title: Methodological approach and tools for systems thinking in health systems research: technical assistants' support of health administration reform in the Democratic Republic of Congo as an application.
abstract: In the field of development cooperation, interest in systems thinking and complex systems theories as a methodological approach is increasingly recognised. And so it is in health systems research, which informs health development aid interventions. However, practical applications remain scarce to date. The objective of this article is to contribute to the body of knowledge by presenting the tools inspired by systems thinking and complexity theories and methodological lessons learned from their application. These tools were used in a case study. Detailed results of this study are in process for publication in additional articles. Applying a complexity 'lens', the subject of the case study is the role of long-term international technical assistance in supporting health administration reform at the provincial level in the Democratic Republic of Congo. The Methods section presents the guiding principles of systems thinking and complex systems, their relevance and implication for the subject under study, and the existing tools associated with those theories which inspired us in the design of the data collection and analysis process. The tools and their application processes are presented in the results section, and followed in the discussion section by the critical analysis of their innovative potential and emergent challenges. The overall methodology provides a coherent whole, each tool bringing a different and complementary perspective on the system.
authors.affiliation: 1. Institute of Health and Society, Universite Catholique de Louvain, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ribesse
authors.affiliation: 2. Belgian Technical Cooperation, Brussels, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Bossyns
authors.affiliation: 3. Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Marchal
authors.affiliation: 4. Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.
authors.forename: Hermes
authors.initials: H
authors.lastname: Karemere
authors.affiliation: 5. Rural Development and Innovation Hub, University of Limpopo, Sovenga, South Africa.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Burman
authors.affiliation: 1. Institute of Health and Society, Universite Catholique de Louvain, Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Macq
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D015023:Democratic Republic of the Congo; D006078:Government Programs; D018166:Health Care Reform / Q000458:organization & administration*; D006290:Health Planning Technical Assistance / Q000458:organization & administration; D006801:Humans; D009936:Organizational Innovation; D013597:Systems Analysis
keywords: organizational development/organisational change; policy/politics; public health; systems