FAMH1003A - FPH & HSS

FAMH1003A- Foundations of Public Health and Health Systems Science

BLOCK 1

Activity- Week 3

What is Health Systems Science?

How can I envision applying this knowledge to contribute to a more interdisciplinary and effective approach in healthcare delivery?

As a future doctor, I now understand that my role extends beyond treating individual patients. I must also engage with the broader health system to create meaningful change. Health Systems Science (HSS) has shown me how healthcare delivery depends on interconnected factors like policies, resources, and collaboration between professionals. To contribute effectively, I need to adopt a systems-thinking mindset, recognizing how each part of the system, whether it be hospitals, clinics, community health workers, or even socioeconomic conditions affects patient outcomes. For example, if diabetic patients keep returning with uncontrolled blood sugar, the issue might not just be medication adherence but also lack of access to nutritious food or health education. By analysing these systemic barriers, I can work with dietitians, social workers, and policymakers to implement sustainable solutions, such as community nutrition programs or better patient follow-up systems.

Additionally, HSS emphasizes interdisciplinary teamwork, which is crucial in South Africa’s resource-limited settings. Instead of working in isolation, I should collaborate with nurses, pharmacists, and public health experts to streamline care. Tools like patient journey mapping can help identify inefficiencies, such as long waiting times or medication stockouts, so we can redesign processes for better efficiency. Furthermore, I must develop advocacy skills to address systemic gaps, whether by pushing for better clinic resources or supporting policies that improve healthcare access for marginalized communities.

Ultimately, my goal is to use HSS principles to bridge the gap between clinical medicine and systemic improvements. By combining medical knowledge with leadership, empathy, and problem-solving, I can help build a health system that is not only effective but also equitable and patient centered. This approach ensures that my impact contributes to long-term improvements in community health. 

Reference:

Bartoletta, K.M. & Starr, S.R. (2021). Health Systems Science. Advances in Pediatrics, 68, 1-19. DOI: 10.1016/j.yapd.2021.05.001 

Artefact Description:  This activity demonstrates my evolving understanding of Health Systems Science (HSS) through Bartoletta & Starr's (2021) framework. It analyses how systems thinking transforms clinical practice, using diabetes management as a case study to explore interdisciplinary collaboration needs in South Africa's resource-constrained settings. Completing this activity fundamentally shifted my clinical perspective. Where I previously viewed patient non-adherence as an individual failing, I now recognize systemic determinants like food insecurity. I believe this will help me in my future as a medical professional to apply Health Systems Science to bring about efficient service delivery 

Activity- Week 4

As a systems thinker, how will mapping assist me in understanding the complexities and interconnectedness of a healthcare system?

As a systems thinker, mapping serves as a powerful tool in understanding the relationships within healthcare systems. Unlike linear thinking that examines components in isolation, mapping allows me to visualize how patients, providers, policies, and infrastructure interconnect to influence health outcomes. For instance, when examining why diabetic patients struggle with medication adherence, a patient journey map might reveal not just clinical factors but also transportation barriers to pharmacies or gaps in health literacy. This holistic perspective is crucial because healthcare challenges are rarely caused by single factors but rather emerge from dynamic interactions between multiple system elements (Meadows, 2008).

Ecosystem mapping, as described by Servicedesigntools.org (2024), provides value in understanding the broader network of stakeholders involved in healthcare delivery. By creating visual representations of all factors, from frontline clinicians to pharmaceutical suppliers and community health workers, I can identify leverage points where small interventions might create system-wide improvements. The Interaction Design Foundation (2021) emphasizes how these maps reveal both formal and informal relationships that impact care quality. For example, mapping might show how a hospital's procurement system indirectly affects patient outcomes through medication stockouts, demonstrating the need for supply chain reforms alongside clinical interventions.

What makes mapping especially powerful is its ability to surface hidden feedback loops that perpetuate systemic issues. When analysing maternal health outcomes, a causal loop diagram could illustrate how staff shortages lead to rushed consultations, resulting in missed complications that eventually increase emergency admissions which would further strain the same limited staff. Recognizing these patterns helps shift from reactive problem-solving to designing interventions that address root causes rather than symptoms. I've added these mapping resources to my portfolio because they transformed my understanding of healthcare as a complex adaptive system.

References:

- Servicedesigntools.org. (2024). Ecosystem Map | Service Design Tools. [online] Available at: https://servicedesigntools.org/tools/ecosystem-map [Accessed 7 March 2025].
- The Interaction Design Foundation. (2021). What are Ecosystem Maps? [online] Available at: https://www.interaction-design.org/literature/topics/ecosystem-maps [Accessed 7 March 2024].
- Meadows, D.H. (2008). Thinking in Systems: A Primer. Chelsea Green Publishing.

Reflection:
Studying these mapping resources has fundamentally shifted how I approach healthcare problems. Previously, I might have viewed a patient's missed appointments as simply non-compliance, but ecosystem mapping reveals how transportation costs, clinic hours, and communication barriers interact to create this outcome. This deeper understanding will make me a more effective clinician and advocate, as I can now identify systemic rather than just individual solutions. In the future, I plan to use these mapping techniques during my clinical rotations to identify opportunities for quality improvement in real-world settings.

Artefact Description: An analysis of ecosystem mapping methodologies (Servicedesigntools.org, 2024) applied to a hypothetical primary care clinic. Incorporates Meadows' (2008) systems theory to demonstrate understanding of healthcare complexity. Developing this theoretical map was my first exposure to visualizing healthcare complexity. While I haven't yet applied this in clinical settings, the process revealed how systemic barriers like transportation costs or clinic hours could disrupt care continuity. This exercise fundamentally changed how I approach case studies, as I now automatically consider multiple interacting factors rather than isolated clinical presentations.

Activity- Week 5

Reflection on the Importance of Health Service Delivery in Health Systems 

When I first began studying health systems, I thought of healthcare as simply hospitals and doctors treating patients. However, learning about the WHO's six building blocks framework completely changed my perspective. The case study about stroke management in South Africa particularly stood out to me. It showed how fragmented care leads to worse outcomes, while coordinated service delivery across primary, district and tertiary levels could save lives and improve recovery. This made me realize health service delivery isn't just about individual clinical encounters, but about how we organize the entire system to provide continuous, quality care. 

The stroke case study resonated with me because my neighbour suffered a stroke last year. Despite living near a clinic, she didn't receive timely thrombolysis because the primary healthcare workers weren't trained to recognize stroke symptoms. By the time she reached a district hospital, the golden window for treatment had passed. This personal experience helped me understand how gaps in service delivery, like lack of training at primary level or poor referral systems, directly impact patient outcomes. The WHO framework explains this perfectly: good service delivery requires effective coordination across all levels of care, supported by adequate workforce, financing and governance (WHO,

In South Africa, we have excellent policies like the National Health Insurance, but implementation faces “bottlenecks” like unequal resource distribution. Well-equipped urban clinics provide comprehensive stroke care, while rural clinics lack even basic medications. This disparity isn't just about money - it's about how services are organized and delivered. The framework helped me see that strengthening service delivery requires addressing these systemic constraints. Good service delivery must adapt to patients' cultural contexts and socioeconomic realities, not just clinical guidelines. 

References:

Health service delivery 1. (n.d.). Health service delivery. Available at: who_mbhss_2010_section1_web.pdf

Artefact Description: Analysis of WHO's building blocks framework applied to South African stroke care, using academic case studies to examine systemic gaps in coordinated care delivery. This case study shifted my perspective from viewing healthcare as facility-based to understanding inter-level coordination. While studying NHI policy documents, I now better recognize how referral systems impact outcomes, which I have applied in public health.

Activity: Week 5

Developing a definition of Health Systems Science and Public Health

Activity: Reflection on the use of AI

The use of ChatGPT and other large language models (LLMs) in academic work presents both opportunities and responsibilities. As a learning tool, ChatGPT can enhance my understanding of complex topics by providing simplified explanations, generating study summaries, and offering alternative perspectives on course material. For assignments, it can assist with brainstorming ideas, structuring outlines, and refining drafts. However, the university’s guidelines require that AI-generated content must be properly verified, critically evaluated, and supplemented with authoritative sources to ensure accuracy and originality. Direct submission of AI-produced work without engagement or attribution would violate academic integrity policies.

To use ChatGPT ethically, I must ensure transparency by clearly indicating when and how it was employed in my work. This includes cross-referencing its outputs with peer-reviewed literature, avoiding over-reliance on AI for core analytical thinking, and maintaining my own voice in assignments. Developing competencies in critical evaluation is essential. I need to assess the reliability of AI-generated information, identify potential biases, and recognize its limitations, particularly regarding context-specific knowledge such as South Africa’s healthcare challenges. Additionally, I must cultivate skills in proper citation and paraphrasing to avoid plagiarism. By treating ChatGPT as a supplementary tool rather than a replacement for independent learning, I can reap its benefits while upholding academic standards.

References: 

University of the Witwatersrand. (2023) Approach to the use of AI in teaching and learning at Wits. Johannesburg: Wits University.

Peer review

The peer offers a thoughtful and balanced reflection on the use of ChatGPT in academic contexts. They clearly outline the benefits of using LLMs for learning, such as simplifying complex topics, summarizing material, and aiding in assignment preparation. Importantly, the peer acknowledges the risks of misuse, particularly the ethical concerns around submitting AI-generated work without proper engagement or attribution. The reflection shows a strong awareness of the need for critical thinking and personal responsibility when interacting with AI tools. However, the reflection could have been strengthened by exploring more concrete examples of potential misuse or common misunderstandings students might have when using LLMs. This would add nuance to the discussion of ethical boundaries.

Although the task did not require the use of specific academic articles, the reflection would have been improved by referencing official university policies on AI use or institutional definitions of academic integrity. Doing so would have added depth and credibility to the ethical claims. Additionally, citing specific course guidelines or relevant real-world examples (such as AI’s limitations in localised contexts like South African healthcare) would have enriched the reflection and demonstrated deeper engagement with the topic.

The reflection is clearly written, logically structured, and easy to follow. Each paragraph has a clear focus, and the writing flows smoothly from one point to the next. The peer answers all the key questions expected from the task: how ChatGPT can be used, what its limitations are, and how to ensure its use remains ethical. The tone is appropriate for academic writing, and grammar and spelling are accurate. Overall, the reflection is concise yet thorough, though a more critical examination of challenges in real-world application would elevate it further.

(Peer review by Sadiqa Mehmood, student number: 2890222)

Reflection of the peer review

Receiving this peer review has been incredibly valuable in helping me refine my understanding of responsible AI use in academic work. I appreciate the reviewer’s balanced assessment, which affirmed the strengths of my reflection while identifying areas where I could deepen my analysis.

The reviewer’s observation about needing more concrete examples of potential AI misuse resonated with me. While I discussed ethical boundaries in general terms, I now realize that including specific scenarios, such as students relying on ChatGPT for nuanced topics like South Africa’s healthcare disparities without verifying outputs, would have made my arguments more tangible. I also agree with the suggestion to reference official university’s policies or course guidelines explicitly. In my initial reflection, I assumed a shared understanding of academic integrity frameworks, but the feedback reminded me that direct citations (e.g., linking to the university’s AI use policy or quoting from our module handbook) would strengthen my credibility. 

The praise for clarity and organization was encouraging, but the call for a more critical examination of real-world limitations has prompted me to reconsider how I frame AI’s role. Moving forward, I’ll pay closer attention to contextual pitfalls, like how LLMs might overlook local health system nuances, to present a more rounded perspective.

Artefact Description: Critical analysis of large language models in medical education, evaluating ethical use through Wits' academic integrity policies and guidelines. Through this reflection, I progressed from viewing AI as a simple tool to recognizing its limitations in healthcare contexts. Peer feedback helped me identify gaps in assessing cultural biases, which I've since addressed by comparing AI outputs with South African journal articles. This activity has developed my skills in source verification.

BLOCK 2