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Complex adaptive systems

Recognising that health interventions take place in complex adaptive systems, we are undertaking systematic learning processes that bring together key actors involved in service delivery and working to understand how iterative, evidence-informed approaches to health systems change can improve implementation.

Recent FHS publications on 'complex adaptive systems'


Buckland Merrett GL, Bloom G, Wilkinson A and MacGregor H (2016) Towards the just and sustainable use of antibiotics, Journal of Pharmaceutical Policy and Practice, 9:31, DOI: 10.1186/s40545-016-0083-5

The emergence and spread of antibiotic resistant pathogens poses a big challenge to policy-makers, who need to oversee the transformation of health systems that evolved to provide easy access to these drugs into ones that encourage appropriate use of antimicrobials, whilst reducing the risk of resistance. This is a particular challenge for low and middle-income countries with pluralistic health systems where antibiotics are available in a number of different markets. This review paper considers access and use of antibiotics in these countries from a complex adaptive system perspective. It highlights the main areas of intervention that could provide the key to addressing the sustainable long term use and availability of antibiotics.

Wang L, Zhang X, Liang X and Bloom G (2016) Addressing antimicrobial resistance in China: policy implementation in a complex context, Globalization and Health, 12:30, DOI: 10.1186/s12992-016-0167-7

The effectiveness of antibiotics in treating bacterial infections is decreasing in China because of the widespread development of resistant organisms. Although China has enacted a number of regulations to address this problem, but the impact is very limited. This paper investigates the implementation of these regulations through the lens of complex adaptive systems (CAS).

Complex and dynamic public health problems require a different approach: an emphasis on the value of people. People who own the problem can anticipate the most likely social obstacles to its resolution, and their participation is essential to maintain an evolving strategy that can institutionalize an approach to the problem.

This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. 

This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals.

This presentation is from a workshop in Baltimore in June 2014 on complex adaptive systems (CAS) research methods held at Johns Hopkins University. In this presentation, Ligia Paina from the Johns Hopkins Bloomberg School of Public Health shows how to use the computer program Vensim to develop Causal Loop Diagrams (CLDs).

This presentation is from a workshop in Baltimore in June 2014 on complex adaptive systems (CAS) research methods held at Johns Hopkins University. In this presentation, Agnes Rwashana Semwanga gives an overview of two case studies where the Causal Loop Diagram methodology has been applied to health systems research.

This presentation kicked off a workshop in Baltimore in June 2014 on complex adaptive systems (CAS) research methods held at Johns Hopkins University. In the presentation, Ben Ramalingam, author of Aid on the Edge of Chaos, and Taghreed Adam from the Alliance for Health Policy and Systems research introduce concepts of CAS and situate the methods in the context of understanding health systems strengthening.

In this presentation, Jeff Knezovich, FHS Policy Influence and Research Uptake Manager, discusses some of the challenges associated with communicating complexity research. He then suggests some techniques and tools to get around these challenges

This is a video from the DC Health Systems Board event, Can systems tools deliver for the 'science of delivery'?, which was organised by Future Health Systems as part of its workshop on complex adaptive systems and held at Results for Development in June 2014.

At the event, panellists discussed and debated how systems thinking tools that are designed to tackle issues of complexity can contribute the successful implementation of health system strengthening interventions. The panel showcased some tools and examples, explaining how they had helped them to understand better health systems fluctuations and to anticipate unintended consequences to create more sustainable large-scale interventions.