A bioethical framework for health systems activity: a conceptual exploration applying 'systems thinking'

Recognizing that the health system is a complex and dynamic network of actors and activities, this paper seeks to push the field of bioethics to develop a more holistic approach from the health systems perspective. Expanding upon the work of existing public health frameworks and drawing upon concepts from related areas such as governance, human rights, and organizational ethics, our provisional list of ethical considerations for health systems fall under the following categories: Holism, Sustainability, Evidence & Effectiveness, Efficiency, Public Engagement & Transparency, Accountability & Feedback, Equity & Empowerment, Justice & Fairness, Responsiveness, Collaboration, and Quality. By outlining these key domains, we hope to stimulate global discussion and further development of an ethics framework that will help guide ongoing work to strengthen health systems. This will be particularly important for low-and middle-income countries where resources are highly constrained and health systems efforts have scaled-up dramatically in the past decade.