Dr. Bossert is involved in five major areas in health systems research, all related to key policy issues of health reform:

• decentralization of health systems
• governance and political process of policy change
• organizational reform of public institutions
• human resource strategies
• social capital and health

Dr. Bossert is currently Director of International Health Systems Program an interdisciplinary program which supports work on economics, politics, organizational and financing issues of health systems and health reform, including decentralization of health systems, public/private mix, political and policy analysis of reform processes, and institutional and governance reforms. 

Dr. Bossert has been involved in research on decentralization of health care systems for over twenty years in Latin America, Africa, and Asia. He has developed an innovative analytical approach, called the "Decision Space Approach" based on principal agent theory. This approach provides a comparative tool for analyzing the range of choice over different functions that is allowed to decentralized authorities. Dr. Bossert has used the approach in studies of decentralization in Chile, Colombia, Bolivia, Nicaragua, Morocco, Zambia, Uganda, Ghana, Guatemala, the Philippines, Pakistan, India and Vietnam. This research was supported by projects funded by the United States Agency for Development, World Bank, and DfID. Lessons drawn from the research are included in the World Bank Flagship Course on Health Sector Reform and presented in special seminars in various countries. Dr Bossert is currently using the decision space approach in comparative research projects to evaluate the impact of decentralization in Pakistan, India, Vietnam and Mexico; assessing the range of choice, capacities and accountability of district officials as a baseline for projects to improve performance of decentralized systems. He has also applied the framework in a study of the decentralization of logistics systems in Guatemala and Ghana.

Dr. Bossert’s research on political processes of health policy reform includes a recent study of the politics of adoption and implementation of the innovative "Guarantees" (AUGE) reforms in Chile under the Lagos administration. Earlier studies include a comparative study of the policy process of social health insurance reforms in Chile (under the Pinochet regime), Colombia and Mexico. This research applied stakeholder and institutional approaches and developed the innovative concept of "change teams" of politically astute technocrats from several key ministries who drive the reforms forward. Research on the policy process of health reform in Poland concluded that usual stakeholder analysis is inadequate because many of the stakeholders do not consistently pursue policy objectives. Research in this area was funded by the USAID and Inter-American Development Bank projects and most recently by the David Rockefeller Center for Latin American Studies at Harvard.

Research on organizational development and institutional reform involved the transformation of the Colombian Ministry of Health during the period of major health reform. This research developed a multi-dimensional approach based on recent organization theories and assessed the existing structure and human resource skills in relation to the desired functions in the new health reform. The research resulted in proposed specific reorganization and transformation processes. This research was conducted when Dr. Bossert was Director of the Harvard Project in Health Sector Reform in Colombia, funded by the Colombian government and the Inter-American Development Bank. Recently, lessons from this activity are being used in a DfID project in India to strengthen institutional capacity in the state of Andhra Pradesh.

In the area of human resources, Dr. Bossert has directed a WHO initiative to develop a evidence based approach to strategic planning for the financing, education and management of human resources in health. This activity involved a careful review of evidence based literature on human resources and on health system elements related to human resources. After developing a framework and assessment guide, the approach was applied to field work in Ethiopia and Turkey. This research has also been incorporated into the IHSP training program in a course on strategic planning for human resources.  Currently, Dr. Bossert is working on the political economy of human resources policies in Sub Sarahan Africa for a book for the World Bank.

In a recent study of social capital and health led by Dr. Bossert in Nicaragua, the impact of leadership and management inteventions on the levels of trust and participation was measured using two household surveys. The study clearly demonstrated one important strategy for strengthening social captial and health in poor, post-conflict communities. This project was funded by USAID.

In the area of health financing, as Director of the Harvard Project in Health Sector Reform in Colombia, Dr. Bossert participated in a three-year assessment of the process and performance of the health financing reform in Colombia. This research produced a major report and ten-year implementation plan and several articles in various journals. This research also produced course material for the World Bank Flagship Course on Health Sector Reform. Recently he has participated in a project to design a new benefits package for the Colombian social insurance system in collaboration with the Fundacion Santa Fe de Bogota.  In another financing effort he has proposed an innovative "needs based allocation formula" for district level financing in Nicaragua and Guatemala.

Ph.D., 1976, University of Wisconsin
A.B., 1968, Princeton University, Woodrow Wilson School

Brune, N. and Bossert T. “Building Social Capital in Post-Conflict Communities: Evidence from Nicaragua” Social Science and Medicine, 68 (2009) 885-893. 

Awa, M., Khatib, R., Donaldson, C., Bossert, T., Hunter, DJ, Alsayed, F. and Moatti, JP. “The Health Care System in the Occupied Palestinian Territory: Assessment and Agenda for Reform. The Lancet. Published online March 5, 2009 DOI:10.1016/SO140-6736(09)60111-2  

Mitchell, A., Bossert, T. Yipp, W., Mollahaliloglu, S. “Do more health workers mean higher immunization coverage? Evidence from Turkey,” Human Resources in Health, 2008, 6:29. http://www.human-resources-health.com/content/6/1/29

Bossert T. and Baernighausen T, Mitchell A. and Bowser D. Assessing Financing, Education and Management for Strategic Planning for Human Resources in Health. Geneva: World Health Organization 2007

Bossert T. and Bowser D and Amenyah J. “Is decentralization good for logistics systems? Evidence on essential medicine logistics from Ghana and Guatemala,” Health Policy and Planning (2007) 22:73-82

Mitchell, A. and Bossert, T. “Measuring Dimensions of Social Capital: Evidence from Surveys in Poor Communities in Nicaragua” Social Science and Medicine  2006, (64), pp. 50-63 Mello, M, Powlowski M and Bossert, T. “The Role of Law in Public Health: The Case of Family Planning in the Philippines”, Social Science and Medicine 2006, 63 (2), pp. 384-396. 

Bossert, T. and Larrañaga O, Giedion U, Arbelaez J, and Bowser D. “Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile.” Bulletin of World Health Organization, 2003, 81 (2) pp. 95-100

Bossert T. and Chitah, Mukosha Bona and Bowser, Diana. “Decentralization Of The Health System In Zambia: Resource Allocation And District Performance” Health Policy And Planning 2003 18(4): 357-369

Bossert T. and Joel Beauvais “Decentralization of Health Systems in Ghana, Zambia, Uganda and the Philippines: A Comparative Analysis of Decision Space” in Health Policy and Planning, December 2001

Bossert T. “La investigación sobre reformas del sector salud en América Latina desde la perspectiva de las ciencias políticas” in Celia Almeida, Roberto Bazzani and Patricia Pittman, eds. Investigació sobre Reformas del Sector Salud en América Latina y el Caribe: Reflexiones sobre sus Contribuciones al Desarrollo de Políticas Washington DC, Organizacíon Panamericana de la Salud, Abril 2001

Bossert T. , Larrañaga O., and Ruiz Meir F. “Decentralization of Health Systems in Latin America” Pan American Journal of Public Health July August 2000 Year 79, Vol 8, Nos ½, pp. 84-92.

Bossert T. "Analyzing the Decentralization of Health Systems in Developing Countries: Decision Space, Innovation and Performance," Social Science and Medicine, November 1998.

Bossert T., et.al. "Transformations of Ministries of Health in the Era of Health Reform: the Case of Colombia," Health Policy and Planning, March, 1998.

Bossert T., Wlodarczyk C. and Koprowska I. " Unpredictable Politics: Policy Process of Health Reform in Poland." Harvard & Jagiellonain Consortium for Health, Data for Decision Making Project Report 74, January 2000. (http://www.hsph.harvard.edu/ihsp/publications)

Bossert T. "Privatization and Payments: Lessons for Poland from Chile and Colombia," Data for Decision Making Project Report 77, March 2000. (http://www.hsph.harvard.edu/ihsp/publications)

Bossert T. "Decentralization of Health Systems: Chile, Colombia and Bolivia." Latin American and Caribbean Regional Health Sector Reform Initiative Report 29, June 2000. http://www.hsph.harvard.edu/ihsp/publications )

Bossert T. and González Rossetti A. "Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia and Mexico." Latin American and Caribbean Regional Health Sector Reform Initiative Report 36, June 2000.

International Health Systems Program - An interdisciplinary program which supports research, training and technical assistance on economics, politics, organizational and financing issues of health systems and health reform, including decentralization of health systems, public/private mix, political and policy analysis of reform processes, and institutional and governance reforms.