System Thinking in Public Health

Enhancing population-based health system needs an understanding of social functions and structures. This article applies system-based thinking on the Indian population for the health issue of HIV (AIDS).

Running head: SYSTEM THINKING IN PUBLIC HEALTH
SYSTEM THINKING IN PUBLIC HEALTH
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Author’s Note:

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Enhancing population based health system needs an changing and understanding of
social functions and structures but oft times counterbalancing forces diminish those changes
which reflects upon the adaptive intricacy fundamental in the systems of public health (Peters,
2014). Therefore the purpose of this article is to apply system based thinking on the Indian
population for the health issue of HIV (AIDS).
Description of the present situation of HIV in India:
India is among the world’s top three most severe HIV epidemic country.
The occurrences of HIV were calculated at 0.2 per cent for adults between the age group of 15
years to 49 years of age. Although, the incidence is relatively low in comparison with the
most other middle income countries, however the large number populace in India (1.3
billion) makes the number of people currently living with AIDS or HIV is equivalent to 2.1
million (Unaids.org, 2019). In general, over the last few the HIV outbreak in India is slowly
declining. New incidence of infections fell by 27 per cent and subsequent deaths from AIDS
reduced by 56 per cent between the year 2010 and 2017 (Unaids.org, 2019). Nevertheless,
new occurrence of HIV infection was escalated to 88,000 from 80,000 infections in the
year 2017, while number of deaths linked to AIDS escalated to 69,000 from 62,000.
Among them, around 79 per cent of HIV sufferers knew about their condition
and approximately, 56 per cent individuals were at the receiving end of the ART or anti-
retroviral treatment (Unaids.org, 2019).
In the year 2017 -18, the infection rate of HIV or AIDS is generally driven by the way
of sexual transmission which represents 86 per cent of new infections. Nagaland, Mizoram, and
Manipur are the top three states with the maximum prevalence of AIDS/ HIV (Mohfw.gov.in,

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2019). Generally, the spread of the epidemic is centered between the major affected populace,
although in different regions of the country there are different shortcomings which causes the
epidemic. The main driving reason among the key affected populace is unprotected sex. In
addition, the high usage of drugs through injections in the north and north-east part of the
country is also majorly responsible for the high HIV or AIDS incidence in these regions of the
country (Mohfw.gov.in, 2019).
Role of the stake holders in addressing the situation of HIV in India:
In this scenario, the key stakeholders for the prevention of HIV in India are Government
of India and various Civil Society Organizations. Indian government has took various initiative
to lower the incidence rate of HIV and most current National AIDS Control Programme -IV
(initial duration of the programme was 2012 to 2017 but extended to 2018) seeks to lessen the
incidence rate by 50 per cent annually by the way of providing full
HIV training, treatment, general public support and care (Naco.gov.in, 2019). The programme
will develop targeted interventions for main affected groups and people who are in danger of
maximum risk of HIV infection. The prevention of new HIV incidence is the primary component
of the National AIDS Control Programme-IV which will target the 80 per cent of the populations
who are affected. The basis of this preventive strategy is that the aimed interventions will be
applied to the main affected populations with HIV transmission which will additionally lower
the rate of HIV transmission amongst the common population (Naco.gov.in, 2019).
India has a vibrant and active civic society with more than 3 million CSO or Civil Society
Organizations along with social movements. It can be seen in the way of participation of
these CSOs in the reply to preventive measure in case of HIV infection in India (Civicus.org,

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2019). In 2018, strength of this groups were demonstrated by a lengthy campaign
led by HIV, LGBTI, and CSOs, and human rights activists which seen the decriminalizing of
homosexuality in India. In fact, ever since Prime Minister Modi took office in 2014 that the civic
space is shrinking. The current government employs strategies like restrictive laws that reject the
right of CSO to register and with regard to few cases it has suspends or withdraw the
authorization CSO operations (Civicus.org, 2019).
Obstacles for the implementation of system thinking approach:
There are many barriers which preventing the application of system based thinking in
HIV prevention in India. Among them, most common are stigma and discrimination. Inequality
between women and men is still a problem. Women living in remote and rural areas have
very little control over the decision making in their life (Naco.gov.in, 2017). The
acquisition, distribution and management of HIV test kits, ARVs, and other HIV related
necessities have suffered in recent years, primarily owing to the bottleneck situation in supply
chain. Challenge also arising from an absence of distinctive patient identifiers and various
surveillance and investigating systems in medical facilities which can be used to continual
diagnosis of HIV treatment and care (Naco.gov.in, 2017).
Recommendations:
This article suggests that additional intervention programs needed to tackle fear of
infection by health care providers, enhance universal precautionary skills and involve individuals
living with HIV at all stages of social life to reduce symbolic stigmatization and to make sure
appropriate skills are available for the communication of patients. In addition, a robust system

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should be employed in order to provide distinctive patient identifiers for better data analysis and
tracking system.

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References:
Civicus.org. (2019). INDIA: Democracy threatened by growing attack on Civil Society.
Retrieved from
http://www.civicus.org/images/India_Democracy_Threatened_Nov2017.pdf
Mohfw.gov.in. (2019). National AIDS Control Organization (NACO). Retrieved from
https://mohfw.gov.in/sites/default/files/24Chapter.pdf
Naco.gov.in. (2017). NATIONAL AIDS CONTROL ORGANIZATION (NACO). Retrieved
from http://naco.gov.in/sites/default/files/Annual%20Report%202015-16_NACO.pdf
Naco.gov.in. (2019). Integrated Counselling and Testing Centre. Retrieved from
http://naco.gov.in/integrated-counselling-and-testing-centre
Peters, D. H. (2014). The application of systems thinking in health: why use systems
thinking?. Health Research Policy and Systems, 12(1), 51.
Unaids.org. (2019). Retrieved from
http://www.unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_en.pdf