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Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China’s healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation,...
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Debate is ongoing about the nature and use of evidence in public health decision making, and there seems to be an emerging consensus that the "hierarchy of evidence" may be difficult to apply in other settings. It may be unhelpful however to simply abandon the hierarchy without having a framework or guide to replace it. One such framework is discussed. This is based around a matrix, and emphasises the need to match research questions to specific types of research. This emphasis on...
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Introduction:The Most Significant Change (MSC) technique is a complex-aware monitoring and evaluation tool, widely recognized for various adaptive management purposes. The documentation of practical examples using the MSC technique for an ongoing monitoring purpose is limited. We aim to fill the current gap by documenting and sharing the experience and lessons learned of The Challenge Initiative (TCI), which is scaling up evidence-based family planning (FP) and adolescent and youth sexual...
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Technical assistance is provided to country governments as part of international development programmes to support policymaking or strengthen state capability. This article presents the conceptual evolution of ‘technical assistance’ linked to capacity development, starting with programmes aiming exclusively to enhance individual capacity in the 1950s to 1970s and progressing to complex systems approaches in the past ten years. It also presents some of the frequent challenges in designing and...
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There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing...
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