Seeing the system: how systems thinking is helping unlock progress in global eye health
Anna McKeon &
Scott Hinkle
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Systems thinking helps us make sense of the messy, interconnected challenges that shape our world. A recent pilot course by Wasafiri and IAPB shows how this approach is transforming how professionals tackle avoidable blindness.
Eye health is the global public health crisis that no one’s talking about. 2.2 billion people, nearly a third of the world’s population, live with some form of sight loss.
The consequences ripple through every part of life: children unable to learn, adults unable to work, and older people unable to live independently. And for half of these people, 1.1 billion people, that sight loss is avoidable. Solutions exist; most are low-cost and proven. So why does avoidable blindness persist?
The answer lies not just in science or infrastructure, but in systems. IAPB (the International Agency for the Prevention of Blindness) shared mission is to end avoidable sightloss, and their global strategy embraces the need for transformative systems change to achieve this.
However, there is a leadership gap in eye health, as in many sectors which have developed from clinical professions. Top-down leadership and siloed, competitive approaches are common, and working with a systems mindset is a relatively new idea.
Systemcraft is Wasafiri’s practical approach to tackling complex problems. In 2024, IAPB partnered with Wasafiri to pilot a Systemcraft course tailored for professionals working in eye health. The goal was to help people working in this field think differently, lead more collaboratively, and identify new leverage points to drive lasting change.
This marked the first time the course had been tailored to a specific health issue, bringing together 16 participants from around the world to learn and apply systems thinking to complex challenges in their work. The feedback was clear: systems change is essential in eye health, and this kind of learning community is one powerful way to build it.
What we did: Piloting Systemcraft for the eye health sector
Over eight weeks, participants from across regions and organisations came together to explore the dynamics shaping the eye health system; power, incentives, narratives, structures, and relationships. The course combined self-directed learning with peer coaching calls and asked participants to bring a real problem from their context and work through it using the tools and approaches introduced each week.
What participants valued: New thinking, practical tools, and connection
The course opened up new ways of thinking and acting. As one participant put it, “I found it an eye opener. I had this opportunity to talk about my complex example, I had good conversations with people around the world… Some people advised me with things that I really need to change in my work.”
Others reflected on how useful it was to have both a strategic framework and practical tools: “It’s very hands-on, I must say. That’s what I really appreciated. A very good composition of theory and practical use. Not expensive, easy to go for, and gives a lot of value.”
Participants noted how applicable the learning felt to the real-world complexity of eye health. One explained: “We were not talking about new problems, but we were exposed to different approaches to the current issues we are faced with in the day-to-day. A bit more critical thinking, even categorising the problem, trying to look for stakeholders and people who we can collaborate with. I think that’s a good approach.”
Another highlighted a powerful insight from the course: “The fact that the system is working, but it’s working for a few people. That’s where the problem is. That point really helps to see how best we make changes.”
Participants also valued the chance to learn together. Peer conversations and feedback were central to the experience. One reflected that the group space helped to embed the learning: “The group was where we put things into practice and got to talk about what we’re doing and hear feedback. It was great.”
What we learned: There’s an appetite for systems change… and room to grow
This pilot confirmed that system change matters in eye health and that there is an appetite across the sector to build capability to lead it. Participants saw this work as relevant not just to specific challenges they’re working on now, but to the long-term evolution of their organisations and systems.
“Even though we have not solved the problem, we have at least improved cataract coverage. The more collaborations we do, the more learning we can share with others. So overall, our impact is bound to be more.”
Several participants reflected on who in their organisations should take part in future cohorts, from team managers and Country Directors to anyone involved in shaping internal or external change: “Each change project internally is at least a bit of systems change – so having that kind of understanding and awareness is something to go for.”
At the same time, there were clear areas for improvement. Many wanted more time with peers and facilitators, and a stronger sense of closure. Some found it hard to make time between sessions for reflection and application.
Others suggested delivering the course more intensively over a shorter time period, or aligning future cohorts with major eye health events.
Several participants proposed setting up a community of practice for alumni – recognising that lasting change requires ongoing reflection, connection and support.
As one participant put it: “This course changed the way I’m thinking.”
If you would like to run a cohort course for your organisation, or if you’re facing a complex problem in the social development space and would like to learn more about our process, view the Systemcraft page or reach out to stella@wasafirihub.com.
