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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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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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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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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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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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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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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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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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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:
- Being involved with the policy-making processWorking with local
governments to develop and test models of health delivery
- 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:
- What is the impact of capitation payment on resource allocation
between primary and secondary/tertiary services?
- What is the impact of capitation on organizational and/or internal
management changes adopted to increase efficient provision of
services (or risk selection)?
- 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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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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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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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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