Rittel and Webber's (1973) description of wicked problems - "stubborn" problems that are characterised by "ambiguity, uncertainty and a multiplicity of stakeholders and values" aptly describes the emergent problems in our health system. South Africa's high rates of poverty, unemployment, currency devaluation, a stifling economy and quadruple burden of disease is enmeshed with exorbitant private healthcare costs and out-of-pocket payments, an overburdened public health sector with deteriorating infrastructure. This results in poor healthcare delivery and health outcomes as well as financial vulnerability.

The difficulty of wicked problems has produced technical 'experts' who have assumed the capacity to both define and solve these issues. These solutions have largely overlooked the 'interlinkedness' of wicked problems, and often rely on conventional, linear solutions that fail to resonate with the real and perceived needs and interests of the target communities, local sentiments, perspectives and sensori-memorbilia.

Instead, leadership should recognise problems emerging in the health system as being located in the complex and chaos domains of the Cynefin Framework. Thus they require the understanding that they are fundementally nonlinear and occur in complex adaptive systems - making them sensitive to the surrounding environment, unpredictable but patterned, self regulated and self organised, and any attempted solutions are subject to disproportionately extensive consequences. Leaders can utilise 'safe to fail' experiments to probe, sense and respond, allowing them to 'shock the system to a new equilibrium. The instructive patterns resulting from this strategy allows leaders and practitioners to reinforce the preferred patterns and inhibit the unwanted ones. Furthermore, strange attractors can be introduced to influence change in the desired direction.

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​References

Burman, C. J. (2019). Engaging With Complexity: Making Sense of “Wicked Problems” in Rural South Africa. Journal of Higher Education Outreach and Engagement, 23(3), 199-217.

Burman, C. J. (2018). The Taming Wicked Problems Framework: A plausible biosocial contribution to ‘ending AIDS by 2030’. TD: The Journal for Transdisciplinary Research in Southern Africa, 14(1), 1-12.

Niskanen, V.-P., Rask, M., & Raisio, H. (2021). Wicked Problems in Africa: A Systematic Literature Review. Sage Open, 11(3). https://doi.org/10.1177/21582440211032163