Chapter 7 presents three high-level insights that can be drawn from this book’s look at a health system from a systems thinking perspective. First, all health systems suffer from one of systems theory’s classic descriptive models called The Tragedy of the Commons, in which a scarce resource is consumed when a collective benefit (e.g., health insurance) is subsidized and its price to the user is less than the cost to produce it. Second, when viewed from a systems perspective of value-for-money, most health systems face competing objectives—satisfying individual’s demands for maximizing their own medical care and providing healthcare as a fundamental right of all citizens regardless of ability to pay. Third, to integrate these goals requires re-framing the way societies think about each. The authors describe double-loop learning, which is required when confronting second-order change. The latter term describes problems where it is necessary to redesign human perceptions for change to lead to improvement. Complex changes require double-loop learning, in which underlying interpretive conflicts and differing values and beliefs are surfaced and managed.
Indigenizing Knowledge for Development: Epistemological and Pedagogical Approaches
