Table 2 . Barriers, enablers and strategies for applying ST concepts and tools (N, %)* .

Barriers	Enablers	Strategies to promote use of ST concepts and tools
Contextual • Perceived costliness of applying ST concepts and lack of funding to operationalize it (33, 53%) • Competing political interests and lack of accountability at the government level (31, 50%) • Lack of policy-makers’ awareness and understanding of its principles and tools (29, 47%) • Limited capacity to apply ST concepts and tools (28, 45%) • Lack of political stability in the region and high turnover at the government level (20, 32%) Practical • Difficulty in coordinating and managing conflicts among health systems stakeholders (24, 39%) • Lack of well-functioning information systems and good quality data (10, 16%) • Difficulty in ensuring the active involvement and support of health systems stakeholders (9, 15%)	Willingness and interest to learn about ST among both researchers and policy-makers (24, 39%) • Readiness to innovate and accept novel approaches for strengthening health systems (15, 24%) • Local and international organizations may be willing to invest in technical and financial support to wider application of ST principles and approaches (14, 23%) • Possibility to strengthen data sources and health information systems (11, 18%)	• Create opportunities to build capacity in using ST tools and approaches (47, 76%) • Seek additional funding to operationalize it in research and policy-making (36, 58%) • Sensitize and build awareness among policy-makers on its applicability and added value to create a demand for its use (32, 52%) • Improve the availability and quality of health systems data (20, 32%) • Establish a central entity at government level to promote its use (15, 24%) • Establish mechanisms for monitoring and evaluation, with ST in mind (13, 21%) • Consider governmental reforms, including organizational restructuring (13, 21%)

ST= Systems Thinking

*N corresponds to the number of respondents. Percentages are calculated out of a total of 62 respondents.