Global health policy makers need to focus on how the entire health system works together. Improving one element will not necessarily lead to better results if the broader system is not ready.
Today (June 21st), we will present the results of that investigation. BMJ Global HealthAn international research team led by the University of Birmingham, Nottingham Trent University and Stellenbosch University has revealed how well-intentioned changes to parts of the healthcare system can worsen patient outcomes.
In one of the first studies to fully capture the complexities of the health care system that provides injury care, researchers mapped how patients move through care, from seeking help, receiving treatment, and continuing care for recovery.
They found about 1,000 interrelated factors that influence patient survival after injury in low- and middle-income countries (LMICs), which account for about 85% of injury-related deaths worldwide. However, health systems are so complex and interconnected that improving one part can unintentionally put pressure on others.
Researchers found that among several possible interventions, increasing trust in the health care system had the greatest impact on clinical outcomes. If trust is high, more people may seek care and outcomes may improve, but if too many people come and services can no longer cope, quality may decline and trust may fall again.
Our research clearly shows that improved care will increase demands on the health system, but this will need to be matched by greater capacity and higher quality services to avoid service overload. Rapid increases in demand can lead to delays, lower quality of care, less trust, and ultimately undermine the very improvements the change was intended to achieve. ”
Justine Davies, first author, Professor of Global Health Research, University of Birmingham
This study analyzes interactions across multiple pathways of care and their interactions. patient and community factors such as beliefs, ability to pay, and trust; Health service elements such as quality of care, staffing, and funding. broader social context such as poverty, infrastructure, and policy;
Lead author Antuela Taco, Professor of Operations Research at Nottingham Business School, said: ‘Patient trust, perceptions of the quality of care and people’s willingness to seek treatment are among the most influential factors shaping health outcomes. But addressing these factors alone is not enough; for example, increasing trust may lead to more people seeking care earlier, improving recovery and reducing mortality and disability.
This research calls for fundamental changes in the way we understand and strengthen health systems through a multisector approach that connects health policy with investments in the workforce, transportation, education, community, and economic development.
Kathryn Chew, Professor of International Surgery at Stellenbosch University, said: “Traditional approaches are insufficient to achieve sustainable improvements. Real improvements are only possible through a whole-systems approach that takes broader social and economic factors into account and puts patient trust, system design and equity at the heart of reform.”
The study involved researchers from the UK and South Africa, including the University of Aberdeen in the UK. Umeå University, Sweden. University of the Witwatersrand, South Africa. National Health Service (NHS), Grampian, UK. University of York, UK. Western Cape Provincial Government, South Africa. University of Cape Town, South Africa. South African Medical Research Council.
This research was supported by a prestigious two-month residential team fellowship awarded by the Stellenbosch Institute for Advanced Study (STIAS) to Professor Justin Davis, Professor Kathryn Chu, Dr Lucia D’Ambruso (University of Aberdeen), Professor Laura Boike (University of York) and Professor Antuella Taco.
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Reference magazines:
Davis, J.I. others. (2026). A systems approach to understanding injury care in LMICs using causal loop diagrams. BMJ Global Health. Doi: 10.1136/bmjgh-2025-023069. https://gh.bmj.com/content/11/6/e023069
