When health systems around the world face their next crisis, the strategic question won’t be whether we have enough clinicians (we don’t). It will be whether we have enough people who understand how health systems actually work.
Health systems are among the largest and most complex arenas of modern life, shaping whether we survive illness and how well we live. In the UK alone, the NHS employs 1.5 million people and consumes more than £180 billion annually. Yet for all this scale and significance, we treat health systems as operational afterthoughts.
Health systems – defined by the World Health Organization (WHO) as “all organisations, people and actions whose primary intent is to promote, restore or maintain health” – encompass not only the delivery of healthcare through networks of health workers in the public and private sector, but also the financing, governance and information systems that shape how resources are mobilised, allocated and used.
The configuration of healthcare provision across public and private sectors is changing fast, and the task of managing health systems and steering their transformation for the greater good calls for capabilities that are in scarce supply. Many graduates – often very capable clinicians, epidemiologists or specialists – are catapulted into leadership roles in health systems without the perspective, analytical vocabulary or interdisciplinary skills they will require. We are simply not training enough people specifically for the work of managing and transforming health systems.
The problem isn’t individual capability – it’s educational infrastructure. There are hundreds of MBA programmes in business schools globally yet despite health systems being comparable in economic scale and social importance to other major industries, a search conducted in September 2025 revealed fewer than 30 master’s programmes worldwide with titles explicitly focused on health systems, the majority in North America.
Where health systems topics do appear in academic programmes, they’re typically folded into public health curricula or treated as add-ons to clinical training. Students learn the WHO health systems building blocks: essential service delivery, health workforce, information systems, medical products, financing and leadership. But they rarely explore how these components interact as dynamic, complex, human systems, with political, economic and social drivers.
This approach produces professionals who can describe health systems in theory but struggle to change them in practice. It’s rather like teaching someone the parts of an engine without explaining how cars actually move.
Furthermore, the current discourse around health systems centres on “resilience”: the capacity to withstand or rebound from shocks and continue functioning during crises. But this is a low bar for societies being transformed by the information and AI revolutions, expanding commerce, and urbanisation. Post-pandemic, this focus is understandable. But resilience thinking, while valuable, risks lowering ambition. It shifts focus from reimagining and redesigning systems to simply coping with adversity.
The alternative lies in cultivating a mindset of learning and innovation. Strong health systems are learning systems: they create, share and collectively act on knowledge to adapt and improve continuously. From practice, information and deliberation emerges innovation: new ways of adapting to change and new visions for bottom-up, systemic redesigns.
The knowledge base for health systems transformation already exists but it is dispersed across disciplines that rarely speak to each other meaningfully. Health systems challenges require more than public health insights. They need political economy and policy analysis to navigate governance and power. They need organisational theory and behavioural science to manage institutional change and shift professional practice. And they need strategic leadership and business management skills to shape change in firms, organisations and professional networks.
Education must integrate these areas and equip students with practical skills for real-world change. This means developing several critical capabilities simultaneously.
This should begin with a recognition that health systems are social institutions, shaped by people, power and values, rather than mere technical delivery mechanisms. It also demands systems thinking: awareness of how actions create ripples across interconnected networks in ways that are rarely simple or predictable. Alongside this, an innovation and action skillset is vital, embracing experimentation, creativity and design thinking instead of seeking single, static solutions. Practical leadership capabilities then translate ideas into impact through skills in policy development, change management and implementation.
Finally, and perhaps most importantly, all this must be grounded in ethics and equity. The ultimate test of any health system isn’t just whether it functions efficiently but whether it serves all fairly, particularly those most marginalised by existing arrangements.
The good news is that demand for health systems education is growing. Students increasingly recognise that improving health requires more than clinical excellence, and governments and global health organisations increasingly seek graduates who can navigate complexity and drive change. Higher education needs to catch up.
We need a broader ecosystem of health systems education, research and practice. This requires investment not just in individual programmes but in the intellectual infrastructure that supports them: research centres, journals, conferences and professional networks that treat health systems as a distinct field of study and practice worthy of dedicated focus.
The scale of health systems matches their importance. It’s time our educational infrastructure reflected both.
Meike Schleiff is associate professor of health systems and policy and programme lead for the MSc in health systems, policy and innovation at UCL’s Global Business School for Health, where Kabir Sheikh is professor of global health systems and policy. They would like to thank Svea Closser, Dina Balabanova and Helen Schneider for their valuable comments on a draft of this post. The views expressed remain those of the authors.