TRAINING


Flagship Course on Health Sector Reform and Sustainable Financing
Washington, D.C. TBD
Applications for the Flagship Course will only be accepted online.

The Flagship team is working to revamp the course and update its content.
Please check this website again for updates on the Flagship Course.

For further information, please feel free to contact Tazim Mawji (tmawji@worldbank.org).

Getting Health Reform Right: A Guide to Improving Performance and Equity by Marc Roberts, William Hsiao, Peter Berman and Michael Reich
"New Book Demonstrates Lessons and Challenges of Redesigning Health Care Systems in Different Countries" (click here to read book description.)
"Flagship Course Draws International Group of Senior-level Health Care Policymakers" (click here to read article.)

Course Background

The Flagship Course on Health Sector Reform and Sustainable Financing is a joint offering of the Harvard School of Public Health and the World Bank Institute--continuing and sustaining this highly successful experience over ten years. The course has been offered under World Bank Institute auspices in Washington, D.C. since 1997 and at Harvard University in 2003 and 2004. The Flagship Course introduces a practical and comprehensive framework for understanding health systems and their performance and a structured approach to developing health system strengthening and reform policies to improve that performance. Specific course modules examine the theoretical and empirical basis for reform strategies in such diverse areas as health financing, payment systems, organizational change, regulation, and population and provider behavior, making extensive use of case materials from countries in all regions and at all levels of development. The course will also examine the issue of gender and health and looks at gender gaps in service delivery and how it affects health outcomes.

The Flagship Course continues to contribute to the World Bank Institute's broader Flagship program, which involves partner institutions throughout the world. Since its inception, this program has reached more than 20,000 participants from 65 countries, with more than 80 percent of training provided by Flagship regional partner institutes in developing countries.

Learning Objectives

The principal goal of the Flagship Course is to provide intensive, state-of-the-art knowledge and training on options for health sector development, including lessons learned and best practices from country experience. The Flagship course is targeted to mid-career, senior-level decision-makers and managers who are actively involved in planning or directing; government-initiated health sector reforms; compulsory social health insurance programs; private-voluntary or private sector initiatives, and developing country training programs in health sector reform and sustainable financing. Enrollment is also open to staff from the World Bank and donor agencies. The course is dedicated to the development of national capacities through dissemination of knowledge and training. Country teams of 3-4 members are strongly encouraged to apply as the aim of the course is to build the capacity of a critical mass who could become agents of change in their country.

The Course will enable participants to:

• Speak a "common language" about dimensions of health sector reform and achieve deeper understanding of heath finance issues and sustainable financing options;
• Situate their health systems within a taxonomy of health systems according to structural, financial, and functional characteristics;
• Assess how well their national health systems perform according to explicit criteria including health status, financial protection, patient satisfaction, efficiency, and sustainability.
• Determine alternate paths their national health systems could take, and why it would be desirable to pursue some paths over others;
• Understand how to move their national health system from its current state to a desired future state; and
• erstand how to select and apply tools and procedures to make desired changes and to assess their effects.

Flagship Core Course

Development and revision of the learning materials is a continuous process with additional materials including new country case studies being prepared for future courses.

The Core Course includes the following major topics:

• Analyzing Health Sector Performance
  
  Ethics, politics and economics all influence how health systems work and how they are judged. This section introduces a framework of ultimate and intermediate health system outcomes, explores their philosophical and analytical bases, and shows how to apply them in a systematic diagnosis of health system problems, causes, and solutions. It also provides an understanding of how markets in general operate and what they can achieve, and how markets for health care and health insurance differ from other markets.
  
  
• Health Sector Reform, Poverty Alleviation and Priority Health Interventions
  
  The Millenium Development Goals call for special attention to poverty and specific priority health outcomes. The course examines how these goals can influence strategies for health reform and how health reform can be designed better to achieve these goals. The linkage between health reform and the PRSP process and new disease control priorities will be discussed.
  
  
• Strategies for Financing and Paying for Health Care
  
  The sources of funds to pay for health care include taxes, obligatory insurance, voluntary insurance and out-of-pocket payment. Different sources have different implications for health system goals, which depend also on how resources are pooled and channeled through funding institutions. Government has a crucial role both in raising funds through taxes and social security, and in regulating public and private insurance. The course examines the four main types of financing strategies- the pros and cons of each, and the conditions necessary to implement each of them.
  
  
• Designing Benefit Packages and Targeting Beneficiaries
  
  There are several criteria for choosing which health services to offer or finance. Course participants will learn to analyze this important decision with emphasis on cost-effectiveness of interventions. It covers the composition and costing of a package of services, in relation to health status, demand and capacity to pay, as well as the criteria and mechanisms for targeting publicly subsidized care to particular groups of beneficiaries.
  
  
• Paying, Contracting, and Regulating Providers
  
  How providers of health care are remunerated affects who produces what, how much it costs, and who benefits, because different payment mechanisms have distinct economic incentives and consequences for performance. Remuneration often involves contracting in advance for services: course sessions will discuss the corresponding requirements, models and experience relevant to the regulation of provider efficacy, safety and quality of care.
  
  
• Organizational Strategies in Ambulatory Health Care
  
  The organization of health care delivery is a major determinant of health outcomes, their distribution, and their costs. This section will introduce organization as a key health system "control knob" and discuss ambulatory care reforms in middle and high-income countries, providing an overview of issues to consider when designing ambulatory health care reforms.
  
  
• Hospital Reform Strategies
  
  This section will review hospital organizational reform based on a recent set of international case studies. Key organizational differences between budgetary units, autonomous hospitals, and corporatised public hospitals will be discussed, and each modality and reform alternative will be illustrated with examples.
  
  
• Organizational Reform and Management of Public Providers
  
  Toward improving performance, health sector policy makers are applying a variety of organizational and management reforms, including introducing new types of health care organization. Reform strategies often seek to maintain (predominantly) public financing as well as public ownership while simultaneously "mimicking" best practices from the private sector - such as more performance oriented organizational and management structures, stronger incentives and exposure to increased market pressures. The objective of this section is to explain the reasons behind these new organizational reforms, and to focus on options, instruments and tools for reform, especially of public hospitals.
  
  
• Human Resources Strategies
  
  Reviewing recent tools for strategic planning for human resources in health and applying them to examples in low and middle income countries. This section will address such key issues as determining appropriate levels of health work forces, improving distribution in underserved areas, addressing migration issues, improving motivation and performance and designing political strategies of reform.
  
  

About the Course Directors

Thomas Bossert
Course Co-Director
Lecturer and Director, International Health Systems Program,
Harvard School of Public Health, USA

R. Paul Shaw
Course Co-Director
Lead Economist/Consultant
HNP Program Human Development Division, World Bank Institute, USA


Other Scheduled Lecturers

Peter Berman
Lead Economist--Health Nutrition Population, The World Bank, New Delhi, India
Professor of Population and International Health Economics

Ricardo Bitran
President, Bitran y Asociados
Santiago, Chile

William Hsiao
K.T. Li Professor of Economics
Health Policy and Management, Harvard School of Public Health, USA

Michael R. Reich
Taro Takemi Professor of International Health Policy
Department of Population and International Health, Harvard School of Public Health, USA

Marc Roberts
Professor of Political Economy and Health Policy
Harvard School of Public Health, USA

Chi-Man (Winnie) Yip
Adjunct Associate Professor of International Health Policy and Economics
Harvard School of Public Health, USA

Plus additional guests