Prashanth, Nuggehalli SrinivasMarchal, BrunoDevadasan, NarayananKegels, GuyCriel, Bart2015-04-202015-04-2020142014Prashanth, N.S., Marchal, B., Devadasan, N., Kegels, G., & Criel, B. (2014). Advancing the application of systems thinking in health: a realist evaluation of a capacity building programme for district managers in Tumkur, India. Health Research Policy and Systems, 12. doi:10.1186/1478-4505-12-42http://hdl.handle.net/10625/53966District health systems are constantly evolving in response to national policies, the local socio-political environment, and internal dynamics within healthcare institutions. A realist evaluation can help to make sense of these complex changes. The study compares outcomes of cases which received a capacity-building intervention for health managers, and explores how individual, institutional, and contextual factors interact and contribute to observed outcomes. Performance of health staff is determined by a variety of factors related to motivation, organisational dynamics and culture, and environmental factors including socio-economic and political forces. The paper describes the complexity of capacity-building interventions at the district level.Text1 digital file (20 p. : ill.)application/pdfenORGANIZATION OF HEALTH-CAREINDIAHEALTH PERSONNELCAPACITY BUILDINGLEADERSHIPSYSTEMS ANALYSISPUBLIC HEALTH ADMINISTRATIONDECENTRALIZATIONPROGRAMME EVALUATIONPROGRAMME OWNERSHIPRURAL COMMUNITIESSOUTH ASIACOMPLEXITYJournal Article (peer-reviewed)