Health systems as human systems: reflexivity, relationships, and resilience in the pursuit of the SDGs

Health Policy and Systems Research (HPSR) plays a critical role in efforts to strengthen health systems in pursuit of the Sustainable Development Goals (SDGs). This manuscript, adapted from the 2024 Virchow Lecture, explores the nature of HPSR, presents a systems-thinking perspective on health systems, and outlines key principles and strategies toward health system strengthening. It emphasizes the human dimensions of health systems-relationships, trust, leadership, values and meaning-making-as foundational to their resilience and outcomes. This narrative is informed by decades of experience and research at the intersection of policy, practice, and academia, particularly in low- and middle-income countries. The paper concludes with a call to reimagine health systems as open, dynamic, and human-centered institutions that generate public value and promote equity.