Overview of IHSP Activities - International Health Systems Program at Harvard

	Harvard School of Public Health
	Department of Population and Intermational Health

International Health Systems Program

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Major Areas of IHSP Activities

Health system financing

As a provider of technical assistance to countries, the IHSP has a long track record of involvement in health sector projects related to health insurance. The IHSP assisted the Ugandan Ministry of Health in an initiative to increase access to health services introducing formal sector health insurance. The project assessed the feasibility of establishing such a health insurance program for formal sector employees and anticipated impacts.

In China, the IHSP members have conducted long-term collaborative studies with the Ministry of Health and other Chinese partners on establishing rural health insurance and medical assistance programs for the urban poor. All these programs included survey studies and intervention studies to help inform the policy-making process.

IHSP faculty and researchers made major contributions to the health system financing reforms in the innovative "managed competition" reforms in Colombia and in the transitional reforms toward regional health insurance in Poland.

In India, an IHSP in Andhra Pradesh, developed a Medium Term Strategy and Expenditure Framework that proposed significant increases in health financing levels and allocation shifts along with major institutional reforms to promote efficiency. IHSP faculty also supported the Indian National Commission on Macroeconomics and Health based in New Delhi to design and conduct background health economics research to support the design of medium term health sector strategy for India.

The IHSP has long been a leader in the development and implementation of the Harvard approach to National Health Accounts which is now incorporated in the multi-donor Producers Guide to National Health Accounts. The IHSP has supported national health accounts analyses in Egypt, Turkey, and Nicaragua. IHSP has also led the creation of regional NHA networks in Africa and Latin America.

IHSP has also implemented studies of "out of pocket" and informal payments in Poland, Hungary, Czech Republic, Romania, and Turkey and made recommendations to address key policy problems.

Politics and Governance

IHSP's Politics and Governance Group initiated a policy and political analysis of the reform efforts in Poland and produced studies of "change teams" for health reforms in Colombia, Chile, Mexico. IHSP faculty have provided training in Policy Maker software for stakeholder analysis and political strategy design in many training programs including the Harvard/World Bank Flagship Course on Health Reform, IHSP training programs and special courses in Latin America with FUNSALUD.

Combining stakeholder analysis and policy dialogue, IHSP teams have been involved in developing advocacy approaches for reproductive health programs in the Philippines and the Ukraine.

The Politics and Governance Group is leading new efforts to approach problems of HIV/AIDS, disaster relief and humanitarian assistance in fragile states. A paper on fragile states and the Global fund has been prepared for the Open Society and new initiatives are being developed with the recently launched Harvard Humanitarian Initiative.

Public/Private partnerships

IHSP was one of the initiators of serious assessments of how different combinations of public and private sector providers can be best used to achieve public health objectives. Recently this work includes the assessment of the relative performance of the public and private sector in healthcare and policy recommendations on the public-private partnership in India, China, Vietnam, Cambodia, and Uganda. This on-going project is carried out in collaboration with the Karolinska Institute in Sweden.

IHSP also provides training in public/private partnerships in our IHSP executive training program.

Building community capacities through social capital improvements

Building on recent interest in the usefulness of "social capital" for improving health and governance in both developed and low income countries, IHSP has implemented a series of studies of social capital in poor communities in Morocco and Nicaragua. This activity has provided policy recommendations and controlled studies evaluating practical community programs designed to improve social capital, health behaviors and governance.

Strengthening health system support for reproductive health and HIV/AIDS projects

IHSP has helped the Philippines develop Contraceptives Self-Reliance strategies including advocacy approaches to decentralized governmental units to use local resources to promote modern contraceptive methods. Building on IHSP expertise in decentralization, this initiative is an important model for countries where national governments are not supportive of family planning programs. In addition, IHSP is currently supporting capacity building and advocacy efforts in Ukraine to reduce the high levels of abortion in favor of other modern contraceptive methods;

IHSP has several initiatives related to HIV/AIDS. IHSP faculty are involved in a comparative study to examine policy and health system responses to HIV/AIDS in India and China. In Botswana, IHSP faculty are using National Health Accounts methodology to assess HIV/AIDS expenditures and project future sustainability of ARV expenditures.

The Politics and Governance Group is preparing a seminar on political science contributions to HIV/AIDS programs to provide a forum for linkages between practitioners and academics on the politics of HIV/AIDS.

Institutional reforms andcapacity building

With more countries implementing decentralization reforms, IHSP's Politics and Governance Group has provided leadership in research, technical assistance and training in health system decentralization. A path-breaking approach which focuses on "decision space" for decentralization has been applied in Colombia, Chile, Nicaragua, Morocco, Philippines, India and Pakistan. This work has also produced innovative approach to a "needs based" allocation formula in Nicaragua.

IHSP teams have been involved in significant institutional reforms of ministries of health in China, Colombia, Poland, Andhra Pradesh and Uttar Pradesh in India, and in the Dominican Republic. This work has included major programs of strategic planning at national and district levels, surveys of functions and staffing, and collaborative team building.

Supporting recent new initiatives by the Joint Learning Initiative in human resources for health, IHSP has developed an innovative strategic planning tool on health systems and human resources for WHO and applied the tool in Ethiopia.

Our training programs have provided major initiatives in management training in Poland, Zambia, Ukraine, and China