title: Application of system thinking concepts in health system strengthening in low-income settings: a proposed conceptual framework for the evaluation of a complex health system intervention: the case of the BHOMA intervention in Zambia.
abstract: BACKGROUND
  The current drive to strengthen health systems provides an opportunity to develop new strategies that will enable countries to achieve targets for millennium development goals. In this paper, we present a proposed framework for evaluating a new health system strengthening intervention in Zambia known as Better Health Outcomes through Mentoring and Assessment.
  
  
  METHODS
  We briefly describe the intervention design and focus on the proposed evaluation approach through the lens of systems thinking.
  
  
  CONCLUSIONS
  In this paper, we present a proposed framework to evaluate a complex health system intervention applying systems thinking concepts. We hope that lessons learnt from this process will help to adapt the intervention and limit unintended negative consequences while promoting positive effects. Emphasis will be paid to interaction and interdependence between health system building blocks, context and the community.
authors.affiliation: Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Wilbroad
authors.initials: W
authors.lastname: Mutale
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Dina
authors.initials: D
authors.lastname: Balabanova
authors.affiliation: Centre for Infectious Disease Control in Zambia, Lusaka, Zambia.
authors.forename: Namwinga
authors.initials: N
authors.lastname: Chintu
authors.affiliation: ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
authors.forename: Margaret Tembo
authors.initials: MT
authors.lastname: Mwanamwenge
authors.affiliation: ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia.|Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Ayles
mesh_terms: D003210:Concept Formation; D003695:Delivery of Health Care / Q000592:standards*; D006291:Health Policy; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D011204:Poverty Areas; D015024:Zambia
keywords: evaluation; health policy; health services research