Conceptual Frameworks: Health Systems and the Community Henry Perry, Johns Hopkins University CORE Group Spring Meeting, April 30, 2010

1. Conceptual Frameworks: Health Systems and the Community Henry Perry Johns Hopkins University CORE Group, 30 April 2010

2. Frameworks are mental models

3. Tools for Transformational Change to Promote the Production of HealthThe Leadership Disciplines* Personal Mastery Mental Models Systems Thinking Shared Vision Team Learning *Peter Senge, The Fifth Discipline, 1990

4. Do we actually see reality or just our “mental models”? “ ‘Mental models’ are deeply ingrained assumptions, generalizations, or even pictures or images that influence how we understand the world andhow we take action.” Peter Senge, The Fifth Discipline, p.8.

5. Mental Models Mental models are the lenses through which we observe reality. Our perception of reality is totally dependent upon the amount of distortion in these lenses. But do we accept that we all have these lenses?

6. Mental Models Mental models are the structures that we impose on reality. We produce in our minds concepts of reality (paradigms), and these predetermine what we will actually be able to see when we observe reality.

7. Mental Models by Other Names Perceptions World View Assumptions Paradigm, Conceptual Framework Beliefs Prejudice How we think determines what we see and how we act. It’s not “Seeing is believing”, but “Believing is seeing”!

8. Mental Models Define Our “Reality” and Pre-determine the Choices We Make and the Actions We Take Who “produces crops” in your mental model of the agricultural system? How does your answer determine the roles and functions of the Ministry of Agriculture? Who “produces health” in your mental model of the health system? How does your answer determine the roles and functions of the Ministry of Health?

9. What is a system?

10. Systems Thinking Looks at: The whole and the parts and The interactions among the parts Studies the whole in order to understand the parts

12. functions as a wholeThrough the interaction of its parts.

13. The Health Production System Households HEALTH Government Communities

14. The Health System has an inherent stability

15. Mosley and Chen, 1984

16. Mosley and Chen 1984

17. Census-base, Impact-Oriented (CBIO) Conceptual Framework Basic assumptions: improving the health of a defined population is the overarching goal Strong community-partnerships are required for this, and this trust between the health system and the community, and this requires, among other things, responding to community priorities

18. CBIO (cont.) Steps: Define the community Make a community diagnosis of epidemiological priorities and the community’s priorities Epidemiological priorities: most serious, preventable, readily preventable or treatable conditions in the community Community priorities: no clear framework for defining this Clarify program priorities by merging epidemiologial priorities and community priorities

19. CBIO (cont.) Steps (cont) - Define resources available (social capital, human resources, money, etc.) - Plan program - Implement program - In 3-5-10 years, carry out community diagnosis again

20. Routine systematic home visitation a key action - For defining epidemiological priorities - For defining community priorities - For delivering key services - For monitoring progress and measuring health improvement

22. Strengthening Health Systems to Improve Health Outcomes. WHO, 2007

24. Framework of the Health of the Public Disease-oriented public health Control specific diseases or conditions Services-oriented public health Ensure that those who need services get them Community-oriented public health Work with communities to help them improve their health All three are equally important and are like the legs of a three-legged stool John Wyon

29. Primary Health Care: An Ambiguous Mental Model? Medical care system delivery concept Alma Ata concept Health system model vs. production of health model (World Health Organization vs World “Disease” Organization) Community-based primary health care

30. IMCI Facility-based IMCI Community-based IMCI

31. What Is Health?

32. Final Challenge What is the most appropriate mental model conceptual framework for thinking about how to achieve a world in which no one dies of a preventable disease or health-related condition?