DOI
https://doi.org/10.1186/s12961-020-00570-4

Summary
Existing frameworks for systems change were adapted to form the conceptual framework for the study. Using a semi-structured interview guide, key informant interviews were conducted with Neglected tropical diseases stakeholders at the global level and at the country level in Nigeria. The interview data were coded and analyzed to create causal loop diagrams that resulted in a qualitative model of the global Neglected tropical diseases system.
The complete qualitative model is here discussed and presented visually as six separate sub-components that highlight key forces and feedback loops within the global Neglected tropical diseases system.
The authors identified five leverage points for NTD system change, namely (1) clarify the potential for and assess realistic progress towards Neglected tropical diseases elimination, (2) increase support for interventions besides drug delivery, (3) reduce dependency on international donors, (4) create a less insular culture within the global Neglected tropical diseases community, and (5) systemically address the issue of health worker incentives. The specific findings for Neglected tropical diseases raise a number of uncomfortable questions that have not been addressed, at least in part, because it is easier to continue focusing on ‘quick win’ solutions.

Relevance for Complex Systems Knowledge
Systems thinking is here presented as “a conceptual approach that can assist stakeholders in understanding complexity and making progress on persistent public health challenges”. In particular neglected tropical diseases, were analyzed as“a complex global health problem responsible for a large disease burden among impoverished populations around the world.” This approach leads to a partial deconvolution of the different aspects that constitute the complexities of the neglected tropical diseases global system, driving the identification of the most effective action that could be undertaken to “catalyse progress towards ending neglected tropical diseases.

Point of Strength
The model proposed in this article represents an excellent food for thought for the application of a systemic approach to other complex global challenges for health and (sustainable) development. The study of complexity is outlined as a method for identifying key actions for changing the system.