International Health Systems Program  
Department of Global Health and Population
Harvard School of Public Health
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IHSP IMPLEMENTATION PROJECTS

D-Tree International

As part of the IHSP implementation team, Marc Mitchell is the leader and founder of D Tree, a hand held devise that provides easy to use protocols to guide the health worker step by step to the correct diagnosis and treatment for each patient. D Tree has been implemented in Tanzania the ground work is being developed for larger scale-up. http://www.d-tree.org/index.php?pid=6

Global Fund Investments in Human Resource and Training

With support from the Global Fund (GF) to Fight AIDS, Tuberculosis and Malaria, the International Health Systems Program is undertaking a detailed assessment of budgetary and expenditure allocations data for human resource and training line items extracted from the Global Fund's Enhanced Financial Reporting (EFR) for 115 Global Fund (GF) countries covering Rounds 1-9. Linking these data to service delivery outcome data tracked by the GF (primarily training activities), as well as, to the ultimate objectives of health improvements, IHSP is analyzing the impact of GF investments in human resources and training by:

1) Disaggregating budgetary and expenditure data by: country, round, geographic region, income level, disease-specific activities (i.e., TB, Malaria, HIV/AIDS) vs. HSS activities, and private/public sector investments;
2) Analyzing expenditure and budgetary investments in relation to GF human resource and training activities by: country, round, geographic region, income level, disease-specific activities (i.e., TB, Malaria, HIV/AIDS) vs. HSS activities, private/public sector, type of health worker trained, pre-service versus in-service training, duration of training, and as a percent of total country training activities.

Case Studies:

Based on the results from the initial analysis, case studies in up to ten countries will be conducted to provide a more in depth approach to measuring and evaluating the impact of GF HRH investments.

Publications:

A report co-authored with the Global Fund will be finalized by November 2009. Please contact Diana Bowser at dbowser@hsph.harvard.edu for further information.

Global Health Fellows Program

The Global Health Fellows Program (GHFP) is a five year cooperative agreement implemented and managed by the Public Health Institute (PHI) in partnership with the Harvard School of Public Health, Management Systems International, and Tulane University School of Public Health and Tropical Medicine. GHFP is supported by the US Agency for International Development (USAID).

The goal of GHFP is to improve the effectiveness of USAID Population, Health and Nutrition programs by developing and increasing capacity of health professionals in Washington, DC and overseas. This is accomplished through the recruitment, placement and support of a broad spectrum of health professionals; a diversity initiative focused on providing internship and mentoring opportunities in international public health to underrepresented communities; and professional and organizational development activities to bolster USAID’s ability to maximize results and strengthen its leadership role in international health.

The GHFP website is: www.ghfp.net

Click Here to access the GHFP Short Guide to Peer-Reviewed Publishing

IHSP ACTIVITIES

Bolivia

Date of Project: 1998-2000

Key Contact:
Thomas Bossert

Sponsors: USAID/LAC Health Sector Reform Initiative and USAID/La Paz

Collaborators:
Ministry of Health and Abt Associates (in PHR Project)

Main Activities:
Decentralization Applied Research Study Applied Research on decentralization of health system. Bolivia has an innovative recent decentralization of investment and supply budgets to municipalities. The study is an analysis of the degree of decentralization and its impact on system performance using the "Decision Space" Methodology developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia, Colombia, Nicaragua.

Key Results:
Decentralization has been limited to funding supplies and equipment and over time even this range of choice has been restricted by earmarking a percentage that had to be assigned to Maternal and Child Health services. Decentralization has had no demonstrable impact on changing indicators of equity, efficiency and quality of services. It has however, increased local innovations and a sense of local control. Evaluation of Maternal and Child Insurance System Evaluation of quality and utilization issues in an evaluation of the new Insurance system. The evaluation found an increase in utilization by the target population and a likely increase in quality since the insurance funds supplies that are often not available. The evaluation also included financing and costing evaluation as well as administrative requirements.

Key Results: The evaluation found significant revisions of financing and administrative processes would improve the insurance system.

Related Publications:


Applied Research on Decentralization of Health Care Systems in Latin America: Bolivia Case Study
Thomas J. Bossert, Fernando Ruiz Mier, Scarlet Escalante, Marina Cardenas, Bruno Guisani, Katherina Capra, Joel Beauvais, and Diana Bowser, June 2000

Decentralization of Health Systems in Latin America: A Comparative Study of Chile, Colombia, and Bolivia
Thomas Bossert, June 2000
English
Spanish

La Descentralización de los Servicios de Salud en Bolivia
Thomas J. Bossert, Fernando Ruiz Mier, Scarlet Escalante, Marina Cardenas, Bruno Guisani, Katherina Capra, Joel Beauvais, and Diana Bowser, junio 2000

Workshop Report -- Cost and Cost-Effectiveness of Health Services, La Paz, Bolivia

Julia Walsh and David Anderso, May 9-11, 1995

Resource Mobilization for the Health Sector in Bolivia

Marina Cárdenas Robles, Jorge A. Muñoz and Mukesh Chawla, July 1996

Popular Participation in Bolivia

Oleh Wolowyna

 
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Chile

Date of Project: 1997-2000

Key Contact:
Thomas Bossert

Sponsors: USAID/LAC Health Sector Reform Initiative

Collaborators: Graduate Faculty of Economics and Public Administration, University of Chile and Ministry of Health

Main Activities:
Decentralization Applied Research Study Applied Research on decentralization of health system. Chile has experienced the longest period of recent decentralization in Latin America. This study is an analysis of the degree of decentralization and its impact on system performance using the "Decision Space" Methodology developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia, Colombia and Nicaragua.

Key Results:
Decentralization appears to increase inequality of primary health expenditures per capita with richer municipalities spending three times the others. Despite Chile's reputation of having a significant decentralization, the actual range of choice ("decision space") in Chile at the municipal level was quite limited and was reduced over time. Health Reform Policy Process Applied Research Study Applied Research on policy process of health reform in financing and insurance focusing on ISAPREs. This research evaluates stakeholders, institutions and role of "change team" in producing the health reforms that began in 1979. This study is part of a regional study of three countries: Chile, Colombia, Mexico.

Key Results:
Policy processes of developing a coalition of key actors in favor of reforms through an formal and informal legislative process occurred even under the Pinochet dictatorship. Key to success was a carefully recruited "change team" of like-minded technocrats with significant political skills and located in the Ministry of Finance, Planning Office, and other key ministries and supported by horizontal and vertical linkages to other important actors.


Related Publications:

Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile
Thomas Bossert, Osvaldo Larranaga, Ursula Giedion, Jose Jesus Arbelaez, Diana Bowser, January 2003


Decentralization of Health Systems in Latin America: A Comparative Study of Chile, Colombia, and Bolivia
Thomas Bossert, June 2000
English
Spanish

Applied Research on Decentralization of Health Systems in Latin America: Chile Case Study
Thomas J. Bossert, Osvaldo Larrañaga, Antonio Infante, Joel Beauvais, Consuelo Espinosa, and Diana Bowser, June 2000

Enhancing the Political Feasibility of Health Reform: The Chile Case
Alejandra González-Rossetti, Tomas Chuaqui and Consuelo Espinosa June 2000


Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia, and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish


Privatization and Payments : Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000

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Colombia

Date of Project: 1998

Key Contact: Thomas Bossert

Sponsors: DDM: USAID/LAC Health Sector Reform Initiative

Collaborators: Ministry of Health

Main Activities:

Decentralization Applied Research Study

Applied Research on decentralization of health system. Colombia may have one of the most decentralized health system in Latin America. The study is an analysis of the degree of decentralization and its impact on system performance using the "Decision Space" Methodology developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia, Colombia, and Nicaragua.

Health Reform Policy Process Applied Research Study

Applied Research on policy process of health reform of the Law 100 in 1993. This research evaluates stakeholders, institutions and role of "change team" in producing the health reforms. This study is part of a regional study of three countries: Chile, Colombia, Mexico.

Key Results:

Key to the success of the Colombian health reform (Law 100) was a carefully recruited "change team" of like-minded technocrats with significant political skills and located in the Ministry of Finance, National Planning Department, and other key ministries and supported by horizontal and vertical linkages to other important actors.

Related Publications:

Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile
Thomas Bossert, Osvaldo Larranaga, Ursula Giedion, Jose Jesus Arbelaez, Diana Bowser, January 2003


Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia, and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish


Applied Research on Decentralization of Health Care Systems in Latin America: Colombia Case Study
Thomas J. Bossert, Mukesh Chawla, Diana Bowser, Joel Beauvais, Ursula Giedion, Jose Jesus Arbelaez,and Alvaro Lopez Villan, June 2000

Enhancing the Political Feasibility of Health Reform: The Colombia Case (Final)
Alejandra González-Rossetti and Patricia Ramírez, June 2000

Enhancing The Political Feasibility of Health Reform: The Colombia Case
Alejandra González-Rossetti and Patricia Ramírez, June 2000


Decentralization of Health Systems in Latin America: A Comparative Study of Chile, Colombia, and Bolivia
Thomas Bossert, June 2000
English
Spanish


Privatization and Payments : Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000

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Costa Rica

Date of Project: 1998

Key Contact: Thomas Bossert

Sponsors: World Bank and Caja de Seguro Social Costarricense

Collaborators: Caja de Seguro Social Costarricense

Main Activities:

Political feasibility of three options for reform of the Social Security System in Costa Rica using the Policy Maker Software developed by Michael Reich at Harvard School of Public Health.

Key Results:

The Social Security System can consider the introduction of competition with private providers but this option will require special additional strategies to gain sufficient support for adoption and implementation. Options to continue and expand existing modernization programs have sufficient support without major new strategies.

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Egypt

Date of Project: September 1993

Key Contact: Peter Berman

Sponsors:
DDM: 1994-1997
PHR: 1997-1998
Policy Project: 1999-2000

Collaborators: Ministry of Health and Population, Arab Republic of Egypt, and American University of Cairo

Main Activities:

IHSP has been engaged in a wide range of activities in Egypt since 1994. Initially, under the DDM project, we developed a three-year program with the Department of Planning, Ministry of Health and Population to put in place a comprehensive information base for analysis of Egypt's health and health care system problems and for the design of appropriate reform strategies. This program included:

Based on this work, we facilitated several workshops with senior staff of the MOHP to discuss and analyse health and health care system problems and strategies for Egypt. Our 1995 report "Egypt: Strategies for Health Sector Change" was widely discussed and used by Egyptian and international authorities.

In 1997, we collaborated with the new Minister of Health, Prof. Ismail Sallam, in applying the data and analysis to the design of a reform strategy for primary care in Egypt. The process of collaboration included intensive meetings with the Minister to review options, in-depth reviews and discussions with a high-level working group in Egypt, and production of new policy strategy: "A Reform Strategy for Primary Care in Egypt". This strategy was adopted as official government policy and became the basis for a major multi-donor program in Egypt.

At present, IHSP continues to work with the MOHP through the PHR project to develop the pilot implementation of the new strategy in Alexandria. One of our staff is posted to the resident team in Cairo and we continue to contribute to policy analysis as well as new work on quality assurance.

In 1999, we initiated a new study in Egypt to estimate the total national expenditure on population and reproductive health care services, based on the national health accounts methodology. This study will be done in collaboration with American University of Cairo.

Key Results:

Related Publications:

The Relative Importance of Price and Quality in Consumer Choice of Provider: The Case of Egypt
Winnie Yip and Aniceto Orbeta, September 1999

The Distribution of Health Care Resources in Egypt: Implications for Equity An Analysis Using A National Health Accounts Framework
Ravindra Rannan-Eliya, September 1999

Understanding the Supply Side: A Conceptual Framework for Describing and Analyzing the Provision of Health Care Services With an Application to Egypt
Peter Berman, September 1999

Perception of Health Status and Limitations in Activities of Daily Living among the Egyptian Elderly
A.K. Nandakumar, Maha El-Adawy, Marc A. Cohen, December 1998

Health Budget Tracking System -- Egypt Phase II: Final Report
Gordon Cressman, July 2, 1998

25.1 Egypt National Health Accounts 1994/95

Department of Planning/Ministry of Health, Egypt and Data for Decision Making Project, October 15, 1997

Cost Analysis and Efficiency Indicators for Health Care: Report Number 1 Summary Output for Bani Suef General Hospital, 1993-1994

Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997

Cost Analysis and Efficiency Indicators for Health Care: Report Number 2 Summary Output for Suez General Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997

Cost Analysis and Efficiency Indicators for Health Care: Report Number 3 Summary Output for El Gamhuria General Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997

Cost Analysis and Efficiency Indicators for Health Care: Report Number 4 Summary Output for 19 Primary Health Care Facilities in Alexandria, Bani Suef and Suez, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997

Health Budget Tracking System -- Egypt Phase I: Software Guide

Gordon Cressman, October 1996

Health Budget Tracking System -- Egypt Phase I: Final Report
Gordon Cressman and Mahmoud Abdel Latif, September 1996

National Health Accounts of Egypt

Department of Planning/Ministry of Health, Egypt and Data for Decision Making Project, October 20, 1995

Cuentas Nacionales de Salud: El Caso de Egipto

El Departamento de Planification/Ministerio de Salud, Egipto y el Proyecto Data Decision Making, 20 de Octubre de 1995

Egypt: Strategies for Health Sector Change

Peter Berman, Michael Reich, Julia Walsh, A.K. Nandakumar, Nancy Pollock, Hassan Salah, Winnie Yip, Nihal Hafez and Ali Swelam, August 1995

Workshop Proceedings: First Health Budget Tracking System Workshop, Cairo, Egypt, June 18-20, 1995
Gordon Cressman, Oleh Wolowyna (RTI) and Mahmoud Abdel Latif

Health Care Utilization and Expenditures in the Arab Republic of Egypt
Department of Planning, Ministry of Health, Data for Decision Making, Harvard School of Public Health, 1994-1995

Egypt Provider Survey Report
Department of Planning, Ministry of Health, Data for Decision Making, Harvard School of Public Health, 1994-1995

Health Budget Tracking System -- Phase I Pilot Study Results: Bani Suef 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995

Health Budget Tracking System -- Phase I Pilot Study Results: Suez 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995

School Health Insurance -- The Experience in Egypt: A Case Study
A.K. Nandakumar and Ali Swelam, 1995

Health Budget Tracking System -- Phase I Pilot Study Results: Alexandria 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995

Workshop Report: Using Cost-Effectiveness Analysis to Identify a Package of Priority Health Interventions, Port Said, Egypt, January 8-13, 1995

Julia Walsh and Hassan Salah

Case Studies of Mosque and Church Clinics in Cairo, Egypt
Priti Dave Sen, December 1994

Workshop Report: Using Cost-Effectiveness Analysis to Identify a Package of Priority Health Interventions, Ismailia, Egypt, July 3-7, 1994

Julia Walsh and Hassan Salah

Egypt: Health Sector Brief
Dayl Donaldson, November 12, 1993

Health Budget Tracking System: Classification of Health Expenditures by Function
Gordon Cressman and Mahmoud Abdel Latif

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Estonia

Date of Project: 1998

Key Contact: Peter Berman

Sponsors: Government of Estonia

Main Activities:

Providing technical assistance in the launching of Estonia's national health accounts study.

Main Results:

Ongoing activity.

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Ghana

Date of Project:

Key Contact:

Sponsors:

Main Activities:

Main Results:

Related Publications:


Decentralization and the Health Logistics System Ghana
Thomas Bossert, Ph.D., Diana Bowser, M.P.H., Johnnie Amenyah, B.Pharm., MBA, Rebecca Copeland, M.S.P.H., July 30, 2004

Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space
Thomas Bossert and Joel Beauvais, March 2002

Hospital Autonomy in Ghana: The Experience of Korle Bu and Komfo Anokye Teaching Hospitals
Ramesh Govindaraj, A.A.D. Obuobi, N.K.A. Enyimayew, P. Antwi and S. Ofosu-Amaah, August 1996

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Guatemala

Date of Project:

Key Contact:

Sponsors:

Main Activities:

Main Results:

Related Publications:


Guatemala: Decentralization and Integration in Health Logistics Systems
Thomas Bossert, Ph.D., Diana Bowser, M.P.H., Johnnie Amenyah, Rebecca Copeland, Management and Technology in Health and Development Guatemala (GETSA)
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Hungary

Date of Project: 1998

Key Contact: Thomas Bossert

Sponsors:
World Bank and Ministry of Health and Welfare, Hungary

Collaborators:
Falso Pannon Region of Hungary

Main Activities:
Assist the Falso Pannon Regional Consoritum prepare a proposal for the World Bank Health Service and Management Project, Health Service Delivery Modernization Subcomponent.

Key Results:

The report recommended that Hungary adopt an incentive program to reward municipalities which consolidated hospitals by closing excess hospitals, experiment with optional payment mechanisms, develop uniform information systems in accounting and medical records for a more effective DRG system, strengthen the regulatory capacity at the county office, and develop strategic planning skills in regional hosptials.

Related Publications:

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India

Health System Reform Strategy for Andhra Pradesh State, India

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Kenya

Date of Project:1998-

Key Contact:
Peter Berman

Sponsors:
USAID/Kenya, Danish International Development Agency (DANIDA)

Collaborators:
Department of Planning, Ministry of Health

Main Activities:
The purpose of this activity was to provide technical support to USAID/Kenya and the Government of Kenya (GOK) to develop a set of national health accounts (NHA). Specifically, this NHA initiative conducted the following activities: 1. Produced a set of NHA accounts and final report for Kenya, describing the sources and uses of health care expenditures, which is a basic requirement for managing the allocation of health sector resources, developing policies, and assessing the impact of policy interventions. Information was disaggregated to illustrate the flow of funds from sources to financing agents. Additional information was presented on the uses of expenditures according to provider type, function and region. 2. Ensured that the NHA process is useful and sustainable in Kenya by:

  • supporting a local NHA technical team composed of a cross-ministerial team in the GOK to conduct the work; and,
  • training the technical team and other collaborating partners in the methodology (data collection, processing, and analysis), use of software, construction of national health accounts matrices, and in the application of NHA results (e.g. secondary analyses, policy implications, health sector reform strategies);

3. Disseminated NHA findings to Kenyan policy makers to promote national-level discussions of the policy implications from the results of the NHA data and any associated analyses that have been done and the conclusions drawn. 4. Provided technical advice on institutionalization of the NHA activity. 5. Coordinated the activities undertaken by the Kenya technical team with those of the larger East and Southern Africa regional NHA initiative. The Kenyan technical team contributed their country experiences to the content of the workshops and benefitted from the technical assistance provided through its participation.

Key Results/Main Findings:

Related Publications:

Hospital Autonomy in Kenya: The Experience of Kenyatta National Hospital
David H. Collins, Grace Njeru and Julius Meme, June 1996

Kenya: Non-Governmental Health Care Provision
Peter Berman, Kasirim Nwuke, Kara Hanson, Muthoni Kariuki, Karanja Mbugua, Sam Ongayo and Tom Omurwa, April 1995

Conference Report -- Private and Non-Governmental Providers: Partners for Public Health in Nairobi, Kenya, November 28, 1994 - December 1, 1994
Gerald Hursh-Cesar, Peter Berman, Kara Hanson, Ravi Rannan-Eliya and Joseph Rittmann

Conference Report Summaries: Private Providers Contributions to Public Health in Four African Countries, Nairobi, Kenya, November 28, 1994 - December 1, 1994
Gerald Hursh-Cesar, Peter Berman, Kara Hanson, Ravi Rannan-Eliya, Joseph Rittmann and Kristen Purdy

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Kosovo

Date of Project:

Key Contact:

Sponsors:

Main Activities:

Main Results:

Related Publications:

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Malaysia

Date of Project: 2001-present

Key Contact: Peter Berman

Sponsors: UNDP/Govt. of Malaysia

Collaborators: Ministry of Health

Main Activities: Technical assistance in the development of National Health Accounts in Malaysia

Key Results: Project ongoing

Related Publications:

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Mexico

Date of Project: 1998-2000

Key Contact: Thomas Bossert

Sponsors:
USAID/LAC Health Sector Reform Initiative

Collaborators:
Ministry of Health

Main Activities:
Health Reform Policy Process Applied Research Study

Applied Research on policy process of health reform of the Social Security System. This research evaluates stakeholders, institutions and role of "change team" in producing the health reforms. This study is part of a regional study of three countries: Chile, Colombia, Mexico.

Key Results:

The failure to develop a full multi-institutional like-minded "change team" with horizontal and vertical linkages to other key actors has resulted in frustrated attempts at reform in Mexico.

Related Publications:

Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia, and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish

Enhancing the Political Feasibility of Health Reform: The Mexico Case
Alejandra González-Rossetti and Olivia Mogollon, June 2000

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Morocco

Date of Project:

Key Contact:

Sponsors:

Main Activities:

Main Results:

Related Publications:

Exploratory Study of Social Capital and Social Programs in Morocco
Thomas Bossert, Diana Bowser, Volkan Cakir, Andrew Mitchell, Final DRAFT May 2003

Proposal for Decentralization of Health System in Morocco
Thomas Bossert, March 2001
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Nicaragua

Date of Project:

Key Contact:

Sponsors:

Main Activities:

Main Results:

Related Publications:

Building Social Capital through Human Capital Development Programs in Rural Nicaragua: An Evaluation of MSH Management and Leadership Programs in Waslala and Pantasma
Nancy Brune, Thomas Bossert, Diana Bowser, August 2005
English
Spanish


Construyendo Capital Social a través de Programas de Desarrollo de Capital Humano en Áreas Rurales de Nicaragua Una evaluación del Programa de Gerencia y Liderazgo en Waslala y Pantasma

Nancy Brune, Thomas Bossert, Diana Bowser, Freddy Solis, Agosto 2005

Social Capital and Health in Nicaraguan Communities
Thomas Bossert, Nancy Brune, Diana Bowser, Freddy Solis, December 2003

Capital Social y Salud en Comunidades de Nicaragua
Thomas Bossert, Nancy Brune, Diana Bowser, Freddy Solis, Diciembre 2003

Studies of Decentralization of the Health System in Nicaragua: Final Report
Thomas Bossert, Diana Bowser, Leonor Corea, September 2001
English

Spanish

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Nigeria

HIV/AIDS and Health Expenditures in Nigeria

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Poland

Date of Project:1995-2000

Key Contact:
Paul Campbell

Sponsors:
DDM/USAID Mission

Collaborators:
Jagiellonian University Foundation for Public Health
Main Activities:
The Consortium's activities have centered on policy and management issues in the areas which the Polish Ministry of Health has structured health sector reform. These areas focus on the decentralization of the central government controlling the entire scope of health care and the creation of sixteen regional insurance funds, having these new regional funds contract with both public and private providers, and providing market-like incentives for improving health care. The Consortium is facilitating their implementation by:

  1. Being involved with the policy-making processWorking with local governments to develop and test models of health delivery
  2. Increasing managerial capacity

Key Results The projects, workshops, trainings and other activities conducted by the Consortium since it's inception in late 1995, have produced the following results:

  • Completion of Poland's first application of market research methods (focus groups and patient surveys)
    at the health facility level.
  • Facilitated the rapid spread of the practice of provider contracts across the country through conferences and training programs
  • Developed and implemented new approaches for quality monitoring of
    gmina-managed outpatient services
  • Assisted with the establishment of the nation's first truly private non-profit hospital of the post-communist period
  • Completed a successful city-wide experiment with public relations related to health sector reform
  • Assisted Krakow city officials with the design and implementation of significant reforms leading to a documented increase in consumer satisfaction levels

Related Publications

Unpredictable Politics: Policy Process of Health Reform in Poland
Thomas Bossert and Cesary Wlodarczyk, January 2000

Public Relations and Health Sector Reform: The Experience in Poland
Paul Campbell, Andrzej Rys, and Witoslaw Stepien, June 2000

Privatization and Payments : Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000

The Impact of Economic and Demographic Factors on Government Health Expenditure in Poland
Mukesh Chawla, Dorota Kawiorska, and G. Chellaraj

Provision of Ambulatory Health Services in Poland: A Case Study from Krakow
Mukesh Chawla, Peter Berman, Adam Windak, and Marzena Kulis

Quality of Outpatient Services, Krakow Gmina
Ann G. Lawthers and Bogdan S. Rózanski, May 1998

Health Care Options for Polish Municipalities: The Implications of International Experience
Marc Roberts and Thomas Bossert

Notes on Health Sector Reform in Poland
Peter Berman, Andrzej Rys, Thomas Bossert, and Paul Campbell

Innovations in Provider Payment Systems in Transitional Economies: Experience in Suwalki, Poland
Mukesh Chawla, Peter Berman, and Dariusz Dudarewicz, May 1998

National Health Insurance in Poland: A Coach without Horses?
Peter Berman, April 1998

Enrollment Procedures and Self-selection By Patients: Evidence From A Family Practice in Krakow, Poland
Mukesh Chawla, Tomasz Tomasik, Marzena Kulis, Adam Windak, and Deirdre A. Rogers, April 1998

Poland Health Policy: Democracy and Governance At Local Levels In International Perspective
Thomas Bossert

Financing Health Services in Poland: New Evidence on Private Expenditures
Mukesh Chawla, Peter Berman, and Dorota Kawiorska

Enrollment Procedures and Self-Selection By Patients: Evidence From A Family Practice in Krakow, Poland
Mukesh Chawla, Tomasz Tomasik, Marzena Kulis, Adam Windak, and Deirdre A. Rogers

Economics of A Family Practice in Krakow
Mukesh Chawla, Tomaz Tomasik, Marzena Kulis, and Adam Windak, July 199769. Physician Contracting in Suwalki
Dariusz Dudarewicz and Mukesh Chawla, February 1997

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Thailand

Date of Project:1998

Key Contact: Winnie Yip

Sponsors: USAID

Collaborators: Chulongkorn University in Thailand

Main Activities:
The objective of the MAR/Provider Payment Project in Thailand is to examine the impact of capitation payment on system performance. In particular, the study aims to answer the following three questions:

  1. What is the impact of capitation payment on resource allocation between primary and secondary/tertiary services?
  2. What is the impact of capitation on organizational and/or internal management changes adopted to increase efficient provision of services (or risk selection)?
  3. What is the impact of capitation on networking building and contracting practices between primary and tertiary care providers, and between public and private providers, and their implications on market structure and market competition?

The study will empirically examine the experience of the Social Security Scheme, which is a social insurance scheme that covers employees of enterprises. The scheme pays contract hospitals by capitation and covers general and specialist outpatient care, hospitalization, drugs and prescriptions, ambulance and transportation services, and ancillary services. This study is one component of the provider payment study which includes 3 countries, the other two are Argentina and Nicaragua.

Key Results:

Findings from the study are expected to generate useful lessons for the host country, such as reforming provider payment of other insurance schemes, e.g. the Civil Servant Scheme and the health card scheme; building a more primary care-based health system; and understanding the market process of public/private competition.

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Turkey

Developing National Health Accounts in Turkey

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Zambia

Date of Project:1999-2001

Key Contact: Thomas Bossert

Sponsors: PHR Major Applied Research Project and USAID/Lusaka

Collaborators: Ministry of Health and Abt Associates (in ZIHP Project)

Main Activities:

Applied Research on decentralization of health system. Zambia has an innovative recent decentralization to district levels of the Ministry of Health. The study is an analysis of the degree of decentralization and its impact on system performance using the "Decision Space" Methodology developed by DDM Project and modified by the PHR Applied Research team. It will be compared to the LAC regional study of four countries: Chile, Bolivia, Colombia, and Nicaragua.

Key Results:

It is too soon to have any significant results from the study.

Related Publications:

Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space
Thomas Bossert and Joel Beauvais, March 2002

Decentralization of the Health System in Zambia

Thomas J. Bossert, Mukosha Bona Chitah, Maryse Simonet, Ladslous Mwansa, Maureen Daura, Musa Mabandhala, Diana Bowser, Joseph Sevilla, Joel Beauvais, Gloria Silondwa, and Munalinga Simatele, December 2000


Decentralization of Health Systems: Decision Space, Innovation and Performance
Tom Bossert, March 1997

Proceedings of Zambia National Conference on Public/Private Partnership for Health, Siavonga, Zambia, June 8-11, 1995
Kasirim Nwuke and Abraham Bekele


Zambia: Non-Governmental Health Care Provision
Peter Berman, Kasirim Nwuke, Ravindra Rannan-Eliya and Allast Mwanza, January 12, 1995

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LAC NHA Network

Bolivia, Ecuador, and Guatemala were countries we worked with directly. Mexico was a regional resource center. Nicaragua, Dominican Republic, and El Salvador were directly supported by PAHO. Peru joined with their own resources.

Date of Project: 1997-

Key Contact: Peter Berman

Sponsors:
USAID, Latin America and Caribbean Equitable Access Initiative through the Partnerships for Health Reform Project and the Pan American Health Organization Collaborators.

Main Activities:

Using the National Health Accounts methodology developed by IHSP through the Data for Decision Making Project, each country team participated in a regional network to develop their own national health accounts study and to allow comparative analysis and learning across countries in the region. The country team conducted data collection and analysis. The PHR project and PAHO organized three regional network meetings for training, exchange of preliminary and final results, and policy discussions. Technical assistance was provided to each country in addition to the workshops through country visits of experts and through participation in national workshops to review results.

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Hospital Autonomy Studies

Zimbabwe
Kenya
India
Indonesia
Ghana

Date of Project: 1995-

Key Contact: Peter Berman

Sponsors:
USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through the Data for Decision Making Project Collaborators

Main Activities:


Based on a common methodology (Chawla et al report on Methodological Guidelines), a national research team carried out a study of the objectives, implementation, and results of efforts to make public hospitals more autonomous. The study assessed the degree of autonomy intended and achieved across several different dimensions. The effects of autonomy effort were also analysed in terms of the financial condition of the institition and changes in technical efficiency, quality of care, equity in use, and community perceptions.

Key Results:
These case-studies suggest that success with autonomy in public sector hospitals in developing countries has been limited, and there have been few gains in terms of efficiency, quality of care, and public accountability. We have drawn on the lessons learned from these studies to advance several testable hypotheses regarding the conceptualization and implementation of hospital autonomy. In general, we have argued that it is as much the confused and erroneous ideas of autonomy, as the poor implementation of the autonomy measures, that have been responsible for the relative lack of success of the autonomy initiative. However, an important caveat is in order. Given the limited sample size of this study, and the fact that in many of the countries hospital autonomy is a relatively new concept, the findings of our research must be viewed as preliminary. In our opinion, therefore, further inquiry into the issue of autonomy in public sector hospitals is a research imperative. A report comparing the results of all five country case studies was produced,
(DDM No-32.2. Recent Experiences with Hospital Autonomy in Developing Countries -- What Can We Learn?) and a set of implementation guidelines for future hospital autonomy efforts was developed.

Results were reviewed and discussed at two regional workshops: Zimbabwe and Senegal

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Resource Mobilization Studies

Zimbabwe
Senegal
Bolivia
Sri Lanka
Cote D'Ivoire

Date of Project: 1995-

Key Contact: Peter Berman

Sponsors: USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through the Data for Decision Making Project Collaborators

Main Activities:

Based on a common methodology (Chawla et al report on Methodological Guidelines), a national research team studied the contributions of different sources of finance to total national health expenditures in the country and how this has changed over time and in response to new health finance policy initiatives such as user charges and health insurance.

Key Results:

These case-studies suggest that although governments often make decisions about individual resource mobilization methods, such as user fees or the level of general revenue financing, they rarely think in terms of a strategy of health financing that considers the overall mix of methods, their interaction with one another, and their linkages with other components of the health care system. Therefore, the success of even individual methods has been limited in terms of contributions to resources, efficiency, equity and quality of care, even if they have been well thought out and implemented. At the same time, a common weakness has been a tendency on the part of most governments to ignore the role of household spending at private providers in financing health services. On the more positive side, our studies show that where it has been possible, private and community initiatives have succeeded in raising funding in the health sector.

A comparative analysis of the five country studies was prepared, (DDM No. 31.2. Experiences with Resource Mobilization Strategies in Five Developing Countries: What Can We Learn?) Results were review and discussed at two regional workshops: Zimbabwe and Senegal

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Managed Care

Zimbabwe

Date of Project:
1998-2000

Key Contact: Paul Campbell

Sponsors: U.S. Agency for International Development/ DDM

Collaborators: Cimas Medical Aid Society

Main Activities:

The managed care project in Zimbabwe has been in operation for just over a year. The team has consisted of Karen Quigley, Arlen Collins and Claudia Corra, as well as Paul Campbell.

We have worked with Cimas, one of the two largest medical aid societies operating in Zimbabwe, as well as the National Association of Medical Aid Societies (NAMAS). Cimas serves the private sector and covers 4-5 hundred thousand lives. (Less than a million of Zimbabwe's 12 million total population is covered by private insurance).

Zimbabwe is under great economic stress. The medical aid societies are fighting for their economic lives as revenue is constricted and costs spiral out of control in large part due to foreign currency problems. Medical aid society failure will only intensify Zimbabwe's current health care crisis.

Key Results:

Economic pressures are forcing the medical aid societies to re-engineer their relationships with providers. Our technical assistance focuses upon these relationships. Under our guidance Cimas has hired the first ever (in Zimbabwe) medical director, and begun to alter the way it interacts with doctors and consumers. Co-payments have been introduced. A new program to strengthen the role of primary care providers is about to be initiated.

We have provided a series of workshops in Zimbabwe on managed care for providers. Next October we will offer a seminar for small medical aid societies. We will also produce a Guidebook on managed care that can be used after our departure. No doubt we will have greatly facilitated the transition in Zimbabwe to managed care, but the rapid adoption of managed care concepts and tools will be primarily caused by the adverse economic conditions rather than our project.

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CEE Network

Poland
Czech Republic
Hungary
Romania

Out of Pocket Payments and Informal Payments for Health in Middle Income European Countries

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The Role of Private Health Care Providers

Kenya
Zambia


Date of Project: 1993-

Key Contact: Peter Berman

Sponsors: USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through the Data for Decision Making Project

Collaborators:

Main Activities:

Based on a common methodology (DDM No. 9. Berman and Hanson methodology for private sector assessment), a national research team studied the numbers and composition of the private health care provider sector. The assessment included developing a typology of private health care providers, including hospitals, ambulatory care providers, and informal and traditional practicioners. Estimates were developed of the shares in national health expenditures accounted for by private providers and of the volume and types of services delivered and how they were distributed in the population according to urban and rural areas and socio-economic distribution.

Key Results:

The results of the country case studies were combined with related work in Tanzania and Senegal and disseminated at a regional conference in Nairobi.
(DDM No. 21.1. Conference Report Summaries: Private Providers Contributions to Public Health in Four African Countries, Nairobi, Kenya, November 28, 1994 - December 1, 1994.)

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IMPLEMENTATION PROJECTS

D-Tree International

Global Fund Investments
in Human Resource
and Training

Global Health Fellows Program

 

 
Activities by Country
Bolivia
Chile
Colombia
Costa Rica
Egypt
Estonia
Ghana
Guatemala
Hungary
India
Kenya
Kosovo
Malaysia
Mexico
Morocco
Nicaragua
Nigeria
Poland
Thailand
Turkey
Ukraine
Zambia
 
 

LAC NHA Network

Hospital Autonomy Studies

Resource Mobilization Studies

Managed Care

CEE Network

The Role of Private Health Care Providers