The Market Corner: Applying Systems Thinking in the Health Sector, Part 1

November 17, 2021


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This month, The Market Corner looks at health systems and why health professionals are turning to systems thinking and market systems development (MSD) approaches in their work.

Systems thinking evolved with contributions from a diversity of disciplines.

Since its early beginnings in the 20th century, systems thinking has relied on and evolved based on the contributions of scientists from a diverse range of disciplines (e.g., biology, mathematics, and management). The intentional transfer of methods and learnings across traditional disciplines led to new insights and applications for a diverse range of stakeholders, including market systems development practitioners.

In this first installment of November’s Market Corner series, I take a page from our systems thinking forbearers to see how health systems strengthening (HSS) professionals apply systems thinking in their work. In the forthcoming second installment, I will share what we market systems development (MSD) practitioners can learn from our counterparts working in the health sector.

To learn how HSS professionals apply systems thinking, I spoke with Anne Liu, New York-based Senior Technical Advisor for the Clinton Health Access Initiative (CHAI) and Lecturer at SIPA Columbia University, and Wilfred Forfoe, field-based Regional Technical Officer for the President's Malaria Initiative (PMI) Impact Malaria.

Health professionals are increasingly turning to systems thinking and MSD approaches.

HSS professionals recognize, like many of their MSD counterparts, that linear A to B solutions are frequently insufficient to tackle the myriad, interconnected, and continuously evolving challenges they face. Improving health outcomes requires more sophisticated frameworks that help diagnose the root causes of poor health service delivery and health outcomes.

This is where systems thinking can provide crucial analytical support. As Anne noted to me, “Systems thinking is about all the components and all the moving parts and trying to step back a bit and say, you know something isn't working. Is it a problem with the intervention itself or is there something underlying in any of these building blocks that is not working?” 

Malaria is a classic example of the need for analytical frameworks which consider the different components (or actors) and how they interact, according to both Anne and Wilfred. There are clear and proven interventions for malaria prevention and treatment, such as drugs, bed nets, and case management protocols. Yet, over 400,000 people a year die from malaria. Is the issue with the drugs? Or protocols? Or something else? Systems thinking enables health practitioners like Anne and Wilfred to see where the root cause(s) of the problem lie. It allows them to look simultaneously at the whole and at the different components of the health system. The health system includes supporting functions, such as logistics, nurse training, and facilities, as well as rules and norms, such as government health and malaria policies, priorities, and budget allocations, to see where the root cause(s) of the problem lie.

Strengthening optimal service delivery.

According to Wilfred, applying a systems lens to his work in Malaria Services with the Ghana Health Service (GHS) enables him to see how the whole system can deliver optimal services. 


WHO Health System Framework

He looks at projects holistically to see how to improve upon service delivery by working with all the sectors that connect to service delivery. For example, the delivery of quality malaria services by GHS is not just dependent on the GHS. A range of other factors influence the delivery of that service, such as the supply of testing kits, bed nets, drugs, training, and the ability of GHS workers to effectively and efficiently manage cases, among other factors.

Importance of safe spaces for iteration and learning.

The complex nature of HSS work means that professionals need a "safe space" to iterate and learn. In Anne’s experience, donors and host country governments each have an important role in creating a conducive space for iteration and learning. Something as simple as the reporting format or required indicators/metrics may discourage innovation and iteration in the HSS space.

This point resonated with me. As a MSD practitioner, I am deeply familiar with the need for piloting, testing, and adapting and the critical role of donors (less so host governments) in allowing and even encouraging failure. This point also reminded me of the recent series published by the BEAM Exchange on adjusting procurement processes for MSD programs, so that they can more rapidly test, adapt, learn and (re)test interventions, among other things.

In the next installment of the Market Corner, we’ll hear more from Anne Liu and Wilfred Forfoe about what insights MSD practitioners can take away from their experience applying systems thinking to the health systems strengthening space.

Have insights or recommendations of your own? Post via your Marketlinks account, or send them to us at, and we will include these in the next installment of the blog.



Anne L

Anne Liu
Anne Liu specializes in the design and implementation of technology to expand access to healthcare in low resource settings. She has worked on innovative solutions for disease surveillance, health education, health worker management, and health systems strengthening across a range of global health priorities, including the 2014 West Africa Ebola outbreak, malaria elimination, and management of childhood illnesses. Previously, she led health systems strengthening efforts for the Millennium Villages Project from 2010-2015, with a focus on community health worker programs and information systems. Anne currently leads product strategy as a Senior Technical Advisor for Clinton Health Access Initiative's Digital Health team and is an instructor at Columbia University's School of International Public Affairs on global health and public policy. She received her Masters in International Health at Johns Hopkins Bloomberg School of Public Health, Masters in Biomedical Sciences at Tufts University School of Medicine, and B.S. at the Massachusetts Institute of Technology.



Wilfred Forfoe
Wilfred Forfoe is a public health specialist and entrepreneur with over 20 years of practical field and research work experience. For the past 10 years, he has worked with different USAID-funded projects, such as JSI/Focus Region Health Project which aimed to strengthen the health system in Ghana and JS/SPRING Ghana which led the effort to reduce stunting in the northern and upper east regions. He currently works with PMI/Impact, which is designed to improve malaria service delivery and reduce mortality and morbidity associated with malaria in Ghana. Mr. Forfoe has a MSc in food science technology and nutrition and a MSc in Health Service Planning and Management. He also has a BSc in Community Nutrition.



photo of Holly

Holly Lard Krueger
Holly Lard Krueger is a managing partner at the Canopy Lab and a market systems development expert with over 15 years of experience providing technical advice in the field of private sector development/engagement with a specific focus on applying digital technology, gender equality and social inclusion (GESI), market systems, and Value for Money (VfM) principles to project and strategy design for agriculture, humanitarian aid, business enabling environment reform, trade, urban development, and women’s economic empowerment programs.

Holly is a proven strategic leader, having managed large market systems projects with diverse teams. She is also skilled as a strategic advisor, coach, and trainer in the practical application of systems approaches to market development, and she is currently an advisor to USAID’s Bureau for Humanitarian Assistance, a World Bank-funded program in West Africa (TFWA), a DFAT-funded program in Indonesia (PRISMA), and a FCDO-funded program in the Democratic Republic of the Congo (Essor). Holly is based in Morocco and has worked in over 15 countries in Africa, Asia, and the Middle East and has implemented projects and conducted evaluations for leading donors, including the Bill & Melinda Gates Foundation, DFAT, IFC, FCDO, USAID, and the World Bank. She has an M.A. from Johns Hopkins School of Advanced International Studies and a B.A. from Vanderbilt University.