Self-Organization and Emergence in Global Health. Insights From Practice, Blind Spots and Possible Contributions From Complexity Science

Abstract

Global health as a discipline is at a moment of tremendous achievements and general optimism, but faces enduring questions, notably about the sustainability of its endeavours. The field of global health defines itself through enumerated goals, targets, and indicators to track progress of complex changes. With this comes a broad panoply of objective-driven strategies resting on assumed control over chains of cause and effect. We present areas where emergence and self-organization play an important role in determining the sustainability of positive outcomes at scale and behaviours of both the population and its service providers. The role of self-organization and emergence seem under-appreciated by the field and we consider three reasons for a possible "blind spot" of global health decision makers and influencers: (1) the culture of command and control inherent to central planning, (2) the structural limitations of large complex institutional edifices in processing information (variety), and (3) epistemological/cognitive constraints. More pro-active allowance for the conditions of positive self-organization and emergence may be required to avoid unintended and negative long-term consequences of global strategies, in spite of best intentions. Observational, analytical and computational multi-disciplinary studies are needed to bring clarity to these questions, and to inform a parallel process of dialogue, provocation, and learning to evolve the institutional culture of global health at both national and international levels.

Travelling models and the challenge of pragmatic contexts and practical norms: the case of maternal health

“…Public health is dominated by the assimilation of any evidence-based medicine (and of any evidence-based policy) with data that are essentially quantitative and experimentalist (for an advocacy paper concerning maternal health see Miller et al [ 14 ]), and which favour and justify the standardisation of interventions. In recent years, however, various theoretical currents have emphasised the importance of context in health interventions, be it realist approaches to evaluation [ 15 , 16 ], approaches emphasising the complexity of health systems [ 17 , 18 ], implementation studies [ 19 , 20 ], or calls to take ‘real-world’ contexts into account [ 21 , 22 ]. Most of these use a qualitative or a mixed methods approach.…”

Evaluation amidst complexity: Eight evaluation questions to explain how complex adaptive systems affect program impact

“…Tools purporting to give steps for successful implementation stresses that ‘simple’ interventions will be implemented more successfully than interventions that involve many stakeholders and actors and complex processes, ignoring the inherent complexity of the systems to be changed (Cooley et al, 2012; ExpandNet, 2009). Untested, local solutions are considered too risky (Sarriot et al, 2016).…”