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Future Health Systems is a research consortium working to improve access, affordability and quality of health services for the poor. We are a partnership of leading research institutes from across the globe working in a variety of contexts: in low-income countries (Bangladesh, Uganda), middle-income countries (China, India) and fragile states (Afghanistan) to build resilient health systems for the future. After a successful first five-year phase from 2006-2011 (see our success stories), we are entering a new six-year phase of research, funded mainly by UK aid.

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Complex Adaptive Systems Training Workshop held by CNHDRC in Beijing

Future Health Systems

From 18-19 July, the First Complex Adaptive Systems Training Workshop was held in Beijing. Professor David Peters, and Professor David Bishai from the Johns Hopkins Bloomberg School of Public Health and Professor FANG Meiqi from People’s University of China were invited as speakers by the China National Health Development Research Center (CNHDRC). Professor ZHANG Zhenzhong, Dirctor General of CNHDRC, delivered a speech and Professor MAO Zhengzhong hosted the opening ceremony. There were over 30 researchers who participated in the workshop from CNHDRC, China Health Economics Association, Beijing Normal University and Haerbin Medical University.

Complex Adaptive Systems (CAS) was a term introduced by Professor John Holland from Santa Fe Institute, United States in 1994. In recent years, it has been applied broadly in the fields of ecomonics, financing, information technology and biology. The approach, however, has not been widely appolied by researchers in the field of health in China. The aim of this training program was to help Chinese researchers apply CAS in the fiels of health development, policy and management.

Professor FANG Meiqi condidered the system of effective drug delivery at Chinese rural health facilities, the project FHS China will be focusing on in the second phase, as a complex adaptive system. The system is composed of self-interest orientated, learning capacity and adaptive agents. The agents interact with each other and environment to exchange information at various layers. Some strategies of agents at appropriate layers might play the key role in maintaining the status quo and sustainable development of the system. A computer-based modelling of this system could show the advantages and disadvantages of all kinds of strategies. The key step was to look for the strategies of agents at appropriate layer.

Professor David Bishai talked about the social science foundations of complex adaptive systems. He introduced the long historical view of CAS citing from a wide range and different ways including Stone age “Homo sapiens”, Plato’s Republic, materialist versions of history of Marx/Engels, system dynamics and agent-based modeling. He also described the general approach to modeling: define desired outcome of the system, define a metric, develop alternative solutions, iterative tinkering against the metric.

Professor David Peters shared his view on the definition and understanding of health systems, systems versus non-systems, as well as common elements in health system including actors, functions, outcomes and oversight. He also talked about the relationship between CAS and health systems, and the way CAS informed health system reforms. Finally, he separated the trainees into 8 teams with 4 members each, organized them to play a game of 'Friday Night at the ER' to mimic the hospital management.

In the training courses, students and professors had a good interaction. The students learned very seriously and discussed actively with a high degree of learning enthusiasm. Professors reacted to the questions about the CAS theory, health service system and other issues with insightful answers. After the closure of first day training, all the participants generally felt they had not only enriched their knowledge but also improved the theoretical understanding, especially with regard to CAS.