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FAMH1003A - Foundations of Public Health and Health Systems Science
Activity 1.2.1: Reflection on Health Systems Science-related Competencies
Health Systems Science (HSS) is a really important part of my medical training. Before this, I mostly thought about medicine in terms of diseases and treatments, but now I see that healthcare is much bigger—it’s about how hospitals, clinics, policies, and even social factors all work together. To be good at HSS, I need to develop skills like systems thinking (seeing how everything connects), teamwork, and compassionate leadership (making sure patients are treated with dignity).
As a future doctor, I should not just focus on diagnosing and prescribing, rather I should also understand how the health system works (or doesn’t work) for different people. For example, why do some patients struggle to get medicines? Why are certain diseases more common in some areas? HSS helps me see these bigger issues so I can be part of the solution.
In this course, I hope to learn how to improve healthcare delivery, not just for one patient, but for whole communities. I want to understand how policies, funding, and teamwork affect patient care so that I can be a doctor who doesn’t just treat symptoms but helps fix the system.
Access to Healthcare Mapping Assignment (Group work)
The link below gives you access to the Miro board that my group has created for our assignment.
My reflection on the mapping assignment
This health systems mapping project has transformed my understanding of healthcare access in South Africa. As the team member focused on analysing user perspectives, I gained valuable insights into how social determinants like location, language, and income shape people's ability to receive proper medical care. The experience not only deepened my content knowledge but also helped me develop important skills for my future healthcare career.
Through this project, I learned to see beyond surface-level healthcare problems to identify their root causes. Mapping personal stories of healthcare challenges revealed how systemic issues like clinic shortages in rural areas or medication stockouts create real suffering for patients. I was particularly struck by how historical decisions about resource distribution continue to affect health outcomes today. The research process taught me to connect individual experiences with broader policy failures, giving me a more complete picture of our healthcare system's strengths and weaknesses.
Working with my group was challenging but also presented growth opportunities. We all came with different experiences – some had family members who struggled to get care, while others knew more about the technical side of health systems. We learned to listen to each other and combine our ideas. This project helped me develop several key competencies. I improved my systems thinking by tracing how different elements of healthcare, from workforce shortages to information gaps, influence each other. Creating visual representations of these connections on Miro enhanced my ability to communicate complex information clearly. Perhaps most importantly, I learned how to use patient stories as evidence for needed reforms rather than just as emotional anecdotes. This skill will be invaluable in my future work advocating for better healthcare access.
This mapping assignment has given me both knowledge and skills that will serve me well in my studies and future career. I now understand healthcare challenges as interconnected systems rather than isolated problems. While I've made progress in analysing these complex issues, I recognize that I still need to practice translating my insights into concrete policy suggestions. Moving forward, I plan to apply this systems perspective to all my healthcare studies, always remembering that behind every statistic are real people whose lives are affected by these structural issues. The project has inspired me to look for solutions that address both immediate needs and long-term systemic changes.
Integrated Assessment: Improving access to healthcare for rural populations (Group work)
My reflection on the integrated assessment
This group assignment fundamentally transformed my understanding of healthcare workforce challenges in South Africa. Initially, I viewed financial incentives as a straightforward solution to rural doctor shortages. However, through our causal loop modeling and evidence synthesis, I now recognize the complex interplay between monetary rewards and systemic retention barriers. Jenkins et al.'s (2015) research revealed that 58% of incentivized rural placements end prematurely due to non-financial factors like professional isolation and limited career development. This finding, combined with the WHO's (2022) framework on holistic health workforce strategies, demonstrated how isolated interventions often fail without complementary system strengthening. The process of analyzing these interconnected factors developed my ability to think critically about policy implementation and its real-world impacts.
The assignment helped me master several key competencies in health systems analysis. First, creating causal loop diagrams enhanced my systems thinking skills, allowing me to visualize how financial incentives interact with workload pressures, community integration, and urban-rural disparities (Meadows, 2008). This moved me beyond linear cause-effect analysis to understand reinforcing and balancing feedback loops in complex health systems. Second, critically appraising diverse studies from George et al.'s (2018) quantitative retention data to Li et al.'s (2014) qualitative insights on doctor motivations improved my evidence synthesis skills. I learned to reconcile different research methodologies to form comprehensive policy recommendations. Third, evaluating models like the Umthombo Youth Development Foundation's (2021) local recruitment approach showed me how context-specific solutions outperform generic interventions.
This project has equipped me with practical skills for future healthcare practice and policy work. I can now better advocate for comprehensive solutions that address both workforce attraction (through financial means) and retention (through professional development and community support). The systems perspective I developed will help me design more nuanced program evaluations that measure long-term stability rather than just short-term recruitment gains. Most importantly, I've learned to challenge simplistic solutions by applying structured frameworks to complex health system challenges, a competency that will serve me well in analysing South Africa's ongoing healthcare reforms.
References:
George, G., Quinlan, T. & Reardon, C., 2018. Human resources for health: A needs and gaps analysis of HRH strategies in Africa. African Journal of Primary Health Care & Family Medicine, 10(1), pp.1-6.
Jenkins, L.S., Gunst, C., Blitz, J. and Coetzee, J.F., 2015. What keeps health professionals working in rural district hospitals in South Africa? African Journal of Primary Health Care & Family Medicine, 7(1), p.5.
Li, J., Scott, A., McGrail, M., Humphreys, J. and Witt, J., 2014. Retaining rural doctors: Doctors' preferences for rural medical workforce incentives. Social Science & Medicine, 121, pp.56-64.
Meadows, D.H., 2008. Thinking in Systems: A Primer. Chelsea Green Publishing.
Umthombo Youth Development Foundation, 2021. Umthombo Youth Development Foundation. Available at: https://www.umthomboyouth.org.za/
World Health Organization, 2022. Global Strategy on Human Resources for Health. Geneva: WHO.
Final Reflection on Foundations of Public Health and Health Systems Science (FAMH1003A)
Throughout this course, my understanding of public health and health systems has evolved from a narrow, clinical perspective to a comprehensive systems-thinking approach. Initially, I viewed healthcare through the lens of individual patient-provider interactions, but the course frameworks, particularly the WHO’s building blocks and South Africa’s National Health Insurance (NHI) policy, revealed the intricate interdependencies between policy, financing, workforce, and service delivery. For example, analyzing rural healthcare incentives taught me that financial measures alone cannot address workforce shortages without parallel investments in professional development and community integration (Jenkins et al., 2015; WHO, 2022). This systems perspective now determines how I evaluate health challenges, ensuring I consider structural determinants alongside clinical solutions.
The artefacts in my portfolio demonstrate my progression in applying theoretical knowledge to real-world scenarios. Mapping patient journeys exposed gaps in care coordination, while critiquing AI’s role in healthcare highlighted the importance of ethical frameworks like HPCSA guidelines (2022). Each assignment refined specific competencies, such as systems thinking and interprofessional collaboration. Causal loop diagrams helped me visualize feedback loops in mental health service gaps, while group projects underscored the value of diverse expertise in solving complex problems, such as designing rural retention strategies with input from public health and legal perspectives.
This course has also shaped my professional identity. Engaging with South Africa’s quadruple disease burden taught me to advocate for marginalized populations, while health law case studies emphasized medicine’s legal-ethical dimensions. Moving forward, I will apply these insights during my clinical training to promote equitable care and systems-level improvements.
References:
Health Professions Council of South Africa. (2022). Guidelines on Ethical Practice. Pretoria: HPCSA.
Jenkins, L.S., et al. (2015). Rural health workforce retention. African Journal of Primary Health Care, 7(1).
Meadows, D.H. (2008). Thinking in Systems. Chelsea Green.
World Health Organization. (2022). Global Strategy on Human Resources for Health. Geneva: WHO.
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