Operationalizing systems thinking approach to sustain public health rehabilitation programs: a rapid review and strategic synthesis

BackgroundPublic Health Rehabilitation Programs (PHRPs) are essential to achieving universal health coverage and disability-inclusive health systems. Despite their importance, sustainability is threatened by demographic pressures, funding variability, and weak system integration. Systems Thinking (ST) provides a structured paradigm to address complexity, identify key leverage points, and embed adaptive capabilities for longer-term program survival. Our aim was to summarise global applications of ST in PHRPs and identify mechanisms that most effectively contribute to sustainability.MethodsWe conducted a rapid review of peer-reviewed literature and global case studies published between 2010 and 2025. The short timeframe was intentionally selected to provide timely, policy-relevant insights while laying the groundwork for more extensive future reviews. Searches in PubMed, Scopus, and WHO repositories identified studies applying ST to sustain PHRPs. Data were thematically synthesized using the WHO 10-step ST framework and the Systems Thinking for Health (ST4H) model.ResultsSix studies from six countries were included. Three mechanisms emerged: (1) Feedback Loops & Adaptive Learning, (2) Stakeholder Engagement & Systems Mapping, and (3) Strategic Leverage Points. Examples from diverse contexts, especially low- and middle-income countries such as Brazil, India, South Africa, and Jordan, demonstrated improved service integration, resilience, and reach.ConclusionST offers a robust framework for addressing persistent sustainability challenges in PHRPs. Embedding ST early in program design, supported by cross-sector engagement, systems literacy, and strong governance, enhances adaptability, equity, and efficiency. This rapid review provides actionable evidence for policymakers and practitioners, while also underscoring the need for context-specific sustainability metrics and broader scoping or systematic reviews to deepen and expand the evidence base

Roadmap for rebuilding the health system and scenarios of crisis path in Gaza

The horrific attacks on Gaza have had a profound impact on Gaza's health system, culminating in a multidimensional crisis. The deliberate destruction of vital infrastructure, such as hospitals, schools, housing, and public facilities, coupled with the deaths and injuries of medical personnel and support workers has only exacerbated the situation and further highlighted the existing gaps. This unprecedented catastrophe proves the criticality of adopting a new national inclusive integrated approach to meeting the immediate and long‐term needs of the population. In this perspective, we explore the recovery roadmap features for rebuilding the health system in Gaza, specifically focusing on determining the primary challenges that might emerge, the trajectory of recovery, and the expected crisis scenarios. The existing evidence and perspectives of key stakeholders, including state and non‐state health authorities in Palestine were synthesised. Despite some local and international initiatives undertaken to generate a concrete road to recovery, there remains a need for realistic, innovative, and comprehensive Marshall plans to rebuild Gaza's health system. The article draws on insights and gaps in current efforts and underscores the urgent need to address the challenges of rebuilding the health system. The authors strive to offer an inclusive and realistic path with the potential scenarios toward recovery and resilience considering the mass levels of loss and damage, and ways to move forward for building back a resilient health system in Gaza

Vibrations of a Single Degree Freedom System

The purpose of the present experiment is to analyse the effect of damping, mass and spring on a system The objectives of the presented experiment are as follows - To determine the natural frequency of the single-degree of freedom (SDOF) system. - To determine the damping parameters of the dashpot. - To determine the effects of damping, mass, and stiffness on the system response. - To compare the measured results with simulated results in Simulink

Palestinian Health Research System: Moving Forward

The importance of a Health Research System (HRS), as an instrument for developing and enabling health systems, is increasing, particularly in developing countries. As a consequence of this growing awareness also within the World Health Organization (WHO), there are many new approaches and initiatives to ensure the national HRSs be strengthened and well-functioned to address the countries' health needs through formulating and analyzing these systems particularly in fragile and resources constraint countries. Assessing the perceptions of system performers is an essential part of a comprehensive system analysis, which seeks to recognize a system’s strengths and limitations with a perspective towards achieving improvements. The present study focused on investigating four key pillars of the system in Palestine. First, it assessed the HRS concept and its importance among systems performers. Second, it evaluated their satisfaction with overall HRS performance and the political attention towards health research. Third, it examined the stewardship functions, governance, policy, and priorities, as a central pillar of this system. Fourth, it analyzed stakeholders’ roles and the status of research capacity. Based on these four axes of analysis, key gaps and avenues of solutions towards achieving a comprehensive HRS strengthening in Palestine were identified. The study targeted three sectors, namely relevant government institutions, schools of public health and major local and international health agencies. A qualitative analytic approach was used where data was collected through 52 in-depth interviews and 6 focus group discussions (FGDs) with 104 policymakers, academics, directors, and experts. In the first part, the study found the level of understanding of HRS concepts among health experts in Palestine is inadequate and not sufficiently conceptualized for the application. The second part found that the HRS in Palestine is remarkably underperforming with a significant lack of political support and engagement. The third part revealed that the stewardship functions are problematic, meaning that a system for health research in Palestine is still not embodied mainly due to a missing structural and regulatory framework and dispersed HR work. It is also found that the Ethical Review and Clearance (ERC) is weak, a policy or a strategy dedicated to health research is lacking, and low levels of knowledge and experience in research prioritization amid of lack of consensus. The fourth part found key findings: low involvement of society, private, local and the international sectors; a substantial weakness in the role of international agencies in supporting health research; and significant deficit in HRS capacity. This deficit is due to the fact that research in Palestine is externally and individually-funded, limited and unsustainable, and importantly, moderate research quality, as well as knowledge transfer and translation are not well-conceptualized and inappropriately performed. The study also identified main further common gaps as follows: lack of HR culture, systems values and principles; structure; policy; resources; defined roles; connection and network; evidence-informed concepts; and politic impacts. The study has recommended further empirical research to be investigated whether in Palestine and could be so in the region. Understanding the reasons behind the apparent lack of knowledge on HRS concepts and assessing the HR performance and impact, based on defined quantitative indicators, are essential research. Moreover, assessments on HR stewardship functions with regards to the institutional functionality and applicability, as well as a national HR capacity assessment using qualitative and quantitative measurements are deserve to be implemented. Once the HRS is structured, a national comprehensive system analysis is required to investigate inputs, processes, and outputs dimensions. The study offered crucial actions to be translated into policy-making levels. First, launching a strategic dialogue on HRS strengthening among actors to ensure a solid commitment, a collective involvement, and a national consensus. This move should pave the ways towards two substantial actions, building a unified national HR body and formulating a national strategy, both are integrated into the structure of Palestinian HCS, that has to include conceptual, regulatory, legal, technical and ethical aspects. Under this body and through this strategy, actions to improve HR prioritization, ERC, HRS awareness, HR performance, HR resources and capacity e.g. research quality, knowledge transfer, and translation, are fundamental components must be integrated and improved. In doing so, operational policies for HR resources and capacity have to be established, along with guidelines, indicators, and mechanisms for HR prioritization, performance, quality, knowledge diffusion and utilization that essentially required to be formulated and adhered. Also, effective networks communications, dynamic coordination, and systematic education and training programs are further feasible actions towards achieving a comprehensive HRS strengthening. This study proofed very worthwhile because it met a longer-standing local demand, as well as was aligned with regional and global strategic directions. Consequently, getting the system pillars well-enabled is possible and yields meaningful benefits to the health system and other development sectors in Palestine. This system analysis attempt opened up new avenues for any future endeavors and for the new generation of health research, HRS, and health system strengthening in Palestine and in the region in general

Reaction of citric acid with calcite.

Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library.This study is the first one to examine the reaction of citric acid with calcite over a wide range of parameters. Its main focus is to study the effects of different parameters such as initial citric acid concentration and temperature on the citric-calcite reaction. A rotating disk apparatus was used to study the reaction of calcite (CaC0₃) with citric acid. Using the rotating disk theory, the calcite dissolution rates in citric acid solutions were evaluated as a function of rotating speed, initial concentration of citric acid, concentration of magnesium (Mg²⁺) & Iron (Fe³⁺) ions, temperature, and pressure. In addition, Scanning Electron Microscopy (SEM) technique was used to explore the precipitation mechanism of calcium citrate during the reaction of citric acid with calcite. Using this technique, several factors affecting the precipitation of calcium citrate were identified. In this research, citric acid was found to be an effective stimulation fluid at pH values < 4, rotational speeds of (100-1,000 rpm), initial citric acid concentration of 1-7.5 wt%, pressure values of 1,000-1,500 psi, and temperatures of 25-50oC. However, SEM analysis has shown that calcium citrate precipitation occurred during the reaction at the calcite disk. The precipitation of calcium citrate was found be function of disk rotational speed, initial citric acid concentration, and the concentration of both Mg²⁺ and Fe³⁺ ions. More calcium citrate precipitated at high rotational speeds and high initial citric acid concentration. The presence of both Mg²⁺ and Fe³⁺ ions minimized the precipitation of calcium citrate. The rate of calcite dissolution in citric acid was found to be mainly dependent on the rotational speed. In general, at low rotational speeds, below 500 rpm, the calcite dissolution is mainly governed by the mass-transfer rate, while at high rotational speed, above 500 rpm, it is controlled by the surface-reaction rate. The mass-transfer and the surface-reaction mechanism were investigated thoroughly. Using the rotating disk theory, the overall mass transfer coefficient was determined at various rotational speeds, initial citric acid concentrations, and temperature values. The effective diffusion coefficient of citric as was determined at various citric acid concentrations and various temperature values. In addition, the apparent activation energy of calcite dissolution in mass-transfer regime was found to be 37.9 kJ/mol. Finally, a simplified expression was developed to model the reaction kinetics of citric acid with calcite. The model parameters: reaction order, and activation energy were found to be 0.833 and 63.1 kJ/mol, respectively. This study highlights the importance of the initial acid concentration, temperature, and calcium citrate precipitation on the citric acid reaction with calcite. Another important outcome is the effect of various key parameters on the performance of citric acid as a stand-alone stimulation fluid at conditions similar to those present in a typical field case. Findings based on this work provide new insights into the applications, usage, and potential limitations of citric acid. Factors controlling downhole reaction of citric acid with calcite are also disclosed.Thesis (Ph.D.) -- University of Adelaide, Australian School of Petroleum, 201

Rethinking the World Health Organization’s leadership of global health governance and the global health surveillance systems

Global health governance is a strategic priority for the World Health Organization (WHO), and the public health surveillance system (PHSS) is a fundamental element of the global health governance structure to timely identify emerging diseases and guide global public health decisions and actions. This analysis explores the overall landscape of global health governance, with a specific focus on the PHSS to understand whether the existing governance landscape facilitates or undermines the WHO’s ability to formulate and implement global health policies and initiatives. To achieve this, the existing evidence was reviewed, and synthesized with the experts’ perspectives. It is reported that fragmentation is the main drawback of the global health governance landscape, necessitating reorganization and restructuring. The disintegration of PHSS at the global, regional and local levels is associated with a lack of leadership, misalignment with global health priorities, imbalance in coverage of surveillance systems, inadequate innovative technology and digitalization, and fragmented data and information systems. The fragmentation and disintegration of global health governance undermine the effectiveness of the WHO’s global health strategic directions and programmes and hinder its ability to govern and guide the global, regional and national public health emergency response. Strategic rethinking of the WHO’s governance is essential because strong governance and leadership lead to a robust, aligned and effective PHSS

Global Health and Peace: The Elusive Path with a Focus on Palestine, Ukraine, and Venezuela

The interrelationality of health and peace is complex, multifactorial, and imbued with political and economic challenges. Peace and health outcomes reflect shared fundamental values related to the achievement of a balanced holistic condition on the individual and collective level. This causal relationship between social inequity and health requires special attention be paid to the impact of political instability and structural violence on undermining health systems in conflict zones. The mutual dependency between peace and health means that peace cannot be achieved without the existence of physical, mental, social, and spiritual health, and holistic health cannot be sustained under violent conditions. The interrelationality of peace and health as mutual conditions shapes our understanding of global solidarity and advocacy in relation to health diplomacy and peace promotion if addressed equally across all conflict zones. This commentary analyzes the unique interdisciplinary contextual factors that contribute to, or undermine the realization of global health and peace in three active conflict zones: Palestine, Ukraine, and Venezuela. Contextual analysis, review of the evidence, and synthesis of the authors' perspectives were used. The health-peace nexus remains a theoretical approach and lacks real application in most settings under crisis. Peace is a multifaceted phenomenon that necessitates the participation, dedication, and action of all sectors and stakeholders in global societies, including health policymakers, scientists, professionals, and people. Both the "right to health" and the "right to peace" even at the minimum remains unfulfilled, particularly in Palestine, and can be realized through two trajectories: (1) honest, responsible, and fair accountability, transparency, and political commitment empowered by reliable global health diplomacy for maintaining peace, eliminating the roots of injustice, and protecting health systems, and (2) equitable and real implementation of peace-health approaches, policies and actions driven by monitoring mechanisms that promote health, well-being, health security and equity for all nations under conflicts

Rethinking and advancing the movement of resistance, activism, and advocacy in health in four central arenas of the Middle East Region

The Middle East region has a long history of resistance, activism, and advocacy movements in health, most recently as part of the 2011 region‐wide Arab Spring. Despite this storied history, however, movements of resistance, activism, and advocacy in health in the region are rarely unpacked, examined, or documented. This historical and contextual analysis aims to examine the long‐standing confiscated health rights and subsequent experiences of resistance, activism, and advocacy in health in populations in Palestine, Lebanon, Egypt, and Iraq. Promoting a health equity and health rights‐based approach is key to achieving Universal Health Coverage and health‐related Sustainable Development Goals, particularly in contexts that experience fragile socioeconomic and humanitarian conditions and political instability such as many countries in the Middle East. Marginalized populations, including Palestinians living under Israeli occupation, Lebanese Lesbian, Gay, Bisexual, and Transgender+ (LGBT) communities, Egyptian women and girls affected by Female Genital Mutilation, and Iraqi refugees and Internally Displaced Persons, have been severely impacted by decades of oppression, conflict, and displacement. These populations have faced various forms of discrimination, neglect, and violence that have hindered their access to quality healthcare and basic health rights. Rather than relying on government efforts, local and international movements to advocate for and protect the health rights of these populations are key. Innovative approaches, strategic dialogue and collective actions are prerequisites for promoting resistance, activism, and advocacy in health in all country's systems structure. This analysis highlights the important of this social public health issue in the most turbulent region and provides evidence to guide all countries to realize equitable human rights for health for all populations

Solar Powered Water Pump System

Solar energy is the most abundant source of energy in the world. Solar power is not only an answer to today’s energy crisis but also an environmental friendly form of energy. Photovoltaic generation is an efficient approach for using the solar energy. Solar panels (an array of photovoltaic cells) are nowadays extensively used for running street lights, for powering water heaters and to meet domestic loads. The cost of solar panels has been constantly decreasing which encourages its usage in various sectors. One of the application of this technology is used in irrigation systems for farming. Solar powered irrigation system can be a suitable alternative for farmers in the present state of energy crisis in India. This a green way for energy production which provides free energy once an initial investment is made. In this project we propose an automatic irrigation system using solar power which drives water pumps to pump water from bore well to a tank and the outlet valve of tank is automatically regulated using controller and moisture sensor to control the flow rate of water from the tank to the irrigation field which optimizes the use of water. The paper is divided into 6 sections discussing the literature survey, proposed solution, implementation, cost analysis and results and conclusion, references. Cost effective solar power can be the answer for all our energy needs. Solar powered smart irrigation systems are the answer to the Indian farmer. This system consists of solar powered water pump along with an automatic water flow control using a moisture sensor. It is the proposed solution for the present energy crisis for the Indian farmers. This system conserves electricity by reducing the usage of grid power and conserves water by reducing water losses