas about
strengthening key elements of their own country’s health system by writing a policy briefing
note as an exercise in communication.
Topics and activities:
1. Reflections on self-study task
2. PHC and UHC as ‘whole systems’ change’: lecture and discussion.
3. Lessons from Thai experience and UHC/PHC debate for own country health systems:
individual work, thinking pairs, plenary discussion
4. What is required for developing a policy briefing?: Guided brainstorm and discussion,
handout
5. Develop a policy brief on an aspect of the Thai experience, for own health system:
preparatory brainstorming exercise
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Resources you will need:
1. Handout 4 - Discussing whole system change in your own country.
2. Handout 5 – Developing a policy briefing
3. Handout 6 - Recognising agents in health systems
4. Readings (see below)
Self-study
 Readings: Read one of the papers below, on people in systems, as allocated by the
facilitator. All the papers focus on actors and decision-making, and all talk to some
aspects of organizational decision-making. In your reading, try to identify the factors
influencing implementation of agents’ attitudes and behaviours, and how power is
exercised in this implementation. Use the questions in Handout 6 to guide your
reading:
Mumtaz, Z. et al. (2003).Gender based barriers to health care provision in Pakistan: the
experience of female providers. Health Policy and Planning. 18(3): 261-269
Wibulpolprasert, S. & Pengpaibon, P. (2003). Integrated strategies to tackle inequitable
distribution of doctors in Thailand: four decades of experience. Human Resources for
Health. 1(12). http://www.human-resources-health.com/content/1/1/12
Penn-Kekana, L. et al. (2004). ‘It makes me want to run away to Saudi Arabia.’:
management and implementation challenges for public finance reforms from a
maternity ward perspective. Health Policy and Planning. 19 (suppl 1): i71-i77.
Meuwissen, L. E. (2002). Problems of cost recovery implementation in district health
care: a case study from Niger. Health Policy and Planning. Sept: 17(3): 304 – 13
George, A et al. (2011). Community case management in Nicaragua: lessons in fostering
adoption and expanding implementation. Health Policy and Planning 26(4): 327-37
Session 5
Recognising agents in health systems
This session focuses on the central role of people and their roles in health systems. It
focuses on the importance of people’s values and mindsets, agency and power, as drivers of
their behavior, and that all these impact on how health systems function.
Topics and activities:
1. Readings about people in systems: Group discussion of range of papers; plenary
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discussion
2. Systems dynamics - people in the system: Squaring the circle exercise
3. What drives health system actors?: Lecture and plenary discussion
Resources you will need:
1. Handout 6 – Questions for readings on recognising agents in health systems
2. Handout 7 – Summary of readings on agents in systems
3. Handout 8a – Budgeting scenario
Self-study:
Read the scenario on HS budgeting, to prepare for doing stakeholder analysis. As
you read, think about:
 what the main features of this case are – i.e. what happened
 who the key agents are in this case and what their positions are
 what impact the new policy and procedures will be likely to have on them
 what power they might have, in turn, to impact on the implementation of the policy
Session 6
Understanding agents’ mindsets, interests and power
The focus of this session is on applying the ideas from Session 5 and thinking about the roles
of health system actors in relation to the process of system change. The session looks at
actors’ values, beliefs, mindsets, and power relations, and considers how behaviour and
attitudes influence system performance. It then considers the significance of the different
views actors have of health systems and the world, for health systems development,
reflecting also on the interaction between system software and hardware.
Topics and activities:
1. Introduction to stakeholder analysis: Brief input
2. Stakeholder analysis in practice: Group exercise based on budgeting scenario; debriefing
Resources you will need:
Handout 8a – Budget scenario
Handout 8b – Tasks on recognising agents in systems (+ 3 forms)
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Self-study
Read the following paper in preparation for session 7, and think about the questions below
as you read:
Barnes, P.C. (1995) Managing change. BMJ. 310: 590-2
Questions:


What were the main management challenges posed in the case described?
What are the five aspects of change leadership that Barnes outlines in the paper?
Session 7
Leading change in health systems
The main aim of this session is to introduce ideas for understanding and managing actors in
health system change. Using a range of analytic frameworks it will focus on complexity and
agency, but also, the understanding that health systems are knowable and changeable.
Students will begin to develop strategies which support intervention and change in systems.
Topics and activities:
1. Managing agents and change: Discussion of readings; lecture (commitment planning;
small wins, sense-making)
2. Video on complexity and development: Viewing and discussion
3. Managing agents and commitment planning: Group task developing strategies for
managing change using SHA scenario; feedback discussion
Resources you will need:
1. Handout 8a – Budgeting scenario
2. Handout 9 – Exercise on leading the implementation of change in systems (including
Form 4 to complete)
3. Three Case studies
4. Assessment guide – for assignment 2
Self-study and assignment task
a.
Assignment 2: Take forward your thinking about strengthening your own
health system, incorporating ideas from this session and developing strategies
for change in your own environment. (See assessment guide for details)
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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b. Guided reading of allocated case studies in preparation for next session. You
don’t need to think about the tasks linked to the case study yet – these will be
tackled in your groups next session. As you read the case, however, think about
the following questions:
o Which aspects (building blocks) of HS is this case mainly about?
o What are the key issues here?
o Who are the most important agents involved and how do they impact on
implementation of the policy?
Session 8
Intervening in health systems – case studies (1)
This session starts to pull together all the strands of the course, by taking an in-depth look at
a range of case studies of health systems’ change. Sessions 8 and 9 will talk to the
integrative and dynamic nature of health systems, the centrality of actors in shaping these
systems, and opportunities for generating change through addressing both the hard and the
soft aspects of systems. The sessions will require teamwork skills.
Topics and activities:
1. Review reading of case studies: Group reading and discussion
2. Health system strengthening – what the case studies reveal: Guided group discussion
and activities based on specific case study.
3. Input and discussion of skills for making presentations: Buzz groups; group discussion
Resources you will need:
1. Three case study handouts, with accompanying tasks, on the following topics:
 Additional Duty Hours Allowance in Ghana
 Patients’ Rights Charter in South Africa
 Health Facility Committees and Direct Facility Funding in Kenya
2. Handout 10 - Points to consider for making an effective presentation
Self-study
Work collectively or individually on whatever part of the group presentation you
are responsible for, to finalise the preparation for next session.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Session 9
Intervening in health systems– case studies (2)
This session continues the in-depth look at case studies and what they reveal about health
policy and systems in practice, calling for the ability to demonstrate an understanding of
health systems’ contribution to public value and societal development. The session will also
require presentation and team work skills, and allow reflection on both. The group
presentations will be marked by students in class (as a peer assessment), and the marks will
become part of the formative assessment marks.
Topics and activities:
1. Presentation of case studies: Group presentations and feedback
2. Cross-case review of experiences; implications for action in and across cases: Plenary
discussion
3. Reflection on teamwork and leadership in relation to the group task: Plenary discussion
Resources you will need:
1. Handout 11 - Group presentation assessment criteria
2. Paper to read for journal club next session (see below)
3. Handout 12 – Questions to guide reading of papers on complexity
4. Assessment guide for Summative assessment
Self-study - Reading on CAS in preparation for session 10.
Read one of the papers below, as allocated by your facilitator, for the journal club activity
next session. Use the questions in Handout 10 to guide your reading of the paper:
Blanchet, K., 2013. How to facilitate social contagion? International journal of health policy
and management, 1(3), pp.189–92.
Gilson, L. et al., 2014. Advancing the application of systems thinking in health: South African
examples of a leadership of sensemaking for primary health care. Health research policy and
systems / BioMed Central, 12(1), p.30.
Rwashana, A.S., Williams, D.W. & Neema, S., 2009. System dynamics approach to
immunization healthcare issues in developing countries: a case study of Uganda. Health
informatics journal, 15(2), pp.95–107.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Session 10
Health system complexity and change
The final session aims to wrap up the course by deepening understanding of complex
adaptive systems and linking this understanding to the different concepts, frameworks and
ideas introduced in the course. The session will place particular emphasis on the analytic
skills of students in being able to apply new concepts in different contexts, and on
communicating ideas and understandings to an audience.
Topics and activities:
1. Review of case studies; application of CAS concepts to case studies: Plenary discussion
2. Reflection on team work: Group discussion
3. Participant-lead journal club, discussing papers applying complex adaptive systems (CAS)
thinking and concepts to health systems: Group and plenary discussion
4. Wrap-up lecture and discussion linking CAS thinking to core concepts discussed in the
course: Interactive lecture
5. Course evaluation: Group discussion; individual written task
Resources you will need:
1. Handout 12 - Questions for journal club readings
2. Handout 13 - Reflection on team work
3. Handout 14 – Summary of papers on complexity
4. Handout 15 - Course evaluation
5. Assessment Guide for summative assessment
Self Study
Summative assessment: See assessment guide below for details.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Assessment Guide
This course will be assessed by means of formative assessments and a summative
assessment. The formative assessment, made up of 2 assignments and a group
presentation, will together constitute 60% of the course mark (60 marks). The summative
assessment, which consists of an assignment pulling together the strands of the course,
constitutes the other 40% of the course mark (40 marks) – making 100 marks in total.
Below each assessment item outlined below is a list of the learning outcomes (LO) which are
addressed. You will see that all 6 of the course learning outcomes are assessed in at least
one of the assessment items.
Also indicated below are the numbers of the course sessions to which the assessments
relate. Each of the assignments should be submitted by the following session. This is
important because these are ‘formative’ assessments, so they are part of the course
learning process, and will be built on in the subsequent sessions. The summative
assessment will be submitted after the final session (Session 10) or written under
supervision on a given date, as appropriate to the setting.
Assignment 1: Describing own country health system (20 marks) 800 –
1000 words – Session 2
a. Draw a diagram of own country’s health system, showing its’ key features and agents
and their inter-relationships. Use one of the health systems frameworks introduced
in this session to help you analyse and depict the health system.
b. Explain why you chose the framework you did – i.e. what about it did you find
helpful or particularly applicable?
c. Write a paragraph on the values base of the system – i.e. What key ethical principles
or values underpin it?
Assessment Criteria
Clear diagram showing relevant features of health
system and indicating inter-relationships between them.
Health system is thoroughly analysed with reference to
chosen HS framework, showing understanding of the
framework and an ability to apply it meaningfully.
Values underpinning a health system are appropriately
identified and clearly explained.
Total
Mark
5
10
5
20
LO 1: Show understanding of the dynamic and complex nature of health systems by
reflecting on and describing their value bases and functioning and their components, as well
as the central roles and behaviours of a range of agents.
LO 2: Discuss health systems as social constructions, influenced by and influencing the
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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agents within them, and influenced by broader political and economic forces, generating
public value and contributing to societal development;
LO 3: Apply understandings of the complex and socially constructed nature of health
systems to assessment of your own health system and comparison between health systems
Assignment 2: Planning for change (20 marks) 1,000 – 1,500 words–
Session 7
Take forward your thinking about strengthening of the health system in your own country,
by planning strategies for change in your own environment. Draw on ideas from the lecture
as well as the group exercise done in session 7.
1. Identify and describe a relevant policy intervention which you will address, and
explain the aspect of the health system to be strengthened, the related context and
your position in it.
2. Apply your understanding of leadership of change in order to develop the outline of
an action plan to support implementation of the policy, with the aim of
strengthening an aspect of the health system. Think about both software and
hardware in developing your ideas. Explain how you will do the following:
 Describe and publicise the policy change.
 Identify key agents whose commitment to the policy you could build (you
can use the form you worked with in the group task for this).
 Plan actions to build commitment (these can be small wins) and tackle
constraints.
Assessment Criteria
Mark
Relevant health system issue identified; context and
5
leader’s position adequately described
Concept of complex health system strengthening
5
clearly understood
Realistic outline of plan for agent commitment and
10
action to strengthen an aspect of own health system
Total
20
LO 3: Apply understandings of the complex and socially constructed nature of health
systems to assessment of your own health system and comparison between health systems
LO 4: Apply relevant analytic skills and an understanding of complex systems in order to
develop ideas about action to strengthen health systems
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Group presentations on case studies (20 marks) – Session 9
Group presentations on the tasks based on the case studies will be peer-assessed as well as
facilitator-assessed, using the rubric below (the tasks are explained in detail in the case
study handouts). Each group will assess one other group and allocate them marks. All the
members of a group will be allocated the same mark.
Group:
Criteria
The overview of the case is clear and succinct and gives a clear
image of what the case is about, including the hardware and
software issues at play and their relationship.
Mark
Group’s
allocation mark
5
The roles of actors, their mindsets, interests and power are
presented and explained convincingly; their relationships and
changing positions in time are clearly shown.
The suggested strategies for leading change are well motivated
with reference to the theory introduced in the course.
5
Delivery of the presentation (visual and oral) is clear, using
appropriate pace and level, and content is coherently and logically
structured.
5
Total
20
5
LO 1: Show understanding of the dynamic and complex nature of health systems by
reflecting on and describing their value bases and functioning, as well as the central roles
and behaviours of a range of actors;
LO2: Discuss health systems as social constructions, influenced by and influencing agents
within them as well as influenced by broader political and economic forces, generating
public value and contributing to societal development;
LO4: Apply relevant analytic skills and an understanding of complex systems in order to
develop ideas about action to strengthen health systems;
LO 5: Develop the personal communication, leadership and teamwork skills which are
important for supporting health systems change;
LO 6: Demonstrate understanding of and openness to different perspectives on the nature
of health systems.
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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Summative assessment - 3,000 – 4,000 words (40 marks) – Session 10
The objective of this assignment is to draw on the group work you did on a case study, in
order to deepen your analysis of it and show your understanding of key concepts covered in
the course. As a summative assessment, it aims to show that you have met most of the
intended course learning outcomes.
There are five sections to this assignment. Please address them all, with reference to the
case study you worked on in your group.
1. Drivers and consequences (400 – 800 words) - Refer to the flow diagram your group drew
and use it to explain the main drivers of the experience, the ripple effects and critical
feedback loops, and how these lead to intended and unintended consequences.
2. Behavioural drivers (400 words) - Refer back to the stakeholder analysis your group did.
Using this and Forms 1 & 2, analyse 3-4 key agents’ mindsets, values, interests, relationships
and levels of power in relation to the policy, and explain how these drive the agents’
influence (positive or negative) over implementation. What is your own mindset regarding
this case, and does it differ from some of the key agents in the case? If so, how?
3. Leading change (1,200 – 1,600 words)
a) Considering the agents whose positions you analysed in (2), suggest how, if you were a
manager in the situation in a role where you lead the implementation of the new policy, you
could build their commitment to the policy innovation. To do this, for each of the key agents
you identified think about the following and note your responses on Form 4:





what their present position is
what their relative power is
what their required position is, moving forward
beyond the general vision, what other actions might be needed to change their
position and generate commitment?
can you build or undermine their power, or go around them – as needed?
b) Take into consideration their mind-sets and the sense-making and trust-building you
would need to do around the new policy, to move towards its more successful
implementation.
c) Explain how you would lead buy-in to the policy by considering:



what small win(s) might generate commitment for change across agents?
what small win might tackle a key constraint on wider change?
what do you need to think about in relation to how you personally engage with
other agents?
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
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d) In what ways would you be contributing to health system development through these
leadership actions?
4. Nature of health systems (400 – 800 words) - What does this case study tell you about the
dynamic and complex nature of health systems? Write 1-2 pages in which you give an
overview of some of the key concepts introduced in the course relating to complex health
systems, drawing on the case study to illustrate and explain these.
5. Reflection ( 400 words)- , commenting on your own and others’ participation, learning
you gained, whether you consider the task successful and why or why not. Also comment on
points for possible improvement of the group tasks and presentation. You will be allocated
marks for insightful and well-argued points, not for a rosy assessment of your group’s work!
Assessment criteria
Clear understanding of the features and drivers of the
case and how they interact to create the situation
5
In-depth and relevant analysis of key agents’ behaviours
in relation to the case study
10
Realistic and appropriate suggestions for commitment
planning, drawing on relevant theory from the course
15
Relevant concepts related to complex health systems are
explained with clarity, drawing appropriately on the case
study for examples.
5
Insightful and critical review of the group task and
presentation, with clear indication of learning gained in
the process
5
Total
40
LO 1: Show understanding of the dynamic and complex nature of health systems by
reflecting on and describing their value bases and functioning, as well as the central roles
and behaviours of a range of agents.
LO 2: Discuss health systems as social constructions, influenced by and influencing the
agents within them, and influenced by broader political and economic forces, generating
public value and contributing to societal development;
LO 4: Apply relevant analytic skills and an understanding of complex systems in order to
develop ideas about action to strengthen health systems;
LO 5: Develop the communication, leadership and teamwork skills which are important for
supporting health system change.
LO 6: Demonstrate understanding of and openness to different perspectives on the nature
of health systems.
Finally - we hope you find the course helpful and interesting, and that you enjoy your
interactions with the materials, the facilitator and your fellow participants!
CHEPSAA - Introduction to Complex Health Systems: Participants’ outline
19