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IHSP TECHNICAL ASSISTANCE
The Harvard School of Public Health (HSPH) brings
together a rich tradition of scholarship, research, and service
in the field of international health. Among the school’s faculty
and senior staff are many esteemed individuals with outstanding
international reputations in health-related disciplines and equally
outstanding records of international service. The school has
on-going working relationships with, and access to, the most senior
health officials—many of whom were trained at Harvard—in
countries and international organizations around the world.
The International Health Systems Program
(IHSP), in the Department of Population and International Health
has gathered a highly experienced, multidisciplinary team of scholars
and experts to apply innovative approaches to improving health care
through research, training, and technical assistance. The
IHSP is committed both to advancing the state of relevant knowledge
and to bringing this knowledge to bear on appropriate applications
to achieve better health status, reduction in poverty, and gains
in human well-being for the poorer populations in both low and middle-income
countries.
The IHSP and associated members have applied several
areas of its health systems expertise to HIV/AIDS. From a
politics and governance perspective, several analyses have
been conducted on governmental HIV/AIDS policies in Brazil.
IHSP capacity-building in HIV/AIDS programs has been undertaken
through such through activities as management of a governmental
ART program in South Africa and overseeing the development of an
ART Global Fund proposal in Guatemala. Examples of IHSP members
strengthening health system support for HIV/AIDS include
helping to organize China’s health surveillance system on
HIV/AIDS and other major infectious diseases – as well as
national and regional China HIV/AIDS Public Policy Workshops, directing
programs and advocacy efforts of a major U.S. AIDS foundation, and
serving on the UN Millennium Development Taskforce on HIV/AIDS,
Malaria, TB, and Access to Basic Medicines. The IHSP can also
draw upon the complementary expertise of the HSPH AIDS Initiative
which focuses on developing HIV/AIDS education and training programs.
The International Health Systems Program's experience
includes:
Decentralization of Health Systems:
IHSP faculty developed and have applied widely the
innovative “Decision Space” approach to comparatively
analyze health sector decentralization. Based on principal-agent
theory, the Decision Space framework focuses on the range of choices
accorded to decentralized authorities over a number of different
functions. IHSP faculty found that the Decision Space framework
was able to comparatively describe decentralization across four
countries: Zambia, Ghana, Uganda and Philippines. In Chile and Colombia
the decision space methodology has been used to analyze relationships
between decentralization and health sector performance. An
innovative assessment of decentralization of logistics system for
vaccines, essential drugs and contraceptives in Guatemala and Ghana
indicated the nuanced relationship between decentralization and
health sector performance. Recentrly, two major new studies have
begun in Pakistan and India using an expanded decision space approach
to study the decision space, capacities and accountability of health
and local officials at district levels.
Health System Financing: IHSP
has collaborated with numerous countries in order to assess, improve
and expand their systems for financing health care, including social
health insurance, community financing, and national health accounts.
In Nicaragua, for example, IHSP has collaborated with the Nicaragua
government in devising a needs base formula for health care allocations.
In India, an IHSP team in Andhra Pradesh, developed a Medium Term
Strategy and Expenditure Framework that proposed significant increases
in health financing levels and allocation shifts. In China, we have
collaborated with 9 major Universities and the China Health Economics
Institute on a 7-year survey and intervention study on financing
and organization of healthcare in China’s poor rural areas.
The results of this study helped inform China’s policies on
establishing the New Rural Cooperative Medical System, a reformed
version of community financing scheme that will soon cover 100%
of China’s rural counties. The IHSP is a leader in the development
and implementation of National Health Accounts in countries around
the world.
Innovative Training Programs: IHSP
has been a major participant in the design and implementation of
the renowned Harvard School of Public Health and World Bank Institute
Flagship Course on Health System Reform and Sustainable Financing
which has been given annually in Washington and also in regional
and country programs. IHSP is also closely involved in organizing
the China Senior Health Leaders Training Program, a five-year program
(2006-2010) as part of the HSPH China Initiative. In addition,
IHSP has been offering for a number of years a series of well-attended,
two-week executive training programs in Boston on policy and management
of decentralization, human resources strategic planning, quality
improvement, strategic planning, and public/private partnerships.
Human Resources for Health:
IHSP has worked with several countries in order to analyze the importance
of effective human resources policies for improving the performance
of health systems. In Ethiopia, IHSP worked with the World Health
Organization and the Government of Ethiopia to develop a tool for
assessing the financing, education, management and policy context
for health workforce development. This tool was used as a
guide to assess the human resource situation in Turkey.
Politics and Governance:
The IHSP team has expertise in analyzing political strategies and
advocacy related to specific policy changes as well as what works
in fragile states. Much of these efforts have been strengthened
by the “decision space” framework developed by Thomas
Bossert, which has been applied in many countries undergoing decentralization,
and the use of the PolicyMaker for stakeholder analysis.
Public/Private Partnerships: The IHSP has
assessed how different combinations of public and private sector
providers can be best used to achieve public health objectives in
India, China, Vietnam, Cambodia, and Uganda.
Building Capacity through Social Capital
Improvements: The
IHSP has implemented a series of studies of social capital in poor
communities in Morocco and Nicaragua in order to improve social
capital, health behaviors and governance.
Strengthening Health Systems Support
for Reproductive Health and HIV/AIDS: The
IHSP has helped the Philippines develop a Contraceptive Self Reliance
Strategies to promote modern contraceptive methods and has worked
in Ukraine on supporting advocacy efforts to increase support for
reproductive health and human rights. Other examples include
helping to organize China’s health surveillance system on
HIV/AIDS and other major infectious diseases – as well as
national and regional China HIV/AIDS Public Policy Workshops, directing
programs and advocacy efforts of a major U.S. AIDS foundation, support
for Africa Centre for Health and Population Studies in Mtubatuba,
KwaZulu-Natal, and serving on the UN Millennium Development
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