Peter Berman

Representatives of more than 20 developing countries will come to HSPH to learn how to improve and cope with changing health care systems in their nations during a course from June 24 to July 12, co-sponsored by the International Health Systems Group in the school’s Department of Population and International Health and the Center for Continuing Professional Education.

In previous years, the course has drawn a variety of professionals, including high-ranking officials such as the Undersecretary of State from the Ministry of Health in Hungary and the Minister of Health of Sri Lanka.

The "2002 Flagship Course on Health Sector Reform and Sustainable Financing" is a joint offering of HSPH and the World Bank Institute. For five years, the annual course was offered in Washington, DC under the auspices of the World Bank Institute. Last year, the course’s organizers decided to move the location to HSPH, in part because material based on HSPH work has grown in importance, said Peter Berman, director of the International Health Systems Group at HSPH and co-director of the Flagship course.

HSPH faculty participating in the course are Berman, Thomas Bossert, William Hsiao, Michael Reich, Marc Roberts and Chi-Man (Winnie) Yip.

The course helps participants understand health systems and their performance and provides ways to develop reforms. In addition, the course offers specific "modules" that examine the theoretical and empirical basis for reform approaches in areas such as health financing, payment systems, organizational change, regulation, and population and provider behavior-making use of case materials from many countries and at all levels of development.

Some developing countries have had a rough time in recent years trying to transform or to build their health care systems. With the decline of communism in Eastern and Central Europe, some countries’ health care systems shifted from government-owned and budget-driven organizations financed by taxes to systems financed by employer and worker contributions. They have moved away from structured, vertical systems to ones involving multiple players, said Berman. Authority, once dominated by a central government, may now be dispersed among local governments and private organizations.

In the mean time, said Berman, health status in many of these countries has still not improved, revealing serious problems related to aging and poor populations, as well as to diseases such as cardiovascular disease, cancer, alcoholism and depression.

"I think it’s been a mixed bag so far in these countries," said Berman. "It takes an awful lot of energy just to restructure the health system. It doesn’t automatically follow that the restructuring does better in terms of public health. Meanwhile, people have a very high and acute demand for treatment. They’re sick, and they want things out of the health system that they haven’t been getting."

Other middle-income countries without a communist history, such as Mexico, Colombia, South Africa and Turkey are trying to figure out how to organize a modern health care system that has new financing structures and has a better-regulated and better-run delivery system, said Berman.

Low-income countries such as India experience other kinds of problems. India has a poorly run public system and a largely unregulated private system, used by many people, he said.

"For a country like India and for other South Asian countries, they have to figure out how to move ahead to improve health with a mixed-structure system," said Berman. "Building up existing public clinics, for example, should not be the sole strategy because most people are not using them."

Really poor African countries reveal a different set of problems. Lacking in trained people, roadways and infrastructure, their task is to meet urgent public health needs quickly while still putting in place a developed health care delivery system.

"The course is very broad and stimulating. We have groups coming from around the world who will share their experiences and exchange ideas," said Berman.

The work that some of the HSPH faculty has done for the course has resulted in a book called Getting Health Reform Right by Roberts, Hsiao, Berman, and Reich, to be published later this year.