“wood already touched by fire is not hard to set alight”; comment on “constraints to applying systems thinking concepts in health systems: a regional perspective from surveying stakeholders in eastern mediterranean countries”

a major constraint to the application of any form of knowledge and principles is the awareness, understanding and acceptance of the knowledge and principles. systems thinking (st) is a way of understanding and thinking about the nature of  health systems and how to make and implement decisions within health systems to maximize desired and minimize undesired effects. a major constraint to applying st within health systems in low- and middle-income countries (lmics) would appear to be an awareness and understanding of st and how to apply it. this is a fundamental constraint and in the increasing desire to enable the application of st concepts in health systems in lmic and understand and evaluate the effects; an essential first step is going to be enabling of a wide spread as well as deeper understanding of st and how to apply this understanding.