Breaking barriers: A toolkit for systems leadership in global eye health
A systems leadership approach offers both unique opportunities and significant challenges for practitioners working to improve global eye health. At its core, systems leadership integrates a variety of foundational theories and frameworks, applying them in ways that not only transform individual practices but also support the development of new leaders capable of using systems-thinking approaches to tackle complex health challenges.
The Early-Stage Systems Change toolkit was developed to capture the key theories and concepts that were most impactful as we, along with our partners, navigated the early stages of applying systems leadership in Bangladesh. In particular, it addresses three major challenges we faced and that are likely to arise as systems leadership is adopted more broadly:
1. The need for clear and effective communication
Systems leadership emphasises collaborative approaches to solving eye health challenges. Effective collaboration requires clear, consistent communication—especially when engaging diverse stakeholders. One of the key challenges we encountered was that many terms used in systems thinking can have different meanings depending on who is using them. For example, terms like “system” or “system change” often led to confusion and misalignment in our discussions. What one person meant by “system change” could differ dramatically from another’s understanding. As such, it’s essential for leaders to define terms clearly and ensure that everyone involved in the conversation is on the same page.
2. Bridging the gap between systems leadership and traditional public health approaches
The differences between systems leadership and traditional approaches to improving population-level eye health can be subtle, yet they are crucial to understand. While many activities and tools used in both approaches may overlap, systems leadership requires not just knowing what to do, but understanding why things are done in a particular way. This deeper understanding enables practitioners to adapt strategies as context and system dynamics evolve.
For example, the way a problem analysis is conducted, or how feedback loops and developmental evaluation are used to support continuous learning and iterative improvement, can differ subtly, but importantly, between a traditional approach and a systems leadership approach. A strong grasp of the underlying theories and concepts allows systems leaders to navigate the complexities of large-scale eye health improvements and make informed decisions that drive sustainable change.
3. Developing new leaders throughout the system
A critical aspect of systems leadership is the recognition that leadership is not confined to a single individual. In traditional leadership models, an individual might focus on perfecting their own leadership style. In systems leadership, however, leaders are also responsible for fostering the development of other leaders within the health and broader system. This means that leaders work not only to solve problems but also to support others in becoming effective leaders in their own right.
In the context of eye health, this is particularly important. The more diverse the group of leaders across various sectors—each recognising the value of eye health for their respective outcomes—the more likely any changes will be sustained over time. The broad involvement of leaders across sectors contributes to long-term, system-wide improvements in eye health at a national level.
Navigating these challenges and moving forward
These are just a few of the challenges we and our partners have faced in applying systems leadership to eye health in Bangladesh. However, we have also seen that these challenges are not insurmountable. While these challenges can be complex, we’ve seen firsthand that many practitioners are already applying key systems leadership concepts. They are now refining their approaches, guided by a shared language, new skills, and the support of a growing community of peers who are committed to driving more sustainable, systems-level change.
To help others navigate these challenges, we’ve focused on creating a feedback loop of continuous learning and adaptation—both within our own team and across the broader network of practitioners. This iterative process, visualised as a reinforcing feedback loop below, has allowed us to refine our approach and improve our impact over time.
This toolkit, which was developed from our early experiences applying systems leadership with the Bangladesh country office and local partners, contains seven core modules that explore the resources and concepts most helpful in those initial steps. These modules are designed to provide practical insights and tools for those embarking on their own systems leadership journey.
The modules are:
1. Complex Adaptive Systems
2. Systems Thinking & Change
3. Systems Dynamics
4. Systems Leadership
5. Pitfalls and Challenges
6. Program Planning
7. Monitoring & Evaluation
Each module includes a brief video that introduces the key concepts and explains how they were applied in our project. Additionally, we provide supplementary resources for those who want to dive deeper into each topic. Recognising that systems leadership thrives on collaboration and co-creation, each module also includes suggested discussion questions, enabling teams to engage with the material and apply it to the specific challenges they face in their own work.
The theories and frameworks in this toolkit reflect the collective learning from our experiences applying systems leadership in eye health, and we hope they will serve as a valuable resource for others on the same path. Whether you’re just starting out or looking to refine your approach, we believe these tools can help support your efforts to create lasting, system-level change in global health.
