When 'solutions of yesterday become problems of today': Crisis-ridden decision making in a complex adaptive system (CAS) - The Additional Duty Hours Allowance in Ghana

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dc.contributor.author Agyepong, I.A.
dc.contributor.author Kodua, A.
dc.contributor.author Adjei, S.
dc.contributor.author Adam, T.
dc.date.accessioned 2019-01-11T11:39:19Z
dc.date.available 2019-01-11T11:39:19Z
dc.date.issued 2012-10
dc.identifier.other DOI: 10.1093/heapol/czs083
dc.identifier.uri http://ugspace.ug.edu.gh/handle/123456789/26770
dc.description.abstract Implementation of policies (decisions) in the health sector is sometimes defeated by the system's response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors; and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or 'fixes'. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper we use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, we unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimize negative unintended effects. © The Author 2012; all rights reserved. en_US
dc.language.iso en en_US
dc.publisher Health Policy and Planning en_US
dc.subject causal loops en_US
dc.subject Complex adaptive systems (CAS) en_US
dc.subject decision making en_US
dc.subject implementation en_US
dc.subject process en_US
dc.subject systems thinking en_US
dc.title When 'solutions of yesterday become problems of today': Crisis-ridden decision making in a complex adaptive system (CAS) - The Additional Duty Hours Allowance in Ghana en_US
dc.type Article en_US


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